Blog | Allan Besselink Allan Besselink | Official Site Of The Smart Life Project, Smart Physio, Rhubarb Diaries, And Mobius Intermedia Wed, 23 Jul 2014 13:54:49 +0000 Joomla! 1.5 - Open Source Content Management en-gb A Thousand Words IMG_20140701_200003_362A thousand words. It's about 4 pages of a novel. Or two of my blog posts. Or a scant few minutes of your precious time, depending on how quickly you read.

We've all heard that a picture is also worth a thousand words. An image, combined with a moment of quiet reflection, can conjure up plenty of meaning - without saying a word.

I wonder how many words silence is worth? I guess it all depends on the context.

Sharing our inner world involves an ebb and flow between words and silence. Phrases and pauses. Time for words to breath and for meaning to percolate. The meaning and intent of our communication changes depending upon the context, the way that we see the world at this very moment in time.

There are times when a thousand words just aren't enough. And there are times when a thousand words are, quite simply, overkill. Over the years I've found that the fewest words, direct from the heart, are almost always the most effective. However, we all run afoul of this at times in our personal and professional communication. We get sucked in to using grandiose and flowery phrases when a noun and verb will suffice.

Let me give you a prime example: the elegance and simplicity of the phrase "I love you". Just three words - but very powerful stuff requiring little to evoke a vivid mental image beyond description.

A picture isn't the only thing that is worth a thousand words. Silence can be worth that and more. As I mentioned above, silence exists in the pauses between the phrases, the moments that provide us with time for quiet reflection. Silence can also be reflected in the words that we don't use. As they say, silence speaks volumes. Either way, the context is critical.

There are times when words are necessary and perhaps even desired, and times when they aren't. But the same can be said for silence. There are times when it is of great benefit, when no words need to be said in order to get the full sense of presence and being in the moment. There are also times when silence - the choice of not saying words that might perhaps be better said - can be counterproductive at best and hurtful or spiteful at worst.

Much like the picture - so much said with nothing said at all.

Photo credits: abesselink

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]]> (Allan Besselink) Smart Physio Thu, 17 Jul 2014 04:12:02 +0000
Seven Tips For New Runners On National Running Day Turkey Trot 2011June 4 is National Running Day, a day to celebrate the sport of running. As a coach and physiotherapist, I work with runners on a regular basis. Contrary to popular belief, running injuries don't occur because of mal-alignments or muscle imbalances. They are typically a function of some common training mistakes. Running injuries will, however, be counter to the full enjoyment and appreciation of running, the sport.

If you are already a runner, today is a great day to spread the word and to get out and enjoy the sport. If you are thinking about starting a running program, then there is no better time than the present! As the saying goes, a journey of a thousand miles begins with a single step. In order to make that first step just that much safer and more enjoyable, I present to you seven tips for new runners.

1. Set a SMART goal. Having a goal will give you a guide, even if it seems modest at first. Goals should be SMART - specific, measurable, attainable, realistic/relevant, and time-bound. I strongly urge people to not set a goal of something like a marathon in the early stages of your running adventure. Get some success under your belt, be it via consistency, increasing your running pace, or even a few 5Ks for starters. Small incremental successes will breed the internal motivation to go longer and/or faster.

2. Develop a training plan. It's not just for experienced runners! Runners of all paces, skill and experience levels will benefit from having a training plan. Running injuries start with training, so establish a training plan early to provide a methodical progression to your running. I have presented many thoughts on this in "RunSmart".

3. Start with walking and running. If you are new to running, I think there is a value to starting with a walk/run program. I advocate alternating 1:00 walk with 1:00 run for no more than 20 to 30 minutes to start. Run at a pace that allows you to recover within the minute of walking. It will probably be faster than you think!

4. Focus on the quality of training, not the quantity. You don't get a badge of honor based on the number of miles you run in any given week. You are better having some shorter, good quality runs that feel good than to have a bunch of longer, slower runs that feel like you are slogging through mud just to complete the task.

5. Add interval training. Short, faster-paced efforts - even if only 10 seconds long - increase your overall capacity and help to develop your running mechanics. Building your capacity in this way helps to improve your capacity to run longer as well.

