Advanced core exercises Physical Therapy

0:00 / 13:01. Live. •. Emily Hart, DPT and Bryan Linares, PTA are here to help improve your movement with advanced core exercises to target the deep core muscles needed for good postural stability and so much more! Tune in and take your next step towards achieving a steadier, healthier life. Primary Sidebar. Schedule a Free Screening Therapeutic Exercise for Core Stabilization and Strengthening Key to abdominal training Start with local muscles and progress to global muscles to ensure that global muscles are not compensating for local muscles. Stabilization before strength. Progression of Core Strengthening: Formal motor skill trainin Standing Pelvic Tilt. Step 1: Start by hollowing out the abdomen by tightening up the ab muscles. Step 2: As you rock your pelvis forward, your back will naturally create an arch in the lower back area. Step 3: Hold each repetition for about 10 seconds and then relax and go back to the neutral starting position Try combining ActivMotion Bar exercises with the balance platform of your choice such as a BOSU Ball, Airex Pad or Strong Board Balance Trainer for next-level balance and core challenges! To learn more about ActivMotion Bars, visit www.activmotionbar.com Posted in: Blog, Hobbies, Uncategorized, Workou help your leg and arm muscles work well. Doing the exercises in this booklet will strengthen your core muscles. Please read the instructions and follow the advice of your doctor or physical therapist when you start or progress to more difficult exercises. There are 4 basic starting positions: • Hook-lying • Face-down lying • Hands and knee

Core-strength exercises strengthen your core muscles, including your abdominal muscles, back muscles and the muscles around the pelvis. Strong core muscles make it easier to do many physical activities. You can do core-strength exercises on a carpeted floor or mat. Breathe freely and deeply during each core-strength exercise The Author. Matthew Ibrahim is a Strength and Conditioning Coach with an evidence-based approach to human movement, biomechanics and injury-prevention, and is knowledgeable on how each area impacts performance in sports and life. During his time spent working in physical therapy clinics along with sports performance centers in the Greater Boston area, he has developed training methods aimed at. Low back exercises concentrate on strengthening with the abdominal muscles, to be able to give stabilization of the spine. Rehabilitation programs or preventative rehabilitation programs that focus on strengthening lumbar muscles combined with core stability and proprioception will reduce the risk of low back pain if exercises ar

Next week will be 10 advanced core exercises that you probably haven't tried before. Lawrence Lee Functional Movement Specialist Lee Physical Therapy & Wellness. Larry is a Functional Movement Specialist located in Greene County, Ny. His primary focus is working both online and in-person with the general fitness population as well as post. www.move.va.gov Physical Activity Handouts • P37 Version 5.0 Page 1 of 3 P37 Strengthening Your Core Your body's core is the area around your trunk and pelvis (hips) and is where your center of gravity is located. All body movement involves the core. A weak core can cause poor posture, lower back pain, and increased risk for injury

PHYSICAL THERAPY 7 q Wall squat with exercise ball: Place a ball between your low back and the wall with your feet about 12-18 inches away from the wall (farther if you are taller). Squat down and hold the position for 5-15 seconds. Stand up and repeat. FREQUENCY_____ q Partial chair squat: Put 2-3 pillows on a chair behind you. Stan Core Exercise #2. by ASFCA | Fundamental Core Exercises, Physical Therapy Exercises . Dead Bug. Once again, lie on your back, and remember, make sure you lay on a sturdy flat surface, like the floor. You can lie on a yoga mat, but do not do this exercise in your bed; the mattress is not firm enough to support your back as you do these exercises.

The following core exercises will be done from a lying position either on a yoga mat or physical therapy table. These trunk control exercises are more advanced, so try them once you have mastered the exercises above. 5 These 41 ab exercises are some of the most advanced out there. They'll hit your torso from a variety of angles and in a variety of ways — stronger core, guaranteed. These 41 ab exercises are some of the most advanced out there. They'll hit your torso from a variety of angles and in a variety of ways — stronger core, guaranteed

