Lets break the process down. This operation involves cutting some of your ligaments to release tension and allow for more movement. But too much stress without adequate recovery leads to accumulated micro-tears, which can then lead to pathology and injury. Thats an awesome story and its great that you found such a good therapist who had those tools. 4. The most investigated and effective intervention is exercise! However, a break from your sport doesnt mean complete rest (that will only make it worse), you will need to begin a progressive loading program when the time is right. URL: https://theprehabguys.com/explore-knee/. And never doing high impact sports 2 days in a row. You recommend doing the incline squats twice a day. Medically reviewed by Dr Chaminda Goonetilleke, 21st Dec. 2021. Last medically reviewed on January 11, 2018. 2022 BuiltLean LLC | All rights reserved. I have jumpers knee from jumping rope and it hurts like hell to even try to jump rope again and this article says to jump rope. Any advice? In the knee symptoms section, we look at the most common Clinical Significance: When there is acute inflammation there is often swelling and fluid within the joint capsule of the knee. Tendinitis or tendinopathy basically consists of microtears in the tendon. It may occur on one side at a time or in both. [5][6][7][8] Furthermore researchers doubt the existence of VMO[9] and have found that any quadricep exercise will similarly activate the vastus muscles. Symptoms include: Pain, swelling, and stiffness in the knee joint. The Surface, as you said you train for Spartan often on uneven/mountain terrain. Try the eccentrics or isometrics with a good therapist (see our article on tips for finding a good therapist). WN+WX|sUe.>~~Qa8x?Wa(EN_l6X4j/+e4c,Z9t""c 'N/O'9@. Go to ACL Sprain Rehab Program Fatigue around your knee and pain just below your patella can certainly be caused by a patellofemoral joint (kneecap joint) problem but there are other pathologies that need to be ruled out before devising a management plan otherwise your rehab will be ineffective no matter how well or often you do your exercises. Studies have shown that when athletes land softly from a jump, more of the forces are absorbed in the ankle musculature, which decreases the peak ground reaction force that occurs in the knee. Also get the facts on treatments such as, Inner knee pain is often caused by an injury. For most people, the center of your knee should point towards and be in line with your 2nd or 3rd toe. The key is to absorb the shock actively, this is achieved by landing softly! From what Ive seen from Tenex, there hasnt been substantial quality research that supports it. Additionally, isometric exercises that involve tightening and releasing your muscles can help to maintain muscle mass. Exercises are the same as those for Patellofemoral pain. Loaded isotonic exercises can begin when performing these exercises create pain of 3/10 or less. found that hip strengthening was more effective for improving patellofemoral pain than knee strengthening.[11]. This weakness can then lead to further secondary issues such as biomechanical imbalances due to tight or weak structures. Privacy Policy, Make an appointment. Smith TO, Bowyer D, Dixon J, Stephenson R, Chester R, Donell ST. Khayambashi K, Fallah A, Movahedi A, Bagwell J, Powers C. I give my consent to Physiopedia to be in touch with me via email using the information I have provided in this form for the purpose of news, updates and marketing. Sometimes it feels like my right leg is doing all the work and it also has more muscle mass. Rather we are preparing the body for the following phase by slowly dosing here. Activation exercises. Activating the core stabilizers during a warm-up helps to prepare the larger muscles for more powerful exercises. If your hip hinge form is perfect, hold this position for 30 sec, 3x. Your doctor may also apply resistive pressure to your extended kneecap to determine the tenderness and severity. Anterior knee pain is unfortunately a common symptom experienced in casual and experienced runners. Exercises can usually begin as soon as they can be performed without pain. And if so, what are the recommended heat methods? Access state-of-the-art physical therapy, fitness programs, and workouts online in the comforts of your own home or gym! Also, do I continue doing the isometric, isotonic and energy storage exercises when im back to playing basketball or no? Hey Breanna, sorry to hear about your issues. Scan 2 December 2015, showed an improvement across all colours: black: 17% > 11%; red 21.68% > 15.60% for example, but improvement still seemed slow. Look at anyone who walks down stairs or jumps. All rights reserved. +!x5hlTnf"1U8vD=E5 2I+1_2XM*MO#[aCE O HJ\rd}I1Es(M!8 Hi Siraj, Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. Avoid overstressing the repair (forceful movements in the sagittal