aka 5 Pet Peeves of Every Healthcare Provider

1.       SPILL THE BEANS ALREADY.

Picture the last time you were in a waiting room and they were "running behind." You often blame it on "overbooking" but did you know the number one reason providers run behind is because of their patients? Have you ever noticed the first thing a doctor asks when they walk into the room is typically: "How are things going? Has anything changed?" This is on purpose. New pain, changes in pain, or new conditions require more time (and sometimes an exam) to determine their cause. Your appointment is scheduled for a specific amount of time before the next patient. Your provider plans their best of use of every time from the second they walk into that room. If you leave that new condition to the end you leave us with a variety of unpleasant choices: push our other patients back and run behind our schedule (who likes sitting in a waiting room?), rush through and possibly miss something, or put it off to the next visit (who wants to spend an extra visit and/or be sent out while still in pain?)

2.       DIDN'T MOM EVER TELL YOU SECRETS AREN'T NICE?

Did you know that GI symptoms (diarrhea, gas, constipation, etc) may be related to some forms of arthritis? Did you know that changes in bowel or  bladder habits with a low back injury is a sign of a very, very serious medical emergency? There are hundreds of other examples. While you may feel embarrassed about talking about your bowel movements, you shouldn't- trust me....we've heard it all! You may not think they are related, and maybe they aren't- but you are always better to tell your provider absolutely EVERYTHING and let us decide if it's relevant- that's why we went to so much school!

3.       THIS IS NOT BURGER KING, YOU DON'T GET IT YOUR WAY (Sorry!)

We LOVE it when our patients want to get involved in their care and you're on board with your treatment plan. We LOVE to see patients excited about their health. That being said, it can be a struggle when a patient walks in and says: "this is what I have and this is what I need." You may be completely right, and it helps to have that input- nobody knows your body as well as you do; but keep an open mind. The entire goal of seeing a provider is to capitalize on their expertise and get back to health as quickly as possible. When a provider incorporates other techniques or options into your treatment plan, don't take it as if they weren't listening. You're provider is usually looking out for your best interest and not all techniques/options are right for all people.  It's called a doctor-patient relationship for a reason....and you should absolutely be involved in your care. If you aren't comfortable with a technique or have questions- speak up!!! We'd rather answer questions and make sure you understand why we are doing what we are doing than have you go home frustrated!

4.       JUST BECAUSE YOUR NEIGHBOR HAD IT DOESN'T MEAN YOU DO TOO.

We've all done it. Bob next door has a low back injury with leg pain, he says: "It's sciatica." Several days later you awake with leg pain. It must be sciatica too. Except for the fact that our leg pain is in a completely different area and doesn't involve the sciatic nerve at all. The best guideline is to seek care if you are in pain, regardless of what your neighbor has. Maybe Bob's "sciatica" got better without treatment; what if your case requires early care and you put it off? It's easy to miss something or over-diagnose just because of what is going on around us. 

5.       WEB MD DOES NOT ACTUALLY HAVE A MEDICAL DEGREE.

While the internet is a thriving source of information and WebMD or mayoclinic.com can have some good information about conditions, it's not exactly a replacement for professional medical advice and care. Treatments are much less effective when conditions are improperly diagnosed and many treatments may actually make the problem worse. In addition, most conditions become harder to treat and will require more treatment (either more aggressive or more frequent= more expensive!) the longer they are allowed to fester. Heaven-forbid something more serious is underlying your pain- the sooner it is diagnosed and treated, the better the outcome. Period. A proper diagnosis is the #1 battle, so don't risk losing the war! 

 
 
I'm already seeing patients fighting colds and immune systems firing up. There are obvious ways to help fight off those pesky winter bugs- from washing your hands thoroughly and regularly to disinfectant sprays and hand sanitizers. But so many people forget about the most important steps! Sleep exercise, diet, and even Chiropractic Adjustments all play a role in the health of your immune system!

SLEEP- While adequate sleep is obvious, we all get caught up in busy daily life. Make sleep a priority. You should feel well-rested when you awake. Sleep allows your body to replenish immune and blood cells.

