Hoop Movement & Dance: More Than Just a Fitness Fad

Five years ago, I was just entering college to study Massage Therapy.  I’d been out of high school for a few years, living on my own, working in retail and was quite frankly, pretty unhappy about the whole thing.  My return to college and my eventual career saved me from death by boredom.

And hula hooping saved me from death by stress.

Working and going to college at the same time was, to say the least, difficult.  I can attest to many a night pouring over anatomy flash cards, physiology flow charts and high-lighted notes blurred by the onslaught of tears because I needed to pass this test. 

I had given up going to belly dance classes in order to go to school, and that worked for about six months until I realized, I need dance.  Going to Dundas by HSR wasn’t gonna work for me, however, so I found a new studio.  But it wasn’t belly dance I wound up taking.

I found hoop dance instead.

I remember the first time I watched the class thinking “what the heck is hoop dance?” and then thinking “oh my god I’m a hoop dancer,  I want one where do I get one it’s so sparkly want want wantwantwant!”  I probably got emotional during my first class, and definitely cried when I watched my first hoop dancing video on repeat, for about 2 weeks.  Even now, just hearing the song makes my tear ducts squeeze a little.  I bought my first hoop at my second class.

During the week before exams, I would spread my notes on the floor, with all their multi-coloured stickies, high lighters, and very important diagrams, and would dance them to shreds.  I would spin until I learned how to not get dizzy.  This spiral taught me a lot, but mostly it taught me to just let it happen.  Everything follows everything else and no amount of cramming two days before the big test would give me any additional edge.

But blowing off some steam would ensure I walked into that test room cool as a cucumber.  So spinning and dancing and music became my pre-test rituals.  It kept me sane, level, ready.

Hoop dance became my prayer, my centre, my source.  Through hoop dance, I found balance and confidence.  It was my way and it could not be wrong.

And now, 6 years later, everything is following everything else.  My career is happening – I’m an RMT.  And the spiral is teaching me more about myself.  I am an artist.  I can say, I never saw that coming.  But I am.  As I spin further and further into the spiral, I find myself building Circus Trees and performing with The Hamilton Aerial Group.  I am challenged daily, personally and physically, by this journey and every step I get stronger.

Hoop dance has been a transformative experience.  Through hoop dance I have freed myself from the bonds of my history, freed myself from the wrong impressions I had of who and what I am.  I have released the ideas of what I am not, and have begun to explore what I am.

I am an artist.  A woman.  A dancer.  I am a sensitive soul with the will to fight and the strength to love.

I have had the notion of teaching Hoop Dance for several years, and have cultivated what I need to fill that role.  And I’m (getting) ready to take you on the journey down the spiral.  In 2014 I will be launching Wild Women’s Circular Movement at Hamilton’s newest (as yet un-named at the time of this article writing) yoga and movement studio on Main St E at walnut.  Keep up to date with developments on my website and facebook page.  And look for me around town.  I’m the one with the hoops.

Jen Fleming

Jen “Hoop Weaver” Fleming is an RMT in the Hamilton area and performer with The Hamilton Aerial Group.  She has attended festivals as a hoop maker and recently begun exploring performance arts.  She is a cat lover, nature enthusiast and daily hoop spinner.  Visit her online at www.hoopweaver.weebly.com or on Facebook at www.facebook.com/HoopWeaver .

Repetitive Strain Injury: Chronic Pain's Annoying Little Brother

In my last article I discussed chronic pain.  This month I want to expand on one of Chronic Pain’s associates, Repetitive Strain Injury (RSI).

An RSI is the resulting injury to the musculoskeletal system or a part of the nervous system that is the result of a repetitive task involving repeated movements, forceful exertions, vibration, or sustained or awkward positions. 

RSI is actually an umbrella term for the hurts and ouches we develop at work, at play, in sports or driving.  They generally fall into two categories; tendinopathies and neuropathies.

Tendinopathies are probably the more familiar type including tennis elbow and carpal tunnel syndrome.*  These injuries involve the recurrent swelling and inflammation of a muscle and it’s tendon with the focus being at the point of attachment on the skeleton.  Because the activity that causes the tendinopathy is often a daily task, the region does not get sufficient time to recover from it’s exertion and so becomes further and further injured.

