169 0 R /GS2 170 0 R >> /Font << /T1_0 171 0 R /T1_1 175 0 R /T1_2 179 0 R WebPatellofemoral pain syndrome (PFPS) is one of the most common conditions limiting athletes. The https:// ensures that you are connecting to the BJSG7opun9fzK9znOPpvY3R0+0fo9AJ0SU6LGljGtLi8tABc6JMdzAASUySUpJSklKSUpJTSPWMF 0000067341 00000 n 0000009474 00000 n tltT3Oa+kta8FjiQXucxg0B+kWafLxTuAosL/tbD3sYC+Xtc4ex35jW2EHTna6UuEqtF+3+mm/7O Knee braces limit any damaging movements while enhancing kneecap stabilization during recovery. RVhX+xu0MeLGvOrjtDXuaedJ4R9ySuEJqMfpHrm+vDsbYRy5jwPoPPta7QHboYHg08QhxmlUEben When inflamed, the infrapatellar fat pad can be pinched between lfiPsse84eNcXGJeACRI5MPnQT8klKpwqrzZVmYFFbAAGkBrtxdDn/miILW/MfBJTaOJiua9rqay 2s6fZUyn9k5JrbqwPYAPe0VnR1oIO3mfypKXnpd9hquwrw6pjrWNsBl4re87WN9Ql0ncQI48oSUx 256 0000037501 00000 n If you are not steady on your feet, hold on to a chair, counter, or wall while you do this exercise. 0000009404 00000 n Lie on your side with the leg you are going to exercise on top. 0000218304 00000 n Tighten the thigh muscles in your affected leg by pressing the back of your knee flat down to the floor. sharing sensitive information, make sure youre on a federal Were here to help! /O 166 2011-07-06T07:30:49-07:00 0000002721 00000 n Lift the lower part of your affected leg until your leg is straight. 8S(} >#m6Yzpxv}3J9zm7?Hf{SM{t7Mx&+'8z("w4YVIP6e,Xq,>#~ C8A.{;W ' Adobe InDesign 6.0 Adobe InDesign 6.0 Attach one end of the loop to a secure object, or shut a door on it to hold it in place. endobj Bridge Exercise with Straight Leg Raise . 2016 Jan;31:74-8. doi: 10.1016/j.clinbiomech.2015.09.018. /OPM 1 /metadata xmp.iid:0B71896720321168B34BA564586C664B kDRJSGs9RDGvswsf1y55O2yA1u47fd6ZJO2JSUyAyannZg1Ev9z3NeGzJcI+hqdoE/FJTFrc8X7X Do this for 8 to 12 repetitions several times a day. saved Lower to starting position, then repeat for 1015 repetitions. As you step up, try to keep your knee moving in a straight line with your middle toe. 0000005775 00000 n See this image and copyright information in PMC. Excellent work. Amy, UK, "Your site and exercises have been a lifesaver! The right PT exercise program for PATELLA STABILIZATION PROTOCOL AQBIAAAAAQAB/+4ADkFkb2JlAGQAAAAAAf/bAIQADAgICAgIDAgIDBALCwsQFA4NDQ4UGBITExMS VtNEWUVX7rSWvbY973A1iNRY9zddvM66cpEkpprj7OwhwwswG8Fz/Tc/a03Dc8wbWwfeRoJEeQQU Typically, your kneecap will shift too far towards the outside of your leg (laterally), but you can experience a shift towards the inside of your leg (medially) as well. /FontWeight 300 STHEykapQ4r1bKC5SSlJKUkpSSlJKUkpSSlJKUkpSSmrndPxuotrZlN3sqf6m3sTtc3X/ORjIhbK Webpatellar tendon of the knee. 2011-06-24T11:43:15-07:00 Clipboard, Search History, and several other advanced features are temporarily unavailable. The patellar tendon comes out from the bottom of the kneecap and connects the kneecap to the shin bone, the tibia. /OP true Patella Alta: A Comprehensive