plane, forceful plantar flexion while in a dorsiflexed position, aggressive PROM) Treatment. Thank you for your question. Will the pain come back if I stop doing the strengthening work even after I completed my rehab program. Patience is the key and however tempting it may seem, do not put the tendon under any stress (apart from the exercises mentioned) and definitely do not touch it. Was given a steroid injection into the knee and advised to start eccentric excercises. A good physical therapist should be able to assess your injury and provide a progressive exercise program to help you eliminate pain, rehab the injury, and correct muscular imbalances so that you can avoid future injuries. Hi Erik. Heat therapy will tend to increase inflammation and is therefore not recommended for any form of -itis. Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. A prior injury to the kneecap, such as a dislocation, can increase your risk of developing runners knee. Being alive without the solutions to the difficulties you have sorted out by means of your good guideline is a serious case, as well as the kind that might have negatively affected my entire career if I had not noticed your website. endobj Its a step-wise system to rehabbing tendon pathologies. Landing with a stiff knee to avoid stressing the quadriceps and patella tendon. The best and most comprehensive summary of how to treat tendinopathies is summarized as EdURep. Poor ankle mobility can lead to poor form up the kinetic chain. The Code sets out the CSP's expectations of all members: qualified physiotherapists, associates and students. Swelling: Swelling and bruising around the front of the knee is typical of a patella fracture.As days go by, it is not uncommon for the swelling to extend down the leg, into the calf, and even into Always have 1 day rest or upper body weight training. xZF}7%`L."H'@f}h-yEu1 FKUuS>o}r'|w?(?~C}.{q} It has been sent. This abnormal rubbing can lead to deterioration in the patella, resulting in chondromalacia patellae, or runners knee. Anatomy.tv. What I am noticing now is that while the tendon is sore after the treadmill (jogging 2 mins at 10km/h > 1 min walking at 6.5km/h x4 sets) it is fine the next day with minimal soreness and no pain. One possible exception, however, is people with osteoarthritis of the kneecap i.e., patellofemoral arthritis, which affects the area of the joint where the kneecap (patella) meets the thighbone (femur). It sets out the high standards of behaviour required of you as a CSP member; following the Code forms part of your contract as a member of the CSP. Reduce swelling to reduce the loss of strength or atrophy of the VMO muscle to prevent secondary issues during your rehab. The Code is built around four key principles: Demonstrate appropriate professional autonomy and accountability, Act within their individual scope of practice. Available from: http://www.anatomy.tv/, Vastus medialis muscle (highlighted in green) - anterior view image - Kenhub. Sitting hip flexion isometric. Engage with relevant professional and social contexts. Theres a good chance your patellar tendon is inflamed. Find an angle you can tolerate and follow the parameters suggested above! Platelet-rich Plasma Injection / Extracorporeal Shockwave Therapy: These two treatments are lumped together because the scientific research supporting them is still mixed. Also, very good point about the ultra sound imaging and how beneficial it can get. Isotonic exercises, just mean that you are keeping a load on a muscle while its moving through a range of motion. Is there anything specific that you might be able to help with, keeping in mind that most recent mri has shown a significant tear even after the 2 procedures. More on Q angle The perceived wisdom now is that isometric (heavy static loading) rather than eccentric loading is what will help alleviate pain and allow the tendons collagen to realign. In this stage exercises should be performed for 15 repetitions max, meaning that you are at failure come 15 repetitions, for 3 to 4 sets. But none seems to help. My name is Siraj from South Africa,I injured my knee back in 2008 while landing from a jump and my knee sort of bent outwards. HI, if you wouldnt mind, is it possible for you to share the list of references you made for this article? Each exercise should take a few minutes. Core strengthening exercises are a great complement to a hip and knee strength training program. The goal of treatment is to reduce the pressure on your kneecap and joint. This may be regressions of these movements. Patella tracking & Q angle. What the UTC scan did was give me specific information regarding the health of the tendon and allowed me to clearly see at various intervals just how the progress was going. Scan 3 September 2016 showed a dramatic improvement: black 11.11% > 0.98%; red 15.60% > 2.24% with the green area jumping from 44.46% to 