Every year, on the 8th September, World Physiotherapy Day takes place – a day to recognise the work that physiotherapists do and the difference that our profession can make to peoples lives.
The campaign for World Physiotherapy Day 2019 is focussed around the theme of chronic pain and the role that physiotherapy and physical activity can have in helping people manage chronic pain.
The campaign is focused around the following key messages about the benefits of using exercise to manage chronic pain to:
maintain flexibility and movement
improve cardiovascular health
build and keep muscle tone
improve mood and general wellbeing
help control pain
increase confidence to take part in activities
take back control of your life and reduce your fear.
These messages are important not just to encourage health and activity in populations. They can help demonstrate how Physio’s keep people moving through interventions which maximise strength and mobility. Through advice and exercise programmes, physio’s support people of all ages to achieve activity goals.
What is chronic pain?
Chronic or persistent pain is pain that carries on for longer than 12 weeks despite medication or treatment. Most people get back to normal after pain following an injury or operation. But sometimes the pain carries on for longer or comes on without any history of an injury or operation. It can be an extremely frustrating, confusing and challenging time.
Here’s a fantastic video that explains it further.
As Physio’s, we can help people with such pain to get moving without fear, where the brain isn’t protecting by pain. There really is so much power in having the confidence and support to get moving.
If you have pain and want help and support, please give us a call on 023 8025 3317 to see how we can help you.
In today’s blog, we explore these recommendations, how we implement them at goPhysio and what it means to you guys, the people with the pain or injury.
#1 Care should be patient centred This goes without saying, but you’re the one and only person that matters to us. We take time to get to know you, learn how your injury is impacting you, and work with you to understand your lifestyle, so we know what we are aiming for. Everyone and everyone’s circumstances are SO different and individual, so it’s crucial our approach to each and every person we see is individualised too.
#2 Screen for serious conditions We take this incredibly seriously and although it may go un-noticed by you, we make sure that there is nothing serious going on. If we are in any way concerned, we’ll make sure we point you in the right direction and will provide any letters, phone calls or support that you need.
#3 Assess psychological factors The body and the mind are inextricably linked. The power of the mind is incredible. You need to feel reassured, informed and have an appropriate understanding of your injury. Any doubts, fears, worries or misconceptions will really impact on your recovery. We make sure we consider any psychological factors that may be impacting you and address them appropriately.
#4 Only refer for imaging if specifically indicated It’s a commonly held myth, that a scan or an X-Ray is needed in order to diagnose an injury. In fact, referrals for imaging (X-Rays or scans) are only needed in very specific cases. Why? Because all too often, symptoms do not relate to imaging results. So, an image may not show any damage or injury, but you may be getting symptoms. Equally, you may have damage on imaging, but be symptom free and seeing the damage on imagery can cause issues in itself! If we think that there is indication for a scan or X-Ray we will make sure we assist you with this. We can even refer directly to low cost, quick, private scanning – so you don’t have to get referred by a Dr, saving you even more time.
#5 Physical examination This is our bread and butter. Using all our senses – looking, feeling, testing, questioning and putting it all together with our evaluation skills in order to explain to you exactly what’s going on.
#6 Evaluate progress Together, we will set your goals, what you want to achieve through coming to see us. That’s the most important bit. However, we will also take measurements and document certain testing, so that we can measure your progress and ensure we’re on the right track.
#7 Education We want to make sure that you fully understand what’s going on in as much detail as you need. Some people only want the basics, some want an in depth explanation. But if you can understand what’s going on and what you can do to help yourself with your recovery, you’re much more likely to succeed in achieving your goal. This may include modifying your activity or lifestyle slightly, changing a routine, adapting a training programme or work activity.
#8 Address physical activity / exercise As a team go health professionals, it’s important that we support everyone in living a healthy and active life. As part of this, we can provide the necessary support and advice you may need to start or increase your physical activity. Some people find having an injury a bit of a wake up call to make some changes and often, getting more active is one.
#9 Apply ‘manual therapy’ as an adjunct We use a huge range of treatments to help you with your recovery. Using our hands (manual therapy) is just one tool, and can be very beneficial in many ways for lot’s of different injuries and to help ease pain. It is very important though that it is used as an adjunct to more active approaches, such as exercise and education/advice. Manual therapy alone is unlikely to be a solution to your recovery, as it’s effects are often short lived – it’s the strengthening, stretching, confidence and education that makes the most impact on recovery.