Review of Current Knowledge. This case report AGgcBp08AlxKphVT0S6p2Fi3WVvtDngw5rve30S+HNGh9T+7hLjNqpL9p6blkivNyBuPrkML2+18 saved xc``d``sf`c`P @16 lj'fob``2d&l 1FO\ MNmOeXee+(vY\YaIamQ8 .;a# /Type /ExtGState The .gov means its official. Put your good leg about a step behind your affected leg. WebPatellar Taping:taping can also help to correct the position of the patella. /metadata y7L]BFFcnqt]; 86sE8#v,_7Rht5DP4NvB4{_^v,lWQE-hWUm"|[g+',"db :3$1e^2Z13I4KC3lAoNjh8{'4:Tjp[JXdx;VxGw5EM=?RlM`=c&sovD"mxa+Bj2lx[m]G.ma(f ,.ei3hyh%-,:7FQ1If\lq |PlZE x1 UkpSSlJKUkpSSkOVmY2FWLcp/psJIBgnUBz/AM0Hs0ogEolIR3XoyKMqsW47w9h7hIilAg7JEEuN 3WfY7mw0FrXQHFxO0tidISMR3VbN2ZeCQ3FsMTtJgAkAEcTAM+CFKttNO5ocQWyAYPInsUErpKUk /metadata /SMask /None 0000025645 00000 n 0000008064 00000 n A patellar tendon tear can be a painful injury that can limit your ability to walk, run, and engage in normal work and recreational activities. The 28 reviews described patella alta mostly with ISI (75%) or CDI (64%). )$*&SQ5G 2,(o*@j0CF(D))IyQ*JKEHQr"K$OeyejTO+Uf5Lkf#lq"UU,FZZ,8aq,[n. Effect of mobilization with movement on lateral knee pain due to proximal tibiofibular joint hypomobility. hb```a``a`e`4ab@ !+PG'] O$NZwM:!ikG*|[[6 (w Hq a46K@GP tWl-XC20L |$bL *d\o4VG<0;=" >/Filter/FlateDecode/Index[15 72]/Length 22/Size 87/Type/XRef/W[1 1 1]>>stream /TrimBox [ 0 0 836.22 595.276 ] Place a single-step footstool on the floor. government site. oX/pws/9sc9JTH6q/wDiX6H/AOEcX/zw1JTo35uHiua3Jvqpc/6Ise1pMAu03EdmlEAlVrszcOxu The exercises for patellar tracking disorder, which fix kneecap instability, are not complicated and can be done at home in 20 minutes or less! saved 0000000017 00000 n 0000083929 00000 n >> Slowly lift one leg upward as far as you can . GwP9fPRKSWWZLqgcfIoDhy5wLmkmCOHt7eaSlqbMp9m1+RQ7j218xHm53f8A3pKU2rqoIL76iZBI WSA2Gw2Wn9ztykpTsjp+NaG2ZeUTU4ksh9gJZA922t2g9OefNJSOx3TmhpfnZ3vYNrQbQQGONbiQ uXf/ANuP/wDJJtr6Y3dTz6anWvy74YJP6R3/AJJAmkgLMzOtOx2ZFuRfULOGm15P8B2TYz4l0sfC -EqD3-%i!} nd8}+-`5znk6]t]3~MTy6zWUx1]+^RkGbwv8_|k\o=Y^\O%/r YJV=&3 7o`})xAS)x Patellar 0000033949 00000 n /CA 1 0000004791 00000 n WebKeep that leg somewhat bent at the knee. It presents as pain just below the Supportive braces. Keep your hip and leg straight in line with the rest of your body, and keep your knee pointing forward. 0000014594 00000 n H\j0~ Patella Alta - Causes & Treatment - Knee Pain Explained Careers. ZJS6SlJKaNl7/VdT9torfubsrgbwDw0h1mu6PAJKYvyLXBjK8/GbYdrT7QdziZhrfV/OHbVJS9We w9N14/NGlKSFtJXE1OT0pbXF1eX1VmZ2hpamtsbW5vYnN0dXZ3eHl6e3x9fn9//aAAwDAQACEQMR SklKSUpJSAWZDcd9l/pMc1zzIcdgrDjtLnOaIOznsCkprW5PU6qrbf1TbUN291rmtgDc7f7Dt2j/ Patella Alta: A Comprehensive Review of Current Knowledge Webthe exercise. 40LhPCfqIy82PQzheujb+wdFNnUiWUPPTHfaf0Jd6dtb6dvpD9JZ9G7bPuPJ1TeKeniv4Mdy29Ov 0000053729 00000 n This abnormality may cause increased pressure between the back of the patella and the trochlea, irritating soft tissues. 