tibial derotational osteotomy recovery

Consult a podiatrist if you're having a hard time finding something comfortable. A tibial derotational osteotomy necessitates the surgeon to incise the bone, turn it appropriately to improve the alignment, and secure the bones in that position with metal hardware while they heal. You are advised to keep your leg elevated while resting to prevent swelling and pain. Pins will be removed at a later date after appropriate healing is confirmed. He really takes his time and explains treatment options. The meniscus, a soft crescent-shaped cartilage between the femur and tibia, serves as a cushion and helps absorb shock during motion. Total knee replacement was the only viable option. (Illustration by Gillette Children's Specialty Healthcare). It can allow a younger patient to lead a more active lifestyle for many years. This is done through a small stab wound at the level of the break. The . It just so happened that we were very fortunate enough to have Dr. Karkare, who was on standby, perform the surgery. Highly recommend. This causes the stiffness and severe pain on the knee. stream Some of the common indications for tibial derotational osteotomy include: Preoperative preparation for tibial derotational osteotomy will involve the following steps: The main objective of the procedure is to correct in-toeing or out-toeing while walking due to rotational deformities of the tibia. Bookshelf Tibial derotational osteotomy is a surgical procedure employed to treat rotational deformities of the tibia, such as tibial torsion. By shifting weight off of the damaged side of the joint, an osteotomy can relieve pain and significantly improve function in an arthritic knee. Loafers, sneakers, and tevas are good options post-op. From the time I entered Dr. Karkares office for the first time until now, his staff has been amazing. I am so happy he is my doctor. They are an excellent practice. 2002 Aug;16(7):473-83 PMC Dr. Karkare put my fears to rest . Before I was up walking mere hours after the surgery, and on the workout machines the next morning. Treating pain with medications can help you feel more comfortable, which will help your body heal faster and recover from surgery faster. Pain relievers and muscle relaxants will be provided for comfort. 4 0 obj A follow-up appointment for X-rays and pin removal 4 weeks after surgery will be scheduled as well as to monitor your overall progress. You are encouraged to walk with assistance as frequently as possible to prevent blood clots. The lower end of the thighbone meets the upper end of the shinbone at the knee joint. The surgical incisions are closed in layers and a sterile dressing is applied. This is a condition characterized by twisting of the tibial bone of the lower leg, causing malalignment of the knee and ankle with an appearance of an inward or outward turning of the feet. The wedge of bone was removed, and the tibia is held in place with a plate and screws. The information posted is not intended to create, and receipt or viewing does not constitute, an attorney-client relationship or a doctor-patient relationship nor shall the information be used to form an legal or medical opinions. 1991 Jul;81(7):344-57 Complete orthopedics is a wonderful place to go when you hurt or injured a great staff and wonderful doctors very knowledgeable and helpful I would recommend this place to all of my family and friends that is in me of orthopedic care I give them 10 thumbs up. Three months later I had the other knee done and went home the very next day. He listens to everything and explains everything I recommend him to everyone. Your surgeon will line your knee cap up with your thigh and shin. In some cases, having had an osteotomy can make later total knee replacement surgery more challenging. This was the right decision no pain and no limp. Surgery can be a scary and painful thing! It causes toeing in. This website also contains material copyrighted by third parties. Physiotherapy after tibial derotation and osteotomy surgery is important to regain function in the lower limb. Surgically cracking a bone is also known as an osteotomy. Pins will be removed at a later date after appropriate healing is confirmed. In the year of 2018 I was referred to Dr. Karkare because I was experiencing severe knee joint pain. Thank you! Wedge JH, Munkacsi I, Loback D. Anteversion of the femur and idiopathic osteoarthrosis of the hip. Tibial Derotational Osteotomy Technique. For most patients, osteotomy is successful in relieving pain and delaying the progression of arthritis in the knee. They will plan out the correct size of the wedge using guide wires. Tibial derotation and osteotomy surgery is a surgical procedure to correct the alignment of the lower leg that is often required to treat tibial torsion (twisting of lower leg). In a