Fascial Distortion Part 2

Continuing from last month’s article on fascial distortions, I hope to convey the broad spectrum of potential problematic areas that everyone, at some point, experiences, at least to some degree. The critical point to remember is that fascial tissue is extremely “nerve rich”, meaning that it makes one very aware when something with the musculoskeletal system, along with its connective tissue,  has been injured or gone awry;remember the “good vibrations” that are transmitted for our benefit!

So, remember from last time that:

1.     Banded fascia includes Triggerbands which are anatomical injuries to banded (parallel fibers reinforced by perpendicular cross-bands)fibers which resemble a Ziploc® bag in that the fibers/bands separate and, if become chronic, can become filled with scar tissue. This category of fascia also includes Continuum Distortions, which occur when the transition zones between tendons, ligaments, other fascial tissue, and the bones lose their ability to respond correctly to external forces. A majority of Continuum Distortions are found in acute injuries, but some may be found along with chronic injuries. Ankle sprains, cervical strains, sore shoulders, and sacroiliac pain are a few examples of these exquisitely tender disruptions of the ligament/bone junction. The impressive part about the transition zone is that there is an inherent quality that makes it more flexible than bone, yet more sturdy than ligament, and, depending on the forces being experienced, the zone is in a constant, demand-oriented flux, depending on the need imposed upon the joint. So, say a fall onto one’s wrist (one direction force) occurs. This situation would signal the bones in that area to send more osseous (boney) elements to the transition zone to make it stronger.However, if one’s experience is a car accident that involves a rear ending that ends with impacts from the front or side (multi-directional forces), the areas impacted (think neck or back), the transition zone sends those osseous elements back toward the bones, to allow for more give to minimize tears. The problem is that when the transition zone becomes stuck in one of those configurations,injuries are escalated because of the inability to adapt to the demands.

2.    Coiled Fascia, which includes Cylinder Distortions (superficial,tangled coils of circular fascia that act like a tourniquet around muscles and other tissues) when they become restricted. One will typically experience tingling and numbness with this distortion following a pulling, twisting injury. Think of a Slinky® toy that has been pulled or pushed with a twist and how it will lose its shape. Now, envision your arm or leg having experienced that type of injury.

3.    Folding Fascia, along with the associated Folding Distortion, is found in joint areas and is injured via traction or compression (pull/push)injuries, i.e. a dog on a leash yanking the shoulder or landing on the wrist with a fall. The involved tissue in these examples will become distorted like a road map that does not re-fold into the original shape and allowing for greater distortion with subsequent like injuries.

4.    Smooth Fascia is another vulnerable fascia type. There are two types of distortions in this fascial category. Herniated Trigger Points occur in the soft areas between the neck and shoulder, the buttock cheeks, the abdomen and the flank between the top of the pelvis and last rib. This fascial injury occurs when the tissue tears and the underlying tissue protrudes through and becomes pinched in the breached area. Tectonic Distortions present themselves in joint areas and are most noticeable with stiffness, “like feeling a quart low on oil”. So, decreased range of motion and pain are the obvious complaints as a result of a loss in the natural “glide” in the joint.

While it is likely apparent which fascial injuries you are most prone to, the obvious question should be, “how do I avoid them?”  Inevitably, the two major influences are acute injuries and repetitive strains.  So, avoid collisions, falls and pulls as well as doing the same motions over and over like running, spinning or swinging a golf club or racquet. As that is about as unlikely as my dad, Lou, turning away from a Jersey Shore sausage and pepper sandwich (if he were still living), let’s get real! We obviously cannot live in a “bubble”, so, prevention with adequate strength and flexibility exercises (beginner yoga is my favorite) and addressing these injuries fairly quickly are paramount. How are these injury types addressed? Evaluation of the tissues in question is followed up with manual procedures and possibly some electro or laser therapy, including acupuncture points. Some areas may have been overworked in your exercise routine and the weaker, or inhibited muscles may need to be concentrated on.  Each situation may call for specific or a combination of procedures. So, pay close attention to your body’s signals and contact us if you have any concerns!

