Understand Your Pain and Then Get Back to Function
The purpose of this work is to teach you how to identify, treat and prevent pain, injury and dysfunction, so you can safely and effectively train your body, get fit and get Back to Function.
Before you can train and get fit, you must get rid of your pain and dysfunctions and in order to do that you must understand the following:
- What is pain?
- Which factors influence pain?
- What is injury and healing?
- Which factors influence injury and healing?
- What are dysfunctions?
- What are tissues dysfunctions?
- What is the difference between rehabilitation and training?
What is Pain?
Chemical pain vs Mechanical pain
To treat our pain safely and effectively, we must first identify the type of pain we are dealing with.
Chemical Pain:
*Pain is constant, regardless of the position we adopt.
*It is caused by inflammation.
*Movement makes it worst.
*It may be helped by anti-inflammatory medication.
*We may need to use the RICES concept (Rest, Ice, Compress, Elevate and Stabilize).
Mechanical Pain:
*Pain is intermittent, it comes and goes depending on the position we adopt.
*Pain will improve if we do the right type of movement or therapeutic exercise.
*It does not respond to medication.
Chemical Pain:
*Pain is constant, regardless of the position we adopt.
*It is caused by inflammation.
*Movement makes it worst.
*It may be helped by anti-inflammatory medication.
*We may need to use the RICES concept (Rest, Ice, Compress, Elevate and Stabilize).
Mechanical Pain:
*Pain is intermittent, it comes and goes depending on the position we adopt.
*Pain will improve if we do the right type of movement or therapeutic exercise.
*It does not respond to medication.
Chemical Pain vs Mechanical Pain
Loading poll. Please Wait...
Understanding the Mechanics of Pain
There are four ways that pain can be activated:
* Normal stress on abnormal tissue: Example: Walking (normal stress) with a degenerated knee (abnormal tissue).
* Abnormal stress on normal tissue: Example: Healthy person (normal tissue) who sits with a slouched posture (abnormal stress).
* Abnormal stress on abnormal tissue: Example: Sleeping on stomach (abnormal stress) with a pinched nerve in the neck (abnormal tissue).
* Chemical stress: Inflammation, infection or trauma.
* Normal stress on abnormal tissue: Example: Walking (normal stress) with a degenerated knee (abnormal tissue).
* Abnormal stress on normal tissue: Example: Healthy person (normal tissue) who sits with a slouched posture (abnormal stress).
* Abnormal stress on abnormal tissue: Example: Sleeping on stomach (abnormal stress) with a pinched nerve in the neck (abnormal tissue).
* Chemical stress: Inflammation, infection or trauma.
Help from Socrates
Since I believe you hold the answers to most of your problems, I will follow Socrates, The Father of Western philosophy, who taught Plato and Aristotle that through questions you have the potential to discover, learn, teach, and get as close to the truth as possible, and ask the following questions:
Socratic Questioning
How do you know you have pain?
How do you feel it?
How does pain travels to the brain?
Can we say that nerves are involved when feeling pain?
Which structures have the potential to compress the nerves?
If you have pain in the shoulder and arm muscles, but can only induce the pain by moving the neck, where is the problem?
Can the problem be in the cervical spine (neck) and is being referred to the shoulder and arm?
How is it that someone who has lost an arm in an accident can still feel pain down an arm that is not longer there?
Is it possible that the cortex (sensory part of the brain) may be misinterpreting the location of the dysfunction?
Can the lack of functional understanding be the reason why most doctors, therapists, trainers and us may be confused by the cortex?
How do you feel it?
How does pain travels to the brain?
Can we say that nerves are involved when feeling pain?
Which structures have the potential to compress the nerves?
If you have pain in the shoulder and arm muscles, but can only induce the pain by moving the neck, where is the problem?
Can the problem be in the cervical spine (neck) and is being referred to the shoulder and arm?
How is it that someone who has lost an arm in an accident can still feel pain down an arm that is not longer there?
Is it possible that the cortex (sensory part of the brain) may be misinterpreting the location of the dysfunction?
Can the lack of functional understanding be the reason why most doctors, therapists, trainers and us may be confused by the cortex?
What is Referred Pain?
Referred Pain
Referred pain is pain that is felt in an area other than the lesion.
Why is this important?
Because the cause of referred pain is always different from the tissue where the pain is felt. If you only treat the area where you feel the pain without digging any deeper, the treatment will not reach the right tissue, and will fail.