#10 Discuss non-surgical approaches (unless surgery indicated) Unfortunately, people still remain entrenched in the ‘medical model’ of belief, thinking that medicine and/or surgery are the only answer. They often want quick fixes and magic cures! Much of the evidence is now very clear on when surgery is indicated and it’s not as often as you may think! Physiotherapy and physical treatments are often much more effective than surgery when given the chance in many conditions. Obviously, there are cases when surgery is absolutely the right decision. In these cases, our Clinicians will help with referrals and work very closely with many local Consultants to ensure you receive the most appropriate care. We can also closely liaise with your GP to facilitate this.
#11 Facilitate continuation or return to work Staying at work or returning to work ASAP when you’ve had an injury is crucially important for your recovery. We can help advise on modifying your activities so this is possible. It may seem a bit daunting, especially if you’ve had to take time off work because of your injury. But remaining in work helps in so many ways.
If you’ve got an injury and want the best possible care, then do give us a call on 023 8025 3317 and see if we can help you.
Helping local people live a healthy, active, positive life, pain and injury free.
The 8th – 16th June 2019 sees in Bike Week, which aims to inspire more people to take to 2 wheels.
Cycling is a wonderful way to exercise, whatever your level or age. It’s great for cardiovascular fitness, muscle strength, flexibility and has a host of health benefits.
It’s a safe form of exercise and is often a great way to start fit if you need to maintain your fitness with a lower impact activity. It’s also a fab way to incorporate exercise into a mode of travel!
However, like many forms of exercise, cycling can become a source of injuries. Cycling injuries tend to fall into 2 camps, either a traumatic injury or an overuse injury.
These are caused by some sort of trauma. This is normally a fall or collision and can be very minor to severe. Traumatic injuries are often accidents that can’t be avoided, but you can take precautions. These include:
Wearing appropriate protective clothing such as a helmet
Being up to date with bike maintenance to make sure you bike is in top working order
Knowing and reading the weather conditions and environment to make sure they fit with your plans
Understanding your personal limitations and being realistic with your ability. Many accidents occur when people are pushing themselves unrealistically.
Common traumatic cycling injuries include:
Fractures – often the clavicle (collar bone) or scaphoid (wrist) as you put your arm out to protect you as you fall.
Bruising – to the muscle and/or bone. This is as a result of falling directly onto the area, often a prominent bony area such as the outside of the hip.
As the name implies, are caused when a part of the body is being ‘overused’ and can’t cope with the physical demands being placed upon it. Cycling is a very repetitive activity, an average cyclist might perform well over 5,000 revolutions an hour. The human body has a threshold of what it will tolerate and sometimes it just can’t cope with prolonged repetitive demands being placed on it. This is when an overuse injury rears it’s head.
The problem with overuse injuries is that they often start gradually as a tiny niggle that you ignore. Before you know it that niggle is a regular occurrence but you think it will just go away just as it appeared. Then it eventually becomes really annoying and can actually becomes so severe it stops you doing the things you love and that may have caused it in the first place, which is even more of a pain!
You can take steps to avoid or minimise the impact of cycling overuse injuries. These include:
Make sure your bike is set up correctly. This is crucial given the repetitive nature of cycling. Very small adjustments such as saddle and handlebar height can make a huge difference.
Increase your cycling gradually. Whether its speed, distance or hills – don’t do too much all at once. You need to give your body time to adapt and adjust to the demands being placed upon it.
Listen to your body. If you feel a little niggle, hold back a bit until it eases off to give your body chance to recover.
Seek advice at the right time. If a niggle is becoming more than that, it’s better to come and see us sooner rather than later. Overuse injuries that are ignored can often become long term problems and then they’re much harder to resolve and take longer to recover.
Common cycling overuse injuries include:
Back pain – which is often related to your posture on the bike and easily resolved by changing your bike set up.
Neck pain – again, this is often posture related and being more aware of your posture and position on the bike can be really helpful.
Knee pain – including tendonopathies, patellofemoral pain (front of knee) or ITB problems (side of knee).
Foot or ankle problems – such as achilles tendonopathy or forefoot pain from the pressure of peddling.
