Sports Performance Coach and Licensed Massage Therapist -- Patrick
Ward, MS CSCS LMT
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SPORTS PERFORMANCE COACH AND LICENSED MASSAGE THERAPIST
WHAT IS THE POINT OF AN EXERCISE DEGREE?
_by_ Patrick
I remember in high school, our teachers (and parents) drilled it
into our heads that, _“If you wanted go anywhere in life, you needed
to go to college.”_ Back when they were in high school, you could
get away with having a high school diploma. Soon, a bachelor’s
degree was (pretty much) necessary to get a job or interview. Now it
seems that you can’t stop there. If you really want to get ahead,
you need to go on and get a Master’s degree, and even that may not
be enough, as more and more people are opting to go ahead and get a
terminal degree in their desired field.
Understanding that some of us may spend anywhere from 4-10 years in
academia (and a life devoted to continuing education – if you are a
true professional), we had better choose something that we are
interested in! Personally, I can’t think of anything more
fascinating than studying exercise and how the body responds to
training. But, I often question the decision to spend your time
studying in an exercise-based field (exercise science, exercise
physiology, kinesiology). While it is interesting, is this really a
field that pays you back the amount time you put into it? I am
basing my observations on the current state of the industry, with so
much nonsense and certifications out there, it appears that other
allied health professionals look down upon those in this field and do
not take them seriously.
I am not writing this article to change anyone’s mind about
possibly studying in one of the fields. In fact, I couldn’t see
myself studying anything else. I am writing this in an effort to get
people thinking and hopefully someday help to progress the field into
a more professional role, and weed out the “certified trainers”
who are dumbing down the industry by doling out information that is
not founded on science.
What should be the role of an individual who has successfully
completed a curriculum in an exercise based field? If you ask me, I
would think that the individual is qualified, or at least should be
qualified, to be an expert on exercise. They should be the person
that people turn to in order to obtain information on exercise,
fitness, health and the way exercise can help them reach their
particular goals – weight loss, general fitness, sports performance,
rehabilitation (IE, bridging the gap between physical therapy and
getting back to normal daily function), etc. However, for some
strange reason, those who hold the exercise-based degrees seem to be
overlooked in areas where they can really make an impact.
WEIGHT-LOSS AND LIFESTYLE
Physicians would rather put their overweight clients on drugs
indefinitely for things like heart disease, diabetes, high cholesterol
or obesity; rather than sending that person to a qualified exercise
professional to help them get off their drugs (or at least lower them)
and live a more healthy life. Instead of these medical weight-loss
clinics, where patients are put on drugs and “special” 200-calorie
shakes three times a day, wouldn’t it make sense to create clinics
where those who have obtained a degree in an exercise based field work
hand in hand with registered dieticians to help educate the patients
on health, fitness, and lifestyle? And, instead of insurance paying
for drugs, actually paying for people to attend these clinics? Makes
sense to me!
GENERAL FITNESS
Given the current state of our nations health, I would think that
the medical community would be focusing more on preventative measures
to help people understand overall health and wellness. Doctors can
write prescriptions and insurance companies will reimburse all year
long for drugs, yet they haven’t tapped into the importance of
preventative medicine yet. Wouldn’t it be great if people could
get their health insurance to cover some general health and
exercise? Something as little as a training session 2x/month with a
qualified professional could be just what the person needs to help
develop a plan and ensure that the plan is not only safe and
effective, but also efficient so that the person is not just wasting
their time (how many people do we see in the gym just wasting
time?). If the insurance companies would cover something like this,
wouldn’t more people take advantage of it? Would we see changes in
the overall health of adults and children in our country?
It is a shame that those who have spent time studying in an
exercise-based field are not looked at as professionals in this
instance to help promote health in the medical community. Especially
since doctors get so little training, and often times no training, in
exercise prescription. Have those who went to school not earned this
qualification? What was the point of their degree if they can’t
even use it properly?
REHABILITATION
This is one that often has me shaking my head. I find it hilarious
that places like physical therapy clinics and chiropractic offices do
not have a resident exercise specialist. These clinics will often
have some sort of aide, like a physical therapy tech or a chiropractic
assistant, who is put into the role of helping the patient go through
their exercise routine. The individuals in this position are
typically compensated anywhere from $8-12/hours and usually don’t
need any sort of special qualifications to obtain one of these jobs.