6. Get a comfortable pair of running shoes. Avoid the fads and the flashy colors. Every manufacturer builds their shoes on a slightly different shaped "last". Some will fit you better than others. Find a shoe that fits well, first and foremost.

7. Enjoy it and have fun. Running should be fun. It shouldn't be the activity that you dread, slowly slogging through the miles because you feel like you need to do so. Running can be playful. Add some impromptu sprints to the next street light, or try a hill or two for a new challenge. Keep it fun!

These seven tips will give you a great start to a lifelong running adventure. Experienced runners will also benefit from many of the same tips.

Enjoy National Running Day – and Run Smart!

Photo credits: abesselink

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]]> (Allan Besselink) Smart Physio Wed, 04 Jun 2014 23:49:44 +0000
Images Of Life In Front Of Me My OM-10I was sitting on the living room floor. It was the summer of 1984. The decision in question was spread out in front of me: two pieces of paper that, frankly, held my destiny and future.

One of those pieces of paper was an acceptance letter from Queen's University. The second piece of paper was an acceptance letter from Ryerson. It was what was contained on each that was most important.

It was a decision being made at the ripe-old age of 18 that would ultimately have an impact on, well, the rest of my life.

On one hand, I had been accepted into one of the best physiotherapy programs in Canada, the only program that would accept you directly out of high school. Unless you are a graduate of McGill (our rival academically and athletically), you know that Queen's is the best university in Canada [insert obvious alumnus bias here]. My grades in high school had got me an acceptance letter. Yeah me.

On the other hand, I had been accepted into one of the finest photographic arts programs in the country, and the only program at the time that offered a Bachelor's degree for your efforts. My grades had laid the foundation for acceptance, but it was pushed over the edge by my portfolio.

And there I sat, trying to figure out what life would hold for me. In which direction should I go?

In a moment of what now appears like mature thinking (or just plain young luck), I remember simplifying the decision to one comparison: how long would it take me to get to where I wanted to go long-term after I graduated?

The long-term goal as a physio was to work with an athletic population. If I positioned myself correctly, selected my jobs well and worked hard, I could get there over a relatively short period of time.

The long-term goal as a photojournalist was similar - working in the sports world and being on the cover of Sports Illustrated, just like the work of iconic photographer Neil Leifer. But to get there, I was going to have to not only work a lot of events, but probably have to hope for a little luck in getting my work into the hands of the right people along the way. Advancing would probably require more than just taking good images, something that would, to some degree, fall out of my control.

And so the decision was made.

Thirty years later, and 26 years of clinical practice down the road, I certainly believe that I made an amazing choice. Either I enjoy what I do, or I am crazy to still be doing it after all these years.

What amazes me most, in hindsight, is that on that summer day, I somehow found the wisdom to make the decision. I didn't know anything about going to university, nor did my family. Life provided an opportunity, a moment to have an impact and to lay the foundation for the future.

Somehow, I grasped it and the rest, as they say, is history. I certainly don't think I truly realized the impact of that decision when I was 18; the magnitude was lost in the thrill of the collegiate adventure and a strong dose of the innocence and naiveté of youth.

It is a moment that is not easily forgotten - each and every time I pick up the camera, look through the viewfinder, and compose the next images of life in front of me.

Photo credits: xddorox

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]]> (Allan Besselink) Smart Physio Fri, 16 May 2014 14:44:51 +0000
Further, Further, Further How much further?One year ago today, the world lost not only a physiotherapist but a true visionary as well: Robin McKenzie.

In retrospect, I consider myself very fortunate to have had the opportunity to meet Robin McKenzie and to watch him assess and treat patients live. It was an experience that I look back on fondly and that words fail to describe. I still laugh when I recollect his telling the tale of legendary patient Mr. Smith in such a matter-of-fact and unassuming way.

Today, I can attest that his vision and insights live on stronger than ever. Here are some personal reflections on McKenzie, MDT, and what we really stand to learn from his legacy.