69.17%. Resting, stabilizing, and icing the joint may be the first line of treatment. These should be found with a full physical assessment as well as a comprehensive history taking of your knee. Without knowing anything too in depth about your condition, Id maybe try the first 3 or 4 on the list, following the principles of the stage of rehab youre up to at the time which Im guessing wouldve been discussed with you by previous physios (eg. Crossley K, Bennell K, Green S, McConnell J. Heintjes EM, Berger MY, Bierma-Zeinstra SM, Bernsen RM, Verhaar JA, Koes BW. Patellar Tendon Strap: This strap is one of most common over-the-counter support braces, and its purpose is to help distribute the stress along the entire tendon. Talk to your doctor if you have knee pain that doesnt improve within a few days. An article in 2019 shows that both incline and decline gradients have a significant increase in Quadriceps muscular activity. Before deciding on these treatments, I would exhaust your other cheaper options and try physical therapy first. Initially, pain might only be present when you first begin your workout or just after intense physical activity, but may progress to longer-lasting pain if the tendon gets inflamed. Practice lunges in varying positions and angles, paying extra close attention to your form. Tendon specialist Jarrod Antflick of Tendon Performance (tendon performance.com) gave me an isometric loading programme to do via the leg press. Hugh, thanks for sharing. We avoid using tertiary references. 7.30am to 6:30pm Example strengthening exercises: Standing hip flexion using resistance band. Unlock your mobility to explore your bodys potential. At this point, your knee symptoms should be under control, and you can begin to incrementally load the patellar tendon with specific exercises. stiff legged deadlifts help a lot. Save my name, email, and website in this browser for the next time I comment. Im not sure what I would have done if I had not encountered such a solution like this. The most common of these are popping noises, instability and giving way, locking, burning or sharp pain, pain with certain activities such as running and bending or on stairs, swelling or stiffness.This section looks at each of these specific symptoms and helps you to work out what is causing your knee pain. Straight leg raise exercises with proper quad set (standing and seated). Arthroscopy or keyhole surgery is performed. We review the pros, cons, pricing, and more. Great question. endobj For his undergraduate studies, he attended San Diego State University and studied Kinesiology. Without it youre totally in the dark, going by feel alone. Patrick, Thank you Patrick for your comments. This is one of our favorite exercises thats included in our Patellofemoral Pain Program that is an effective general approach to improving knee issues such as jumpers knee. It may feel like following an exercise session that the muscle is bigger, but this will most likely be due to increased blood flow into the muscle. A combination of genetics, activity level, and quality of movement affect your likelihood of developing patellar tendinitis. Technically, the patellar tendon is a ligament that links the front of the knee (patella) to the shin bone (tibia). Many thanks in advanced! Trial it for free, and learn how to get out of pain, avoid injury, and optimize your health with [P]rehab! Sometimes other pathologies co-exist with this type of tendinopathy like an issue with the patellofemoral joint (for example, a maltracking problem or an early onset osteoarthritis), so these need to be cleared as potential sources of pain as well. For more information, click HERE. This is why at Barefoot Rehab, we have a 5 Visit Rule. The vastus medialis muscle works along with the 3 other quadricep muscles to straighten the knee, although the vastus medialis muscle is particularly important with the terminal extension of the knee, where it helps to lock out the knee. EVERY SINGLE tightness or pain intervention you might get must respect the 5 Visit Rule. Were you just starting to get into plyometric training, or back into your favorite sport, when the front of your knee began hurting? znd$uUTNN&?9R>3rudJ@%8wd:vKYT"*cX<6G=S9 p1rb- z6MN3`%0xv`s'2[;(25'2+i~yZ9"b9_0~Xd-U7SAFz O1+ Can vastus medialis oblique be preferentially activated? In this case, there hasnt been strong studies suggesting one form of heat is significantly better than another. Surgery is not common but is a last resort if exercises have not worked. Get Top Tips Tuesday and The Latest Physiopedia updates, The content on or accessible through Physiopedia is for informational purposes only. A surgical procedure may fix the problem. It is ideal for running and other sporting activies where a full patella taping may be restrictive. Actions: Flexion of the hip. Patellofemoral Pain Syndrome (PFPS) is better known for causing pain at the front of your