As Physio’s we’re highly skilled at identifying and resolving all the injury issues that may arise from cycling. Many of our team are keen cyclists themselves, so can truly identify with what you’re experiencing. If you are suffering with an injury as a result of cycling, give us a call to see how we can help you and get you back on your bike! #BikeWeekUK
Musculoskeletal conditions: the elephant in the room?
Conditions of the bones, joints and muscles are a big problem in the UK; with over 17 million people living with a musculoskeletal condition, more people suffer with disability from musculoskeletal conditions than anything else.
Good health of bones, joints and muscles underpins living life well. Musculoskeletal conditions affect nearly everyone at some point in their life. They can cause pain, fatigue, restricted mobility and activities of daily living. They impact people’s lives, their work and even people’s other health conditions. Conditions of the bones, joints and muscles represent a significant cost to the individual, the economy and health and social care.
Acknowledging the problem
Everyone knows conditions like arthritis and back pain are common. But they are often misunderstood and ignored, like the figurative elephant in the room. The solution begins in acknowledging the problem. That’s why we need to shift our mindset and start planning and acting nationally, locally and individually for healthy bones, joints and muscles throughout life.
If we’re brave enough to tackle this big and growing problem, to champion lifelong good musculoskeletal health, there are large rewards! We see it day in day out here at goPhysio – poor MSK health has a huge impact on quality of life. If you invest in your MSK health, like in other areas of your health and wellbeing, you can get more out of life!
Why are MSK conditions the elephant in the room?
From our years of experience, there are many factors!
Firstly, MSK conditions often occur gradually or creep up on you. It starts as a niggle or minor ache or pain, that you accept as part of life. You manage it yourself or make small adjustments in your life to compensate. Over time, your pain, stiffness and limited mobility gets worse, but the impact on your life has been so gradual, you don’t really notice until the effects are huge. Suddenly you’re not walking so far, aren’t exercising, avoiding certain activities and you take a look and are shocked what affect it’s had on you.
MSK conditions aren’t immediately life threatening. Let’s face it, no matter how painful the condition is, there is nothing immediately at stake aside from quality of life. Subsequently, they aren’t always a high priority. However, this view is very short sighted – because over time, the impact of long standing MSK conditions can have a huge impact. Being less active and living with a painful MSK condition can cause many other issues as there will be knock on effects with mental health, cardiovascular health, maintaining a healthy weight and all the complexities that come with health.
Culturally, we’ve been lead to believe the ‘wait and see’ approach is OK! How many times have you heard ‘rest’, ‘take painkillers’ ‘it’ll get better in time’? Funding cuts in the NHS has bread this culture! The truth is, if people had the support, education and correct personalised, professional advice from the early onset of an MSK condition, the issues could be reduced massively.
Preventing MSK conditions and the solutions aren’t easy! Everyone now wants the easy option, the quick fix! But preventing and addressing MSK conditions need investment in time and effort. If you could take a magic pill that would solve it – great. But tackling these conditions takes time, there often isn’t a miracle miracle cure. e.g. If you have back pain, there is overwhelming evidence that exercise is the best management. But what do most G.P.s do if you go and see them with back pain? They’ll often advise painkillers and rest as the first step. Take osteoarthritis of the knee. Again, exercise is a highly effective treatment for this condition. But shockingly, many people would rather have a risky operation with no guarantee of a positive outcome than commit time and effort to doing regular, prescribed, specific exercises that would help them.
This week is officially Bone and Joint Week. Hopefully, getting the message out there will help filter out awareness of these conditions, the impact they have on so many people.
World Physical Therapy Day takes place every year on 8th September. The day is an opportunity for Physiotherapists (physical therapists) from all over the world to raise awareness about the crucial contribution the profession makes to keeping people well, mobile and independent.
Get Active. Stay Active. Talk to one of our Physiotherapists today.
The campaign message of World Physical Therapy Day 2018 is “Physical therapy and mental health”, demonstrating the role that physical therapy and physical activity has in mental health.
The campaign is focused around the following key messages:
Exercise as an evidence-based treatment for depression.
The role of physical therapists working with patients who may have mental health issues.
The benefits of physical activity in protecting against the emergence of depression.
How better outcomes are experienced when exercise is delivered by a qualified healthcare professional, such as a physiotherapist.
How people with mental health issues are more at risk of having poor physical health.