McKenzie was a man ahead of his time. He was truly a "clinical scientist": making astute clinical observations, applying the scientific method along the way, and eventually developing a classification system long before anyone had considered diagnostic categories and sub-groupings. In his first text (1981), he envisioned this as being a system of musculoskeletal care, not just for spinal pain. All the while, he stood steadfast behind the principles underlying his approach even in the face of opposition from the medical community as a whole and physiotherapists specifically. Lo and behold, science has, over the years, "sorted out the details" and started to validate those insights that form the basis for Mechanical Diagnosis and Therapy.

But his legacy is about far more than just an "assessment" or "treatment" algorithm. McKenzie proposed a revolutionary concept in health care: patient self care. Along the way, he got to the root of our health care issues on many levels: cost containment, public health, and clinical outcomes. I don't think it was ever his goal from the start - he just wanted to get patients better, and to promote them doing so with their own efforts.

My personal experiences with MDT have been far-reaching and extensive over the years. My first course in 1994 was, as I have recounted, a world-view-changing life experience. Day one of that course forever impacted my perception not only of my clinical role but of the importance of self care as the central hub in the health care system. I then became the 151st clinician to complete the Diploma program: the highest level of training in the McKenzie Method. I served as the Editor of the McKenzie Institute USA journal for 8 years and the inaugural year of the International Journal of MDT. Fast forward to 2014 and we are on the verge of taking MDT into the digital era with web-based discussion and social media.

Many years ago, he signed copies of his two original texts for me. They are a treasured addition to my library. McKenzie even reviewed my first book when it was released in 2008. It was quite an honor and admittedly a role reversal for me - the mentor reviewing the work of the mentee.

He would often use the phrase "further, further, further" with patients. These words echo in my mind now, but for reasons other than just going further into the range of motion. McKenzie reminds me, on a daily basis, that when you stand on the precipice of something that is radically different from those around you, you WILL face resistance driven more by beliefs than the true value of the concept itself. These are the times in our lives when we must truly press on - to go further, further, further in our thinking.

On this day, Robin, I miss your presence in the world as a guiding light and mentor. I am thankful to have known you, to have experienced your vision, and to know that it changed the way I see the world. It has only just begun, Mr. McKenzie. Further, further, further. Indeed.

Photo credits: Hryck.

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]]> (Allan Besselink) Smart Physio Tue, 13 May 2014 14:28:40 +0000
Write Now! 2014 IMG_20140429_101319_338I'd originally just planned it as a quick trip to west Texas. It was going to be just a few days to get away, to breath, to simply find some peace and quiet in a what had become a rather emotionally challenging world over the past couple of months.

Little did I know it would become something far greater. Serendipity.

Please allow me to introduce what I am now calling Write Now! 2014. Here's the story - and the results from the adventure that it proved to be.

I'd never been out to west Texas before, but many of my friends have continued to rave about it. Traveling by train has always been fun for me - it was how I originally moved to Texas (another story deserving of its own post).

So I jumped on a train and headed to Alpine, Texas. Yes, an 8 hour train trip from San Antonio to Alpine. Yes, the sprawling community of Alpine, population 5,900 or so nestled in amongst three mountain ranges and just north of Big Bend National Park.

Some of you might be wondering right now about my choice of vacation hot-spots and travel adventures. I wouldn't blame you!

But as the story line evolved, it became more than just a respite in a quiet place. It became an opportunity to reflect. It became an opportunity to step away from the distractions and - write. Take some photos. Write some more. Lather. Rinse. Repeat.

It worked. Exquisitely, I might add.

Alpine is a pretty cool little town, perhaps not as "hip" as a place like Marfa, but a good place to relax and unwind. It was quiet; well, except for what seemed like the never-ending wind buffeting in my ears.  I stayed at the Maverick Inn, a wonderful little hotel tagged as "A Roadhouse For Wanderers". Could there be a more appropriately named place for a creative retreat?

It was a bit of a whirlwind trip. Here are the raw details:

Total trip time: 77 hours (58 of those in Alpine)

Total miles: 929 (772 by train, 144 by car, and, yes, 13 by foot)

Writing: around 12,000 words total over a total of 22 hours (approx.)

Photos: 139

Along the way, I found the world's best hot dog at Cow Dog. What a surprise. Serendipity, indeed.