Neuropathies can be a little trickier to pin down as their pain patterns are often more diffuse.  A neuropathy can occur when the structures around the nerve are congested and inflamed thus placing pressure on the nerve.  Like everything in the body, the nerves are also wrapped in fascia, a tough fibrous tissue that keeps all our parts separated and organized.  If the compression on the nerve becomes great enough, then this fascia can also become inflamed putting the nerve itself at risk of more direct injury.  The most well known neuropathy is sciatica and it is often a result of spending a lot of time in a crouched or seated position. 

Carpal Tunnel Syndrome can actually be classified as either a tendinopathy or a neuropathy and sometimes even both.  In the former, the tendons that attach to the palm of the hand become inflamed within the Carpal Tunnel resulting in pressure on the nerve.  And sometimes the nerve itself can become inflamed or otherwise irritated, being a neuropathy.

So how does one deal with an RSI?  Better yet, how do you know if you have an RSI?  Consider whether the “mystery pain” crops up in association with specific tasks.  Perhaps after lots of computer work your shoulder hurts in that same spot.  Or maybe after a few games of aggressive volley ball your knees are inflamed.    If you can link your pain to an activity, it is very likely you are dealing with repeated strain. 

The best course of action with any RSI is to rest, stretch and ice the area.  Take breaks from your task as often as you can.  Allow yourself recovery time 100% away from the activity (facebook-ing does not count as a break away from computer work!).  Learn some stretches for the area that is hurting you the most and then DO THEM.  Frequently.  And hold them for 30-60 seconds.  Icing doesn’t have to mean frozen cubes of water directly on your skin.  Really you just want to have a significant enough temperature difference between the inflamed region and the cold pack to have an effect. 

But bare minimum, take a break!

Jen Fleming, RMT

www.jenflemingrmt.com

What is Chronic Pain?

Chronic pain is pain that lasts more than 6 months.  It can involve exacerbations and remissions, increases and diminutions in intensity but pretty much lingers as a constant nagging ache, burn or stiffness.  It affects the way one is able to live his or her life and is one of the top reasons a person off work or unable to return at all.

Causes of chronic pain can be lumped into a few different categories: acute injuries that fail to heal properly, repetitive strain injuries, neurological conditions, problems with hormonal regulation and/or other systemic diseases.  As a manual therapist, I primarily work with the first three; acute become chronic injuries, repetitive strains and neurological conditions.

 Acute-become-chronic injuries can be further subcategorized as really severe injuries including some surgical procedures, repetitions of the same injury or repeated injuries to the same area.  A really severe injury could include near complete to complete rupture of ligaments and muscles, badly broken bones, impact traumas that damage internal structures, or a joint replacement surgery.  In these instances the body likely experienced a period of shock as it scrambled to deal with the moment of injury and the convalescent period.  These injuries can involve many structures, or a single structure and typically call for a longer period of healing and potential immobilization.  In the event of less severe but repeated injury, we can see a lingering of inflammation and syndromes in other, closely related areas.  For instance, a mildly sprained ankle, once, isn’t a terribly injury and one is likely up and doing their thing right away.  Repeated sprains though decrease the stability of the joints, leading to the potential for a more severe sprain, stiffness and a constant swelling in the ankle.  This can set the stage for shin splints to develop as the Tibialis Anterior muscle on the front of the shin sees a lot more activity in stabilizing the joint than it ought.

Repetitive strain injuries (RSIs) involve constantly working a part in the same fashion, frequently/daily, without adequate rest and care in between bouts of effort.  Some of the most common include Golfer’s and Tennis elbow, where the knobby bits on either side of the elbow get really sore and inflamed.  Presently, tendonopathies like these are understood as being repeated periods of inflammation leading to adhering of the various layers of tissue.  With these tissues getting bogged down and stuck together by the inflammatory fluids, glide ceases to happen between the tissues and restrictions begin.  Eventually the tissues get thicker as a means of protection from the constant friction and we see a decrease in available, pain-free range of motion.  This sort of tendonitis can happen just about anywhere there is a tendon. 

Neurological syndromes can be a bit trickier to pin down.  Nerves are like tubes that split off of main channels to carry their messages all across the body.  Because of this, what appears to be a Carpal Tunnel syndrome may actually be associated with a dysfunction higher up the chain at the elbow, shoulder or neck.  Even issues like the above mention RSIs can be associated with poor neurological functioning.  Causes of neurological dysfunction can be either mechanical or chemical.  It becomes very important to work closely with the diagnosing physicians to ensure that what may appear to be a simple mechanical neuropathy isn’t in fact a more complex problem involving even higher branches of the nervous system or hormonal dysfunctions.

