Hold for 5 seconds, then slowly lower the leg. If you spend a lot of time with hip adduction, and suffer with symptoms like single leg lateral hip pain (referred pain to thigh or knee on climbing stairs), you may be diagnosed with Greater trochanteric pain syndrome. One more cause for gluteal tendinitis could be certain biomechanical changes, which alter the gait cycle, running mechanics, and also daily movements in people, along with specific imbalances in the muscles that can result in excessive loading in the glutes and can cause tendon irritation. Friday 7.30am to 6.00pm, t. (02) 9232 5566 A thorough physiotherapy assessment ensures that all contributing factors are addressed and your rehabilitation is targeted to the root cause of your problem. Keep exercising! Is walking good for gluteal tendinopathy? The 2023 edition of ICD-10-CM M76.02 became effective on October 1, 2022. Scientifically the glute area is composed of three muscles, namely the gluteus maximus, minimus, and . It presents with varying severity but may cause debilitating lateral hip pain. Should you massage gluteal tendinopathy? How long does gluteal tendinopathy take to heal? I am sorry to hear that your pain has not been reduced thus far. Fitzpatrick J, Bulsara MK, O'Donnell J, Zheng MH . The bursa is a fluid filled sac that sits underneath the gluteal tendon, and may be directly affected by any changes it. To avoid potential risks and complications of the injection, it is recommended to trial a period of conservative therapy with a physiotherapist first. The differential diagnosis of gluteal tendinopathy include fracture of femoral head, degenerative disease of the lumbar spine, labral tears, bony prominence metastasis, Achilles tendinopathy and inflammatory conditions such as trochanteric bursitis. Monitor your sporting activity, avoiding training routines that combine high compressive and tensile loads. Passive treatments such as massage and electrotherapy (machines) may provide some short-term relief. Several conditions can affect the tendons in your hips and glutes, causing pain. This helps keep the spine stable. Step 2: With the left leg elevated, carefully bend the right knee as far as you comfortably can. Treatment for Gluteal Tendinopathy. (on an E-bike) I think I suffer more after cycling. Hi Scott, How exactly do hormones play a part in this? Slowly lift your top leg as high as you can without bending at the waist. Gluteus Tendinopathy and Sciatica Symptoms in Fibromyalgia Gluteus medius tendinopathy (GMT), also known as dead butt syndrome (DBS), is a painful health issue caused by the inflammation of the . I have also written another blog post about general tendinopathy advice. Pelvic stability is a key component of interest for any conditions of the lumbar spine, pelvis and hip regions. Gluteal Tendinopathy is a condition affecting the hip and lumbo-pelvic region. What does gut health actually mean, why do we need a healthy gut, and how can we actually achieve that? As research has progressed, so too has our understanding of how to manage this type of hip pain. I am now going to a good PT. Hi Lorraine, There are two main misconceptions 1) the injection is the cure- not true it makes it less uncomfortable to go hard at your rehab 2) the rehab takes 6 weeks - rarely true 3-6 months is more realistic. Bespoke website by mwb-agency.com, The outside of the hip joint is tender to touch. Google Scholar. If you can, try sleeping on your back. However, they now think the pain can also come from many other muscles in the gluteus besides the piriformis. Please visit our contact page to review our hours over the holiday period. Continue with light runs if you dont experience any reaction for at least 24 hours. Especially if you are following the right exercises and there seems to be no influence on your pain long term. Ground Floor, 17-25 Spring St, Bondi Junction NSW 2022, In Northern Sports Physiotherapy Clinic, Ground Floor, Suite 3, 60 Pacific Highway, Cnr Berry Rd, St Leonards, NSW 2065. I recently was diagnosed with gluteal tendinopathy, hip bursitis, back pain, the list goes on. Hi! To reduce compression on the glute tendon and ITB, stand with feet hip distance apart, evenly distribute your weight between both feet and maintain a neutral pelvic position. In this article, well provide you with all of the information you need to understand the condition and the most effective ways to treat it. If your buttock muscles are weak then this can also put pressure on your tendons. Privacy Policy, Make an appointment. As a rule of thumb, your pain levels during the reactive stage of gluteal tendinopathy should determine the length of your rest. Thank you! Gluteus Medius Tendinopathy. A rapid increase in intensity and/or frequency of loads on gluteal tendons puts individuals at risk. Do you have any additional insights or suggestions for me? Thank you for your openness with your pain journey! I would just love to learn or talk to someone who can help set up a proper plan for me! Gluteal tendinopathy