Here are some great infographics that summarise how mental health can be improved with exercise and the crucial role physiotherapists can have in supporting this.
I absolutely love taking my children to the Southampton General Hospital Open Day. I still remember being taken there by my Mum when I was very young and it was my experiences at the open days that sowed the seed of curiosity about working in a health care profession. My dreams were realised as I became a physiotherapist and even though my role now at goPhysio isn’t directly clinically based, my times spent working in many hospitals and different healthcare settings have left a significant imprint in my memory.
I am still moved by the differences we make to people’s every day lives through physiotherapy and am proud to be part of the profession.
The hands on activities and behind the scenes glimpses at the open day can really inspire young minds. The human body is truly fascinating and the people who do so much when it isn’t working right, for whatever reason, are amazing. Whether or not you have children to entertain, I’d thoroughly recommend adding this event to your diary.
The 2018 Hospital Open Day will be taking place on Saturday, 8 September 2018 from 10.30am to 3.30pm at Southampton General Hospital with hundreds of activities and stalls on offer throughout the day.
The Open Day is a fantastic day for all the family to find out more about the hospital and UHS, the services they provide, the amazing opportunities available and ground-breaking work taking place.
The theme this year will be Health Hero Academy through the years and give visitors the chance to not only pick up new skills and have fun, but find out more about the history of University Hospital Southampton NHS Foundation Trust, as well as their plans for the future.
With the end of season finally upon us for many of our most popular kids sports, we’re seeing a huge spike in the number of youngsters we’re seeing in the clinic with injuries. Unfortunately, many of the most common growth related injuries (Severs, Osgoods Schlatters, Sinding Larson etc.) affect the most active and sporty children at a time they are experiencing growth spurts. Although there is a part of this that we can’t control (growth!), what we are seeing increasingly contribute to the injuries these kids are presenting with is very frequent, intense participation in single sports. We also see this across a huge spectrum of sports, so football, swimming, gymnastics, tennis, dance & more!
Our sporting culture here in the UK (and many other countries too) is to ‘pigeon hole’ children into a single sport from a very early age. Before they know it, children are training / playing / competing / performing in a single sport 5 – 7 days a week! Unfortunately, much of this early specialisation in single sports is driven by the coaches and/or teams. Parents and children fear that if they don’t specialise and fully commit to a single sport they are risking their chance and future success.
The intentions of most parents, coaches and teams is well meaning – the more they train or practice for the sport, surely the better they’ll get and the higher the chances of ‘success’ (defining what success is is a whole other topic that won’t be covered here!).
However, all the evidence points towards the opposite being true – there are many benefits to playing multiple sports and risks to early specialisation in a single sport. The title image of this blog was recently published in the Sports Business Journal, why kids shouldn’t specialise in one sport is discussed here.
The benefits of playing multiple sports
Improved sporting performance – studies suggest playing multiple sports at a young age will actually enhance sporting performance in the long run
Between the crucial development ages of 6 – 12, playing multiple sports will enhance development of fundamental movement skills
Increased athleticism, strength and conditioning – playing a single sport can improve skill for that particular sport, but can limit overall athletic ability
Increase chance of developing a lifelong love of playing sport / exercising – if enjoyment, fun and variety are the focus, children are less likely to burnout
Develops a more creative athlete by exposure to many skills, situations and environments
The risks to early specialisation in sport
Injuries – repeated movement and demands placed upon developing bodies can increase risk of injury. The more movement variety youngsters have, the less risk they have go picking up an injury.
Burnout (see the great infographic below on how to prevent this).
Social isolation – commitment in hours to training, travel and competing can have an impact on a youngsters social life.
Early over-professionalisation – sport is seen in an adult, commercial context with winning being the main focus.
The crux of it is, for the majority of youngsters, taking part in sport is a way for children to develop well physically, have fun, enjoy activity with friends and importantly install lifelong love of being physically active to help them live a healthy life!
Unfortunately for many sports, naivety from the top won’t change things, it’s very shortsighted and their well-meaning intentions don’t actually have the health and wellbeing of children as a priority. However, sports such as Hockey, do give a glimmer of hope. Their Player Pathway is an excellent example of a great framework for specialisation.