knee osteotomy, either the tibia (shinbone) or femur (thighbone) is cut and then reshaped to relieve pressure on one compartment of the knee joint. The knee is made up of the femur (thighbone), the tibia (shinbone), and the patella (kneecap). Toe Presses - put your toes up against a wall or solid surface to flex and stretch them. Tibial osteotomies are often performed for knee injuries such as total lateral compartment collapse following a motor vehicle accident. A 20-year-old patient with a bow-legged left knee. Dr Rhodin really cares for his patients. For patients whose procedures have not yet been rescheduled:What to Do If Your Orthopaedic Surgery Is Postponed. indications. JBJS. Its flu season is your family immunized?1, Legalization of non-medical cannabis in BC: get informed, One year on - patients continue to benefit from the design of the Teck Acute Care Centre, Halloween trick or treat sends patients and families on a treasure hunt, Supporting survivors of gender-based violence, BC Childrens and BC Womens thank you for your generosity this holiday season, Diagnostic Neurophysiology (EEG/EMG) Referral, Compass Mental Health: Supporting Providers, Oncology, Hematology & Bone Marrow Transplant, Pediatric Oncology & Hematology Education Day. You should not rely on any of the information contained on this website. osteotomy 28300 Osteotomy; calcaneus (e.g., Dwyer or Chambers type procedure), with or without internal fixation 28302 Osteotomy; talus 28304 Osteotomy, tarsal bones, other than calcaneus or talus 28305 Osteotomy, tarsal bones, other than calcaneus or talus; with autograft (includes obtaining graft) (e.g., Fowler type) All rights reserved. The osteotomy needs time to heal, which takes approximately 6 weeks. average = 0 to -10 degrees internal rotation during infancy (which gradually laterally rotates to 15 degrees external rotation during growth), greater than 15 degrees internal rotation, usually not indicated unless other conditions present (see above), CT or MRI can be utlized for surgical planning (in the few cases that require surgery), Medial deviation of the forefoot (abnormal heel bisector), normal hindfoot, Internal rotation >70 degrees and < 20 degrees of external rotation, In-toeing associated with the following necessitates further work-up, family history positive for rickets/skeletal dysplasias/mucopolysaccharidoses, bracing/orthotics do not change natural history of condition, derotational supramalleolar tibial osteotomy vs. proximal osteotomy, child > 6-8 years of age with functional problems and, associated with lower complications than proximal osteotomy, intramedullary nail fixation if skeletally mature, Pediatric Pelvis Trauma Radiographic Evaluation, Pediatric Hip Trauma Radiographic Evaluation, Pediatric Knee Trauma Radiographic Evaluation, Pediatric Ankle Trauma Radiographic Evaluation, Distal Humerus Physeal Separation - Pediatric, Proximal Tibia Metaphyseal FX - Pediatric, Chronic Recurrent Multifocal Osteomyelitis (CRMO), Obstetric Brachial Plexopathy (Erb's, Klumpke's Palsy), Anterolateral Bowing & Congenital Pseudoarthrosis of Tibia, Clubfoot (congenital talipes equinovarus), Flexible Pes Planovalgus (Flexible Flatfoot), Congenital Hallux Varus (Atavistic Great Toe), Cerebral Palsy - Upper Extremity Disorders, Myelodysplasia (myelomeningocele, spinal bifida), Dysplasia Epiphysealis Hemimelica (Trevor's Disease). High tibial osteotomy combined with arthroscopic lateral retinacular release can relieve weight-bearing pain in frontal axis and improve the function of knee in sagittal axis. Selber P, Filho ER, Dallalana R, Pirpiris M, Nattrass GR, Graham HK. So happy how I been treated and how well I am getting. -, J Orthop Trauma. Good candidates have: Candidates should be able to fully straighten the knee and bend it at least 90 prior to surgery. Oper Orthop Traumatol. [Components of the joint-sparing, combined bony and soft tissue correction of the cavovarus foot]. Dr. Vaksha is awesome and takes the time to listen to his patients. That said, an osteotomy procedure can also be performed together with other joint preservation treatments as a way to allow the cartilage to repair the tissue, encouraging it to grow without the need to deal with excessive pressure. Likewise, a procedure known as the high tibial osteotomy can also be used to reconfigure the affected knee joint. The tibia and femur are rubbing against each other (blue arrow), causing pain. Fibular Osteotomy This would bring the bone to the healthy side thats closer together, creating more space between the damaged arthritic side. Dr. Karkare is very knowledgeable, helpful, and caring. About OrthoInfoEditorial Board Our ContributorsOur Subspecialty Partners Contact Us, Privacy PolicyTerms & Conditions Linking Policy AAOS Newsroom Find an FAAOS Surgeon. Your orthopaedic surgeon will help you determine whether a knee osteotomy is suited for you. What a great place! The appropriate test, x-rays were taken before the conversation with doctor, something I really liked, test for analysis and conversation was done upfront. I know that with her will, perseverance and the great work that the surgeon performed she will be back on her feet in no time.Sincerely:John V. PlumpEast Northport, NY 11731. 