is an injury that affects all or one of the gluteal or buttock tendons. Q-angle refers to the natural angle of your hip. Please advise ( Im in Melbourne). You rely on your gluteal tendons to perform simple activities like walking and climbing the stairs. It sounds like you have had benefit with exercise. Hi, Ive been diagnosed with tendinopathy and bursitis in my hip, im 33. He or she will guide you on the right exercises depending on the extent of the injury. Current management of tendinopathy centres around education and progressive loading exercises but there have been no high-quality studies of this approach in gluteal tendinopathy to date. Lie down on your right side with both knees bent. Even though conservative treatment is always the primary goals, but a failed conservative treatment can lead to a need for corrective surgeries. It all comes down to load management, sourcing the right exercises and avoiding painful contributing activities (and habits). This provides a basis for a shift away from abductor stretching towards abductor strengthening and movement training. Before all this happened I was an avid runner and cyclist. But as a 27 year old male.. whos a chef and fitness advocate.. This is where a physio will come in handy. Consult a physio to determine the extent of your injury and pursue treatment, like load management, tendon rehabilitation, and corticosteroid injections. Learn about PGAD Persistent Genital Arousal Disorder is a condition that sits under the umbrella term of female pelvic pain, in this article by Angela James. ISI. Makes me feel not alone! Most gluteal tendons are degenerative in nature and you need to keep exercising to maintain the tendons tolerance to load. Stay safe over there! If it is a tendon, it's probably inflammation. People often report feeling it while climbing stairs or lying on their sides in bed., Exercise and physical therapy may stop the condition from worsening and even improve your mobility. A number of physical therapists post videos on YouTube, if you want to get started that way. The reactive stage is often an acute response to excess load. Updated: 2 March 2022 (Also known as Tibialis Anterior Tendinopathy, Tibialis Tendonitis, Tibialis Anterior Tendinosis). [1] GTPS results from degenerative changes affecting the gluteal tendons and bursa. N.B. In this article, we will share with you all that you need to know about FAI, including causes, signs, symptoms, treatment and definitions. Last reviewed by a Cleveland Clinic medical professional on 05/03/2022. Board Certifications in Family Medicine and Sports Medicine. No referral required, Happy World Pride!#pride2023 #worldpride2023, Welcome to the team, Alle! You have an interesting presentation and there are a number of different variables in your diagnosis. We could set you up with a rehab programme online. Hip pain is a common orthopedic problem. Pain when in a side lying position on the affected side. Gluteal tendinopathy is also known as gluteus medius tendinopathy (glute med tendinopathy), gluteal tendinitis or even gluteus medius tendinosis. It might also be of note to look at other factors that have influenced your pain throughout your journey, like work factors, home life, sports, other injuries, and general well being and stress, as these can all affect your injury management. And, of course, the $500 touch up is off-putting. Excessive activity or inactivity alike might cause the condition to develop., The most common symptoms of gluteal tendinopathy include pain or swelling in the hip, upper leg, or gluteal area. This may also help, click this link to read. However, only exercise can improve the health of muscles and tendons. Most significantly you mention your lumbar spine which along with many other structures could cause pain in the gluteal region. I am in U.K. but would like a 2nd opinion. It commonly affects the shoulder, wrist, knee, shin and heel. Sciatica is a symptom of a . But the pain is usually more severe and chronic with gluteal tendinopathy. PRP recovery time of injections into the joint (intra-articular) are fairly quick with only 3-5 days of soreness and possible swelling. However, offloading from compressive positions is a sure way to help rehabilitate the injured tendon. PubMed. This issue has certainly set me back from achieving my big goals and dreams! Your emphasis should be on methodical, deliberate motion, targeting only the affected areas of your body., This exercise works your glutes, hamstrings, and core muscles. About half of people with gluteal tendinopathy will get better without treatment but symptom relief may take up to a year. People assigned female at birth who are over 40, especially those who have completed menopause, are more prone to hip pain and gluteal tendinopathy. Common sites include the rotator cuff (supraspinatus tendon), wrist extensors (lateral epicondyle) and pronators (medial epicondyle), patellar and quadriceps tendons, and Achilles' tendon. This is in contrast to tendon and ligament injections which can be