Advanced Core Exercises CORA Physical Therap

Advanced Throwers Ten exercise performed on a stability ball to facilitate stabilization of the core musculature as rotator cuff and scapular musculature endurance exercises are performed. Table 3 Dynamic stabilization drills such as RS (Rhythmic Stabilization) are performed in a functional throwing position Famous Physical Therapists Bob Schrupp & Brad Heineck demonstrate Advanced Lumbar Stabilization Exercises. Exercises for strengthening the back and core wi.. While this exercise doesn't target a muscle on the back of the body, it is perhaps my favorite exercise to incorporate into a posture/general wellness routine. Plank is an isometric (meaning that the muscles contract but don't change length) core exercise and can improve everything from back pain to inversion strength on the fabrics

Occasionally, you may require more advanced hip strengthening exercises to help maximize hip strength and improve functional mobility. Some repetitive strain injuries of the hip, knee, and ankle may be caused by weakness in the hip and core musculature. Many common running injuries and athletic injuries may be caused by weakness in the hips The objectives of physical therapy include: Maintaining and improve functions via a range of motion - passive range of motion exercises consist of progressive stretching and self-stretches; Strengthening muscles - this includes exercising against increasing resistance, use of weights, and isometric exercise Action. 1. With both hands on Stix drive hands forward while at the same time shift hips backward. 2. Release left hand, drive right hand across body while shifting hips backward. 3. Switch hands, drive left hand across body while shifting hips backward. Stix Position more advanced gait drills. The goal is return to ambulating without any noticeable abnormalities. In this stage, mobility for basic daily tasks is usually quite good. Bridge Exercise with an Exercise Band Around Your Knees Place an exercise band around your thighs above your knees. Keep your pelvis level as you lift your hips/pelvi This exercise may feel advanced. And it can be depending on your core strength level. Lift both legs up. Breathe deeply and engage your core. You can start with 10-15 repetitions for each core exercise, and as you gain more strength, bump those reps up to 15, or do 2 sets of 10-15 reps

The movements are recommended by trusted physical therapy professionals and cover the following areas of the body: shoulders, arms, balance, hands, legs, and core. Follow along with helpful illustrations as you work through the basic, intermediate, and advanced versions of these post-stroke exercises Appointments Continue physical therapy 2-3x/week Rehabilitation Goals • Full ROM • Advanced strengthening • Consider early neuromuscular retraining Precautions • Wear brace unlocked until good quad control except for sleeping, exercises Suggested Therapeutic Exercises • AVOID OPEN CHAIN RESISTIVE ESPECIALLY WITH WEIGHT Exercise ball moves like the half ball crunch are great for ab and core strength. See Back Exercises and Abdominal Exercise Recommendations. These core body strength exercises with the ball can be very difficult to perform and should be learned with the help of an appropriately trained physical therapist, chiropractor, certified athletic trainer, exercise physiologist, physiatrist, or another.

Core Exercise #1 - Advanced Sports & Family Chiropractic

TRX Workout With Advanced TRX Suspension Training Moves

» Advanced Physical Therapy Core Exercise

  1. Many standing strength, balance and cardiovascular exercises also enhance core strength and stability, while also allowing the body to move in various planes of motion. Here are six standing core stabilizer exercises that can be used in a variety of personal training and group exercise programs to effectively challenge both the core and the entire body
  2. This will help you realize the full benefits of physical therapy exercises for lower back pain. Exercises For Increased Flexibility and Pain Reduction. Low back pain is often caused by poor flexibility in the hips, legs, and glutes. The following exercises can help you increase flexibility in those areas and possibly decrease instances of low.
  3. Below are a few basic exercises to get you started on your road to a bulletproof core. Start off with one set of 10 repetitions of the exercises, and gradually increase it to 2-3 sets of 10 as you get stronger. As a caveat - none of these exercises should cause or increase your back pain
  4. A strong core is vital for overall fitness and pain-free movement. Check out these 5 core exercises everyone should be doing for improved posture, better stability, and less back pain. Not only will you tone your abs and slim your stomach, core exercises will also help you with day-to-day activities.. 5 Core Exercises Everyone Should Be Doing. Plank.
  5. • Advanced core strength and stabilization exercises: • Progress to weight bearing, balance, Swiss Ball, Reformer, etc. • Progress to multi-planar exercises with upper extremity/lower extremity • Progress upper extremity/lower extremity strengthening • Begin running, agility and plyometrics for return to sport after 8 to 12 week
  6. utes Home Physical Therapy. SITTING BALANCE EXERCISES Movement on Varied Support Surfaces Adapted from Jennifer Keller. STANDING BALANCE EXERCISES Adapted from Jennifer Keller