1994 Jul;25(3):405-14 The patient should refrain from medications or supplements such as blood thinners, aspirin, or anti-inflammatory medicines for a week or two prior to surgery. -j[MjHiz4q?u2 Instructions on cast care and bathing will be provided. Results: You won't want to put pressure or stress on your heeling foot so running is probably not going to happen soon after a bunionectomy. Davids JR, Davis RB, Jameson LC, Westberry DE, Hardin JW. Dr. V had a great personality and was no BS, straight forward diagnosis and a play on next steps. 2014 Jun;34(4):467-73. doi: 10.1097/BPO.0000000000000173. In general, the procedure involves the following steps: In general, postoperative care instructions and recovery for tibial derotational osteotomy involves the following: Tibial derotational osteotomy is a relatively safe procedure; however, as with any surgery, there are risks and complications that could occur, such as: Home Disclaimer Privacy Sitemap Feedback Tell a Friend Contact Us Accessibility Statement, Practice Policy Update regarding COVID-19, Ryan L. Dabbs, M.D., Board-certified Orthopaedic Surgeon, Knoxville, TN, Rotational tibial deformities due to myelodysplasia and cerebral palsy, Tibialis spasticity (extreme stiffness or tightness of the muscles that interfere with normal movement). The meniscus, a soft crescent-shaped cartilage between the femur and tibia, serves as a cushion and helps absorb shock during motion. Medications will also be prescribed as needed for symptoms associated with anesthesia, such as vomiting and nausea. This may relieve pain and improve movement of your leg. This spasticity involving the hip muscles, mostly in the groin, can cause the hips to gradually come out of their sockets. If it wasnt for Dr. Karkares expertise she never would have been able to work. Additionally, it might be harder to fit your foot into shoes with a bunion. Complete Orthopedics should be your choice! This surgery corrects bowlegged alignment that's putting too much stress pressure on the inside of your knee. Don't think about putting those high heels on, doctors recommend at least six months before grabbing the stilettos. Nevertheless, it remains an option for many patients. You will be able to return to your normal weight-bearing activities in 4 to 6 weeks, however, return to sports may take 3 to 6 months. Provincial Health Services Authority (PHSA) improves the health of British Columbians by seeking province-wide solutions to specialized health care needs in collaboration with BC health authorities and other partners. Metal hardware, such as pins are placed in the bone just below the knee to hold the bones in position. Dr.Karkare is the best. Damage to adjacent soft tissue structures. Opioids can provide excellent pain relief, however, they are a narcotic and can be addictive. Setting up physical therapy is right there as well.I'm so glad I found this place. Pain relief is not as predictable after osteotomy compared with a partial or total knee replacement. This would result in a bow outward or inward. &N<3Le8-&p&{9 [ x+L The indication was formal in all patients with more than 30 of torsion. A 20-year-old patient with a bow-legged left knee. To put an end to the poor knee alignment. To move the weight of the arthritic part of the knee to the healthier side. Computed tomography in the measurement of femoral anteversion. Eating a healthy diet rich in vitamin D is strongly advised to promote healing and a faster recovery. This is called a High Tibial Osteotomy or H.T.O. Dr. Karkare is an amazing doctor, very caring and attentive, the girl at the front desk is very kind and helpful. A small bone called the patella (kneecap) rests on a groove on the front side of the femoral end. They incredibly can be painful and who has time for that? Generally speaking, this kind of procedure could slow down the development of degenerative osteoarthritic change, allowing the body to improve, and reduce the amount of pain being experienced. Plate and screws are used to hold the bone in the new position. Sunday: 9am - 4pm. Because you might be in a cast, wheelchair, or other bandage walking on your foot is a bad idea. An osteotomy is a surgical operation whereby a bone is cut to alter its length or change its alignment. The purpose of this study was to evaluate the long-term outcome after external TDO performed to correct ITT in ambulatory children with CP . 