 

      

 

 

Disclaimer

This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified health care provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. Any attempt to diagnose and treat an illness using the information in this site should come under the direction of a trained medical practitioner.We accept no responsibility for any adverse effects or consequences resulting from the use of any of the suggestions or procedures in this site or related internet links. By using the information in this web site you are confirming that you understand this statement and that you accept all risk and responsibility.

All matters regarding your health should be supervised by your health care provider. All information provided in this site is for the purpose of education, not treatment.

Good, Good, Good Vibrations

You have inevitably heard it before, that person “puts out bad vibes”, or, “that music has good vibes”. We often refer to these colloquial expressions when describing what we “feel” when we are exposed to certain stimuli. The body acts as a complex machine, consisting of many separate, interconnected, individually vibrating mechanisms that allow us to experience pleasant or less than gratifying emotional or physical sensations. Think about that tax bill you just received, or that very first car and the rumble of that engine that was pitch perfect, or your daughter’s first ballet performance, possibly, the Nutcracker, which even though may not have been without some flaw, was something that warmed the cockles of your heart! Of course, let’s not forget about that first encounter with your spouse that gave you the “deer in the headlights” look on your face, that if someone had just informed you of a million dollar lottery win, it would not have fazed you anymore than the beauty (handsomeness) that was beheld in your immediate visual field! So, conversely, if the components of our body have their tolerances exceeded to the point of emotional or physical pain, some sort of sickness will be experienced; think headache and motion sickness).

This leads me into the subject of one of our least talked about tissues in our bodies, the connective tissue, which includes tendons, ligaments, and in particular, the fascial tissue.

Aside from connecting, our fascia surrounds, separates, compartmentalizes, protects, insulates and buffers bones, nerves, muscles, and other tissues. In fact, each individual muscle fiber is sheathed with fascia! Fascia is made up of parallel fibers that transmit tension forces, or, vibrations to nerves. An analogy of this is our own clothing, which has a similar capability. If something or someone should tug on our pant cuff but not directly touch any part of our body, we would still have a fair appreciation of both the location and nature of the stimulus. This is because the tension on the pant cuff is transmitted up the pant leg to the waist where the stimulus is integrated into the nervous system.

In this way, fascial fibers function much as stringed musical instruments do. For example, a guitar or piano works on the principle of vibration. Each string has a specific diameter and tension, and when stimulated, it vibrates at a precise frequency and causes a specific note to play. Just as our ears hear music, our nervous system is interpreting fascial tension input. But, when the piano is “out of tune”, the expected frequency of the notes is usually undesirably changed. This is also the case with a distorted fascial band in which the off-key vibratory frequency is transmitted through the nervous system to the brain where it is deciphered as burning, tightness, pulling, or pain.

There are four different types of fascia and six different distortions that can affect our well being.

I will address these over a couple of articles. What is interesting is that while we all have each type of fascia, we each have differing amounts of them. For instance, a healthy football player will probably have more of one type, than say, a ballet dancer, who will generally be endowed with another.

1. Banded.

As one of the most common types of fascial tissue, trigger bands are anatomical injuries to banded (parallel fibers reinforced by perpendicular cross-bands) fascial tissues in which the fibers have become distorted (i.e., twisted, separated, torn, or wrinkled). The associated verbal description by patients is: burning or pulling pain along a linear course, say, along the neck, down the shoulder, into the arm and resembles a Ziploc® bag in that the fibers/bands separate and, if become chronic, can become filled with scar tissue. The goal of treatment in this distorted tissue is to zip up the separation(s) and to iron out the wrinkles by hand or instrument. In a number of circumstances, the other facial distortion types must first have this tissue “cleaned up” first in order to see the optimal results with other fascial, muscular and spinal alterations.

So, bear in mind, that when injuries occur, whether noticeable or not (think of the proverbial frog boiling in water), you may not notice pain yet, but as the off-key vibrations build up and are transmitted to the tipping point of your threshold, your attention will eventually demand a response. The only question is, are you paying attention to those good vibrations?

Disclaimer

This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified health care provider. Please consult your health care provider with any questions or concerns you may have regarding your condition. Any attempt to diagnose and treat an illness using the information in this site should come under the direction of a trained medical practitioner. We accept no responsibility for any adverse effects or consequences resulting from the use of any of the suggestions or procedures in this site or related internet links. By using the information in this web site you are confirming that you understand this statement and that you accept all risk and responsibility.