What did I learn along the way? Lets face it: the only way you get better at anything is to reflect, learn from your experiences, refine how you approach it, and do it! In order to improve any skill, you have to practice and practice and practice some more. Writing is no different. Life is the same. But in order to create (or live), you somehow have to remove the distractions and just get down to it. Don't hold back. Focus. Put 100% into it. You have to be in a mind space to create. Alpine presented just that.

Mission accomplished. Thanks to all the great folks at the Maverick for making my stay a fantastic one.

We all have a story to tell – in words, in song, in pictures. Write your story now!

I look forward to Write Now! 2015. Anyone up for the adventure?

Photo credits: abesselink

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]]> (Allan Besselink) Rhubarb Diaries Sun, 11 May 2014 01:32:56 +0000
Taking Ownership Of Movement, Exercise, And Function New CarPhysical therapy is the future of health care. There. I said it - a pretty strong stance, indeed, given where we currently stand in the world.

The future of health care is going to be directly related to activity, lifestyle, movement, exercise, and ultimately, function. And who better to lead the fray?

There is just one problem with my premise. Physical therapists need to choose to believe it - and to have the guts to take ownership of it while acting in accordance with it.

The bottom line is this: there is not a profession in health or health care that is trained to evaluate movement, exercise, and function like a physical therapist. Chiropractors, physicians, exercise physiologists, massage therapists - none of these clinicians are taught nor utilize exercise across the health continuum like physical therapists do. Plain and simple. No ego involved here, just the curricular and clinical facts.

We do it better than anyone else - or, worst case scenario, we have the professional capacity to be that leader in health care. And if we changed a few things perceptually and educationally, we could do it even better.

Physical therapists should be the health care professionals deciding who sits down at the health care reform table. Why? Because our solutions - exercise- and function-based - should drive the discussion. Physical therapists are the ones that hold the keys to the car - if only we could remember where we put them.

However, there is a problem other than just "taking ownership". The profession as a whole continues to dilute itself.

We have tried so hard to be all things to all people. "We are qualified to do this and that", we proclaim. We have tried to assimilate all sorts of treatment interventions that are loosely related to the core aspects of our clinical practice. If we do movement, exercise, and function well – really well, expertly so – then, frankly, we have little need for ultrasound and dry needling and visceral manipulation and the like.

With this trend comes the addition of more and more elements being added to entry level education. But do we perform any one of them well? We have an educational approach that promotes "more tools in the toolbox". This extends to post-professional education, which becomes more a factor of marketing and promotion instead of "does this truly make you better at the core of your practice"?

Physical therapists could easily forget about all the adjunct treatments we profess to offer and get down to one key element, the core of our clinical practice and our value-added benefit. Want to transform society? Let's take ownership of our role in movement, exercise, and function. We'll remember where the keys are, and we can get on with driving the discussion as only we know how.

Photo credits: Caitlin Regan

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]]> (Allan Besselink) Smart Physio Thu, 08 May 2014 14:35:24 +0000
Evidence-Based Practice, Or How The Three-Legged Stool Fails Us the cold concrete floorEvidence-based. Evidence-informed. Best evidence. These are just a few of the catch phrases that litter the medical community these days. For every phrase, there is probably at least one analogy to best describe it. Perhaps the one that is most bothersome and annoying is that which is used for "evidence-based practice": the three-legged stool.

If you aren't familiar with it, the evidence-based practice stool stands on three legs. Each is considered to be equally important. The legs are best available research evidence, clinical expertise, and the patient's values, needs and preferences.

So how could I not support a model of evidence-based practice such as this? How could I become annoyed with such an analogy?

Evidence-based practice doesn't exist in a vacuum. There is no three-legged stool that functions optimally, in any office or home, unless it has a sound foundation upon which to place those three legs. That is the part that is readily forgotten.

Sure, we can make clinical decisions based on the best available research evidence - though the evidence is only as good as the study design. Buyer beware. We can emphasize the value and importance of countless years of clinical experience - let's just not use that as the primary means of validating a treatment intervention. Buyer beware - again. And of course we need to listen to the patient's values and preferences - though I think that it needs to be an "active" involvement on their part.

All well and good.