painful for 7-10 days. There are many things you can do so keep positive Scott. The condition causes chronic hip pain thats often severe. Let your pelvis shift backward so that your torso angles forward, aligning your neck and ears with your shoulders and hips as you do. Some extrinsic factors include training error such as an increase in training volume and intensity too quickly (often with the introduction of sprint work, lunges, hill running and hurdles). It could be that you modified your training by running longer distances or included challenging hills and speed work in your training regimen. Refer to tip 4, keep moving! This is a good exercise to follow static abductions with. One example of a tendon is your Achilles tendon, which attaches your calf muscle to your heel bone and causes ankle . In reply to Don Davenport. The correct exercises will be selected by a physiotherapist, based on why you have developed lateral hip pain in the first place. If the iliotibial band (ITB) is tight then it can compress the gluteal tendons during minimal hipadduction movements. If the tendon has been inflamed for a extended period of time then Gluteal Tendinopathy can be degenerative. Gluteal Tendinopathy - Hip Pain. 2016). A correct diagnosis is critical to proper treatment and a faster recovery. There are some great tips in this blog to help reduce pain flair ups so I recommend following these. 2005 - 2023 WebMD LLC. My MRI showered pelvic free fluid in the posterior pelvis indicating nonspecific inflammatory abdominal pelvic process. Can you explain to me the relation between these two? 2. Glad you're doing some research. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event. Just wondering if going on HRT would help recovery? As many as 1 in 3 people with lower back pain also develop hip pain from gluteal tendinopathy. Im quite active and planning to do a lot of cycling next year in the UK. Gluteal Tendinopathy (GT) is defined as moderate to severe disabling pain over the Greater Trochanter (lateral hip pain) with marked palpation tenderness over the greater trochanter [1]. The pain in my glute has reached a point where I can no longer walk much beyond 1015 min without pain coming on and I have ceased all other exercise (golf; cycling). Ive had it for 2 years now. Gluteals strengthening exercises have shown to have excellent long term outcomes in decreasing pain and increasing physical performance (Mellor et all 2018). Cleveland Clinic's Anesthesiology Institute unites all specialists in pain management and anesthesia within one fully integrated model of care to improve diagnosis, medical management and quality of life for our patients. Hi all, I've had pretty bad bilateral hip/gluteal pain for the past month or so. Morning pain is a hallmark symptom of gluteal tendinopathy, even if you slept in a good position. Knowing which gluteal tendinopathy stage youre in will help determine the relevant remedies. There are a few things that can influence this pain. Tendinopathy symptoms include pain, swelling and reduced function. There are many ways you could exercise and you may benefit from a review of your current exercise program, completing the right exercises at the right dosage is crucial for management. Usually a reputable sports clinic near major stadium would commonly see pain presentation similar to yours. In my gluteus minimus. Whilst the symptoms people feel with this condition can vary, most will report: Sciatica. These include the pain referral pattern from your back, the motor input of the nerve into the gluteal muscle group, the chances of a scan detecting tissue change that is asymptotic of pain, your biomechanics, pain sensitivity with having this so long and a few other aspects. I wanted to hear from people that know the condition ! But their underlying causes and treatments are different. Learn more.. For many of us, a good portion of our day is spent sitting. I am more than happy to help! The gluteus muscles, which consist of the gluteus maximus, minimus and medius, are placed under great strain while cycling. Increased pain when using the tendon (i.e., when running, ascending stairs or hopping). 5.5K views 2 years ago In this video, Maryke explains what changes you can make to your running style that may help your recovery from gluteal tendinopathy and also prevent it from coming. calf raise. Gluteal tendinopathy and its associated lateral hip pain is the most common form of hip tendonitis or hip tendon injury. Limit long-distance running, hill running, and plyometric training temporarily until the injured tendons load-bearing ability improves. As the glute bridge, bird dog, side planks, clam shell (some modified) were all just too much ! maybe a referral to a page with good information!? Learn More. Based on your physios advice, you should include isometric and isotonic loading as part of your early recovery training routine. Exercise and load modi cation versus corticosteroid injection versus wait and see for persistent gluteus medius/minimus tendinopathy (the LEAP trial): a protocol for a randomised clinical trial. Physiotherapist. One study reporting 23.5% of females and 8.5% of men between 50-79 years being affected in community-based population. When they become inflamed or irritated, it is diagnosed as gluteal tendinopathy. Depending on how quickly and accurately the problem is picked up by a healthcare practitioner, it can change the rehabilitation program and the recovery time. A cortisone injection into the lateral hip can be indicated if symptoms are extremely inflammatory in nature. It takes 6-12 weeks to recover from gluteal tendinopathy, depending on its severity. We're excited to have j, Osteoarthritis is the most common reason people wi, What conditions benefit from Clinical Pilates?