WOW, talk about a slap in the face to real people who actually studied
this stuff in a college or university!
I remember seeing an ad on craigslist for a chiropractic office
looking for an exercise therapist. The pay was $15/hour. What a
joke! If I put an ad on craigslist for a chiropractor to work at my
facility and offered to pay them $15/hour, my inbox would be flooded
with hate mail. In addition, the ad went on to state, “No
experience necessary. We’ll train the right candidate.”
HAHA. I don’t know what is more funny, the pay or that last
statement?
Maybe funny is the wrong term? Maybe offensive should be the
proper term? I mean really, that is incredibly offensive. I guess
they just need someone to run people through a simple exercise
progression so that they can bill the insurance company for one more
thing? Always looking to make a buck! Lets see, we can bill for
our adjustment, electrical stim, heat, exercise therapy, soft tissue
therapy and then hopefully we can sell them some of our fake herbal
crap supplements as they walk out the door, and if they are really
naïve, maybe we can get them to pay cash to sit in our “energy
garden”.
People need better exercise prescription following rehab. This is
where the exercise professional should come into play! The side
lying hip abduction and thera-band external rotations are only going
to take the patient so far. How does that prepare them to get back
to normal life? How does that enhance their overall movement and
function? Wouldn’t it make sense to have a qualified exercise
professional on staff to help teach people quality movement? I hope
this doesn’t offend anyone, but I haven’t met too many physical
therapists out there that could coach or cue a real exercise (not that
scaption raises and glute bridges aren’t real exercises). While
there are some therapists out there who are incredibly knowledgeable
about exercise (and I am grateful that I have had the opportunity to
work with and learn from some of them), most cannot write a training
program to save their lives and don’t understand simple progression
and periodization principles. Yet, people look to them for exercise
prescription following therapy, and while they are rehab specialists
most are not exercise specialists. Like I stated earlier,
shouldn’t there be an exercise professional to help bridge the gap
from rehab too real world? And, doesn’t it make sense that the
individual in this position should have at least a 4-year degree and
paid a normal salary that any other professional would be paid, rather
than an hourly wage that can be made at Starbucks?
I hope this article helps people see the possibilities that those
who choose to study exercise in college can have within the medical
community. Unfortunately, those who have spent time studying in this
field are often not taken seriously, and there are even those who have
gone on to get Master’s degrees and PhD’s in this subject and they
are still compensated poorly for the knowledge they have. Yet they
could be used so much more efficiently as an allied health provider.
I hope someday that the profession can advance and those who are
exercise professionals can take a more active role in various health
arenas.
After all, what is the point of the degree, if you can't do anything
with it?
Patrick
May 24, 2009
DON’T LET THE KNEES PASS THE TOES OTHER SQUATTING MYTHS
_by_ Patrick
Don’t Let the Knees Pass The Toes however, safe depth is often
argued between strength coaches and athletic trainers. It is
typically understood that patellofemoral joint forces are increased
during the eccentric portion of the squat at greater angles of knee
flexion. A 2001 study published in _Clinical Biomechanics_ looked at
patellofemoral joint kinetics during three different squat depths (70
degrees, 90 degrees and 110 degrees of knee flexion). Researchers
Salem and Powers hypothesized that patellofemoral joint reaction force
would increase with increased knee flexion; however, patellofemoral
joint stress would remain constant through the greater squat depths.
They based this hypothesis on the idea that with increased flexion,
patellofemoral joint contact area has also been shown to increase in
previous cadaveric studies, leading them to believe that increased
joint contact area would better distribute joint force over a larger
area and maintain or potentially decrease patellofemoral joint stress.
Before continuing, I should note that a squat to 70 degrees of knee
flexion is about a quarter squat, a squat to 90 degrees of knee
flexion is a half squat and a squat to 110 degrees of knee flexion
would be closer to a full squat (IE, femur parallel to the floor).
Out of the three depths, 70, 90 and 110 degrees, the full squat (110
degrees) produced the highest amount of patellofemoral joint reaction
force (5097.1 N). However, this was not found to be statistically
different than the joint reaction force of the 70-degree shallow squat
(4319.2 N) or the 90-degree half squat (5065.7 N). Similarly,
patellofemoral joint stress was greater in the 110-degree squat (12.3
MPa), however, this again was not statistically different than the
70-degee (10.8 MPa) or 90-degree (11.7 MPa) squat.