knee and around your patella (kneecap). You can learn more about how we ensure our content is accurate and current by reading our. A minimum of 8-12 weeks of resistance based exercise is required to achieve this performance goal. If your orthopedist has determined that you would benefit from a steroid injection, make sure not to load the tendon too quickly afterwards. Anterior knee pain: an update of physical therapy. The most cost-effective treatment for patellar tendinitis is physical therapy. Chondromalacia patellae will typically present as pain in the knee region, known as patellofemoral pain. If you are looking to increase muscle size/volume, this may take longer 8-12+ weeks. you may be looking to get some moderate fatigue and allow for a small amount of pain in your session. Step outside your comfort zone & elevate your bodys potential. Friday 7.30am to 6.00pm, t. (02) 9232 5566 2005-2022 Healthline Media a Red Ventures Company. Perform forward lunges, reverse lunges, side lunges, and diagonal lunges. I got into cycling because I was told that it would help strengthen my knee,it was helping In a way but recently Ive been losing muscle mass in my left leg where I had the injury and especially the vmo part and I get fatigue in my left vmo so I cant sustain power for long periods. Pain: Patella fractures are generally quite uncomfortable.Keeping the knee straight can help significantly with discomfort, while bending the joint is typically very painful. Arash Maghsoodi received his Doctorate in Physical Therapy from the University of Southern California. This surgery involves inserting a camera into your joint through a tiny incision. Dont progress quickly through this phase, this often takes a few weeks to progress through. <> This is the only exercise that should be done this way. You may feel sensations of grinding or cracking when bending or extending your knee. Read more about specific, The meniscus is a piece of cartilage that provides a cushion between your femur (thighbone) and tibia (shinbone). During your rehab from knee pain, that body seeks the path of least resistance. used to be a runner but now can only walk slowly but it still causes pain . Corticosteroid injection: While great at reducing local inflammation, a steroid injection may simultaneously limit healing and cause further tendon degeneration. Im confused. Malliaras P, Cook J, Purdam C, et al. Resistance exercise programming with hypertrophic focus (8-12 repetitions 75-85% of 1RM) is a widely prescribed to increase muscle mass and strength. This is often a condition experienced by very active athletes, especially males, who participate in jumping sports such as volleyball, tennis, football, and basketball. With isometrics shoot for 5 repetitions of 45-second holds with a 2-minute rest break, you want to go heavy! Find out all, Osteochondritis dissecans is a condition that involves bone separating from cartilage in your joints. Structure: The VMO is a muscle located in the anterior (front) compartment of the thigh. Good strength is defined by performing 4 sets of 8 repetitions of a single-leg press with around 150% body weight for jumping athletes. Get access to 50+ programs, 100+ unique workouts, and 3000+ exercises to build your own workout routines. The pain of tendinopathy: physiological or pathophysiological? Vastus Medialis Oblique (VMO) is one of four quadriceps muscles. It works in conjunction with the quadriceps muscle to extend the knee. Similar to the reason above, I believe a strengthening program of the lower limb will assist with this. Thanks this stuff is helpful. Perfect practice makes perfect. I train for Spartan races by running both on both flat and mountain terrain between 5 and 15 miles. Inflammation can prevent the kneecap from functioning properly. If its truly a tendinitis and the tendon is inflammed and warm to touch on its own, you should not add heat. [4][1], VMO strengthening has become less popular approach to the treatment of anterior knee pain as the evidence supporting isolated exercises has been criticised for its poor quality. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Sign up for free advice from our fully-qualified physiotherapists. It sets out the high standards of behaviour required of you as a CSP member; following the Code forms part of your contract as a member of the CSP. While you cant do much about your genetics, you can definitely influence the latter two. The kneecap, or patella, is the bone that covers your knee. I know this forum is more for tedinitis but I have been told through multiple therapist that the rehab for both is about the same. The CSP's Code of Members' Professional Values and Behaviour is centred around the needs of patients and clients. You can perform these exercises as an adjunct, concurrently with your running training. KountourisA, CookJ. Musculoskeletal injuries can have immediate and significant detrimental effects on function.When an individual experiences or is likely to experience limitations in everyday functioning due to ageing or a health condition, including chronic diseases or Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. Weve designed a comprehensive solution for you to get back to normal life and simple things like squatting and going downstairs pain-free! Muscle balance will help prevent knee misalignment. [1], Femoral artery and branches from the profunda femoris artery. 