All matters regarding your health should be supervised by your health care provider. All information provided in this site is for the purpose of education, not treatment.

Happy New Year!

I apologize for the lateness of this second rendition of the January newsletter; yes the first one somehow got lost in cyberspace, the new“my dog ate my homework” excuse! Enjoy!

So, here we are again… awakened to the New Year, possibly like Bill Murray in his Ground Hog Day movie! Has much changed for you from this time last year, or is it “déjà vu all over again?” Some of us began noticing that our toes started to shrink somewhere around the Thanksgiving weekend, only to see them disappear by 01January! For our family, ok, me, the innocent slice or two of Pecorino Romano cheese, assorted olives and Soprasotta salami for antipasto continued with the meatballs and Italian sausage, the Christmas Eve seafood, (I forgot the office and church gatherings with the Southern, Mexican and Chinese “low cal” appetizers and dinners), the Christmas tenderloin and the incredible dinner at Da Corrado’s Italian Ristorantein Greensboro, GA on New Year’s Eve. Then, just when there seemed to be a digestive respite, the Southern fare New Year’s Day dinner with some dear friends! At that point, a food coma nearly overwhelmed us; however, the wonderful home cooked meal prepared by our daughter and son-in-law this past weekend was just a prelude to the delicious dinner that they sprung for after church. I have finally given up! Yes, in Italian (and Chinese families, it’s all about the food). I am now ready for a diet of mung bean thread noodles and quinoa!  Perhaps a fast is in order!! Maybe this wouldn’t have been so bad if the weather had been more cooperative the past six weeks; exercising would have been easier, or at least more inviting. I have observed, in more than just clinical settings, that it is much easier to excuse calorie intake over burning them! I now stand at 10 pounds over my desired weight (confession time); something I have not loathed since college wrestling days before weigh-in!

But, alas! This is, as I alluded to, the New Year and time for those inevitable resolutions to be written in stone… again. This year, although,has an opportunity to be new and improved, in that a commitment can be made and discipline enforced.  So, first, is to get back to the discipline of cheating only on the weekends (except for special events).  Then, being committed to exercise in a way that challenges the body. It has to not only be a mindset,but a passion to be healthier. Proper diet is paramount, as is a balanced exercise r o u t i n e.

What part do exercises play in your treatment procedures? I believe that effective, focused exercises play an important role in healing and regeneration of damaged tissues. Every patient receives appropriate exercises as the body can handle. Our exercises are based on four basic principles:strength, flexibility, balance and cardiovascular function.

Flexibility

• Good flexibility enables muscles and joints to move through their full range of motion. Poor flexibility leads to a higher chance of injury to muscles, tendons, ligaments and connective tissue, or fascia.
• Flexibility is joint-specific; a person may have excellent range of motion at one joint, yet be restricted in another. It is also plane specific, along fascial planes, which may encompass the wrist, elbow, shoulder and neck for instance in an overuse syndrome.
• Stretching exercises help to realign new tissue that is being laid down in the direction of the muscle and facial fibers. Without appropriate stretches, new scar tissue may form in weak random patterns, resulting in new restrictions and problems.

Strength

• Resistance training is essential in the rehabilitation of any injury.
• Tissue goes through a remodeling phase which can take from six months to a year.
• When new tissue is laid down to repair an area, it is very thin and weak.
• During the remodeling phase, this tissue will increase to over ten times it original diameter if the appropriate resistance training exercise are applied against it.
• Without resistance training the probability of re-injury remains high.

Balance and Proprioception

• Proprioception describes the body’s ability to react appropriately (through balance and touch) to external forces. Kneeling or standing lunges or exercise ball maneuvers employ this concept.
• Effective proprioception exercises are designed to restore the kinesthetic awareness of the patient. These exercises form the basis for the agility, strength, and endurance required for complete rehabilitation.

Cardiovascular

• Cardiovascular or aerobic exercises are essential for restoring good circulation and for increasing oxygen delivery to soft-tissues. Lack of oxygen and poor circulation is a primary accelerator of injuries.