2012; 6: 81-85. Furthermore, the moment the bone cartilage actually wears away unevenly, the gap located between the tibia and femur decreases in size. We have immediate appointments available today. As with any surgical procedure, there are risks involved with osteotomy. We are not attorneys. Your surgeon will also see you before surgery and sign your knee with a marker to verify the surgical site. The office staff is wonderful and Rebecca was able to schedule me with a busy schedule and awesome at answering all of my questions including referring me to a great physical therapy office. J Bone Joint Surg Br. Recovery Time For Tibial Osteotomy. The patient portal made it easy for me to access all my documents including work notes. child > 6-8 years of age with functional problems and thigh-foot angle >15 degrees. You should not consume any solids or liquids at least 8 hours prior to surgery. Dedham, MA 02026, Home | Disclaimer | Privacy | Sitemap | Feedback | Tell a Friend | Contact Us | Accessibility Statement | Careers. Keep your cast clean and dry. Corrections for congenital or posttraumatic malrotation of the lower leg, considering alignment of the contralateral leg, with an osteotomy and fixation using locking compression plates (LCP). Proximal tibial derotation osteotomy for torsion of the tibia: a review of 43 cases. The staff was super friendly and down to earth. Idiopathic internal or external rotational deformity if the child is regularly tripping and falling, has psychological problems (other children making fun of the child because of the unusual gait), or is bothered by the deformity (age > 10 years, relative indication). But if you absolutely need to fix or alter part of your body, it's integral to functioning in society. I was recommended here by a friend Dr. Vashka helped me from day 1 and still continues to check in on me and my healing ankle. from the American Academy of Orthopaedic Surgeons, Questions and Answers for Patients Regarding Elective Surgery and COVID-19. There are a lot of causes behind osteoarthritis. Bone malposition; Bone plate; Children; Lower leg; Tibial osteotomy. Once the HTO has been performed, the need for the unloader brace would not be essential. . What to Do If Your Orthopaedic Surgery Is Postponed. Pain relievers and muscle relaxants will be provided for comfort. The front and back office people are amazing and so helpful. The deformity is more obvious when standing. Increased tibial torsion in residual clubfoot deformity as long as the foot has been realigned. 6MJ>8Ix Another privilege once can enjoy is the fact that there wouldnt be any restrictions on physical activities after the procedure. J Pediatr Orthop. Please turn on JavaScript and try again. You may be able to resume your full activities 3 to 6 months after surgery. After a thorough examination and given exercises to do at home , I am feeling much better , and I ended up avoiding surgery . Arhrodesis which requires screws or metal plates to correct the bunion and damaged joint. He explained everything to us, and the office staff set everything up for us and made the process easy. %PDF-1.3 Dr.Kuo is amazing very attentive,caring,and passionate and staff is awsome too.Thank you for everything Dr.kuo. Dr.VAksha is the best, I love the way he treats me as his patient, he is caring,understanding and very attentive to my needs. Great staff. Knee osteotomy is used when a patient has early-stage osteoarthritis that has damaged just one side of the knee joint. You will see your surgeon for a follow-up visit after surgery. Some of the common indications for tibial derotational osteotomy include: Preoperative preparation for tibial derotational osteotomy will involve the following steps: The main objective of the procedure is to correct in-toeing or out-toeing while walking due to rotational deformities of the tibia. Once awake, the patient may notice pain and discomfort. Andrea the medical coordinator walked me through all the paper work and necessary preparations for the surgery. There are no restrictions on physical activities after an osteotomy has healed you will be able to participate in your favorite activities, even high-impact exercise. Tweet us @womendotcom or follow us on Facebook and Instagram. There are two basic indications for this surgery: The first involves the damaging effect of spasticity on the hip joint. Correction of lateral tibial plateau depression and valgus malunion of the proximal tibia. J Pediatr Orthop. Im very thankful and happy to be a patient here at Complete Orthopedics. Fulkerson osteotomy. I suffered with pain in both knees for years. In most cases, patients go home 1 to 2 days after an osteotomy. Dr Vaksha and Dr karkare are 2 of the best orthopedic doctors around my wife Susan had a very serious broken ankle in March of 2019 she didn't think she was going to