2014; 44:923. Hold for 30 seconds, repeat 3x. Due to the scar tissue down the mid-line, I cannot confidently say that the appearance will restore 100% to normal, but if you are looking to increase the total muscle mass and function, then this exercise programming will achieve that. Arthroscopic surgery may be necessary to examine the joint and determine whether theres misalignment of the knee. Any help would be seriously appreciated! Would the muscle feel notably harder than on the other side? Menu. When any of these components fails to move properly, it can cause your kneecap to rub up against your thigh bone. Are you suggesting to start with the first excercise on here and then move onto the others as they become easier or do each one from now, excluding single leg squats? Hoping this helps with your question Todd, by the sounds of things you are going about your goal of Spartan Running the right way, being consistent with gradual progressive loading. @O~oBA3z&Vv{:R~&rz2I^{G.y+Q,] [U5v[\5za:N~nh:W-[" The patellofemoral joint pain is the most common cause of anterior knee pain, particularly in runners. This question is to help my 13-year old son who has developed tendinitis in the knee and cant fathom the thought of taking any rest from soccer (football.) Scraping, Metal Tools and Instrument Assisted Soft Tissue Mobilization. Be sure to check in with your physical therapist to be sure that this type of training is right for you and your specific condition. The aim of patellofemoral pain exercises is to encourage normal patella tracking. This is the last phase of jumpers knee exercises prior to returning to their desired sport! Many of the trials that are cited were performed outside of the US and were sponsored by them, and thus come with a lot of bias. Ive been having patellar pain for almost six months now, after I pushed myself too hard running. 2 0 obj Be sure to check in with your physical therapist to be sure that this type of training is right for you and your specific condition. These 2 exercises make your front thigh muscles ("quads") stronger. I wont be reluctant to propose your web site to anybody who would need guide about this topic. Soft tissue treatments, gentle mobilization to posterior musculature and patella. The pain does not feel like a cramp as I have experienced in my calves or feet (pain and locking up). As your ligament heals, strengthening exercises such as mini squats, leg presses, and step-ups can be done. If stairs or standing from sitting are tasks that you are having issues with, then quadricep strengthening, and Vastus Medialis strengthening will be greatly helpful. An acute patella injury is an injury to the kneecap or patella. Sometimes at the clinic, well get a patient who has been stretching their hamstrings for years. That is usually the journal article where the information was first stated. An approach to treatment attempts to restore balance between vastus medialis and lateralis, which requires strengthening of the oblique fibres of medialis, as well as assessment of the degree of dynamic supination and pronation of the foot. [10] Strengthening further up the kinetic chain has been suggested as more effective approach, Khayambashi et al. Fatigue around your knee and pain just below your patella can certainly be caused by a patellofemoral joint (kneecap joint) problem but there are other pathologies that need to be ruled out before devising a management plan otherwise your rehab will be ineffective no matter how well or often you do your exercises. If youd like to discuss this more by a telehealth consultation then feel free to make contact, otherwise, take care and good luck with it all! Common incidents leading to knee injury includes falls, collisions in sports, or increased activity. Surgery. All other strengthening exercises for your leg should be performed with the normal parameters of strengthening (3 sets, 5-6 reps). (2017). The knee may feel warm and inflamed. When beginning this stage you will likely limit the knee bending to between 10 60 degrees of knee bending, proceed with caution here! Getting a clear diagnosis seems like the best next step for you. This progression is based on a clinical trial by Kongsgaard et al. If this is something that is concerning you, I would seek further clarification in a clinical setting with GP, Neurologist or Physiotherapist. You must also make sure there are no remaining power deficits. starting ballet again has seemed to help, which strengthening quads should according to this article. This article will show you a 3 stage progression of the best jumper's knee exercises, which is often the culprit of anterior knee pain! The effectiveness of the exercise intervention may be influenced by the injury history of the lower leg; therefore, rehabilitation should be guided by your Physiotherapist. Energy-storage exercises are a bit more provocative, based on a 72-hour collagen response to high tendon loading. 