The thing to really take home about chronic pain is how dramatically it can alter one’s lifestyle.  To go from being an active participant to restricted in simple things like standing at the counter long enough to make a sandwich, put on one’s socks or brush the teeth is very frustrating at best.  The emotional toll can be high as quality of life diminishes and the ability to experience pleasure is challenged.  Relationships with self and others suffer and even personal identity can be affected.

For those who are close with person’s living in chronic pain it is important to remember that this pain is a daily experience and is truly exhausting.  It is up to us to remain sensitive to their emotional and physical needs, and to be as compassionate as we can.

ABOUT THE AUTHOR

Jen Fleming, RMT

www.jenflemingrmt.com

Diagnosis Sciatica, Or is it?

By: Jen Fleming

I’m gonna share a little bit of an ongoing success story with you.  We will call my patient Scott.  Four weeks ago Scott’s wife sacrificed her scheduled treatment with me so he could come in.  For seven months he’d been suffering with pain, sometimes debilitating, in his left hip.  He had seen countless other professionals – doctors, specialists, and other health care professionals – to try and figure out just what was going on, and everyone seemed to agree, sciatica.

For those of you who don’t know, sciatica is a nerve dysfunction.  The sciatic nerve exits the lower lumbar and upper sacral vertebrae and travels through the muscles of the buttocks, down the back of the thigh, does a little twist around the outside of the knee where another branch splits off, curves across the front of the lower leg, and into the first three digits of the foot.  Like the previous sentence, it is a long nerve.  The longest in the body, in fact.  An impingement, or other injury to the nerve, is called sciatica.  And it hurts.  A lot.  Like cut-off-your-leg a lot.  The pain is searing, electric like zingers that run basically the entire course of the nerve.  Pretty much constantly.  It’s awful.  Don’t get it if you can avoid it.

But the problem with Scott was NOT sciatica.  Not even a pseudo sciatica.  Nope, it’s been a whole different ball game.  And for 7 months, he was receiving treatments that may have been effective for sciatica, but were totally ineffective for what was going on with him.  What a little information would have done for him 7 months ago…  So I present to you, a brief differential guide for Sciatica and other pain’s in the hip/butt.

Symptom: Burning hot pain in the hip and buttock, stops about where the thigh attaches to the hip.
What it could be: Psoas (major hip flexor) spasm or strain (like Scott’s case), gluteal muscle pain, piriformis spasm, bony misalignment of pelvic joints.

Symptom: Burning pain in the front of the hip that travels down the front of the thigh.
What it could be: Compression of the anterior transcutaneous femoral (front of thigh skin and surface muscle) nerve.  Compression usually happens in the inguinal region, where the front of your thigh connects to the hip.  Can also be a psoas spasm or strain, which can cause compression of the ATF nerve.

Those two symptom sets are the most common for a misdiagnosis of sciatica.  True sciatica will involve pain down almost the entire length of the nerve.  Where it ends can depend on which nerve roots are involved.  Sometimes it goes all the way to the big toe and can involve the second and third digits, and sometimes it stops at the knee.  But it will always involve the back of the thigh and hip.  And NEVER the front of the thigh and hip.

P.S. – After a few treatments with me, and a quick referral out to my go to Osteopathic Student and super awesome RMT, Kevin Deiroff for a proper diagnosis, Scott is well on his way to pain free mobility.  Yay for proper assessment and diagnosis!

The Pelvis : A Web To Hold The Bowl

By Jen Fleming

I talked previously about the bony structure of the pelvis. Today I am going to talk about the ligamentous structure of the pelvis and how it helps support the articular relationships between the lumbar vertebrae, the 3 bones of the pelvis and the femurs.

Because the pelvis holds a lot of weight, and is responsible for distributing forces from the ground up and the head down, the Sacroiliac Joints - SIJs – don’t want to be too mobile.  They need just enough movement to ensure the forces can actually move through the pelvis without getting hitched up anywhere.  Therefore there are a lot of really big, thick and strong ligaments to support this terribly important balancing bowl.