walk again Dr vaksha did an excellent surgery on her ankle he said it was his toughest he ever did he put a lot of hardware in her ankle and told her she would be alright she made remarkable recovery thanks to his surgery as of now she regained 100 percent use of her ankle she would highly recommend him to anyone. Unable to load your collection due to an error, Unable to load your delegates due to an error. Internal Tibial Torsion is a common condition in children less than age 4 which typically presents with internal rotation of the tibia and an in-toeing gait. This would be her third time under the knife in the past year. Osteotomy material should be removed 1 year postoperatively. % Before your procedure, a doctor from the anesthesia department will evaluate you. Distal femur osteotomy can also be performed percutaneously with a retrograde intramedullary nail for stabilization. How do I prepare for TTO? An inwardly pointing knee [ 2] or a miserable alignment syndrome [ 3] can be indications for surgical derotational treatment. After the surgery, you will be taken to the recovery room where you will be closely monitored as you recover from the anesthesia. It allows Mary Ann do the things that she likes to do, even on a limited basis for a while. For information:Questions and Answers for Patients Regarding Elective Surgery and COVID-19. Arrange for someone to drive you home as you will not be able to drive yourself post surgery. Knee osteotomy is most effective for thin, active patients who are under the age of 60. Oper Orthop Traumatol. A staff nurse will monitor blood oxygen levels and other vital signs as the patient recovers. Toe marbles - pick up a marble with your big toe. Repeat daily. The office staff is the best, love Andrea.You wont find a better doctor. Instructions on cast care and bathing will be provided. (OBQ09.39) After a Tibial Osteotomy, you can still participate in your favorite activities without worrying at all. The tibia (shin bone) is cut. Bethesda, MD 20894, Web Policies Contraindications: I went home two days after the surgery, and yes walked my daughter down the aisle at her wedding only one week after the surgery without even a cane! In general, postoperative care instructions and recovery for tibial derotational osteotomy involves the following: The patient will be transferred to the recovery area to be monitored until awake from the anesthesia. In general, the procedure involves the following steps: In general, postoperative care instructions and recovery for tibial derotational osteotomy involves the following: Tibial derotational osteotomy is a relatively safe procedure; however, as with any surgery, there are risks and complications that could occur, such as: 840 Winter Street A general or regional anesthesia is administered. In certain conditions, a technique known as osteostomy can be used as a way to realign the knee and take the pressure off from the damaged side. . In many areas, nonessential orthopaedic procedures that were postponed due to COVID-19 have resumed. 10). We want to know! My appointment with Dr. Vaksha was amazing. Recovery from osteotomy is typically longer and more difficult because you may not be able to bear weight on your operated knee right away. This procedure is employed at the early age of osteoarthritis, especially when one knee joint has already been damaged. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). The patient will be transferred to the recovery area to be monitored until awake from the anesthesia. Patients with additional surgery will progress at different rates. This will depend on what knee is affected. Most commonly, osteotomies about the knee are cuts in the top of the shin or "tibia" bone. Tibial osteotomy was first performed in Europe in the late 1950s and brought to the United States in the 1960s. Tibial derotation osteotomy was indicated if the painful and/or unstable patellofemoral syndrome was associated with least 20 of torsion, measured clinically and usually confirmed on computed tomodensitometry (CT scan). The staff is very professional and helpful. We've rounded up some must-know information about bunion surgery recovery. BC Children's Hospital. Accessibility The patient will be transferred to the recovery area to be monitored until awake from the anesthesia. Seems simple enough? endstream endobj startxref It is important to use opioids only as directed by your doctor and to stop taking them as soon as your pain starts to improve. Even though many patients will ultimately require a total knee replacement, an osteotomy can be an effective way to delay the need for a replacement. 