DIET- This becomes a little more detailed.  Your immune system relies heavily on the nutrients you put into your system daily; deep fried chicken, fast food lunches and ice cream don't exactly pack a punch in the nutrients your body needs! To keep it very basic, your body especially needs vitamin C, vitamin A, Zinc, and Selenium. The best foods to stock up on are leafy-green veggies, and a variety of bright colored fruits and veggies. The more variety you can get from fruits and especially vegetables the better nutrient variety you get. Make it a goal, one big salad every day is a great place to start! A high-quality multivitamin to supplement what you don't get is also a big help, but don't rely fully on this. Your body will more readily absorb and use nutrients from food before a supplement. So use it as it was meant- as a supplement!

EXERCISE- Again, this is very detailed. High-intensity workouts, training for sporting competitions, or "weekend-warrior" workouts actually make your body more susceptible to infection until you have recovered. So be careful, during a competition season is the time you need to be most diligent with all of your preventative steps! Regular and moderate intensity exercise, however boost the immune systems surveillance and response to invaders. As with typical exercise recommendations, change your type of workout every 4-6 weeks. As your body adapts to your workouts, so does your immune system!

CHIROPRACTIC ADJUSTMENTS- This is often an overlooked step. While your immune system has two "sides," one side is heavily controlled by your nervous system. The nerves which carry the information to up regulate your immune response sit just in front of the spinal column and/or exit the spinal column to get into the periphery. Chiropractic manipulations influence and affect the nervous- hence being such a safe and powerful tool! This is no exception. By normalizing the nervous system information and stimulating specific areas of the nervous system we can actually increase your body's immune response.

While this article touches on the very basics of steps you can take to help prevent getting sick, catching a cold isn't always completely avoidable. Stay tuned to the best recommendations when the sniffles do hit! For more information on the details of how the immune system works, also read THE IMMUNE SYSTEM: DEMYSTIFIED. 

 
 
I apologize it has been so long since I have written. I plan to begin posting more regularly again on a variety of topics- if you have anything in particular in mind, please send the request to my email at: drtmiller@millerswc.com.

As many of you know, the past several months have been full of changes. In an effort to better serve our patients and improve our care, you will find many new features in our office and some big changes coming soon. To help keep you up-to-date, here is just a sampling:

We changed our billing procedures. All billing requiring insurance now uses a company called ChiroBill, located right here in southeast Wisconsin. This allows for more timely and accurate billing. Any services which are paid at the time of service are still managed in our office.

You'll see two new faces in the office: Cori just graduated Homestead High School and will be pursuing her college degree in the fall. Susan is a Chiropractic Technician and is continuing her education in the clinical sciences.

We've extended our office hours due to high demand. Over the past several months, we've added 5 additional hours to Mondays, Tuesdays and Thursdays!

We have a new online scheduling system. We've received great feedback from you about the ability to schedule online. This new system is easy to use and allows a realtime look at our available schedules. 

We've upgraded our phone system to better assist your needs. 

And the real big one.......long awaited......we have a NEW LOCATION!!! It's been in the works for a while, and as many of you know we have been searching for the perfect new home. Now we've found it. We will be moving to 3400 S. 103rd St, Suite 300, Greenfield WI 53227. We expect the move to occur in mid-August. Construction is rolling, but as we know more we will keep you up to date!


I'd like to thank all of my patients for their support and understanding as we grow, change, and improve as a company. I know change is hard, but we're trying to make it all for the better!
 
 
HOW LONG SHOULD I WAIT AFTER AN INJURY TO GET CARE?
         
Unless your injury is truly minor and will heal completely by itself in 2-4 days, the answer is almost always - DON'T WAIT! Evaluating an injury quickly will not only reduce the severity of the injury and speed healing, but will also typically save you money! Here's why: Inflammation. What's Really Wrong? Pain Cycles. Compensations.

INJURY AND INFLAMMATION 101

When you have any type of injury, some cells are broken open and damaged. This damage releases chemical messengers into the body and to the brain to "send reinforcements" to begin healing the area. Some of these chemical messengers are toxic and irritating- they irritate nerve endings causing pain and can irritate or damage the surrounding tissues. This is a process known as inflammation. Bruising, swelling, pain, redness and heat are all signs that inflammation is occurring.

Overall inflammation is a good thing. It causes nutrients, oxygen, blood and building blocks for new tissue to be sent to the area. The problem is controlling this inflammation.

SECONDARY DAMAGE.