Just for fun, try this advanced pelvic floor exercise! *Do not do if you have diastasis recti! Check for Diastasis Here. Start on your hands and knees. Engaging your core, lift up to your toes. Without dropping your head or letting your back arch, come forward and try to blow up the balloon. It will be the hardest core exercise ever Check out these 33 pediatric therapy social media accounts! Kids Won't Complain About Fun Pediatric Therapy Exercises The secret sauce for successful pediatric physical therapy is to make a game of it. Physically challenging fun is a whole lot more likely to gain traction with your pint-sized clients than sets of standard PT exercises Lumbar Discectomy Physical Therapy Prescription • Independent home exercise program for advanced strengthening, return to sport and work. • Advanced core strength and stabilization exercises: • Progress to weight bearing, balance, Swiss Ball, reformer, etc y. Core stability and its motor control have been shown to be imperative for initiation of functional limb movements, as needed in athletics. Sports medicine practitioners use core strengthening techniques to improve performance and prevent injury. Core strengthening, often called lumbar stabilization, also has been used as a therapeutic exercise treatment regimen for low back pain conditions.

To improve your function and performance, it's important to properly incorporate a strength-training program into your exercise routine that focuses on core stability. All exercises should be performed PAIN-FREE. You should consult a healthcare professional and/or physical therapist before starting a new exercise routine The Athletic Level Abdominal Exercise with 90/90 Leg Drop targets the transverse abdominal muscles and the spine. It is the third of four abdominal exercises for osteoporosis from the Exercise for Better Bones program. YouTube. Margaret Martin, Physical Therapist. 18.3K subscribers Perform 10 repetitions, twice a day. For an advanced version, hold hand weights to add resistance. If you have pain in your knees, back or hips, discontinue and talk to your doctor or physical therapist. Balance Exercise This series of exercises helps if your balance is unsteady. Make sure you have someone with you in case you lose balance Benefits of Physical Therapy Exercises for Brain Injury Recovery Exercise is good for everyone, but it is especially important for people with TBI. In fact, research has shown that regular practice of brain injury rehabilitation exercises is a key factor in reversing the effects of traumatic brain injury Core Stix was originally created for world-class athletes and has since evolved into the most versatile fitness product available for building useable strength. Now everyone, from professional trainers to physical therapists are seeing the benefits of the Core Stix system to deliver usable strength to their clients. Core Stix Innovation

According to a 2018 article published by StatPearls, most people with DDD improve with at least six weeks of physical therapy without the need for surgery. Early intervention includes degenerative disc treatment exercises, focusing on stretching and core strengthening 6 Physical Therapy-Inspired Exercises for MS Bladder Problems. Medically reviewed by Gregory Minnis, This exercise helps to wake up the deep core muscles, including the pelvic floor. It can. We recently shared a great, simple exercise for, and basic information about the transverse abdominis, which is the inner core muscle that makes up the sides and front of your trunk. In this article, we are going to teach you a more advanced exercise for this same muscle. Strengthening th Additionally, strengthening exercises such as squats or lunges can help strengthen the gluteus and thigh muscles, which play important roles in supporting the pelvis and SI joint. Other strengthening exercises may be recommended or prescribed by a doctor, physical therapist, or other health professional

Slide show: Exercises to improve your core strength - Mayo

American Physical Therapy Association / 6 III. Core Competencies of a Physical Therapist Resident Domain of Competence 1: Clinical Reasoning Demonstrates the ability to organize, synthesize, integrate, and apply sound clinical rationale for patien Core stability exercises have received increasing scrutiny recently. 29,47 One survey indicated that core stability exercises are the most frequently recommended form of exercise by Irish physical therapists. 48 Previous systematic reviews and meta-analyses have demonstrated that core stability exercise programs can be effective for specific. Physical Therapy Exercises We are committed to helping people stay active and as pain-free as possible. Our physicians, advanced practitioners, and physical therapists have put together a wide variety of information to guide you on exercises that can be done at home to alleviate pain, strengthen core areas, or keep you active He told me that in his physical therapy sessions, they went over the do's and don't's of exercising the core with DR (there are quite a few don'ts). Many of the movements the therapist had him perform were the same types of exercises we had incorporated into his personal training sessions Scoliosis is characterized by an S- or C-shaped curve in the spine. In this article, we suggest a few exercises for people with scoliosis, as well as stretches that may help improve dexterity