From this study, it appears that the consistent knee extensor moment
created little variation in patellofemoral joint force or stress when
squatting from 70 to 110 degrees of knee flexion. This led Salem and
Powers to conclude, _“The results of this study do not support the
premise that squatting to 110 degrees places greater stress on the
patellofemoral joint than squatting to 70 degrees. These findings
may have implications with respect to safe design of athletic training
regimens and rehabilitation programs.”_
LEG PRESS AND HACK SQUAT ARE SAFER THAN BARBELL SQUATS!
Gym goers and personal trainers tend to favor things like the leg
press, hack squat machine, and smith machine over the regular barbell
squat stating that, “they’re safer than regular squats”. In
addition, many rehab clinics have a leg press machine or some sort of
total gym machine (which behaves similar to a hack squat), or they
teach their patients to squat with their back against a stability ball
placed against the wall (wall/ball squat). While I don’t deny that
in a rehab setting these options may be necessary for some, it should
be the goal to eventually progress the patient from the controlled
environment of the leg press or wall/ball squat to a free standing
squat (even if it is just body weight). The goal of rehab should be
to rehabilitate the patient back into normal life. By having them
only leg press or wall/ball squat and telling them to not perform
regular squats ever again because they are “unsafe”, is doing the
patient a total disservice since they will need to call on this
pattern at some point in their daily activities.
Escamilla et al., looked at knee forces and muscle activity during a
squat and leg press under a variety of technical variations using a
load equal to the subjects 12RM. The squat variations included a
squat with a narrow stance or a wide stance and with feet pointed
either straight ahead or externally rotated to 30 degrees. The leg
press variations included a leg press performed with the feet high on
the footplate or the feet low on the footplate. In addition, the
subjects were asked to use both a wide stance or a narrow stance in
both the high and low foot placement.
Co-contraction of the quadriceps, hamstrings and gastrocnemius is
extremely important for stability of the knee and has been shown to
help decrease stress on the anterior cruciate ligament (ACL). During
the knee extension phase of this study, the squat displayed a greater
co-contraction of these muscles than leg press at either the high or
low foot placement, implying that _“the squat may be a more
effective exercise for quadriceps and hamstring development compared
with the leg press.”_
However, while ACL forces were not produced in either the squat or
leg press variations (which may be due to hamstring activity),
posterior cruciate ligament (PCL) forces were greater in the squat
compared to either leg press variation. This could have specific
implications for individuals who are rehabilitating a PCL strain.
Patellofemoral compressive forces were increased at great angles of
knee flexion for both the squat and the leg press. This was shown in
the study discussed in the previous section by Salem and Powers.
Escamilla et al. state, _“Performing the squat, leg press high and
leg press low within the functional range of 0-50 degrees may be most
active for athletes or patients with patellofemoral pathologies.
However, performing the squat, leg press high and leg press low at
greater knee flexion angles may not be problematic for athletes with
healthy knees as long as healthy loads are not used exclusively.”_
I wonder about their 0-50 degrees of squatting recommendation, as
that is an extremely short range of motion to go through. That is
even less than the 70-degree squat used by Salem and Powers. In
addition, if the athlete or patient is rehabilitated properly, should
they not be able to squat to appropriate depths, given the fact that
at the greater knee angles more muscle activation should occur. This
would probably be up to the rehab professional or maybe even the
trainer working with the client as to understanding progression and
knowing when the individual is ready to move forward with their
training program, rather than just doing the same thing over and over
and becoming stagnant. Anecdotally, I have improved squat range of
motion in clients I have worked with and myself, after suffering from
some knee issues in the past. The quote above does imply that knee
ranges of motion during the squat or leg press will vary given the
individuals specific condition (IE, limitations for those with
pathologies and normal ranges of motion with those who are healthy),
however, would proper squat depth right off the bat, when the
individual is not pathological, help to prevent these pathologies from
occurring? I would think so!
The researchers go on to conclude that, _“The greater muscle
activity and knee forces in the squat compared with the leg press low
and leg press high implies that the squat may be more effective in
muscle development but should be used cautiously in those with PCL and
patellofemoral disorders, especially at greater knee flexion angles.