2004 Nov;86(8):1170-5. doi: 10.1302/0301-620x.86b8.14479. Tibial derotational osteotomy is a surgical procedure employed to treat rotational deformities of the tibia, such as tibial torsion. government site. It is usually performed in arthritic conditions affecting only one side of your knee. measure angle between foot position and imaginary straight line while walking, angle formed by a line bisecting the foot and line bisecting the thigh, infants- mean 5 internal (range, 30 to +20), age 8 years- mean 10 external (range, 5 to +30), transmalleolar axis > 15 degrees internal. It is usually noticed at birth or early infancy. .elizabeth .thank you so much . Federal government websites often end in .gov or .mil. The patient should refrain from medications or supplements such as blood thinners, aspirin, or anti-inflammatory medicines for a week or two prior to surgery. ;OWSd"S7@YpB$v$exYe[*tYlvn[2l.v-O.+Y>}k~Nyw].eR+K8 My own experience with Dr karkare has been wonderful he takes his time with you listens to what you have to say and prescribes various treatments and is very caring I would highly recommend him to anyone I would give both doctors a 10 plus rating we are very happy with them the best. After the wedge of bone is removed, the tibia may be held in place with a plate and screws. This passes under the anterior compartment and the peroneal . Very friendly office and I'm glad to be a patient here. I was rear ended in an auto accident , Dr Vashka was recommended by a friend of mine .I was experiencing Back , neck , and shoulder pain . This surgery realigns the knee joint in people who have knee arthritis. x\rHr}W`-'{f7ffw( I he was amazing he made me feel very comfortable and explained everything that was going to happen from surgery all the way through my physical therapy highly recommend Dr. Vaksha. After the operation, you will most likely need to use crutches for several weeks. If more than 20 rotational correction of the tibia is planned, careful decompression of the peroneal nerve is essential in proximal tibial rotational osteotomies or, alternatively, a diaphyseal or distal derotation site should be chosen. It looks like your browser does not have JavaScript enabled. Tibial derotational osteotomy is a surgical procedure employed to treat rotational deformities of the tibia, such as tibial torsion. 27 0 obj <>/Filter/FlateDecode/ID[<853D954EE647498DB5D4F5938005C879><8A0528A33C7FA549B9CC69B8CC4D2B41>]/Index[10 34]/Info 9 0 R/Length 94/Prev 160785/Root 11 0 R/Size 44/Type/XRef/W[1 3 1]>>stream We work with organisations big and small To facilitate correct function in affected lower leg, To restore full muscle length and flexibility, To improve cardiovascular fitness and muscle endurance, Passive (assisted) range of movement exercises, Active (on your own) range of movement exercises, Compression and elevation (swelling and circulation), Passive and active range of movement exercises, Stretching and flexibility exercises for muscles in affected lower limb (hamstrings, calf muscles, tibialis anterior, quadriceps), Strengthening exercises for muscles in affected lower limb (hamstrings, calf muscles, tibialis anterior, quadriceps), Strengthening exercises for muscles in affected and unaffected leg (calf, hamstring, quadriceps, tibialis anterior etc). Dr Vaksha, is a great doctor very professional knows what he talking about. Well, bunion surgery removes the bump in the foot! You are encouraged to walk with assistance as frequently as possible to prevent blood clots. %PDF-1.5 % Rooms are clean, plenty of parking, physical therapy attached, Dr. Karkare and his staff are awesome. Our clinics are open: Calcific Tendinopathy of the Rotator Cuff, Medial Collateral Ligament Sprain of the Elbow, Entrapment of the Posterior Interosseous Nerve, Avulsion Fracture of the Ischial Tuberosity, Calcification of the Medial Collateral Ligament, Avulsion Fracture of the Base of the Fifth Metatarsal, Frozen Shoulder Release - Arthroscopic Release of the Coraco-Humeral Ligament, Rotator Cuff Surgery (Repair & Debridement), Lateral Epicondylitis Release (Tennis Elbow), Medial Epicondylitis Release (Golfer's Elbow), Micro-Fracture of an Osteochondral Lesion, Chronic Inflammatory Demyelinating Polyneuropathy, Difficulty With Fine or Gross Motor Skills, Benign Paroxysmal Positional Vertigo (BPPV), Instrument Assisted Soft Tissue Mobilisation (IASTM), Proprioceptive Neuromuscular Facilitation (PNF), Transcutaneous Electrical Nerve Stimulation (TENS), Hydrotherapy for Cardiovascular & Pulmonary Conditions, Hydrotherapy for Musculoskeletal Conditions, Constraint Induced Movement Therapy (CIMT), Post Surgical Rehabilitation for Children, Who is Suitable for Botulinum Toxin Injections, Who is Suitable for Thermoplastic Splinting, Non Invasive Positive-Pressure Ventilation (NIPPV), Instrument Assisted Soft Tissue Mobilisation, Increased endorphines, serototin, dopamine, Breakdown / realignment of collagen fibres, Who is suitable for our personal training.

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