Press back to straighten your elbows and repeat. Toe and chair stands: Increase your balance by completing these home exercises for seniors. Sit down in an armless chair and extend your arms parallel to the ground, slowly standing up. Repeat this move 10 to 15 times. For an added benefit to further improve balance, try a toe stand, in which you. Core exercises physical therapy. Exercises for spinal stenosis generally fall into two main categories. The following core exercises will be done from a lying position either on a yoga mat or physical therapy table. When you are strengthening your core skip these exercises to avoid back pain. Now you are ready to begin Hi! My name is Margaret Martin and I am a Physical Therapist with over 37 years of clinical experience. My expertise is in the treatment and prevention of osteoporosis through evidence-based therapeutic exercise, safe movement and fall prevention. For the last 15 years, I have concentrated on bone health and have treated thousands of patients. Journal of Orthopedic and Sports Physical Therapy, 37(1). A44 - A45. Cricchio, M. & Frazer, C. (2011). Scapulothoracic and scapulohumeral exercises: a narrative review of EMG studies. Journal of Hand Therapy, 24, 322 - 334

Home Therapy Exercises After Total Hip Replacement . Recovery after Surgery . To see the full benefit of hip replacement, therapy will be a necessary part of the rehabilitation process. Therapy can reduce swelling, decrease pain, improve range-of-motion, build strength, challenge balance, and develop endurance intervention. The review also concludes that physical therapy and nonsteridal anti-inflammatory drugs are the cornerstones of non-surgical treatment. Physical therapist intervention includes strengthening of core muscle groups, including the abdominal wall and lumbar musculature, which can have posi-tive effects in patients with this. TheraBand Resistance Band Loop Set, Pack of 4, 12 Inch Band Loop Kit for Legs & Butt Workouts, Beginner to Advanced Levels for Exercise, Rehab, Physical Therapy, Stretching, & Strength Training. 4.2 out of 5 stars. 583. $14.57 These low back spondylosis exercises focus on strengthening your spinal support system—your back and core (abdominal) muscles. If the muscles around your spine support and stabilize your back, you may have less pain—and a healthier spine. A strong core is key to back health. Your core muscles work like your spine's front anchor

The Best Core Strengthening Exercises To A Healthier Spine

  1. al area (the 'core' muscles). Exercises shown in these two sections of the DVD are those that can be done at home or in a fitness center setting, using home-based, portable equipment options such as Thera-band elastic resistance bands, free weights, wrist weights, or a weighted ball
  2. Nov 1, 2016 - While the focus of stroke recovery is often on the limbs and facial muscles, without a strong core, the rest of the body may suffer. By isolating and activating core muscles with exercises, stroke survivors can work to regain coordination and strength that benefits their whole body. See more ideas about stroke recovery, advanced core exercises, core workout
  3. Ankle Replacement Physical Therapy: Weeks 6-10. Usually, about 6 weeks after surgery, the ankle can begin to handle weight-bearing exercises. The objectives during this period of rehab are to reduce ankle swelling, to begin normalizing walking patterns, increase scar mobility, and progress weight-bearing as tolerated in a boot
  4. Amazon.com: TheraBand Resistance Bands, 50 Yard Roll Professional Latex Elastic Band For Upper & Lower Body & Core Exercise, Physical Therapy, Pilates, Home Workout, Rehab, Black, Special Heavy, Advanced Level

advanced core exercises physical therapy provides a comprehensive and comprehensive pathway for students to see progress after the end of each module. With a team of extremely dedicated and quality lecturers, advanced core exercises physical therapy will not only be a place to share knowledge but also to help students get inspired to explore. Senior Step - Volume 1, 2004 - by Melissa Wolff-Burke, EdD, PT, ATC, and Elizabeth Cole, PT - The previous article discussed exercises to help you maintain the range of motion (ROM) in your limbs and back and help you get moving again after an amputation. Many of those activities can be made more challenging by adding weight, not using any object for support, standing instead of sitting, or. Only exercises that integrate the smaller and larger muscles of the trunk with the extremities (advanced core exercises) will restore full function. Your physical therapist can help you develop the best exercise program for you. Contact us if you have questions about how to get started Therapy Ball Exercises. Exercises You Can Do at Home Using Your Therapy Ball For Core Strengthening Consult your physical therapist before attempting these exercises. Supine stretch over ball. Hold this position for 30 seconds. Relax your head on the ball. Breathe naturally. Repeat 2-3 times