The body goes into hyper drive! As all of these new products are sent to the area, the lymphatic system (the structures that work like sewers to drain away the "waste" and damaged tissue) can't keep up. You get one huge traffic jam. As congestion builds, pressure builds up and begins causing damage to the surrounding tissue (this is combined with irritation and damage still occurring from those previously released chemicals). As this damage occurs, more chemical messengers are released. Snowball!!!

REASON #1: Stop the inflammation and prevent Secondary Damage.

This is the premise behind RICE: Rest, Ice, Compress, and Elevate. These are very important to quickly control the inflammation and reduce the secondary damage!

There are also many additional treatment options to reduce inflammation quickly. Kinesiotape, electrical stimulation, lymphatic massage, ART....the list could go on and on. The sooner we are able to address a problem, the less inflammation is allowed to persist. Decreasing inflammation means decreasing secondary damage. Decreasing secondary damage means actually reducing how severe the injury could have been.

REASON #2: WHAT'S REALLY WRONG?

This one seems obvious, but many serious injuries are often overlooked thinking the injury is something else. Some of those more serious injuries may require special treatments, or may actually get worse with some treatments that are otherwise recommended. The longer the big injury goes untreated, the higher the risk of long-term problems and even disability over time.

For example....Did you know there are 5 common sites of ankle fractures connected with simple ankle sprains? And one isn't even in the ankle- it's in the knee! So if you aren't looking for it, it's likely to be missed. And contrary to popular belief, most people can walk on several of these fractures! There are also 6 commonly sprained ligaments in any ankle sprain. Treatment is very, very different depending on the location and severity of fracture or sprain. Three of these common injuries, if left untreated will result in needed surgery- when they could have been corrected simply with early treatment!

Needless to say: A quick exam to rule out the scary stuff is well worth your time and money!

REASON #3: PAIN CYCLES

Your body is much smarter than most of us give it credit. It actually learns patterns and forms habits. Two of these patterns are pain cycles and compensation patterns.

As your nerve endings are irritated with chemical messengers, or have been damaged themselves the obvious occurs- you experience pain. Like any information carried through your nervous system, the signal is transported up the nerve and "synapses" with the next nerve. It continues "leap frogging" or "synapsing" with each new nerve until it reaches the brain.

Every time a synapse is used to transport information, that connection becomes reinforced. That connection becomes stronger every time a signal is relayed. What happens when that signal is relayed constantly for 3 weeks, 3 months, 3 years, before you decide to do something about it? It becomes infinitely stronger and more difficult to break. This is known as a pain cycle.

This is one reason why we may be able to treat an injury completely in one visit immediately after the injury occurs, but the same injury may take weeks or months of treatment to respond if the condition has been there a long time. Needless to say, again, a quick evaluation and treatment early on will save you time....and money......in the long run!

REASON #4: COMPENSATIONS

As I said above, the body is smart! The second type of learning it does with an injury is learning compensations.

How many times have you sprained an ankle only to find your other leg begins to hurt, or your knee, or your back? Your body doesn't like pain and will do anything to get away from it- even without you knowing. Your gait with change, you will use your arm differently, etc.

These changes, known as compensations increase the amount of strain on other tissues, joints and ligaments. Similar to pain cycles, every time you use the new pattern- that pattern is strengthened. Overtime, the body forgets how to use "normal" patterns. Overtime those tissues are not designed to withstand the types of forces they are being subject to. Overtime they break down, stop working or cause pain themselves.

Controlling pain quickly and treating an injury appropriately and completely discourage compensations from occurring.  The last thing you want to do is spend time, energy, pain and money addressing a second, third or fourth problem all because you didn't take care of a simple injury to begin with!

SUMMARY: Evaluating and treating an injury quickly and completely will save a lot of pain and hassle in the long run. If you are even unsure if an injury needs to be treated, assume that it does. At the very least, you will avoid future injuries and potentially costly treatments and learn something about your body in the process!

 
 
Have you ever wanted to network with other companies, meet new people, spread the word about your business? Try this FREE EVENT! (& free coffee!)

If you RSVP on this link by March 16th. Guest speaker Gail Olsen will be discussing the Health Care Reform and how it could and will affect you! Click on this link to learn more and sign up today!

http://www.intouchprofessionals.com/opennetworking.html
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How do you feel about the five finger Vibram shoes?  Good idea?  Waste of money?  Do you own a pair?  Have you thought about it? 