Because all forces increased with knee flexion, training within the
functional 0-50 degree range may be efficacious for those whose goal
is to minimize knee forces. The lack of ACL force implies that all
exercises may be effective during ACL rehabilitation.”_
A more recent study (2009) by Escamilla et al. compared
patellofemoral joint force and stress between a one-leg squat, a wall
squat with the feet close to the wall, and a wall squat with the feet
further from the wall.
For those that are unfamiliar, the wall squat is a squat performed
with the back against a wall. This is similar to the wall/ball squat
and the position is also similar to a hack squat or total gym squat in
that the feet are typically out in front of the torso rather than
centered underneath it, which changes the mechanics of the squat
greatly. This is also the way that some choose to perform their
smith machine squats, which is nothing more than an accident waiting
to happen in my opinion. In this study, the wall squat was performed
while holding dumbbells down at the side. A towel was also placed
between the lifter and the wall in order to prevent friction and allow
for a smooth squat movement.
While discussing the one-leg squat in the introduction of this
paper, the researchers note, _“Performing a one-leg squat also
causes the stance knee to translate forward beyond the toes at the
lowest position of the squat. Clinicians and trainers often believe
that anterior translation of the lead knee beyond the toes during
squatting type exercises increases patellofemoral joint force and
stress, but there is currently no evidence to support this belief.”_
The wall squat long and short exercises both produced higher
patellofemoral joint forces and stress when compared to the one leg
squat. The wall squat short also produced a higher amount of force
and stress at a 90-degree knee angle when compared to the wall squat
long. This was thought to occur because the knees in the wall squat
short went further passed the toe, changing the direction of patellar
tendon force and potentially increasing patellofemoral force, than in
the wall squat long, where the shins remained fairly vertical.
However, the knees also migrated passed the toe a similar amount in
the one-legged squat, but this exercise produced less joint force and
stress than the wall squat short. The cause of this was the greater
amount of quadriceps force during the wall squat short. The
quadriceps force was approximately 30-40% greater at 70-90 degrees of
knee flexion in the wall squat short compared to the one-legged
squat. In addition, at those same knee angles (70-90 degrees)
hamstring force in the one-leg squat was 60-70% greater in the one-leg
squat! The researchers made some extremely important observations:
1) The increased quadriceps force and decreased hamstring
force it the wall squat short is due to the fact that the trunk is
erect in the wall squat and is tilted approximately 30-40 degrees in
the one leg squat.
2) The wall squat required a greater amount of knee extension
because the erect trunk produced a line of force from the center of
mass (the lifters mass plus the dumbbells held at the side) decreasing
the ability of the hip extensors to contribute.
3) The forward trunk tilt in the one-leg squat produced a
line of force from the center of mass which allowed for a larger hip
extension contribution
These three points are critical because they highlight the
importance of maintaining the center of mass over the base of support
(which takes place in a normal squat). In a hack squat, wall squat,
wall/ball squat, total gym machine squat, or the way some perform a
smith machine squat, the center of mass is displaced behind the base
of support (the feet are out in front) which does not adequately allow
the hip extensor mechanism to contribute to the movement.
The researchers went on to conclude that, _“Except at 60 and 90
degree knee angles, patellofemoral joint forces were similar between
the wall squat short and the wall squat long. Between 60 and
90-degree knee angles, wall squat exercises generally produced greater
patellofemoral compressive force and stress compared with the one-leg
squat.”_
CONCLUSIONS
Clearly it appears the myths surrounding squats are not founded on
scientific information, but rather anecdotal evidence passed down from
teacher to student in classrooms all over the world.
Squatting is safe and is an extremely important movement for
everyone to learn as it is performed frequently in our daily lives
(just think about how many times a day you sit down to your computer
desk and then get back up).
Obviously there are specific instances where squatting may be
contraindicated for certain individuals and it is up to the clinician
or trainer to understand their client and screen out any potential
factors that may prevent the client from safely performing a squat.
As the research suggests, those with specific knee pathologies may
benefit from a reduced range of motion. However, I would argue that
the rehabilitation program should focus to rehabilitate the patient to
safely performing a squat down to a depth that would be needed in
daily life, for example, sitting down to a chair, which is probably
right around 90 degrees of knee flexion if not a little more.