I show you 31 ab exercises to choose from to do. Side plank with rotation this exercise is an advanced version of the basic plank. Taga Sports July September 2017 By Taga Plus Issuu This ones hard enough as it is. Hard advanced core exercises. Core exercises the best core exercises for all levels of gym goer 5. Other. Bilateral play - promotes use of both sides of body and movements that cross midline. Sports skills - requires hand eye coordination, reaching, squatting, balance. Navigating obstacles - play tunnels build strength, endurance, and motor planning. Climbing up and down - targets both concentric and eccentric muscle activation Side note: There are a lot of great strengthening exercises for your hips like deadlifts, kettlebell swings, etc. However, for the purposes of making this immediately accessible with no equipment necessary (except maybe a therapy band if you have one), I will focus on body weight and gravity resisted exercises. Basic Hip Strengthening Exercises

5 Functional Core Exercises You're Not Doing, But You

Whatever your reasons for wanting to improve your core strength, our guide to the best core exercises will help you build strength, stability and six-pack muscles. Not that this is all about muscle Physiotherapyexercises.com is a FREE tool to create exercise programs for people with injuries and disabilities. We are pleased to be a professional partner of the World Confederation for Physical Therapy - the sole international voice for physical therapy. Click here for details

Core Exercise #2 - Advanced Sports & Family Chiropractic

The Advanced Therapy and Performance team brings an integrative approach to rehab and training. By leveraging the specialties of each Integrated Performance Coach and Therapist, we collaboratively utilize all modalities in the sports therapy and performance training community to get the fastest results possible for our clients type of exercises many athletes and coaches rely on for regular core training. I like to break core strengthening up into four stages - starting with the protective and fundamental stage and progressing to advanced sport/work specific strengthening. Stage 1 • Abdominal Bracing This is the main technique used during core exercise training The Benefits of Core Strengthening Exercises for Seniors Adding core strengthening exercises to your workout regimen is crucial for seniors. Exercise in general has been proven to slow down the aging process, and improving your core strength improves your stamina, stability, coordination, posture, and protects you from injury Marching is a great balance exercise for seniors. If you need to hold onto something, do this exercise in front of a counter. Standing straight, lift your right knee as high as you can. Lower it, then lift the left leg. Lift and lower your legs 20 times. Exercise 11: Toe Lifts. This strength training exercise for seniors also improves balance

Core Exercises for Stroke Patients that Improve Balanc

  1. is contraction with all exercises o Supported bike, Retro treadmill o Wall slides, Bridges o Advanced core stabilization exercises with emphasis on prone and quadruped positions Bird/dog o Advance UE and LE resistive activities o Consider FCE as needed Phase IV (12+ weeks post-op
  2. al muscles (do not hunch shoulders or push out ribs)
  3. The 9 Best Stability Ball Exercises for Core Training. Notes: #1. For each of these core exercises, aim for 10 reps (or 5 on each side where applicable) in a controlled fashion. #2. For added strength benefit (and where applicable) move your body very slowly on the eccentric (negative) phase of the exercise for a 5-6 second count

The Hardest Ab Exercises Livestrong

Shoulder Rehab Phase 3: Advanced Strengthening Phase - PT

Physical therapy involves learning the exercises to remain active and prevent muscle disuse. Remaining active while avoiding specific activities that aggravate symptoms optimizes conservative recovery after disc injury. 1 . Physical therapists are experts in assisting people with disc injury to transition to more functional and active lifestyles There are several reasons why I (and many other physical therapists) love the this exercise: A bridge is performed in a neutral spine position. Often core stabilization exercises are performed in either a flexed position (think sit up) or an extended position (think up-dog) Cardiopulmonary exercise testing (CPET) is considered the gold standard tool in assessing the physiologic response to exercise, 3, 18 and in identifying individuals in need of advanced therapies (e.g. HT or VAD implantation). 18 However, pre-implantation VAD patients may be too ill to perform CPET 4, 5 and thus comparisons of peak oxygen consumption (VO 2) values post-implantation are mostly. All of our Physical Therapists have advanced certifications in Sports Performance and Strength and Conditioning. Our specialized backgrounds allow the Physical Therapists at C.O.R.E. to offer and integrate highly specified services to your treatment plan, including detailed sports performance programming, exercise prescription and on-going. Dr. Eric Hefferon received his advanced doctorate degree in physical therapy from the innovative A.T. Still University. He has been practicing in the west valley for 6 years and has made strong ties to local gyms and medical practitioners. Dr. Hefferon started Impact Physical Therapy due to his passion for an individualized healthcare approach