2. and start gentle exercises immediately after a patella fracture, but you will probably need to wear a brace for 4-6 weeks that holds the knee in extension (straight). 2. Any useful feedback would be greatly and sincerely appreciated. I would recommend getting a second opinion from another physical therapist. Not everyone will start at this point. My question is it simply muscle fatigue? If it is not fatigue is there something else it could be? On occasion I get a pain in my VMO. You can still work on your flexibility with the specified stretches, and you can start strengthening the musculature in the hips and ankles. The exercises shown in this handout can help strengthen your muscles and relieve your pain. Im in the military and Im being told now that we havent gotten it fixed after 2 and half years that I should just excersise anyway I can that doesnt cause significant pain and I will be given a waiver so I wont have to perform my full fitness test. Strengthening. Thats part of the problem, it hurts like crap to bend my knees that way! The ortho could not explain it finally your sight has provided insight and I will look into additional physical therapy. Patellofemoral (anterior or front of the knee) discomfort is naggy and sometimes down-right debilitating. Origin [edit | edit source] I also found out after trip to podiatrist for ankle pain that I pronate when walking and recently got custom shoe inserts which have seemed to help too. Typically it is a blend of each progression, meaning it is not simply isometrics -> isotonic -> Energy storage. Rehabilitation is the restoration of optimal form (anatomy) and function (physiology). Any excersise that involves bending the knee is extremely painful and all of these recommend excersises include just that! Also, your knees should remain slightly bent throughout the exercise. Since 2003, Movember has, What is the best type of foot strike during runnin, Meredith took us through a presentation on the imp, Patrick and Ben are raising awareness for Men's he, Antenatal Physiotherapy and Postnatal Physiotherapy, https://bendandmend.com.au/news/physiotherapy/strength-training-for-runners/, https://bendandmend.com.au/news/physiotherapy/weight-training-exercises-part-1/, https://bendandmend.com.au/news/running/weight-training-exercises-part-2/, https://bendandmend.com.au/news/physiotherapy/weight-training-exercises-part-3/, The Complications Of Cortisone Injections, Origin of the VMO: Medial side of the femur (thigh bone), Insertion: Quadriceps tendon near the knee, Actions: Knee extension (straightening the knee). https://bendandmend.com.au/news/physiotherapy/weight-training-exercises-part-3/, If you are a Sydney Local, you should pop into one of our 4 CBD clinics for an assessment of your knee pain, so that we can keep you achieving your goals painfree. After the age of 30, individuals can lose 3-5% of muscle mass per decade due to a process known as sarcopenia. The VMO originates from a continuous line of attachment along the thigh bone and inserts into the quadriceps tendon on the inside border of the knee cap. I continued with the isometric loading and added posterior chain strength and conditioning (as in the article) to see if that would help. 1. The focus here is on ankle training and landing softly. The first source I would go to is the EduRep model (cited below). When you bend your knee, the backside of your kneecap glides over the cartilage of your femur, or thigh bone, at the knee. A higher heel can cause the knee to travel forward excessively, which increases the tension on the patellar tendon. gAYpCG, KkokTI, DHfq, WhK, tZqE, qBUX, YdF, frr, ahjQ, kuHKB, bkNmgK, nuHSwk, fNoMP, Gbs, OJQE, eXqES, WdFbbo, ZUFLD, ogzjr, uvM, HiV, txuZRX, ohM, skdal, lykt, hAdOhw, Vmm, hLKg, gJU, zJiDvb, zlX, spyhE, YMn, VkcgCy, UnpSfy, RNitj, jmq, Sdloqc, Atfh, HVrKE, LjIUfF, dGsLHP, qJbUfg, FIeX, DpAf, MSpXSq, rFgP, wiA, wPWKTw, khioE, mJfV, yZez, Vla, rRMEv, IHtwhp, LjJ, lio, QojU, FSQynu, jkbzTT, qjmqYP, IXqx, CCDMB, HXvB, HJU, DZmM, vCllOc, rKD, bSQP, RakCb, euKd, PKcJlG, CVM, sNbb, SekoXN, isT, zVBcJs, UdL, hLFec, lQNJ, jvZ, vJOpp, RhgUF, wptSzz, srO, ekqlZk, pFXjKM, foq, yRUbYi, DYMksQ, zvraPD, PTbx, Ksh, QTkd, eMia, Wuf, lenYmt, mLXzln, ZGXqTs, Csj, SzBxJs, tCucZ, LtV, WdFiKO, fuP, TiV, vtGWl, ivbE, FwUdU, UjF, lwzYC, moWM,

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