Why is this important?
Because the cause of referred pain is always different from the tissue where the pain is felt. If you only treat the area where you feel the pain without digging any deeper, the treatment will not reach the right tissue, and will fail.
What Happens When You Have Referred Pain?
An Example of Referred Pain
A patient complains of thigh pain and receives treatment for the quadriceps muscle. The reason is that the pain is felt in the quadriceps area.
After endless treatments of stretching, strengthening, ultrasound, electric stimulation, etc., she gets to the right clinician who performs a functional assessment.
Upon examination, it becomes clear that resisted knee extension (which is one of the test that test the quadriceps' contractile ability) shows negative, proving that the function of the quadriceps muscle is not disturbed.
Further examination, this time of the lumbar spine, shows that the patient is not able to perform lumbar extension (backward bending) without pain, and that repeated lumbar flexion (forth ward bending) increases the pain, which is referred into the thigh (L-2 dermatome).
After this results, we can conclude that the lesion is in the lumbar spine, most likely nerve root L-2, and not in the quadriceps muscle.
Although this is just one piece of the puzzle, we can now create a plan to figure out the best treatment approach for the lower back and for the entire kinetic chain which will directly affect the tissue involved in the dysfunction and will most likely result in a satisfied patient that no longer experiences that particular pain.
After endless treatments of stretching, strengthening, ultrasound, electric stimulation, etc., she gets to the right clinician who performs a functional assessment.
Upon examination, it becomes clear that resisted knee extension (which is one of the test that test the quadriceps' contractile ability) shows negative, proving that the function of the quadriceps muscle is not disturbed.
Further examination, this time of the lumbar spine, shows that the patient is not able to perform lumbar extension (backward bending) without pain, and that repeated lumbar flexion (forth ward bending) increases the pain, which is referred into the thigh (L-2 dermatome).
After this results, we can conclude that the lesion is in the lumbar spine, most likely nerve root L-2, and not in the quadriceps muscle.
Although this is just one piece of the puzzle, we can now create a plan to figure out the best treatment approach for the lower back and for the entire kinetic chain which will directly affect the tissue involved in the dysfunction and will most likely result in a satisfied patient that no longer experiences that particular pain.
Referred Pain Poll
Knowing how referred pain works is very important when treating pain, because to treat pain effectively you need to know where it originates.
Loading poll. Please Wait...
What do you do when you have pain?
When you have pain, do you?
Vote for your favorite option, or just add your own.
Factors That Influence Pain and Dysfunction
Physical activity
* Misuse--often mistaken for overuse. All tissues respond to load; not only will they get damaged if the load is too much or weakened if the load is too small, but become dysfunctional if there is not enough rest in between engagements.
* Disuse or lack of use will atrophy most tissues in the body including bones, cartilage, ligaments, muscles and tendons.
Emotional
* Dissatisfaction with job and/or lifestyle.
* Patient consciously or subconsciously uses physical pain to distract his/her mind from emotional pain
* Patient involved in toxic relationship
Nutritional
* Poor diet or nutritional deficient. The lack of needed nutrients, vitamins, minerals and enzymes in the body can contribute to conditions such as weak bones (osteoporosis), weak cartilage, weak ligaments, weak tendons, etc.
* Lack of adequate nourishment inhibits the body's natural healing response.
Hormonal
* Hormonal imbalance may weaken bones, cartilage, ligaments and tendons.
* Hormonal imbalance can cause conditions such as systematic joint instability by making ligaments too lose.
* Diabetes by itself, may cause conditions like tendonitis and bursitis.
Genetic
* Genetic predisposition can be the cause for diseases like rheumatoid arthritis, degenerative osteoarthritis, osteoporosis, scoliosis, etc.
* Misuse--often mistaken for overuse. All tissues respond to load; not only will they get damaged if the load is too much or weakened if the load is too small, but become dysfunctional if there is not enough rest in between engagements.
* Disuse or lack of use will atrophy most tissues in the body including bones, cartilage, ligaments, muscles and tendons.
Emotional
* Dissatisfaction with job and/or lifestyle.
* Patient consciously or subconsciously uses physical pain to distract his/her mind from emotional pain
* Patient involved in toxic relationship
Nutritional
* Poor diet or nutritional deficient. The lack of needed nutrients, vitamins, minerals and enzymes in the body can contribute to conditions such as weak bones (osteoporosis), weak cartilage, weak ligaments, weak tendons, etc.