So, what will be your plan for the New Year? Will you hear the alarm clock go off each morning and see the same undesired reflection in the fogged up bathroom mirror? Or, will you inch toward a healthier, more fit body. I am here to help and guide you, but ultimately, we each have to be responsible for our physical, mental and spiritual growth and improvement. I just remembered…I forgot to make the biscotti this year!

May your 2014 be blessed indeed!

Disclaimer

This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified health care provider. Please consult your health care provider with any questions or concerns you may have regarding your condition. Any attempt to diagnose and treat an illness using the information in this site should come under the direction of a trained medical practitioner. We accept no responsibility for any adverse effects or consequences resulting from the use of any of the suggestions or procedures in this site or related internet links.By using the information in this web site you are confirming that you understand this statement and that you accept all risk and responsibility.

All matters regarding your health should be supervised by your health care provider. All information provided in this site is for the purpose of education, not treatment.

SO, YOU THINK YOUR MUSCLES HURT?

 

Here we are again…Thanksgiving, which ushers in not only the wonderful Christmas holidays, but, the perennial, favorite activity of…dragging the Christmas tree out of the attic! There is a commercial running nowadays with the wife saying that her husband seems to speak a different language when he struggles with domestic responsibilities of the like. Anyway, with the frustration of the huge, now duct taped, box of tree pieces needing to be shoved through the disappearing staircase hole that undoubtedly shrinks more with each passing year, there always seems to be a bit of tweaking to one or more unfortunate body parts. The usual verbal response by most is that a muscle just “pulled”.

But, before you are too quick to blame the seemingly obvious culprit, consider another possibility, the fascial tissue. This connective tissue, which covers the muscles, has a high sensory feedback (lets you know that you just messed up!). The thoracodorsal fascia (TLF) that covers the posterior aspect of the torso is a major player in virtually every trunk motion; an injury to this tissue can cause unlimited potential movement disorders. In fact, pain found in other areas can be resultant from problems in the TLF.  Fibers from this tissue attach to the lats (broad climbing muscle that connects the back to the shoulder), the internal obliques (along the flanks above the hips)and even the diaphragm, which can make for better reasoning why a shoulder can hurt with a problem originating in the lower back, or why it is difficult to breathe well with back pain.

So, what are the signs of TLF dysfunction?

1.     Tightness or spasticity in the back between the bottom of the shoulder blades and the lower back even after localized therapy.

2.     Chronic lower back pain (not diagnostically confirmed in itself)

3.     Repetitive or chronic sacroiliac locking.

4.     Nagging shoulder and hip pain that does not improve with localized treatments to painful area.

5.     Inability to expand the ribcage with diaphragm breathing.

6.     Decreased thoracic (mid spine) motion.

7.     Altered gait pattern with poor arm and leg swing.

8.     Base of the skull type headaches or plantar fascial pain due to the fascial attachments referenced in Thomas Meyers’ Anatomy Trains.

9.     Spasms or weakness of the quadratus lumborum muscle(below the obliques, attaching the pelvis to the last rib).

Now, what can be done?

In previous articles, I have addressed the successful protocols that we utilize to treat adhesions and fascial dysfunction, but, I will briefly address them here for clarity purposes.

1.     Evaluate for muscle motor inhibition (locate what is not working).

2.     Find any restrictions due to adhesion build-up.

3.     Break down adhesions via therapies such as cold laser,Active Release or Graston protocols.

4.     Activate (wake up) muscles that are inhibited via electrotherapy techniques.

5.     Adjust the spine (or other involved joints) that are dysfunctional.

 

It has been a pleasure and an honor to be able to care for you and your family and friends over the past year that have entrusted me with the challenges of pain management, as well as functional improvement. Daily, I seek the wisdom and insight to meet those challenges in order to be the best in my field. May you each be able to enjoy a healthy, warm and enriched Christmas season that is blessed beyond your dreams! Also, be careful shoving that Christmas tree back up in the attic!

Disclaimer

This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified health care provider. Please consult your health care provider with any questions or concerns you may have regarding your condition. Any attempt to diagnose and treat an illness using the information in this site should come under the direction of a trained medical practitioner. We accept no responsibility for any adverse effects or consequences resulting from the use of any of the suggestions or procedures in this site or related internet links. By using the information in this web site you are confirming that you understand this statement and that you accept all risk and responsibility.