The posterior of the pelvis is supported mostly by the interosseous sacroiliac ligaments. This large web of soft tissue connects the large ilia/hip bones to the sacrum and supports the pelvis from the back, preventing too much forward movements of the bones. It also supports the connection between the coccyx and the sacrum.

On the anterior aspect we have the anterior interosseous ligaments attaching to the same structures. These ligaments prevent backward movements of the pelvis.

Above the ligaments is the iliolumbar ligament which holds the L5 vertebra against the base of the sacrum.  It checks rotational movements of the L5 on the sacrum ensuring that it remains in  a proper alignment with the sacrum.

The Sacrotuberous Ligament is a very special ligament because it acts like a keystone to the whole web of soft tissue of the pelvis.  Something to keep in mind about ligaments, in the pictures they look very separate but in the real body they all blend together.  There is a fine layer of connective tissue that covers the bones called periosteum.  It is this periosteum that the ligaments and tendons blend into.  

So the Sacrotuberous ligament blends into the periosteum of the ishcial tuberosities (sit bones) and the sacrum.  This then gives rise to the Sacroilliac Ligaments and the Ilio-Lumbar Ligaments.  The tendons of the hamstrings, deep gluteal muscles, pelvic floor muscles and the muscles of the lumbar spine all blend together.  By working directly with this segment of the pelvic web one can create change, or initiate the opportunity for change, throughout the connecting structures.

As a functional unit, these ligaments are a fine web. By altering one area of this web, much like a shifting layer of fabric, the entire unit is primed for change.  Most don’t realize the power this area of the body holds and the amount of responsibility it carries. Literally it is the base of our structure and, just by becoming familiar with the interconnected nature of the immediate area, we can begin to see how it supports and affects the whole physical being.  

Indeed the whole body is one giant web woven into a tapestry of wonder. Pretty darn cool, right?

Jen Fleming RMT

www.jenflemingrmt.com

The Pelvis: Returning to balance

By: Jen Fleming, RMT

When we think of our “root” or base we often immediately think of our feet.  They are at the bottom of our structural pile, they are what touches the Earth and are what absorbs the most impact.  And certainly they do carry the most weight – the whole rest of our bodies rest atop them.

But they are not the true source of stability.  Stability comes from a much larger structure; the pelvis.

The pelvis is a bowl shaped collection of four bones; the paired innominates or hip bones, the triangular sacrum and the remnant of a tail, the coccyx.  Together these four bones create the true root of the skeleton and the base line on which posture rests.  

When we walk, during heel strike a kinetic force moves up from the ground through our legs to the pelvis.  From here the force is distributed across the pelvis, up through the lumbar spine where it is then transferred our across the thoracic cage.  At the same time, the force of gravity pulling down on our bodies is transferred across the same channels then down our legs into the ground.  Structurally speaking this is the primary job of the pelvis; to evenly distribute kinetic and gravitational forces through our bodies.

When this baseline is out of proper alignment this job becomes much more difficult to do.  The forces can no longer be properly distributed and certain areas see more than their due.  Take for instance the most common pelvic posture, the forward tilt.  If we think back to the bowl analogy, a forward tiling pelvis would be pouring out the front aspect of the bowl.  If we imagine the lumbar spine resting atop the sacrum, we can immediately see why low back pain is a common symptom of this simple postural problem.  

Beyond muscular pain, if this forward tilt is not corrected in a timely fashion, damage to the discs in the L4/L5/S1 region can become an issue. Nerve compression can lead to sciatica and the postures above the lumbar spine begin to change as well. 

Luckily it really is quite simple to address.  Lying on the floor with the knees up over the seat of a couch or chair is the easiest way to relieve discomfort.  From this position gravity does all the work, elongating the muscles of the lumbar spine and opening the spaces between the vertebrae.  This alleviates most of the pressure in this area, giving compressed nerves, muscles and discs a break.  By opening up the channels between the vertebrae, drainage to the over worked areas can also be achieved decreasing any fluid congestion or swelling present in the area.

To correct, assume the same position and engage the lower abdominal muscles to flatten the low back into the floor and hold for 5-10 seconds.  Repeat this crunch 5 times to start building your muscles up.   

The primary cause of this postural problem is not the muscles of the back, but the muscles of the front.  When the abdominal muscles get too long they no longer pull the front of the pelvic bowl upwards and instead allow it to tilt.  By doing this simple tiny crunch one can train the lower abdominals to maintain a mild engagement throughout the day thus shortening them and return the pelvic bowl to balance.  