I should also note that back squatting might not be appropriate for
every client. Often times, physical therapists and rehab
professionals here the word “squat” and immediately think of
someone with a load of weight on their upper back, which is why they
may shy away from this exercise for their patients. Squats can be
performed a variety of ways – front squat, back squat, trap bar, DB
squat, kettlebell squat, as well as any of the several single leg
variations, such as split squats, lunges, Bulgarian squats, or 1-leg
squats. It is important to emphasize that people should first be
taught how to squat with just their body weight, as this is an
important pre-requisite to loading the client.
If you are still doing curls in the power rack, chances are this
paper just went way over your head.
References
Fry AC, Smith JC, Shilling BK. EFFECT OF KNEE POSITION ON HIP AND
KNEE TORQUES THE BARBELL SQUAT. _J Strength Cond Res._ 2003;17(4):
629-633.
Salem GL, Powers CM. PATELLOFEMORAL JOINT KINETICS DURING SQUATTING
IN COLLEGIATE WOMEN ATHLETES. _Clinical Biomech._ 2001;16:424-430.
Escamilla RF, Fleisig GS, Zheng N, Lander JE, Barrentine SW, Andrews
JR, Bergemann BW, Moorman CT. EFFECTS OF TECHNIQUE VARIATIONS ON KNEE
BIOMECHANICS DURING THE SQUAT AND LEG PRESS. _Med Sci Sports Exerc._
2001;33(9):1552-1556.
Escamila RF, Zheng N, Macleod TD, Edwards WB, Imamura R, Hreljac A,
Fleisig GS, Wilk KE, Moorman CT, Andrews JR. PATELLOFEMORAL JOINT
FORCE AND STRESS DURING THE WALL SQUAT AND ONE-LEG SQUAT. _Med Sci
Sports Exerc._ 2009;41(4):879-888.
ABOUT THE AUTHOR
_Patrick Ward holds a Masters Degree in Exercise Science. He is a
Certified Strength and Conditioning Specialist (CSCS) through the
National Strength and Conditioning Association (NSCA) and a USA
Weightlifting-Certified Club Coach. In addition, Patrick is a licensed
massage therapist focusing on Neuromuscular therapy and Active Release
Techniques (ART). He lives in Chandler, Arizona and is the owner of
Optimum Sports Performance () and the Co-founder of Reality Based
Fitness (). He can be reached at
patrick@optimumsportsperformance.com._
© OPTIMUM SPORTS PERFORMANCE LLC, 2009.
May 19, 2009
TIPS TRICKS FOR A CLEANER CLEAN
_by_ Patrick
Here are a few of the tricks I use to help people quickly learn how
to perform hang cleans. Hope you guys like it!
Patrick
patrick@optimumsportsperformance.com
May 17, 2009
HIGH SCHOOL ATHLETE TRAINING PROGRAM
_by_ Patrick
I have been getting a number of emails lately about training for
high school athletes, so I decided to give an example training day for
one of my clients.
He is a 16-year old high school athlete with no lifting
background. You will see that the program is nothing fancy, but
rather, a healthy dose of the "basics".
WARM UP
We always start with a full body warm up which moves from slower
movements to more complex movements. The first part of the warm up,
I have him do some core stability exercises as a way to just gain
"awareness" with regard to his body and get the muscles prepared. We
then move to our dynamic warm up and then finish with some easy
plyometric or explosive movements before moving to the lifting.
_A typical warm up may look like this:_
Plank
bird dogs
side planks
Body weight squats
Body weight squats to toe raise
Walking knee hugs
Walking heel to glute
Forward lunge
Side lunge
push ups
face pulls
jumping jacks
squat jump stick the landing or some kettlebell swings
RESISTANCE TRAINING
Next we move into our lifting and this is where we stick to the meat
and potatoes. I actually have him perform the olympic lifts and
front squats (as part of a complex with his cleans) each session to
help drill technique. We start with the snatches first and then, as
we add weight to the bar, we move up to cleaning the weight, 2 reps
followed by 2 front squats. For beginners, it is important to keep
things consistent, and since the olympic lifts and front squats are
crucial to his development, we do them every time.