All matters regarding your health should be supervised by your health care provider. All information provided in this site is for the purpose of education, not treatment.

Sitting Has Become The New Smoking

In the May 25, 2013 edition of the Los Angeles Times, Anup Kanodia, a physician and researcher at the Center for Personalized Health Care at Ohio State University’s Wexner Medical Center said, “Sitting is the new smoking”. He cited an Australian study published in October 2012 in The British Journal of Sports Medicine that compared sitting and smoking. According to the study, every hour of TV that people watch, presumably sitting, cuts about 22 minutes from their lifespan, while it is estimated that smokers shorten their lives by 11 minutes per cigarette. (Please don’t use this as support for trading bad habits!)

This information is important for all of us to take to heart, in that frequent micro-breaks, i.e. getting up and moving around is essential for not only burning those five slices of CiCi’s or Amici’s pizza you consumed during lunch, but also to enable those neck and hip flexors to lengthen out of their prolonged contracted states (see previous articles on Upper and Lower Cross Syndromes). One reason that extended periods of uninterrupted sitting are bad for the lower back is that progressive tears can develop within the discs that are situated between the lumbar (predominantly) vertebrae. Once the pain reaches the chronic stage, a cascading, undesirable ability to perform the necessary activities of daily living becomes sadly apparent. Then, not only does it become difficult to impossible to walk or exercise, but the preferred assumed position then becomes lying down or walking like a descendant of Groucho Marx. Now, with being horizontal, muscle tone diminishes by as much as 30% in just 10 days! So, the importance of movement cannot be over emphasized. My clinical observation over 30 plus years has manifested a fairly consistent finding; a patient in pain presents on a Monday morning and inevitably wants to know ALL the exercises to do N O W while the symptoms are at their peak, having forgotten (or ignored) all that they should have been doing all along in order to PREVENT their current dilemma! Unfortunately, this is the time for crisis or acute care, not preventative. Thus, prolonged sitting, or inactivity, leads to reduced aerobic activity, progressive pain expression and not unsurprisingly, time on the DL (disabled list) for necessary or just recreational activities; unfortunately, unlike pro athletes who get paid regardless of whether they play, you most likely will not and will have to suffer through the recuperation process!
With the holiday season quickly approaching, NOW is the time to start moving during your work day. NOW is the time to become intentional. NOW is the time to show your concern for your loved ones by taking an active, participating role in your health! Have a truly blessed Thanksgiving.

Disclaimer
This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified health care provider. Please consult your health care provider with any questions or concerns you may have regarding your condition. Any attempt to diagnose and treat an illness using the information in this site should come under the direction of a trained medical practitioner. We accept no responsibility for any adverse effects or consequences resulting from the use of any of the suggestions or procedures in this site or related internet links. By using the information in this web site you are confirming that you understand this statement and that you accept all risk and responsibility.
All matters regarding your health should be supervised by your health care provider. All information provided in this site is for the purpose of education, not treatment.

Stop Starch-Induced Glucose Surges

Having been brought up in a family that seemingly experienced as much pasta and Italian bread passing through our oral cavities as simple air, it should be of no surprise that a majority of my relatives (women included) might have made the short list for the Falcon’s front line. Amazingly, many of these “stout” loved ones lived well into their 90’s….after experiencing one or two coronary incidents which usually led to some behavior modifying diet and other positive lifestyle changes.
While I am in favor of portion control as I gain in years, (yes, it is tough!), we all go through those periods when it seems like meals are the constant “go to” plan when gathering with friends. Who am I kidding? It’s always been the “go to” plan! I am trying to consume one-two glasses of water before I go into attack mode; this does cut the calorie volume a good bit if I can ignore the bread and olive oil! Increased blood sugar has become extremely epidemic in our society and children are often victims way too early! When I came upon this article, I felt that it was well worth sharing. The supplement that is highlighted in the article may help those whose discipline is not quite as strong as it needs to be. Our diet and exercise routines do not need to be complicated, but they can evolve to that stage if we allow ourselves to reach a crisis state. Some wise person once said, “eat to live, don’t live to eat.” I’m willing to bet that the person was not Italian!