References: Principles of Anatomy and Physiology, Tortora, 11th Ed.  Principles of Physiotherapy, Hertling and Kessler, 4th Ed.

 Jen Fleming RMT
 jenflemingrmt@gmail.com
 www.jenflemingrmt.com

Jen Fleming: Toughen up to train up

By: Jen Fleming

As of late, I have been discussing this concept with a lot of people.  The idea that you can jump into the middle of a work out regime after you’ve either been away from the gym for an extended period of time, or have sustained an injury, can spell disaster.  Not to mention poor results, or an inability to even follow the regime.  Worst, you can worsen an existing injury or create a new one.

Sometimes you gotta train to train, toughen up before jumping in full throttle.  In other words, start where you are.

The first step to that is to test your self.  Let’s say you used to be highly conditioned and could perform a deadlift with 150lbs … a year ago.  Start with half the weight, and perform as many reps as possible up to 12.  Too easy?  Add some pounds.  Were those last 3 reps a challenge?  Leave it at that weight and do another 2 sets of 8-12 reps.  Too hard?  Drop the weight.  Just be honest with yourself – you’ll save your body the grief of an injury.

What if you have an injury?  Whether it is fresh or old, that injury will probably be with you for the rest of your life, if it was bad enough.  Even if you were highly conditioned before, these injuries lose conditioning faster than healthy parts and will be significantly weaker.  That means you will have to cater to where that injury is in its health, rather than the rest of your body.



Some people really stick to the old adage no pain no gain, and in some instances that can be true.  In others it’s just dead wrong.  A good way to tell the “good hurt” from the “bad hurt” is when it starts to hurt.  If you feel a little sore after you finished your last set, you may have pushed it too hard and you will likely be very sore for the next few days.  

But  that’s not necessarily a bad thing, pushing the boundaries is how we grow.  If it’s sore in the first few reps, or even at the end of the first set, you are doing some bad damage and you need to back off the weight, or stop all together.  
Injuring yourself will do you no favours in trying to reach conditioning and body composition goals and will in fact set you well back.

Another thing to consider, for those of you who have no pain scale at all and would “walk off” a broken leg is FORM.  Form, hands down, is always more important than the number of pounds or reps.  

If you are on rep 5 of your first set and your movement is really sloppy, or you are swinging your whole body back to do a bicep curl your weight is too heavy!  Either do fewer reps and some research on pyramid weight training or lower your resistance, do it right.

So, go to the gym, enjoy yourself, lift weights, get big and strong and sweaty but do it SMART!  Injuring yourself just costs you money by coming to me to help fix you.  And of course I will probably make you read this article aloud while I K-Tape an ice pack to your wounded pride.

(Information extrapolated from text book, Management of Common Musculoskeletal Disorders, Physical Therapy Principles and Methods, 4th Ed. Hertling/Kessler.)

                                                Jen Fleming RMT
                                        jenflemingrmt@gmail.com
                                         www.jenflemingrmt.com

Hot v.s. Cold Therapy

By: Jen Fleming

Hot baths, hot pads, hot water bottles, heated blankets, the list goes on for heat therapy.  It’s relaxing; it’s soothing, makes us feel sleepy and gives us that overall warm fuzzy feeling.  Ice bags and cold packs, on the other hand, give a lot of people anxiety - and with good reason – some of us are so stressed and exhausted by our lives we feel like we can’t get warm.  


The idea of a cold pack actually makes some people feel afraid; like we may never get warm again.  And because of this fear, we put heat pads on everything, even injuries. But a heat pad is far from a catch all solution, and in many instances can increase the problem!  Below are the do’s and don’t of hot and cold therapies so you can use them properly to treat aches and pains at home.

Hot Therapy Do…

    • Take a hot bath at the end of a long day of physical activity or inactivity. The         heat from the tub willrelax your muscles and bring blood to thesurface layers        of skin, thus cleansing it as it moves through the lymphatic structures under        the skin.

    • Put a moist heat, like a hot towel, on an achy and stiff arthritic   
      joint.  The heat will help loosen the tissues and increase the 
      circulation through them.  This followed up by a gentle massage 
      can improve mobility by a lot.