They don’t identify ‘talent’ until players reach 12/13
Their over riding aim is to “provide fun, enjoyable, learning for every player”
They develop close links with local clubs and schools
They provide an extra 6-10 hours training a season for ‘talented’ players which then leads to a very structured pathway of progression
Children can continue playing for their local and/or school team
When it comes to tape, taping and strapping, things can get a little confusing due to the shear number of different tapes on the market, application methods, reported effects, when to use them, etc.
This blog aims to shed some light on four of the most common tapes out there by describing what they are, why you’d use each them and at what times to use them.
First up, Leukotape
Used for stabilising joints following injury or during rehabilitation to prevent reoccurrences.
Also used to offload painful structures such as irritate knees or hips.
This is a non-stretchy, 100% rigid tape that will cause a decrease in range of motion when applied correctly.
It has a high adhesive strength which allows it to stick well to skin, and even better to hyperfix (white underlay).
It’s 100% cotton which makes it skin-friendly, handy for hikers or runners looking to avoid blisters.
Drawbacks: non-elastic and range limiting.
Zinc Oxide Tape
Similar to Leukotape, this white tape offers a little more comfort but with the same rigid properties.
Used to protect and stabilise joints for injury prevention.
Lighter and less bulky than a brace, this tape will conform to the shape of a joint to provide support.
Very popular in climbers to protect the joints of the hand and fingers.
Drawbacks: restrictive, range limiting and ineffective if used on oily or sweaty skin.
Kinesiology Tape (K Tape)
A popular cotton-based, water-resistant tape with various effects on the applied tissues.
This is the colourful tape you often see on athletes or sports people.
Lymphatic effects: creates a vertical lift from underlying tissues which decompresses the space between the skin and the muscles. This facilitates blood flow, fluid drainage (management of bruising) and the removal of pain-provoking chemicals from injured tissues.
Mechanical effects: longitudinal stretch of up to 180% provides stability and elastic resistance to muscles, ligaments and tendons.
Neurological effects: creates a stimulus on the skin that reduces pain signals received by the brain (pain-relief). The vertical lift will also reduce pressure on free nerve endings to help reduce pain levels.
Drawbacks: can cause skin irritation if applied incorrectly. Can occasionally cause allergic skin reactions. Application can be complex. Research on the effectiveness of this tape is inconclusive.
A synthetic material (nylon and lyrca) with 4-way stretch.
Strong elastic properties make this the ultimate biomechanical tape, with stretch capabilities of up to 200% of it’s resting length.
Great adhesion means it will last longer, even when worn during vigorous exercise or in the shower.
When applied correctly this tape will offload injured tissues and offer elastic resistance when performing exercise.
This purely biomechanical, load-absorbing tape reduces the force on injured tissues, assists weak muscles, provides support during eccentric loading and improves movement patterns.
This tape can also lift the skin if applied accordingly, to facilitate the removal of bruises or relieve tension on underlying structures.
Drawbacks: can cause skin irritation and the stronger dynamic tape (eco tape) can reduce mobility quite considerably.
So, in a nutshell……
Opt for Leukotape or Zinc Oxide to immobilise and protect joints, the latter offering slightly more comfort but being less durable.
Choose K Tape for its range of potential effects, but remember that it lacks strong elastic properties to facilitate movement with any real support.
If you need strong, elastic support choose Dynamic Tape. It can be applied in a number of ways to work just as muscles do, which supports tissues and improves movement patterns.
If you have any doubt on the application or desired effects of taping, make an appointment to see one of our team at our clinic in Chandlers Ford, Hampshire. Just give us a call on 023 8025 3317.
In a recent survey we carried out of the people attending our clinic, we found their key frustrations when dealing with health care providers was
Having to wait for an appointment
Availability of appointments
Thankfully, there’s a way forward. Self referral. With physiotherapist being the experts in effectively diagnosing and treating a huge range of painful conditions; from back pain to calf tears, post surgical recovery to sports injuries, arthritis to growing pains. For musculoskeletal (MSK) injuries, a physiotherapist is your best first point of call. Regulated medical practitioners in their own right, you don’t need to be referred by a middle man – you can refer yourself.