Leave a comment and let us know how you feel about them!  Tell us what you really think - you can even be anonymous if you'd like!

Then take a look at this website (click HERE) and see why the U.S. Military has banned them.   There's two sides to every story though.  There's also the "If it isn't broken, don't fix it" attitude as the Running Jackalope says!  Or look HERE to see Vibrams in the news and who's wearing them!

Whatever you decide,

 
 
As a wedding gift, my husband took me to get my first pair of (affectionately termed) frog shoes; aka Vibram Five Fingers. He had read about them and had a good friend who had recommended them; he knew I would be intrigued and he was right. I threw myself head first into evaluating every aspect of this new "biomechanical wonder."

                 I was skeptical, to say the least. I had heard all about the barefoot movement and minimalist shoe design. I had read articles both for and against this concept; and I still debated whether this was a fad or something that would change biomechanics forever. I had new reason to objectively re-evaluate the literature and have lengthy discussions regarding the underlying biomechanics with my mentor and good friend.

                I had already been doing my foot fitness from years of previous injury and my own biomechanical deficiencies. I thought I was ahead of the game, and wore them immediately.  I was shocked how different they were and how far I still had to go! Over the next several weeks, I attacked my foot fitness with a new energy and very gradually increased my use of the shoes in my workouts and daily life.

                By the time of our wedding, I had strengthened myself to wearing Vibrams all day, every day without complaint; in fact they were starting to become more comfortable than regular shoes. While on our honeymoon, we went for a very rigorous canyon hike, on very uneven and difficult terrain. After ten hours of difficult hiking, I finished strong and felt as if I could do it all over again- right away. I was shocked that for the first time of long duration, strenuous activity I had no joint aches or pains and my feet didn't even feel tired!

                I was beginning to believe that maybe there was something to this new movement. When we returned home, I scoured for information from reputable sources. I realized there was overwhelming evidence that those who are good candidates, should convert to a "minimalist" or "barefoot" style of training. Not only for running, but fitness as well.

                For thousands of years we roamed the forests and our feet were forced to grip and bend with every step. Most of us have been in shoes since we began walking. Our feet only grip a flat, solid surface and rarely if ever bend because of the rigid soles. Many people know they "overpronate" and therefore are told they need a specific shoe to correct it. We rely on "arch support" or on stabilizers to prevent our ankles from rolling. The result is weakness, stiffness, and often injury.

                Over the past few decades the choices in footwear and athletic footware have skyrocketed. Yet, there has been a consistent increase in foot and ankle injuries from ankle sprains, metatarsalgia, plantars fasciitis and even stress fractures. Current research is now suggesting it is because we have outsmarted ourselves and need to go back to the basis. This is the foundation of "minimalist" shoes. They are designed to allow foot movement and encourage gripping and proper foot musculature, just as our feet have done for ages. 

                There are many factors which determine whether barefoot training is the best option for you. For most people minimalist shoewear is the best option, but you must first do your homework.  Jumping into a minimalist shoe without properly training your feet first is a recipe for disaster. Gradually increasing your use, and combing the appropriate foot strengthening will help reduce your risk of injuries associated with minimalist shoes. A complete evaluation  is needed to help determine your foot movement, foot strength, natural biomechanical tendencies, and any residual problems from previous injuries.

               
                Hopefully you found this series interesting. Next week, stay tuned for a new series: Its All Connected!

 
 
_                                     THE GREAT ORTHOTIC DEBATE


                Orthotics are good. They are bad. Hard vs. Soft Orthotics. Custom vs. store bought? Hard Casted, foam casted, Static vs. Functional? So many debates about such a seemingly simple concept. There are hundreds of theories out there, so what is the true answer? As always, it somewhat depends. First, the answer is different for everyone and should be evaluated by someone who truly has done their research. Caution here: many providers that sell orthotics choose their type solely because that is what worked for them; many providers have not truly research WHY certain types of orthotics are best, the rules have changed drastically in recent years. Just because you are told you need them, does not necessarily mean that is the case.

                While this article represents my "opinion" based on the current research and theories, these are the best guidelines and backgrounds I can currently give to help muddle through the quagmire of information.

 

DO I NEED ORTHOTICS?