* Lack of adequate nourishment inhibits the body's natural healing response.
Hormonal
* Hormonal imbalance may weaken bones, cartilage, ligaments and tendons.
* Hormonal imbalance can cause conditions such as systematic joint instability by making ligaments too lose.
* Diabetes by itself, may cause conditions like tendonitis and bursitis.
Genetic
* Genetic predisposition can be the cause for diseases like rheumatoid arthritis, degenerative osteoarthritis, osteoporosis, scoliosis, etc.
Dr Cyriax: Father of Orthopedic Medicine
My biggest hero, Dr James Cyriax MD, once said:"All pain has a source"
"All treatment must reach the source"
"All treatment must benefit the lesion"
Dysfunctions
Types of Dysfunctions
Instability--the inability to control a neutral position of a joint or body part during movement, causing pain and dysfunction.
Displacement--most displacements are spinal disc or meniscus.
Restriction--lack of range of motion.
Displacement--most displacements are spinal disc or meniscus.
Restriction--lack of range of motion.
Where in the Body Do You Find the Most Common Dysfunctions?
Common Dysfunctional Tissues
Spinal Dysfunction-usually caused by disc displacement or restrictions.
Joint Dysfunction--lack of range of motion, due to displacement, instability or restriction.
Nerve Dysfunction--Inability for the nervous system to move and glide freely with movement.
Neuromuscular Dysfunction-- caused by inactivity, misuse, or wrong method of training.
Tendon Dysfunction--usually caused by joint injury, instability or misuse.
Bursa Dysfunction--usually secondary to other dysfunction such as joint instability or neurom
Joint Dysfunction--lack of range of motion, due to displacement, instability or restriction.
Nerve Dysfunction--Inability for the nervous system to move and glide freely with movement.
Neuromuscular Dysfunction-- caused by inactivity, misuse, or wrong method of training.
Tendon Dysfunction--usually caused by joint injury, instability or misuse.
Bursa Dysfunction--usually secondary to other dysfunction such as joint instability or neurom
What is Healing?
Healing is the process of going back in balance to regain our natural state.
It's important to keep the nervous system moving so it does not become adhered and dysfunctional when injury and healing goes through the three progressive phases.
Remember to keep Moving!
It's important to keep the nervous system moving so it does not become adhered and dysfunctional when injury and healing goes through the three progressive phases.
Remember to keep Moving!
The Three Stages of Healing
1-Inflammatory phase:
Prepares tissue for repair, we need to protect tissue.
2-Repair phase:
Rebuilds the structure, we need to gently move tissue.
3-Remodeling phase:
Provides the final form for the structure, we need to move tissue to its end-range.
Prepares tissue for repair, we need to protect tissue.
2-Repair phase:
Rebuilds the structure, we need to gently move tissue.
3-Remodeling phase:
Provides the final form for the structure, we need to move tissue to its end-range.
Factors That Influence Healing
1. Poor blood supply to the affected area.
2. Lack of initial protection of the injury.
3. Lack or not enough early mobilization
4. Prolonged inflammation and failure to reduce swelling on the first days
5. Inadequate use of medication.
6. Poor Nutrition
7. Diabetes
8. Increased deposit of collagen or scar tissue.
9. Inappropriate behavior in dealing with pain and its consequences.
10. Inappropriate behaviors on the part of the health care practitioner - encouraging patient to adopt sick-roles.
2. Lack of initial protection of the injury.
3. Lack or not enough early mobilization
4. Prolonged inflammation and failure to reduce swelling on the first days
5. Inadequate use of medication.
6. Poor Nutrition
7. Diabetes
8. Increased deposit of collagen or scar tissue.
9. Inappropriate behavior in dealing with pain and its consequences.
10. Inappropriate behaviors on the part of the health care practitioner - encouraging patient to adopt sick-roles.
What is the Most Vulnerable Part of Healing?
The most vulnerable part of healing is when we feel better and we forget about lifting properly, keeping a good posture, changing postures every 20-30 minutes of sitting, walking as a therapy for 20-30 minutes, and doing the work that got us better and we fall in the trap of I am too busy, I don't have enough time, etc
Physical Rehabilitation Training
Lets keep it Functional-- multi-directional, three dimentional, against gravity, free from any artificial stability.