So many people still see their GPs as the ‘gate keepers’ to their care, and in many instances this still holds true. But with MSK injuries, this in’t always the best way. If you have an MSK pain or injury, seeing your GP first will only result in the following:
Waiting time to see your GP, which can be weeks if it’s not urgent
Taking time off work to see your GP during their opening hours
A brief consultation with your GP, who will often recommend resting and/or medication as a first line of action
Possibly referral to an NHS Physiotherapist, which again can be weeks if not months
So, whats the alternative if you’ve got an MSK injury? You can pick up the phone from 8am 6 days a week (until 8pm Monday – Thursday) or hop onto your computer 24/7 and book online to see one of our specialists.
You’ll get an appointment to see one of our experts, normally within 24 hours if not the same day
You’ll come away with a diagnosis and pro-active treatment plan to resolve your individual injury tailored around your lifestyle
You’ll be back doing what you love doing, free from pain, quickly
So, not only does this save you lot’s of angst, worry, waiting and frustration, it significantly helps reduce the burden on the NHS, freeing up their resources to help ‘sick’ people. Your GP does not have to be the ‘middle man’, you can refer yourself directly to physiotherapy.
“GP’s are not hands on when making a diagnosis and lack expertise in different areas – no reflection on GPs, but they are not the experts”
In my experience, I’ve found many runner’s to have a high pain threshold, which can be a help when you’re a runner. However, deciding whether to run through pain is a dark art and filled with many pitfalls!
So, in this blog, I’d like to help you avoid unnecessary injuries and share with you some insider information built up over a lifetime of clinical practice treating runners, offering you some clarity and debunking these myths related to running through pain:
Pain is weakness leaving the body!
Pain is a sensation and all sensations are pleasurable, so enjoy the pain!
No pain no gain!
So, “should I run through pain?” Well, in a nutshell it depends on what type of pain you’re experiencing. Broadly speaking there are 2 types of pain related to running and it’s crucial to be able to distinguish between the main 2 types.
1. Delayed onset of muscle soreness, also known as DOMS for short, which is a normal part of any successful exercise training programme. It’s often described as “heavy legs” and in runners is mostly felt as a broad, dull, heavy, ache in the large propulsion muscles of the leg i.e. gluteals, quadriceps or claves.
DOMS is often experienced the day after a run, when you’ve increased the mileage or done a hard hill or speed session, when you are doing day-to-day tasks that work those muscles, such as getting out of a chair or walking downstairs. It’s entirely normal and desired for the training effect.
Physiologically, one way to describe what’s happening within the muscle in DOMS is that during the harder exercise session, you get microscopic tears within the exercised muscle. The body is then in a phase where it’s laying down new muscle fibres, increasing muscle cross sectional area (getting larger) and increasing strength and endurance, hence the desired “training effect”. It normally peaks day two after the exercise session and then subsides. Read more about DOMS here.
2. Pain as a result of injury This type of pain is undesirable as any part of a training programme. Unless there is a definite memorable traumatic incident whilst out running either a slip, trip or fall (which you would be able to remember), all other running injuries can be classified as overuse injuries.
By their very nature, overuse injuries, will start gradually and mostly occur when there is a perfect storm of intrinsic and extrinsic factors.
Intrinsic (Internal) Injury Factors
These are factor internal to your body, namely:
A recent increase in body weight
Your running technique
Poor or altered foot & lower limb biomechanics
Long term muscle imbalance
Muscle strength & control
Extrinsic (External) Injury Factors
These are factors that are external to your body and focus generally around your training parameters, namely:
Running volume – frequency, duration or distance
Running intensity and speed
Running terrain – hilly or flat, road or off-road
When we assess runners at goPhysio we will often find a unique mix of these factors. When combined together, they lower their body’s loading capacity or ability to cope with the demands that are being placed on their body. This results in the body complaining, often with a sharper, more niggling pain, where injury has occurred. An important part of our job as physiotherapist’s is to prioritise which factors, if addressed, will give the quickest, best outcome i.e. return to running symptom free long term.
However, if you continue to mindlessly run on this type of sharper pain without addressing the predisposing factors, it will likely worsen in severity and frequency, being felt earlier into a run and to a greater severity, eventually limiting your ability to run.
At this stage, what is usually happening physiologically, is the DOMS described above has developed into pain from injury. The micro-trauma, if left unaddressed, becomes inflammation, pain and eventually an injury.
So, if you think you’re experiencing these worsening, sharper symptoms over 2-3 runs in a week to 10 day period, stop and seek an expert physiotherapy assessment to identify, modify and remove all the predisposing factors getting you back to painfree running quickly!