                The answer is most likely no. As discussed previously, most people have never trained their feet; since the age of 2, we have been put in a solid shoe that provides constant stability and support. Of course our feet are weak, our arches falling, and our movement patterns destroyed. The vast majority of conditions for which orthotics are prescribed can be corrected solely by doing a little work. Orthotics are nothing more than band-aids. They may make you feel better, and get rid of your symptoms, but it is only a matter of time before another ache/pain come creeping in because you have not corrected ANY of your mechanics.

                 If you supposedly have a "leg length discrepancy" make sure you find out if it is "anatomical" (meaning actually a different in length of bone) or "functional" (meaning one leg functions longer than the other, but the bones are equal length). Basically, if you did not have a difference at birth, a fracture during childhood through a growth plate, or a major joint replacement (and the surgeon told you there would be a difference)- it's almost guaranteed functional! Functional discrepancies will get worse with an orthotic or heel lift, and can be corrected through corrective exercise. Anatomical differences should only be corrected if significant symptoms accompany the discrepancy.

                IF you have performed extensive foot training and/or corrective exercise with the help of a knowledgeable professional, and still find yourself stuck- then and ONLY then should an orthotic even come onto your radar.

 

CUSTOM VS GENERIC ORTHOTICS?

                Custom orthotics are almost always the way to go for a long-term solution (IF you need them). These orthotics are designed just for you; but be careful because there are many different types, and research has changed its tune in recent years about what is best!

                Generic orthotics can be great for several purposes, however. First, using an orthotic during your foot training to encourage new patterns as strength is built. Second, to provide additional support during recovery from some sort of injury. Think of generic orthotics as short-term band-aids but not as permanent solutions.

 

HARD vs. SOFT ORTHOTICS?

                There was a reason for the old saying: everything in moderation!

                Rigid, or hard orthotics have been shown very effective in supporting the arch and forcing the foot into proper positions and patterns. They do not break down as easily, and can just be "re-soled" to add life to an expensive venture. However, there is a downside. They force the foot into proper positions. This can cause pressure points and sores (absolutely a no in diabetic patients, or those with reduced sensation in their feet). This also stops the dissipation of force. Remember our discussion last post about pronation actually being a good thing?

                Soft orthotics have been shown very effective in absorbing forces and cushioning. They typically do not allow for sores or pressure points. Very soft orthotics create a relatively unstable surface; this causes the intrinsic muscles of the feet to work much harder and can actually make some symptoms worse. They also can break down quickly, losing their ability to support the foot as they once did.

                You're best bet is to look for an orthotic in the middle. Some companies have a rigid plastic that actually gives under load (and will be ordered according to your weight and type of activity); they do not deform over time. Cork orthotics are also available (although these will deform more long-term and will need to be replaced). These can provide the best of both worlds.

 

TYPES OF ORTHOTIC FITTING?

                There are many types of fittings for orthotics. From making a cast or foam mold of the foot, to standing or moving across a board with sensors. The best way to cover all of these concisely is to group them into two main categories: Static vs. Dynamic Fittings.

                Static Fittings include casting the foot in plaster or foam, standing in one position on a sensor board, etc. They typically are performed either sitting or standing and are based on only one position of the foot. These do not evaluate the actual motion of the foot, and are almost always not the best choice.

                Dynamic Fittings include using a sensor board, or ink mapping to evaluate the motion of the foot during an activity. While they take longer and are slightly more difficult to get an accurate read, these are the best choices. Your gait and movement will be assessed in any number of activities from standing or walking to running. What your foot does at any point during an activity can be vastly different than the snapshot of you standing!

 

Bottom Line

                Orthotics should be viewed as either a temporary training aid, or last resort unless there is a very real and true anatomic reason the body cannot perform its proper functions. While it takes a little elbow grease (or tow jam in this case), the work you put into your foot fitness will determine what you get out. IF an orthotic is deemed necessary (by a very knowledgeable provider only), request a custom orthotic that is dynamically fitted and is moderately hard.

 

Stay tuned. Final post this series: The Gift of Frog Shoes.

 
 
                                PURCHASING PROPER FOOTWEAR


                There is always a debate to the proper type of footwear. Every person is different, their foot mechanics are different, and their needs are different. However, anatomically we are all the same and there are some very important commonalities you should look for.