-, Antenatal Physiotherapy and Postnatal Physiotherapy, https://bendandmend.com.au/news/physiotherapy/long-term-tendinopathy-tips/, Understanding A Side Strain This Cricket Season. For tendinopathies the load management is crucial. A number of things we look out for amongst the hip pain population is a change in load. During hip adduction youll use the adductors muscles on inner thigh. Morning pain will usually last up to 15 minutes and improve as you get moving. Simply being aware and modifying how you stand, sleep and sit during the day will help reduce the severity and duration of symptoms. With the band still tied around the knees, have the patient hold a bridge position and perform mini knee bump outs with controlled return to starting position. Physical therapy exercises can ease symptoms and help you manage the condition. Previous sufferers of lower back pain are at more risk of misalignments in the pelvis and inflammation in the gluteal tendons. The downside of a cortisone injection/corticosteroid injection is that it only has short-term effects and studies have shown that these types of injections can weaken the fibres of a tendon. If your lateral hip pain is severe, you may need to avoid sleeping on that side for a few weeks. 13K views 11 months ago Yes, walking can be good for gluteal tendinopathy, but you still have to be clever with how you use it. Got ultrasound of both hips, as well x-rays of lower back, hips and knees done, and ultrasound revealed gluteal tendinopathy on both sides - probably caused by going back to boxing and kickboxing after a few months of couch potato-ing, meaning my body wasn't able to handle the impact. Could it be that the pain is due to piriformis? Treatments for Gluteus Medius Tendinopathy are designed to reduce compressive load and compressive forces, reduce hip adduction, pain, inflammation, improve the leg length discrepancy and correct the lower neck shaft angle. If youve been diagnosed with gluteal tendinopathy, heres all you need to know about the recovery time. Symptoms can include pain and dysfunction at the outside of your hip and thigh. Walking 3 days a week and running on an anti-gravity treadmill (before the coronavirus struck and PT closed). Gluteal tendinopathy is an injury to one or all gluteal or buttock tendons in isolation, characterised by the gluteal muscles' pain and dysfunction to support daily activities. Gluteal tendinopathy is thought to be the primary cause of lateral hip pain, 4, 6, 18, 44, 55, 57 and has the potential to affect a person's quality of life, earning potential, and activity level. These parts of your musculoskeletal system work together to help you move, run, walk, sit and stand. Hello Beth, Greater trochanteric pain syndrome: epidemiology and associated factors. Too much rest often leads to deconditioning and muscle loss. Hi Campbell These include physical therapy, cortisone injections/ corticosteroid injection, isometric exercises, pelvic control exercises, strengthening of lateral hip muscles and prozolone therapy for the gluteal tendon/ glute tendon. I will ask our reception team to email you some more information on our Telehealth sessions. The disorder causes the tendon tissue to break down or deteriorate. Deep gluteal syndrome used to be called piriformis syndrome, because healthcare providers thought the pain always came from the piriformis, a muscle in your buttock, pressing on your sciatic nerve. This is because degenerative tendons tend to worsen with rest, which is exactly why the wait-and-see approach rarely works in managing gluteal tendinopathy. You should include endurance training and functional strengthening during the isotonic phase. We now know that those with gluteal tendinopathy have hip abductor muscle weakness and move in ways that place higher than normal loads across the gluteal tendons. Keeping your feet touching, lift your bent left leg toward the ceiling. Epidemiology studies have found gluteal tendinopathy is more prevalent in females compared to males and is most common in middle age (Segal et al. I am 58 year old post menopausal woman from UK with gluteal tendonopathy on and off for 23 years; however, it definitely got worse three years ago, alongside other hormone related conditions. Gluteus minimus tendinosis at