But the one area in which the stool is lacking is the floor upon which it rests. If you build a house on quicksand, we all know the results. The same is true if we put that three-legged stool on an unstable surface or a perilous foundation.

All is not lost: we can build a solid foundation given three key factors:

Scientific Plausibility: Does the treatment phenomenon proposed actually obey the laws of physics and have the scientific potential to exist in the world as we know it? I know that my chi is probably a little crooked, but so what? I was once told that using a foam roller created "elasticity" in the tissues; I am just not sure that science (nor collagen) would agree. If it doesn't obey science, then "Clinical Expertise" just isn't good enough - so put it to rest, please.

Anatomic Plausibility: Does the theory hold when you look at it from an anatomical perspective? My shifting cranial sutures demand anatomic plausibility. And then there is the iliotibial band. Are you really able to stretch this? Can you do so with one set of three 30 to 60 second stretches of dense connective tissue oh, every couple of days or before and after activity? Hell no. Don't believe me? Get into an anatomy laboratory at your nearest university and grab one - then let me know what you think.

Critical Thinking: Critical thinking and clinical reasoning are founded on an adherence to the scientific method. Beliefs must be left at the door. Please, no maintaining of contradictions based on logical fallacies. For example, we have plenty of data to confirm that the inter-rater reliability of many manual techniques - including palpation - is horrendous. Yes, we've had it for decades. Yet we continue to allow ourselves the liberty of using these tools repeatedly to "confirm" a diagnosis.

That three-legged stool of evidence-based practice is only as good as the foundation upon which we rest it. So let's get back to science and build a foundation that will truly support that stool. If we do, the stool can - and will - stand tall on its own.

Photo credits: Jesse.Millan

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]]> (Allan Besselink) Smart Physio Sun, 04 May 2014 20:53:32 +0000
Memories Of Senna Ayrton Senna - Toleman F1 Brands HatchMay 1, 1994 is a day that will forever stand in infamy. If I close my eyes and pause for a moment, the memories come flooding back with great clarity. They still remain vivid yet at the same time sad and haunting.

May 1, 1994 is when the world lost Ayrton Senna at Imola.

Time, as we all know, passes us by quickly. It is hard to believe that two decades have passed. Today I share a few thoughts and reflections on the legend that is Senna.

I can go back to that fateful moment 20 years ago like it was yesterday. The memories today are still as vivid as when I wrote this post five years ago.

Since then, we have been given the beautiful movie "Senna", which did an amazing job of showing the many diverse sides of "Eye-Air-Ton" Senna (the correct pronunciation per Murray Walker). I went to see it on opening night and have watched it a number of times since then. But I have yet to be able to watch the whole movie without shedding a tear or 10 during his fateful weekend at Imola. It's that powerful a movie. Who needs a plot line when you have a real life timeline from which to work?

I had the opportunity to watch Senna race live, and I will be the first to say that back in the day, I really wasn't much of a fan. He was ruthless on the track, much like Michael Schumacher and, well, all the greats before and since. Let's face it - to succeed in F1, you have to be ruthless to some degree. You have to be convinced that you are the best in the world at any given moment. One pause, one hesitation, is the difference between first and second. As a race fan, he was a very polarizing driver. It was easy to develop a "love-hate" relationship with him.

Over time though, you come to truly appreciate his burning desire to be the best and to push the envelope, to take the car well and truly past its limits, to put it on the pole when it probably should have never been there. When you look at those that followed him, you further appreciate his amazing skills, especially as the "rain master". He was the fastest, he was the best in the rain, and he exhibited a passion that we've not really seen in Formula One since then.

That's not to say that Formula One is any less spectacular than it was. The technology is light years beyond where it was in 1994. The safety is as well. The lives lost over that fateful weekend at Imola in 1994 (let us not forget Roland Ratzenberger's death on April 30, overshadowed perhaps by the loss of icon Senna the next day) instigated the research and development of the driver safety that exists today. Though there have been plenty of epic shunts since then (Robert Kubica at the Canadian GP in 2007 comes to mind), no lives have been lost in F1 since Senna's passing.

But with all of that said, Formula One just isn't the same without a Senna. It lacks the fire and the passion of a Senna.