Lets keep it Simple-- no fancy exercises, try to train as close to real life and/or sports requirements as you can.
Lets keep it Effective-- train to fulfill a need and train with a purpose.
Lets keep it Efficient-- engage most amount of movement patterns and body parts with each repetition.
Lets keep it Simple-- no fancy exercises, try to train as close to real life and/or sports requirements as you can.
Lets keep it Effective-- train to fulfill a need and train with a purpose.
Lets keep it Efficient-- engage most amount of movement patterns and body parts with each repetition.
Exercise Myths and the Problems They Cause
There are two main exercises that are often prescribed for lower back pain and dysfunctions: sit ups and back extensions. They're both recommended on the assumption that back pain is caused by weak muscles.
Although weak trunk muscles are part of the problem and sit ups and back extension exercises do strengthens some of the trunk muscles, they're also the most destructive exercises for the spinal disc.
Just look at this chart to see how much excessive load there is on the spinal disc.
According to the studies on spinal disc pressure by Dr. Nachemson, there is 210% of your body weight of pressure into the spinal disc with sit ups and 180% of your body weight of pressure with back extension.
Although weak trunk muscles are part of the problem and sit ups and back extension exercises do strengthens some of the trunk muscles, they're also the most destructive exercises for the spinal disc.
Just look at this chart to see how much excessive load there is on the spinal disc.
According to the studies on spinal disc pressure by Dr. Nachemson, there is 210% of your body weight of pressure into the spinal disc with sit ups and 180% of your body weight of pressure with back extension.
Sit Ups for Lower back Pain
Myth # 1
Sit ups for lower back pain.
Although this concept has been disproved many times before, it keeps being recommended by many therapist and trainers. It is based on the assumption that all lower back pain is caused by weak abdominal muscles when in reality every back pain is different, and every back pain responds to different treatments. Different pain responds to different approaches like: stability exercises, nerve mobilization exercises, end-range stretching, strengthening of the trunk muscles, static and dynamic posture correction, gate correction, lifting techniques, and some may need a combination of all or some of them.
Although this concept has been disproved many times before, it keeps being recommended by many therapist and trainers. It is based on the assumption that all lower back pain is caused by weak abdominal muscles when in reality every back pain is different, and every back pain responds to different treatments. Different pain responds to different approaches like: stability exercises, nerve mobilization exercises, end-range stretching, strengthening of the trunk muscles, static and dynamic posture correction, gate correction, lifting techniques, and some may need a combination of all or some of them.
Is Posture a Pain in the Neck?
Can poor posture cause pressure and stress on the kidneys, liver, stomach, lungs, pancreas and the many other organs, vessels and arteries?
I am not sure. But I do believe that poor posture creates pain and dysfunctions, such as bulging disc, herniated disc, degenerative disc disorders, spinal arthritis, and nerve compressions among many others.
I am not sure. But I do believe that poor posture creates pain and dysfunctions, such as bulging disc, herniated disc, degenerative disc disorders, spinal arthritis, and nerve compressions among many others.
Does Posture Needs to be Straight all the Time?
Myth # 2
Posture must be completely straight all the time.
I am the first to admit that at the beginning of my career I also bought into this theory.
It was frustrating for me as a therapist but specially frustrating for my patients. They had the best intentions of maintaining a straight posture but would give in after just a few minutes because of lack of muscle endurance or because they would get distracted by the computer or book they were reading and would go right back to old habits.
So I asked myself...
Is a sustained straight posture good for the spinal disc?
Is asking patients to sustain a good posture on will alone a reasonable approach?
Is there a better approach?
I believe good posture is a combination of different postures within a neutral zone, where ears are on top of shoulders, and shoulders on top of hips, and the spine in neutral position.
We must find a different neutral position every twenty to thirty minutes for the pressure of the spinal discs to get redistributed and evenly loaded and unloaded.
We must build strength and endurance of all muscles, specially those of the trunk, so we do not rely on will alone but also in the strength and endurance of those muscles.
I am the first to admit that at the beginning of my career I also bought into this theory.
It was frustrating for me as a therapist but specially frustrating for my patients. They had the best intentions of maintaining a straight posture but would give in after just a few minutes because of lack of muscle endurance or because they would get distracted by the computer or book they were reading and would go right back to old habits.
So I asked myself...