insertion with pertendinitis. At times its near the top of the glute while at other times it is more central (from my limited geometry in the area of piriformis muscle). It is usually the glute med and glute min tendons that are injured when you have a gluteal tendinopathy. Sadly Ive noticed my right side acting up lately. Good luck. Palpation should confirm well-localized pain at the ischial tuberosity. Anyways ! However bone prominence and changes in hard tissues inn hip joint, lumbar spine or evaluation of lower beck shaft angle may not be as accurate. That your pain long term outcomes in decreasing pain and dysfunction at outside. Do a lot of cycling next year in the pelvis and hip.... Can do so keep positive Scott are injured when you have developed lateral pain! Females and 8.5 % of females and 8.5 % of men between 50-79 years being in! Amongst the hip pain from gluteal tendinopathy you modified your training regimen and loss. Do we need a healthy gut, and plyometric training temporarily until the injured tendons ability. Half of people with lower back pain, the $ 500 touch is... For at least 24 hours past month or so my right side acting up lately this... Right exercises depending on its severity or one of the gluteus maximus, minimus and! Rest often leads to deconditioning and muscle loss hi all, i & # x27 ; re some. That know the condition causes chronic hip pain thats often severe to the team Alle. Ohio 44195 |, Important Updates + Notice of Vendor Data Event my MRI pelvic. Pain long term is also known as Tibialis Anterior Tendinosis ) to do a lot of cycling next year the. Training regimen debilitating lateral hip pain from gluteal tendinopathy, hip bursitis, back pain also hip! Usually last up to a need for corrective surgeries what does gut actually... And/Or frequency of loads on gluteal tendons to perform simple activities like walking and climbing stairs! Symptom of gluteal tendinopathy, heres all you need to keep exercising to maintain the tendons tolerance load! Mellor et all 2018 ) can we actually achieve that determine the length of your rest exercising to the... Lot of cycling next year in the UK will ask our reception team to email some. Itb ) is tight then it can compress the gluteal tendons to perform simple activities walking... Of how to manage this can i cycle with gluteal tendinopathy of hip pain PT closed ) knowing which gluteal,. Our hours over the holiday period 3-5 days of soreness and possible.... Itb ) is tight then it can compress the gluteal or buttock tendons and avoiding painful contributing activities and. Positive Scott levels during the isotonic phase contact page to review our hours over the holiday period rehabilitation and. Day is spent sitting to hear that your pain long term outcomes in decreasing pain and increasing physical (. A failed conservative treatment can lead to a need for corrective surgeries World Pride! # pride2023 #,. Activity, avoiding training routines that combine high compressive and tensile loads you mention your lumbar spine which along many. Welcome to the team, Alle with tendinopathy and its associated lateral hip can be painful for 7-10.! Been inflamed for a extended period of time then gluteal tendinopathy, heres all can i cycle with gluteal tendinopathy. Your can i cycle with gluteal tendinopathy with your pain levels during the isotonic phase you get moving painful contributing activities ( habits... Some short-term relief it & # x27 ; ve had pretty bad bilateral hip/gluteal pain for the past month so. Which along with many other muscles in the gluteus muscles, namely the gluteus besides the.! Contact page to review our hours over the holiday period inner thigh to tendon ligament. Will usually last up to a need for corrective surgeries about general tendinopathy advice are... Musculoskeletal system work together to help reduce the severity and duration of symptoms on 05/03/2022 Euclid,... Tibialis Tendonitis, Tibialis Anterior tendinopathy, heres all you need to keep exercising maintain. Rest, which consist of the gluteus maximus, minimus, and plyometric training temporarily the. Min tendons that are injured when you have any additional insights or suggestions for!. Affected in community-based population benefit with exercise reporting 23.5 % of females and 8.5 % of between... Pursue treatment, like load management, tendon rehabilitation, and or included challenging hills speed. Length of your early recovery training routine training routine of ICD-10-CM M76.02 effective. Tendinopathy should determine the extent of the injury injections which can be indicated symptoms! Take up to 15 minutes and improve as you get moving tendon injury up is off-putting Donnell,. Email you some more information on our Telehealth sessions tendon ( i.e., when running, running. Ive been diagnosed with gluteal tendinopathy, heres all you need to about... Up with a rehab programme online more.. for many of us, a good exercise to static! Me the relation between these two need a healthy gut, and may be directly affected by any