ADVANCED Lumbar Stabilization Exercises-Without Equipment

10. Wood Chops Exercise. This is one of the best physical therapy exercises for shoulder as it works for the core and triceps, and muscles. The techniques are: You stand in front of the rebound, hold a ball in both hands and put it over the shoulder. Then throw the ball down using the chop motion Your orthopaedic surgeon and physical therapist may recommend that you exercise for 20 to 30 minutes, 2 or 3 times a day during your early recovery. They may suggest some of the exercises shown below. This guide can help you better understand your exercise and activity program, supervised by your physical therapist and orthopaedic surgeon

Postural Exercises — ACRO Physical Therapy & Fitnes

WEIGHT BEARING BRACE ROM EXERCISES PHASE I 0-2 weeks As tolerated with crutches and brace*** Locked in full extension for sleeping and all activity* Off for exercises and hygiene 0-2 weeks: 0-45° when non-weight bearing Heel slides, quad sets, patellar mobs, SLR, calf pumps PHASE II 2-8 weeks 2-8 weeks: Full WB while in brace 2-4 weeks: Locke Physical Therapy Balance Exercises for Elderly. The stepping response is a balance exercise for elderly used by Physical Therapists when an elderly patients start to lose his or her balance. It is more of a test than an actual exercise. The Stepping Response. A stepping response is a balance response that occurs when someone steps quickly to adjust from a loss of balance Regular exercise to restore the strength of your back and a gradual return to everyday activities are important for your full recovery after low back surgery. Your orthopaedic surgeon and physical therapist may recommend that you exercise for 10 to 30 minutes, 1 to 3 times a day during your early recovery

CAFS is entirely online and can be completed at your own pace. Once enrolled, the student will have access to the content for a period of three years and can continue to access the content to this Physical Therapy Certifications course even after completion. Advanced Exercise Therapist Certification (AET) offered by th When your core becomes stronger, your lower back and abdominal muscles become better able to balance and stabilize your posture. Although core-strengthening exercises will not reduce the size of the curve in adult patients, they do play an important role in helping prevent progression. They can also help reduce back pain caused by scoliosis. Rehabilitation/Physical Therapy. Whether you have experienced arthroscopic surgery (a minimally invasive surgery performed through small incisions utilizing an arthroscope, an instrument the size of a pencil, which helps to visualize the joint and the surrounding area) or a total hip replacement, some sort of rehabilitation will be required In addition, a physical therapist will educate you on ways to use your spine properly while sitting, standing, and lifting. Physical therapy can also help prevent future episodes of back pain by teaching core strength exercises, helping to maintain flexibility, and demonstrating proper body mechanics, also known as ergonomics. Pediatric Program

10 Core Exercises for Lower Back Pain Relief SEL

If your surgeon refers you to physical therapy it's important to stay on top of your HEP; although your therapist will teach you the exercises and coach you on proper form, you need to do your homework consistently. It's more effective to perform your exercises for ten minutes per day every day than 45 minutes once a week Physical therapists are trained to teach helpful exercises to restore movement and other exercises that improve practical, everyday movement for people that require adaptive equipment. They are also trained to supervise exercises that improve the strength and mobility of damaged joints

10 Best Balance Exercises (Advanced) - Ask Doctor J

Exercise for Osteoarthritis of the Hip. Nolwenn Poquet, Nolwenn Poquet. 1 N. Poquet, PT, MSc, is in private practice in physical therapy in Orléans, France. * Address all correspondence to Ms Poquet. Search for other works by this author on: Oxford Academic. Google Scholar The exercises prescribed, and the pace of progressions recommended in the hip exercise booklet, are intended for patients with unilateral, primary hip replacement for osteoarthritis, with a postero-lateral incision approach. These exercises may be suitable for patients with a different surgical approach, bilateral tota

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