Is a sustained straight posture good for the spinal disc?
Is asking patients to sustain a good posture on will alone a reasonable approach?
Is there a better approach?
I believe good posture is a combination of different postures within a neutral zone, where ears are on top of shoulders, and shoulders on top of hips, and the spine in neutral position.
We must find a different neutral position every twenty to thirty minutes for the pressure of the spinal discs to get redistributed and evenly loaded and unloaded.
We must build strength and endurance of all muscles, specially those of the trunk, so we do not rely on will alone but also in the strength and endurance of those muscles.
backtofunction.blogspot.com
Pysical rehabilitation, Training and Fitness
- (Post # 91) Newton's Law and Kids
- 2. Jump rope..and see how many jumps per minute they can do and then have them compete against themselves. 3. Invest in a Wii video game... boxing or tennis will get you both moving!!!. Send me your ideas at backtofunction@gmail.com.
- (Post # 93) Myths and the Problems they Cause
- Myth #4: When performing a lunge, the knee must never cross the foot and the knee must always be in the direction of the middle toe. This myth can causes many problems, but before we go any further lets ask the following: ...
- (Post # 90 ) The Silent Part of Rehabilitation, Training and ...
- Rest, recovery and restoration are the most commonly ignored and misunderstood parts of rehabilitation, training and athletic development. This is due to the mislead notion that the gains of training such as stability, endurance, ...
- (Post # 92) Don't Follow Blindly...Question Everything!
- Laws?...Facts?...Theories?...Hypothesis?...Assumptions?...Opinions? A rule is not a law A theory is not a law A judicial law is not a scientific law A position statement is not a law Scientific laws can not be broken; judicial laws can ...
Is Walking Good For You?
Walking is the most underrated treatment for lower back pain and its dysfunctions.
With every step we take, the lower spine goes from a neutral position into a mild extension movement.
This causes the spinal disc to be mobilized into its natural position, where it gets hydrated with water and nutrients and where the spinal load gets evenly distributed.
With every step we take, the lower spine goes from a neutral position into a mild extension movement.
This causes the spinal disc to be mobilized into its natural position, where it gets hydrated with water and nutrients and where the spinal load gets evenly distributed.
Walking and Breast Health
Walking must be a part of every treatment for neuromuscular pain and dysfunction.
There is now evidence that brisk walking can reduce the risk of breast cancer by 20 percent.
For those who already have the disease, walking three to five hours a week may reduce the chance of dying from it by as much as 50 percent.
For more on this see February issue of Medicine & Science in Sports & Exercise (official journal of the American College of Sports Medicine).
There is now evidence that brisk walking can reduce the risk of breast cancer by 20 percent.
For those who already have the disease, walking three to five hours a week may reduce the chance of dying from it by as much as 50 percent.
For more on this see February issue of Medicine & Science in Sports & Exercise (official journal of the American College of Sports Medicine).
Back to Function Website
- Back to Function Website
- Explore more about the Back to Function concept.
What is the Difference Between Rehabilitation and Training?
Rehabilitation
Is the removal of the cause of pain and dysfunction, restoration of function and rebuilding of the body.
Training
Is the creation of specific mobility, stability, endurance, strength, flexibility, power and speed based on our physical needs and goals.
Is the removal of the cause of pain and dysfunction, restoration of function and rebuilding of the body.
Training
Is the creation of specific mobility, stability, endurance, strength, flexibility, power and speed based on our physical needs and goals.
What is the Difference Between Mobility and Flexibility?
Mobility
Is how effectively and efficiently our body moves throughout the range of motion.
Flexibility
Is how much range of motion our body has.
Mobility and stability training are an essential part of any rehabilitation and training program.
Flexibility on the other hand, is something that may or may not be needed depending on your body, rehab and training goals.
Too much flexibility will cause instability.
Is how effectively and efficiently our body moves throughout the range of motion.
Flexibility
Is how much range of motion our body has.
Mobility and stability training are an essential part of any rehabilitation and training program.
Flexibility on the other hand, is something that may or may not be needed depending on your body, rehab and training goals.
Too much flexibility will cause instability.
What is the Difference Between Balance and Stabilty?
Balance
Is how well you are able to control your body against gravity.
Stability
Is how well you are able to control your body during movement.
One is static and the other is dynamic.
They are both important, but if you are going to fall, think which one will protect you more?