0000008045 00000 n 0000037683 00000 n l+VA0lP61UxvbI0IkfBBSxvoa3e6xgae5cI0MJKUb6GxusYJO0S4aniElLi2ovFYe0vI3BoImNNY saved FOIA 2011-07-06T07:25:49-07:00 x+kcCy2XFs1/QPuOjjpCSmTqum+i5r8W9lbIf7W2SSJp0FbtxIH4QeySkX2XpVFm4YVznSHzDnCZ 0000009089 00000 n 0000008173 00000 n wWIzNHKC0UMHJZJT8OHxY3M1FqKygyZEk1RkRcKjdDYX0lXiZfKzhMPTdePzRieUpIW0lcTU5PSl 7 Patellar Tracking Exercises for Subluxation & Dislocation saved YOUR GUIDE TO CHONDROMALACIA PATELLA DUlOk6yMuur1axure70SP0jtprG9p3fRbuh3t/OGo7pTSyMnPF5rx7sVrQ/3es4hwYCyYaGjsT35 Do not roll your body or pelvis backward. saved Y+n2cCkpdubVXdtvzqJY4sfWS1pl0Fo1dMj8UlPEf4xbAzrlP/hRn/ny5Nkvjs4NGT6ePZa47QYa 0000067195 00000 n 0000022714 00000 n UkpSSmm+vqe6w1upif0e4HiQdYb4fFJSg3qUsg0FkAvJ3Oc7UzBG0cRrHyCSmAb1rcwu+ybQZeGh There are a number of different methods used to diagnose patella alta. Make sure that your low back has a normal curve. 4l+h/wDhHF/88NSU65c0GCQCexPikpdJSklLcpKUCDqDPbTySUouaCGkgE8DuYSUqRMd0lLpKUkp Ez7RruSU+c/40H7OvUEmAMNhP/blyaRZXx0Dx1X2rqHTrxU4hz3D0hJAAYQ7T8U8kRkFouUW50n6 Epub 2015 Oct 9. Initially, the patient scored a 50 on the ADL-KOS and rated her function at 30% of normal. 0000039648 00000 n pJTWuqxsbDuDKC6uLLHU0t9z3PJe+GiJc5xJ+KSnKtxOlEknpmUQAHSwObuJPqa7bASZ8e6Sk76O WebFigure 2: Lateral subluxation of patella alta Figure 3: Patellar slightly subluxated and osteochondral lesion below lateral condyle in the joint. S0tiSd47eCSkQGU+0MHVqyQ5wfW2uuTG4bR7twiPwSUzqyWHIP8AlOuxkucKWiuQI3QSJOg1SUh9 Start each exercise slowly. 0000001575 00000 n << +lUlOf1b6z/VuzP6K+vq2C9tOc99jm5NRDGnDzWbnEP0G54HxKSn/9k= 0000003984 00000 n /BM /Normal VTdjiW7LNATLZ+iNdpSUnsf1D0XCqusXHRhcZaJmHEe0mNNNElKst6gPU9Khjtrhsl8b29zwdv4p 0000004350 00000 n Hold your knee locked in extension for five seconds, then relax your quadriceps and slowly lower your leg back to its resting position. Therefore, it is important to strengthen the muscles, such as your thigh muscles (quadriceps), that stabilize your kneecap (patella). If youre worried about your kneecap subluxing or dislocating again, try wearing a knee brace throughout the day and while exercising to prevent maltracking of your kneecap. Patellar Instability Michelle, US, "This is the best site dealing with knee problems that I have come 0000004567 00000 n +s0z257JKW243qUt/Z+SX07rGGR7C5zp93rQSTWDEnkJKfNf8cPrD6x47q3O2t6exzmgwDFuRKdG %PDF-1.4 % pPTLrGMDqg1rAG7WF+g3PYIM6f1vCUlK6ji9Pre667p9uV6kOca2mw7o2Abd2nt8PywkpWLVg/aq If you do not have a footstool, you can use a thick book, such as a phone book, a dictionary, or an encyclopedia. AKp/Ikpy+s/8o9C/9OFn/tjnpKY/VX/xL9D/APCOL/54akps9ROO57Kb8W7JGxzw6tpLWxtBBO5v AD8A6joXQvqpV9U+m9R6h0vBd/k/Huvufi12OJ9Fr3vd+jc4nklEAk0iUhEWUH27/FX/ANxOn/8A h2SU3TiuJcfXtG524QR7fpaDTjVJShinY6t11p3CN26HDzBEJKWOHYQR9pt14MiR8NElJq2Fjdpc 2cn7pV+wut/+V+V/2zZ/5FL3Id1ezk/dKv2F1v8A8r8r/tmz/wAil7kO6vZyfulX7C63/wCV+V/2 The patella usually remains somewhat subluxated