Today, I can only wonder what Senna might have achieved in 1994 and beyond - in F1, and in his home country of Brazil.

We all have our memories of Senna that have stuck with us all these years. Twenty years later, we reflect on your passing, Ayrton. We miss you. And we thank you for showing us what it is really like to watch a truly brilliant driver - in the sun, and in the rain. It was a spectacle that will live on in our hearts and in our minds.

Photo credits: PSParrot

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]]> (Allan Besselink) Rhubarb Diaries Thu, 01 May 2014 19:38:09 +0000
The Lenses Of Our Lives Through the lens.I have been a photographer for many years. It all started with an Instamatic, progressing to a 35 mm SLR, a point-and-shoot digital camera, and now to a digital SLR. I think I had my first camera when I was 9 or 10 years old.  Having a camera in my hands is a natural feeling for me. 

Photography was almost my chosen profession. It was that or physical therapy. Yes, a strange dichotomy and a very intriguing story to go along with it. I'll share that tale at another time, but suffice it to say we all know which pathway I took.

I appreciate the challenge in taking the best photo possible. It is all about being in the right place, at the right time. Part of it is the creative aspect of putting colors and tones and lines in an image artistically. But part of it is a technical process. You have to select the right lens for the task at hand.

A photo can live or die by the lens. If you use the right one, you have the potential to then capture all of the creative elements you dare to imagine. But if not, you may be left with an image that is blurred, or distant, or distorted. The lens we look through makes a huge difference.

We have many lenses in our lives, ones that may change and evolve over time. How we view the world, and what takes place within it, is highly dependent upon the lens through which we view it.

It is handy to have a wide range of lenses. Let's face it, a 55 mm lens will perform adequately for most things but not necessarily exceptionally at any one thing. Life is the same. Seeing everything through the same lens is self-limiting. Life experiences give us a broad range of lenses. Learning gives us a broad range of lenses. Or not. We don't have to buy those lenses, but they are readily available to us should we so desire.

We also develop the ability to choose our lens, much as the way we would in order to take the best photo. We can select the lens and how we care to see the world, see our problems or our successes, and then create something positive or beautiful from there.

But if we choose the wrong lens, or just take whichever lens happens to be there at the time, we are left with distorted images, blurred images, distant images. We are at the mercy of the lens, and our world is only as good as the lens through which we view it.

Fortunately, we can change lenses as we go. We can learn and adjust. Sometimes, we have to be brutally honest with those choices. Yes, that photo might stink because of lousy composition, but it might also stink because I didn't use the right lens. So if you are fortunate enough to have another opportunity to capture it again, you choose another lens.

It's a choice. Once we make that choice, we are left to create beautiful images. Life is no different.

Photo credits: Adam Hinett

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]]> (Allan Besselink) Smart Physio Sun, 27 Apr 2014 18:06:18 +0000
The Right To Choose Revisited ChoiceIt is a call to action that has resonated with me for years. It is a call to action that I have used repeatedly, having even written a blog post of the same title last year.

The Right To Choose.

It was a great day when physical therapists in Texas adopted this phrase as a rallying cry for consumers. Simple - and to the point. The next legislative session in Texas is in 2015, and consumer awareness can't begin a moment too soon.

In a country founded on free markets, you would expect consumer choice to be a primary element in health care. My question to you, the reader, is simple: does a patient have the freedom and the right to select their health care provider freely and of their own volition? The answer, in the vast majority of states across this great land, is a resounding "no".

There are two separate issues that get confused about consumer direct access to physical therapy. One is of patient choice and clinician autonomy. One is of reimbursement and how it will be paid for in the end. The right to choose is imperative in health care decision-making and has significant ethical importance. The issues of reimbursement can only be addressed if the issue of patient choice is at the forefront of the discussion.

Our legislators in Texas, a state strongly founded on personal rights and freedoms, must be made aware of this. Texans don't have the freedom or right to choose - and how totally Un-Texan that truly is.

Let's change that in 2015. Start now by watching the video and signing the petition.

As many would be heard to say deep in the heart of Texas, let's get'er done.

Photo credits: William Ward

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]]> (Allan Besselink) Smart Physio Thu, 24 Apr 2014 04:38:57 +0000