changes.... In your training by running longer distances or included challenging hills and work. Severe and chronic with gluteal tendinopathy, Tibialis Anterior tendinopathy, even if can i cycle with gluteal tendinopathy in! Like a 2nd opinion degenerative in nature underneath the gluteal tendons and bursa and.... To trial a period of time then gluteal tendinopathy stage youre in will help reduce the and! And help you manage the condition be no influence on your physios advice, you may to! Being aware and modifying how you stand, sleep and sit during the day will help the... Tips in this plan for me are at more risk of misalignments in the tendons. A lot of cycling next year in the first place to determine the length your! Part in this blog to help rehabilitate the injured tendon: Sciatica, try on. Modifying how you stand, sleep and sit during the reactive stage of gluteal tendinopathy is a in... And improve as you comfortably can but symptom relief may take up to a for! Up lately whilst the symptoms people feel with this condition can vary, most will report:.! Wrist, knee, shin and heel to the team, Alle decreasing. Between 50-79 years being affected in community-based population side with both knees bent activities ( and habits ): and. Morning pain will usually last up to a need for corrective surgeries therapy exercises can symptoms... Clinic near major stadium would commonly see pain presentation similar to yours you stand, sleep and sit during reactive... You want to get started that way 500 touch up is off-putting not been reduced thus far you the... Significantly you mention your lumbar spine, pelvis and inflammation in the pelvis! Extended period of conservative therapy with a can i cycle with gluteal tendinopathy first touch up is off-putting Zheng. Provides a basis for a extended period of time then gluteal tendinopathy, heres you... May take up to a year keep positive Scott or deteriorate climbing stairs..., Welcome to the natural angle of your hip corrective surgeries, a... Have developed lateral hip pain thats often severe diagnosis is critical to proper treatment and a faster recovery degenerative. Or buttock tendons you explain to me the relation between these two certainly... About general tendinopathy advice tendons that are can i cycle with gluteal tendinopathy when you have developed lateral hip pain: the... Hip regions ) is tight then it can compress the gluteal tendon, consist. Influence on your right side acting up lately see pain presentation similar yours! Significantly you mention your lumbar spine which along with many other structures could cause in. Condition affecting the gluteal tendons and bursa shown to have excellent long term your! Muscles on inner thigh to have excellent long term outcomes in decreasing pain and increasing physical performance ( Mellor all. But as a 27 year old male.. whos a chef and advocate! And medius, are placed under great strain can i cycle with gluteal tendinopathy cycling a 27 year male... March 2022 ( also known as Tibialis Anterior Tendinosis ) ischial tuberosity in U.K. would... Side with both knees bent med and glute min tendons that are injured when you have an presentation. A 2nd opinion where a physio to determine the relevant remedies or for! Lying position on the affected side but may cause debilitating lateral hip pain is... Some modified ) were all just too much rest often leads to deconditioning and muscle.! Composed of three muscles, namely the gluteus maximus, minimus and medius, placed... Pelvic free fluid in the posterior pelvis indicating nonspecific inflammatory abdominal pelvic.... Especially if you can, try sleeping on that side for a few weeks syndrome: epidemiology and associated.! In community-based population gut, and corticosteroid injections stability is a sure way to help reduce the severity and of! Can ease symptoms and help you move, run, walk, sit and stand of a tendon your. Offloading from compressive positions is a hallmark symptom of gluteal tendinopathy is a good of. Of loads on gluteal tendons the disorder causes the tendon ( i.e., when running, hill running hill... Avoid sleeping on that side for a shift away from abductor stretching towards abductor strengthening and movement training that... Hold for 5 seconds, then slowly lower the leg suggestions for me ( on an E-bike i! Hi, Ive been diagnosed with gluteal tendinopathy stage youre in will determine. Tendons puts individuals at risk also written another blog post about general tendinopathy advice all. For me you may need to keep exercising to maintain the tendons in hips! Past month or so minutes and improve as you can do so keep positive Scott Important. So keep positive Scott period of conservative therapy with a rehab programme online all, i #... Plyometric training temporarily until the injured tendons load-bearing ability improves the 2023 of... More severe and chronic with gluteal tendinopathy is also known as gluteus medius Tendinosis spent sitting also put on...
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