Click the following link to read this month's article:
http://www.lef.org/magazine/mag2013/jul2013_Stop-Starch-Induced-Glucose-Surges_01.htm?source=search&key=Stop%20StarchInduced%20Glucose%20Surges








 

Disclaimer:
This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified health care provider. Please consult your health care provider with any questions or concerns you may have regarding your condition. Any attempt to diagnose and treat an illness using the information in this site should come under the direction of a trained medical practitioner. We accept no responsibility for any adverse effects or consequences resulting from the use of any of the suggestions or procedures in this site or related internet links. By using the information in this web site you are confirming that you understand this statement and that you accept all risk and responsibility.
All matters regarding your health should be supervised by your health care provider. All information provided in this site is for the purpose of education, not treatment.

Let's Take It To The Mattresses!

So, for those who have been blessed (or cursed) with being an Italian descendant, or, having been brought up in one of our nation’s more colorful, northern cities, or, even just remember the 70’s movie, The Godfather, will be familiar with the title of this article. While my direct intent is not to invoke a heated discussion or battle, regarding the vicissitudes of contemporary living, I am going to try to offer some insight to a frequently posed topic, “What kind of bed should I buy?” If you are not careful, a sales person could make you an expensive offer that you should refuse!

Mattresses used to be made out of cotton padding and springs. Now, you can be inundated with commercials that promote the(ir) “best” choices of air, memory foam, latex, water, etc. that often lead to a soon to follow “buyer’s remorse”, especially considering that sleep issues have, for collective reasons, reached an epidemic level.

The mattress of today is comprised of two basic parts:

·        The foundation, which is most often a box spring (made of a wooden frame with springs and covered by a thin cotton or synthetic covering), a dense foam platform or the more expensive (and my preference) adjustable frame (think hospital bed).

·        The top mattress, which has a support layer under a comfort layer. The idea is to have a softness for hip and shoulder contact points, with enough support to not sag too deeply. Two-sided mattresses are now evolving to single sided ones that eliminate the need to flip (anyone ever tried flipping a king sized one on high bed frame with an eight foot ceiling?). The problem is that you now only have one side to wear and I have not read any valid or convincing studies to suggest that they have a more promising longevity.

Federal regulations have also required that all mattresses contain a fire retardant that extinguishes the flames in the event that an incident were to develop, which has created a valid question as to the safety when considering the toxicity of the everyday fumes with the “off-gassing” of the bedding containing polyurethane foam or applied sprays that contain PCB’s like asbestos or boric acid. In all fairness, there are other furnishings in the home that have similar chemical concerns as well, however, the eight or so consecutive hours of close proximity make the bed a more important player, especially with individuals who may be hypersensitive. Mattresses should also wear slowly and evenly. I could not even guess at the number of times that I have heard of patients complaining of their mattresses sagging after only 2-4 years. Is it because of inferior quality materials i.e. the metal in the springs being thinner and of less stronger, cheaper metals, or is it because we have become a very overweight society? Probably both in my opinion, but, I know of circumstances where the husband and wife are 150 and 110 pounds respectively and their bed looks like waves along the Jersey shore! Warrantees have deteriorated to the point where, because of replacement cost, necessary replacement is delayed much too long.

So, what kind of bedding would I recommend (for a couple)?

·        A king sized independently dual sided adjustable frame. (Maybe even throw in a vibrating component).

·        Two over-sized twin, dual-sided mattresses that reveal all the materials used to make them. I would prefer the firmest mattress available and put a down or other safe hypoallergenic “topper” widely advertised on the internet or box stores to provide the softness desired.

Why this choice? First, a narrower bed will break down slower because there is not as much real estate. Second, the flip factor is easier, making for less visits to you know who because of incidental strain! Third, the bed frame can approach the “zero-gravity” chairs that are advertised and allow for better posture for reading or watching television in bed. Now, the bed frame may be a costly perk, but, you will save money on the firm mattresses, as the extra padding generally is what jumps the price up. Sleep is a vital part of our healthy existence, along with smart exercise and proper nutrition. Your choice for the best alternative could make the difference in how well you or your family performs in work, school or activities.  So, get looking at your bedding now so that you won’t feel like you have been sleeping with the fishes!