on the initial radiographs due /;/metadata 0000025971 00000 n endstream endobj 140 0 obj <>stream PMC Sign In 8600 Rockville Pike %PDF-1.4 % Physical Therapy Stand with your hands lightly resting on a counter or chair in front of you. Inches 2011-06-24T11:44:09-07:00 << 0000001386 00000 n Adobe InDesign 6.0 ]xFo% # endstream endobj 93 0 obj <> endobj 94 0 obj <> endobj 95 0 obj <> endobj 96 0 obj <> endobj 97 0 obj [107 0 R] endobj 98 0 obj <>stream 0000004461 00000 n /ca 1 0000007892 00000 n %PDF-1.4 % Step 3: Circle the leg in a clockwise direction 20 times. % slide 1 of 6, Straight-leg raises to the front. 0000002882 00000 n Epub 2018 Jan 24. E6f/AOwH/vul93ydlffMPdX27/FX/wBxOn/+wH/vul93ydlffMPdX27/ABV/9xOn/wDsB/77pfd8 Keeping your ankles together, slowly lift your top knee up. 135 0 obj <> endobj 154 0 obj <>/Encrypt 136 0 R/Filter/FlateDecode/ID[<292196579D884CAE99E90871EC32E77A>]/Index[135 29]/Info 134 0 R/Length 88/Prev 413526/Root 137 0 R/Size 164/Type/XRef/W[1 2 1]>>stream saved SUiNuRDGWZVDbHODm7RG5rR7xDnO7lJS7bcr09b6DY5xDY+j+bA5ng/ikpgLM5un2jHc1vLnc6ci 0000003667 00000 n Patellar xmp.iid:74117FEA2007116883808B8213850D82 cS4h1r3N18GucQElJ0lKSUpJSklKSU+Y/wCNDEZf1pr3GCcANE+T7z/FRz3Xx2cDpXT6DQ0u/SNe H/2Mr/8ASiSlf86fqp/5dYP/ALGV/wDpRJSv+dP1U/8ALrB/9jK//SiSlH6z/VNwLT1nBgiD+uV/ Keep the back of your knee on the foam roll or towel. The first is known as a traumatic patellar dislocation. 0000001617 00000 n 0000001733 00000 n xmp.iid:EC423A7620251168B34BA564586C664B /FontFamily (Interstate) Anterior Knee Pain: pain at the front of the knee, aka patellofemoral pain, is common with patella alta, especially when walking up and down slopes, squatting, sitting for prolonged periods and on stairs How Is Patella Alta Diagnosed? To diagnose patella alta, your doctor will start by examining your knee. Patella Alta: A Comprehensive Review of Current Knowledge. across. 0000008601 00000 n 67LXiuppe93DWgkn4AIE0kAlT67K9vqNLd43N3AiWnuPJK1EEKYx9jgytpc5xhrWiSSewCSgLU9j hbbf`b``1@ endstream endobj 88 0 obj <>/Metadata 13 0 R/Pages 12 0 R/StructTreeRoot 15 0 R/Type/Catalog/ViewerPreferences<>>> endobj 89 0 obj >/PageWidthList<0 612.0>>>>>>/Resources<>/Font<>/ProcSet[/PDF/Text/ImageC]/XObject<>>>/Rotate 0/StructParents 0/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 90 0 obj <>stream As you step down, try to keep your affected knee moving in a straight line toward your middle toe. [5] [6] It often results from a non-contact injury to the knee. 72.00 /XHeight 729 The explanations are so clear. Patellofemoral pain syndrome (PFPS) is one of the most common causes of anterior knee pain encountered in the outpatient setting in adolescents and adults /OP true HW[oH~aa'sHR8mi/+B0%&I=v.uX`{.|s.3>n-zjpO[tvv>r) ^dpI8 0000022753 00000 n Patella alta was reportedlypresent in50to60% ofprimary patellardislo-cations [20]. saved HPLwLN0MdANeyWnTn3j/AFhLgNK4glt6v0+hzm22Fpa4MjY8y5ziwBsN19wjRIQJVYRt670x93ot uuid:db03cf78-26df-4a78-abaa-f236e97c1c97 Subscribe to our email list for exclusive offers and tips on healthy healing. 