  Hot Therapy Don’t…

 • DON’T put heat on a new injury of any kind – even a muscle strain.    
    All new injuries are inflamed and placing a heating pad on the 
    inflamed part with increase the inflammation and nerve conductivity 
    creating more pain.  In addition, this will slow down the healing 
    process making your injury take longer to recover.

 • DON’T put heat on an arthritic flare up!  As the above line states, 
   inflammation and heating pads are not friends and the heat will 
   make the flare up worse. Basically when it comes to heat therapy, if 
   you are inflamed NO HEAT.

So now,  if our bodies have to deal with those chronically on a daily 
Cold Therapy Do…

      •  Got inflammation?  A fresh injury?  Then a cold pack really will be  
          your best friend.  The cold will reduce the inflammation and the 
          pain and will help speed the recovery process.  Try it out for 
          yourself some time and you will see that it’s true.

      •  Use a cold pack during an arthritic flare up  - when the joints are all 
         red and swollen.  Again, this will reduce the inflammation and the 
         pain.

      •  Use a cold towel when you have a head ache – place it on the base   
        of the skull and feel relief.  Light sensitive?  Drape the towel over 
        your head to block the light and gain relief from the cold.
  
     •  Keep a water bottle or bean bag in the freezer at all times to use 
        for nasty foot pain like plantar fascitis.  Just rest your foot on the 
        cold bag or roll it out on the bottle.

When inflammation occurs remember RICE: Rest Ice Compress Elevate.  And inflammation occurs every time your body is hurt.  So no more heating pads on your boo-boos, ok?

      

Muscle Strain & Spasm: Just what is going on in there?!

By: Jen Fleming

We’ve all had that annoying tweak  – or super painful  “stop-me-in-my-tracks wrench – of a muscle spasm.”Presently I am nursing a spasm in my right hamstring.  I did it at the gym doing dead lifts; the first set went well, but the lunges and squats I did before the second set of dead lifts was not a great idea.  And I was dehydrated.  And the muscle has been spasming on me rather frequently as of late.

You could say it was in a state of readiness.

So what causes muscle spasms?  How exactly do they happen?  What makes it hurt so much and, please, what can you do about it?!  Read on my friend, be demystified as we learn about muscle spasms.

There are about as many causes of muscle spasms as there are types of spasms.  Generally though, the type of spasm we are thinking about is the painful “I can’t move” type of spasm.  To shed some light on this, a little neuro-anatomy…

Neurologically, the muscles have two main proprioceptors, the muscle spindle and the Golgi-tendon-organ (GTO).  The muscle spindle is located deep in the muscle belly and monitors changes in muscle length.  When the muscle spindle is fired, a spinal reflex arc called the stretch reflex occurs.  This happens when the length of the muscle changes suddenly, like when the doctor taps your knee with a reflex hammer or when you reach for something suddenly at an awkward angle.

The GTO is located in the tendon of the muscle and monitors muscle tension.  When triggered by a sustained increase in tension, the GTO will initiate the tendon reflex and cause relaxing and
lengthening of a muscle. This is what we experience when we hold a stretch for a minimum of 30 seconds. Holding a stretch for longer will re-trigger the reflex, thus increasing the muscle’s length. This reflex feels good.

The stretch reflex does not feel good.  If it’s just a reflex hammer test it’s not so bad but, if one is lifting something too heavy,watch out!  It can produce a very powerful contraction with a
sudden jolt of pain causing you to stop what you’re doing.  In some instances, the contraction can be so powerful it can cause bones to momentarily come out of alignment for the sake of preventing fracturing!  This is usually what is meant when someone says, “I threw my back out.”

So what does one do when laid up with a really bad muscle spasm?  Keep the muscle off tension.  A muscle spasm is a guarding mechanism, mucking around with that only re-triggers the stretch reflex.  Step two is a cold pack.  And that doesn’t have to mean ice.  A towel run under the coldest tap water you have, or a bean bag stored in the freezer is great.  You just need it cold enough to be a lower temperature than the area of concern.  The greater the disparity in surface temperatures, the stronger the reaction.  Cold will decrease the presence of fluids and slow down nerve activity.  Win win!  Leave the cold pack on for a max of 20 minutes, or rotate it 5 minutes on 5 minutes off to allow fresh fluids to come in and old fluids to go out.

And if it’s really bad, you can always call in the Professionals.

 Jen Fleming RMT
 jenflemingrmt@gmail.com
 www.jenflemingrmt.com