_Here is an example of a training day:_
1) Hang Snatch - 4-6 sets x 2 reps (I have him perform some hip
mobility drills in between sets here)
2) Hang clean + Front squat - 4-6 sets x 2+2
3a) Step Back lunge - 35-6
3b) Chin up - 35-6
4a) DB bench press - 35-6
4b) Half kneeling chop - 310
STRETCH
We always finish with some flexibility work
There is nothing fancy about the workout. We do the basic
exercises and we work on being very good at them. If need be, I do
some soft tissue work to try and free up restrictions and enhance his
overall movement. The goal is to keep things simple and allow him to
concentrate on a few key movements (the olympic lifts and front squats
are the critical ones) so that when we progress to more advanced
training he is technically proficient.
Hope that gives everyone some ideas.
Patrick
patrick@optimumsportsperformance.com
May 15, 2009
SHOULD PERSONAL TRAINING BE REGULATED?
_by_ Patrick
The is a company that specializes in marketing and business
strategies for the health and fitness industry. In their blog this
month, they are running a poll on whether or not the personal training
industry should be regulated. Click to see the poll and/or cast your
vote.
I think this is an extremely important question and quite honestly,
I feel that the personal training industry should be regulated in some
way.
I think it is silly that students can spend thousands of dollars
earning degrees in exercise science, exercise physiology or
kinesiology and when it comes time to apply for a training job at a
gym, those degrees are pretty much worthless as the gym is more
interested in whether or not you have a specific certification (the
certification that the gym chooses to endorse is probably centered
around some sort of affiliate kickback). They gym is more interested
in whether you took a weekend course and can answer questions like:
_Which of the following is a macronutrient?_
_a) Water_
_b) Chocolate_
_c) Protein_
_d) All of the above_
And yes, that is a real question from one of the _top_ certifying
bodies in the country. Seriously, WHAT A JOKE!
I feel that with some regulation, we can start to weed out the
people who not only are clueless as to what they are doing, but don't
care to learn or advance their knowledge in anyway. I base my
opinion on the nonsense that I see going on in the gym when I go
workout.
- Trainers with fat loss clients working on biceps and triceps for
an hour.
- Trainers not being able to teach a squat, lunge, deadlift or push
up properly.
- Trainers relying on machines rather than teaching exercises where
the client has to actually move their body through space against
gravity.
- Trainers not understanding assessment and how to determine what is
appropriate (or not appropriate) for a given client.
- Trainers who do the exact same workout with all of their clients.
- Trainers who don't understand anatomy and physiology and cannot
properly communicate with doctors, physical therapists or
chiropractors about the best way to properly integrate a specific
client back into an exercise program following an injury.
- Trainers who don't understand simple concepts of program design
and how to properly set up a training plan for the client.
The list goes on and onYOU KNOW WHO YOU ARE!
Now, this is not to say that getting an education from a school or
university automatically makes you superior or knowledgeable. I have
met several people who have degrees from universities who don't
understand any of the things that I discussed above. On the flip
side of that, some of the smartest people I know have no degree in the
exercise field; however, they were motivated enough to read textbooks,
attend workshops and learn as much as they possibly could about
exercise, physiology and science.
This is true in every field, even those that are heavily regulated
like the medical field, physical therapy, and chiropractic. There
are good and bad in each of those fields, even though they all have
gone through the same amount of schooling (relatively) and have passed
the same types of board exams. One thing that sets those fields
apart from the exercise field is that the students actually have to do
residencies, clinicals, precticums or internships to help them gain
real-world experience. The majority of those in exercise-based
programs around the country simply take the necessary courses, they
may work in the rec center at the college training people (which is
hardly an internship or learning experience), and then they graduate
with their degree. Shouldn't these students be spending time working
with industry professionals, learning the "in's and out's" of how to
work with a client and properly develop an exercise program?
I think that some sort of regulation would be great for the fitness
industry as it would not only raise the bar as far as the people
coming into the field, but it would give the field a lot more
credibility and make it a lot less of a "joke". One large certifying
body would ensure that we are all on the same page with regard to
education (as opposed to the hundreds of certifications which all have
their own idea of how things should be done), it would establish
personal trainers as credible experts on exercise and it would ensure
that we all maintain a certain level of education and stay on top of
current trends and science with specific continuing education demands.
What do you guys think?
Patrick
patrick@optimumsportsperformance.com
May 12, 2009
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