                With the "minimalist" shoe movement, many of these shoes have these qualities. Whenever possible, and for most (not all) people, these are the best choices. However, you still need to evaluate what you are getting. Just because a shoe is labeled "minimal" does not mean it is good!

 

NO heel

                Our bodies are designed to balance our weight straight up and down. With proper posture, our bodies have to expend little to no energy to maintain this position; tension on ligaments and pressure from bones and joints mainly hold us there. With ANY positive heel, meaning higher heel than toe, every joint angle changes from the ankles to the neck, along with the pressures on these joints.

                Many athletic shoes can have up to a 2 inch heel without you realizing it (Nike shocks, anyone?). Look at the shoe from the side, if there is thicker rubber under the heel than the toe, put it back.

 

(Side Note. Many people have "inactive" glutes. This not only causes injuries, but limits your performance. This is a major culprit. If you have not "earned" heels but fixing ALL of your mechanics you should  never, ever have a shoe with a heel on.)

 

Wide toe box

                There should be ample room not just in front of your toes, but to the sides of your toes. Your feet and toes help grip the ground AND distribute forces as you move. If your toes and the longer bones of your foot cannot spread out, the muscles cannot do their jobs and forces are not absorbed properly.

                Look at the shoe from the top. Is the toe box (toe area of the shoe) wider than the heel? Is the toe more square than rounded or pointed? If not, keep looking.

 

(Side Note: Bunions, Metatarsalgia, Morton's Neuroma, etc are all conditions related to long term wear of shoes that do not fit properly. The human foot SHOULD be wider at the base of the toes than at the ankle. Most peoples' feet have changed as muscles have weakened. See the article titled "FIT FEET" for more information.)

 

Flexible sole

                There are some exceptions to this (i.e. recent stress fracture, fracture or foot injury, etc). However, the sole of your shoe should mimic how your foot naturally moves. There are 33 joints in your foot and ankle; each has movement which combines to make (or should make) a very flexible foot. Many people have rigid feet and toes from being shoved in shoes since an early age. If some joints "stick" others have to pick up the slack. Leading to arthritis. If the joints don't carry the extra forces, something else has to: Plantar's Fasciitis, Metatarsalgia, Stress Fractures, Tendonosis, the list could go on....

                As a rule you should be able to bend, twist and flex the sole very easily. If not, put it away.

 

Minimal Arch Support

                Several things here. First, pronation is actually a good thing! Pronation is how your body absorbs the force of all of you weight when you move. Sticking something in the arch that stops this process actually creates a brick wall that those forces hit. Those vibrations are transferred up every joint and tissue until they are absorbed. Remember middle school when you built protection for your egg that got dropped from the roof? The whole point was to create cushioning and to slow the egg down over a longer period of time instead of having it splat on a hard surface. Putting a block under your arch negates this same process (see the article titled: "THE GREAT ORTHOTIC DEBATE" for more information).

                Second, your feet have muscles for a reason. The muscles both in your foot, and in your lower leg that help control the foot are designed to stabilize the foot and arch on their own. Using an arch support weakens these muscles. Then when you attempt to walk or move without that added support the body cannot do its job.

                You may need to work into this rule. BEFORE you start changing shoes, perform the necessary exercises to strengthen your feet. Gradually work into this one. As a rule, when you place your foot inside the shoes, there should be no pressure or bulge on the inside middle portion of your arch.

 

Make sure to buy shoes based on need, not on price or marketing. Your foot should absorb forces naturally, so you shouldn't NEED to buy new shoes constantly. That being said, if you have not strengthened your feet first and they are not functioning properly; when shoes do begin wearing out, or when you notice changes in how your body feels after activity, it's probably time to retire your old friends. Also realize that high priced "technology" in shoes doesn't always mean superior mechanics, but cheap shoes often don't last as long as they should.

 

Stay tuned for more information. Up next: THE GREAT ORTHOTIC DEBATE.

 
 
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Next weekend, January 28th and 29th, come visit me at the MultiSport Expo at the Milwaukee County Sports Complex! I'll be there along with Elizabeth Hoffman of Hands On Inc., and Nick Rosencutter of Rosencutter Ultra Fitness and Performance! Stop by if you have a chance! Your body will thank you!

Click on the photo to be taken to the MultiSport Expo website!