0000040181 00000 n 0000000016 00000 n /AIS false 0000003224 00000 n WebPATELLAR TENDONITIS Home Exercises Patellar Tendonitis is an overuse injury that causes inflammation of the tendon in front of the knee. HEEB0aGD3QtNFiihSSlJKbvRP+WcD/w1T/58amZPkPkyYf5yPmH1frP/ACj0L/04Wf8AtjnrMdtz Picture illustrating the patellar alignment, Picture illustrating the patellar alignment of the right (a) and left (b) knee, Lateral radiograph of the subjects left knee used to examine patella alignment, Diagrammatic representation of the direction, Diagrammatic representation of the direction of force applied through taping to the patellofemoral, Picture illustrating the application of tape for the treatment of patella alta on, Line graph demonstrating patient status according to the assigned scores from selected indicators. *.o^(di%^A5}[-W}z/>p__Oy>s|Xi~\,OL) I>Gk?c6ITS'??eUhFuon58QP[c%b~Vs. YWN6TTYBY2z3FkO9MbDVpOgPuSUytdntJFGFQ4Na30y63b7uXDSl0QUlJqWve5xyaKqyCDXtIcTI - Exercise where you have poor balance and control of your lower limb movement can also increase your risk of developing patellar tendinopathy. Your heels should remain on the floor at all times. Chondromalacia: Exercises to Relieve Knee The patellar tendon is soft tissue that connects the tibia bone to the patella. Federal government websites often end in .gov or .mil. << Treatment of patella alta with taping, exercise, WebPatellar Tendon Mobilization. [1] Numerous studies have interpreted anatomic and biomechanical factors for PFPS. Correcting inward movement of the knee during squatting is a primary goal. Up/UMRgJe+ADtJ2u5AafD+UElLtz8R5YGWbvULgwgEglpDXax2JSU2ElMbf5t/8AVP5ElOX1n/lH xmp.iid:D4656DF3201B1168B34BA564586C664B 0000038907 00000 n /Rotate 0 The three lines indicate the superior margin of the patella, the inferior pole of the patella, and the tibial tubercle. 012701-006 (7-11).indd m1vBsc1lJDGzO08xInU/70pkHZmyt7uqVwJqe9jGODrQ5xIPhDRETp5pKXe670y0dWrY58vZYWMi American Journal of Orthopedics. Webthe risk of dislocation at early knee flexion [19]. /FirstChar 1 PmH1frP/ACj0L/04Wf8AtjnrMdtzsSuy7/F5hVVNc97+kVtaxokuJxYAACfjNTDHmBOOXk+dfsLr WebPATELLAR INSTABILITY Home Exercises When the knee bends, the patella slides evenly up and down within a groove at the end of the femur. 0000039437 00000 n /Ascent 914 %%EOF m3VO9bp1wZU5zgCyS42udvc1rHkmSyfgQkpj9n6YaHbenXhljqRsawsJ2vds9u9u1rCS48DWeUlM application/pdf xmp.iid:EC423A7B20251168B34BA564586C664B created Brandon, Colin R. Smith, Tom F. Novacheck, / u8UbKZxc/c4ubsbY/czds3F7hft8Pzj3jWUlMb68T7S6q3Hz3G0kOe2y70/00T9G0NEF0CPo9ohJ /ArtBox [ 0 0 836.22 595.276 ] Patellar Femoral Pain Syndrome (PFPS) - OUH Adobe InDesign 6.0 /SA false hb`````sf`c`*gd@ A lZ50F^,LtvImasf2y=Etso(e+-`](j)32Di] H3 xmp.iid:0B71896920321168B34BA564586C664B  \Og>$-Cx`Ukz>; saved 0000014147 00000 n mna4GAe4SErUY09J9T+o5/UK88Z1zrvTbXs3RpuFsxEeCcCtkHT6z/yj0L/04Wf+2OeitY/VX/xL January 2012, This site complies with the HONcode Standardfor trustworthyhealth information. WXsmdrjyJHMIS2THd4JmW027Q4EjkSmMjevd9roaC9otYRG8gEtHhPJ1UvJzGLKCdmD4jhlzPLmI 213 0 obj saved and transmitted securely. pJTzzuq/V/GzbTbn5DbWWWtfUXWlgdIDgGhu3SdPj9yUluyOlUfbK35+S11LWuvIe9xqDSHe0bSP 63muxpY9phzXCCCOxBS3URTFFCklKSUyfXZXt9RpbvG5u4ES09x5IWkghiihSSmTq7GsbY5rgx87 xMaSkpzMyvGstyN92ZVBJf6R9obsghkB0gzujmfuSUlxcWrJcbaMvLLajZS8Pc5vvjaSNwaDtnQ6 Adobe InDesign 6.0 qOz6Rb/Nv/qn8itNdy+s/wDKPQv/AE4Wf+2Oekpj9Vf/ABL9D/8ACOL/AOeGpKdhJSklMXsZYx1d saved Verify here, This is one of the best self-help & info sites of any medical condition I've ever seen. 6l7du7Rg1bMhJTLI6MzJx349mTkAP3gvDmbosABbrWRGngkpmOmx6f61kRWx7ANzRO/dq6Gct3af Details. xSUyONnl73fbNrXPDmNFTfayCNkkmddZSUkx6cqpx9fI9ZsaAta0zJn6KSmwkpSSlJKUkpSSlJKU 170 0 obj xmp.iid:D4656DF2201B1168B34BA564586C664B Make sure your knees do not go in front of your toes. a03BopbUPV9N7LPUDt0BvI7lOycZhqswnHHLp4pMinouT0UZ7q2OyLy2x9jXt3Mufd76z6mUbC0M The C-shaped buttress of this knee brace can be moved for either lateral or medial patellar misalignment. 0000002942 00000 n 164 0 obj YIqcBp7TEfBJTmdZ/wCUehf+nCz/ANsc9JTH6q/+Jfof/hHF/wDPDUlOqXuFraxW4tc1zjbLdrSC Best Exercises for Patellofemoral Syndrome - WebMD 0000039225 00000 n The effects of patellar taping on knee kinetics, kinematics, and vastus lateralis muscle activity during stair ambulation in individuals with patellofemoral pain. FsfP6mculpy7yDYwEG18HXg+5PtYQH0e3+bf/VP5E9jcvrP/ACj0L/04Wf8AtjnpKY/VX/xL9D/8 0000013982 00000 n 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Patellofemoral Pain Syndrome | AAFP 0000009689 00000 n bvHu2Rx93CSmdWSy1/phr2u2h/uaQIIB+lxOvCSnjfrt1nq3T+sU0YOS+ip2O17mtiC4vtE6jwCB Hold for about 6 seconds, slowly lower your leg back down, and rest a few seconds. WebPain during exercise and activities that repeatedly bend the knee, such as climbing stairs, running, jumping, or squatting. /Type /Font Lie on your back with your good knee bent so that your foot rests flat on the floor. 0000005329 00000 n /ca 1 uuid:91a0aa47-95d2-452f-b780-8e237f0ee657 0000248494 00000 n 0000018659 00000 n Rachel L. Lenhart, Scott C.E. 4fxX+yfVu39BbXTSyn9nvdeyx25/rbRkA+8iAPAacpcUx+KjDEdK7NjNb0trcevIpxS3Exs6xuNX /Widths [ 730 531 522 407 559 566 372 540 559 251 567 592 567 659 260 678 wPIeGNBDLA5+SyNx7hrpPYBCcpxA3TjhjkToN6/lq57vsmT1Lold7W5NQwa22V+o1gJBuO0uc9gB xmp.did:D4656DF2201B1168B34BA564586C664B 1, 2 Patellofemoral pain syndrome can be caused by direct trauma to the knee, or This site needs JavaScript to work properly. Place your feet shoulder-width apart. Many options exist for treating patellar instability. pjZ/Nu/qn8iSnL6z/wAo9C/9OFn/ALY56SmP1V/8S/Q//COL/wCeGpKdNzm/aWNmzca3kAB3pwCy
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