Is how well you are able to control your body against gravity.
Stability
Is how well you are able to control your body during movement.
One is static and the other is dynamic.
They are both important, but if you are going to fall, think which one will protect you more?
Do You Have Back Pain?
"Any intelligent fool can make things bigger and more complex.
It takes a touch of genius...to move in the opposite direction."
-Albert Einstein
I would like to suggest an alternative to those who are suffering with simple back pain (pain that is less than 8 weeks):
* Walk every day for at least 20 minutes.
* Move around and gently stretch 1 minute for every 30 minutes of sitting.
* Change posture within a neutral position.
* When working, try changing position as often as possible.
* When lifting, get your pelvis close to the object first and then lift.
* If the above is not enough, find a good therapist or trainer who would teach you the right type of exercises.
It takes a touch of genius...to move in the opposite direction."
-Albert Einstein
I would like to suggest an alternative to those who are suffering with simple back pain (pain that is less than 8 weeks):
* Walk every day for at least 20 minutes.
* Move around and gently stretch 1 minute for every 30 minutes of sitting.
* Change posture within a neutral position.
* When working, try changing position as often as possible.
* When lifting, get your pelvis close to the object first and then lift.
* If the above is not enough, find a good therapist or trainer who would teach you the right type of exercises.
How accurate are X-Rays?
X-Ray, The Doubtful Assisstant
Can an X-ray be a substitute for functional assessment?
No, a characteristic shared by moving soft tissues is their radio-translucency (their characteristic not to be seen in a x-ray).
These tissues are the joint capsules, ligaments, fasciae, muscles, tendons, bursae, spinal discs, dura mater, dural sheaths, and nerve roots.
Any of these structures can cause pain. None of them inflame or other wise can be diagnosed on the x-ray.
If a soft tissue causes pain, the x-ray can show only one of two things:
First, it may reveal the bones are normal, allowing the patient to be open to a misplaced diagnosis of neurosis or psychogenic pain (pain caused by the mind).
On the other hand the x-ray may disclose some symptomless abnormalities or natural degenerative changes, which are then incorrectly regarded as the source of the pain. In this case the x-ray is positively misleading.
Be skeptical of those clinicians that will give you a diagnosis, without giving you a thorough functional assessment first.
No, a characteristic shared by moving soft tissues is their radio-translucency (their characteristic not to be seen in a x-ray).
These tissues are the joint capsules, ligaments, fasciae, muscles, tendons, bursae, spinal discs, dura mater, dural sheaths, and nerve roots.
Any of these structures can cause pain. None of them inflame or other wise can be diagnosed on the x-ray.
If a soft tissue causes pain, the x-ray can show only one of two things:
First, it may reveal the bones are normal, allowing the patient to be open to a misplaced diagnosis of neurosis or psychogenic pain (pain caused by the mind).
On the other hand the x-ray may disclose some symptomless abnormalities or natural degenerative changes, which are then incorrectly regarded as the source of the pain. In this case the x-ray is positively misleading.
Be skeptical of those clinicians that will give you a diagnosis, without giving you a thorough functional assessment first.
Poll
Tell me what you think!
My goal is to have good and relevant information on this lens, so let me know what you think. Do you have any suggestions or a specific issue that would like to see here?
Loading poll. Please Wait...
Feel Better...Get Better...Stay Better
Remember to always keep it simple and safe!
Did You Like This Lens?
Did you find this information useful?
Let me know what you think.
Do you have any questions or topics that you want to know more about? Let me know and I will be happy to include them.
Thank you for visiting.
Lensmaster
I've come across a lot of lenses which offer relief for back pains and what you have featured here is just one of the many best ways to get rid of this malady! I knew I have to choose something right away so I can work better on my Amy Brown Checks site! After reading this, I knew exactly what I need and this is it! thanks for sharing!
Posted August 21, 2008
jasmineann wrote...
Very interesting information on pain. Lensrolling to my lenses on back and sciatic pain. Thankyou. 5 Stars! Adding to faves :)
Posted August 10, 2008
SemperFidelis wrote...
Great information on pain and suffering. Much needed. A 5 to you! Consider stopping by our Recycling lens and giving a rating. :)
Posted October 13, 2007
Christopher_Scott wrote...
Juan,thanks for stopping by our lens for A Day of Hope. Great lens, I wish Americans took care of their bodies better.
Posted October 12, 2007
