Upper Back Pain - Identification And Some Useful Solutions

Upper Back Pain is as painful or troublesome as the pain in the lower back or the neck. An injury or a strain is the most common reason for the pain in the upper portion of our backs. Although back pain in upper portion is not a common phenomenon, it can cause significant discomfort and needs to be treated carefully. The identification of the exact cause is necessary to treat the pain in the upper back.

Muscular irritation and joint malfunction have been found to be the most common causes of upper back pain. An injury or a poor posture can also result in back pain. In recent years, it has been found that people sitting in one posture for example working in front of the computer are more prone to suffer from this type of back pain.

Lack of activity or poor strength of our muscles is a very common cause of upper back pain and can be treated through chiropractic cure, acupuncture, massage, physical therapy and various types of stretching exercises. Again an injury or strain in the joints between the ribs and the upper back can result in severe pain. Such a situation can be rectified by exercises aimed at strengthening the muscles and loosening the back. A ruptured disk or a degenerative disk disease can also result in back pain in upper part.

An appropriate posture and regular strengthening exercises are a must for avoiding the pain in the upper back. A poor posture can lead to weak muscles and a strain in our joints and ligaments and thus cause upper back pain. Osteoporosis, a disease which makes ones bones fragile and weak, a rupture in the spinal disk or any other form of injury can also result in back pain. People suffering from heart disease can also experience pain in the upper back. Such people need to consult a specialist so as to avoid any complexities.

Upper Back Pain 

It is important to get proper medical treatment if the cause of your upper back pain is Osteoporosis, a ruptured disk or any other injury. However, if the pain is caused by a poor posture or a strain, we can take some self remedial action such as massaging the area of pain. Pain in the Trapezius or the triangle shaped muscles of the upper back and the shoulder blades can be rectified through self massage or massage by somebody else. Also try to concentrate on improving your posture and sit straight instead of slouching.

A poor posture eliminates the natural, weight-supporting S curve in our backs and weakens them. In contrast a right posture- chest out, stomach in, and buttocks tucked under- helps one to restore the S curve in our back. Proper exercises can enable one to rectify his/her posture. Proper massage by a physical therapist, use of acupuncture techniques and physical therapy also go a long way in relieving upper back pain.

Upper Back Pain Relief - Causes and Cures

Upper Back Pain Relief - There are many different causes of upper back pain, and while not as common as pain in the lower back, it can often times be a much more painful, often chronic condition. The good news is...There ARE medications and pain management treatments that can be very effective.

Some of the causes are myofascial pain (irritated muscles), dysfunction of or degenerative joints, and even an injury or herniation to one of the discs in the upper spine, called Thoracic Herniation. You may even have a genetic disease or disposition to having these problems. Other scary sounding problems could include osteoporosis, rheumatoid arthritis, sciatic nerve impingement, compressed vertebrae and others.

In other words...before you start on any course of self treatment, check with your doctor to be certain your  pain relief effort doesn't require surgery.

Causes...

Though more common in lower back pain, pain in the upper back can also result - over time - from poor posture.

If you are sitting at a desk all day, hunched over doing work, this puts a strain on your upper back. The upper back vertebra are not designed to be constantly bent over like this. It is a more rigid part of the spine, designed to support the weight of the person, and protect the internal organs. If it is not held in an upright position, the muscles surrounding the spine itself can become strained.

Upper Back Pain

Upper back pain can be extremely discomforting. Usually, in addition to having upper (cervical)  back discomfort, you may also experience shoulder and neck pain, as well as pain in the lower back and spine. To find upper back pain relief, you will want to really dig in and find ALL the causes. It could be a combination of several acting together - not just one.

Luckily, if you happen to have upper back pain, there are a number of ways to alleviate it. Surgery, medication, back strengthening and stretching exercises, massage and even acupuncture to name a few. Prevention...

But, when discussing your health, it prevention should be your first - top - line of defense.

Since it is so important that you prevent the problem in the first place, here are a few things you can do:

1. The first is get enough sleep at night, with a bed that is supportive of the spine. Sleep is important, not just to rest the back muscles, but to repair nerve and muscle damage.

2. If you are someone who does sit in front of a desk for long periods of time, or in front of the television, that's all right, but it is important that you get up at least once every half an hour.

Move around, stand up straight as much as possible, and walk around a little bit. This way your back and spine don't strain by sitting in one position for so long a period of time.

3. There are a number of back stretching and strengthening exercises you can find that can help... try taking a class in Yoga. Building up weakened muscle tissue in the back helps!

4. Changes in diet can also help to prevent upper back pain. Reducing the amount of caffeine in your diet, eating foods that have anti-inflammatory properties.

Sometimes, upper back pain is unavoidable. It may even happen from doing something you aren't even aware of, and all of a sudden you have these pains.

Frequently, when you get sudden pain from nothing more than twisting or turning at just the right angle, this is caused by a herniated or bulging disc. Since there is no pain unless it actually touches a nerve (we are talking millimeters), it is estimated that 60% of all of us have disc problems - but we aren't aware!

We are all going to have a certain amount of upper back pain occasionally, and here are just some of the many ways to get severe back pain relief.

Upper Back Pain Relief...Cures

One way to find upper back pain relief is to soak in a tub of water with Epsom salt. Adding a bag or two to water that is hot enough to just stand it can be a great relief, not just for you upper back, but other areas of the body as well. If you want, you can even add some essential oils for aromatherapy.

Upper back massage is another great way to relieve pain, and you can do this even if you are by yourself. Take a couple of tennis balls, lay them on the floor, and lay down on them.

Gently move your body back and forth, allowing the balls to massage the muscles. Every thirty seconds to a minute, change the positioning of the balls. If you find an area that is particularly painful, you don't have to stay there, move the balls in another location.

Upper Back Pain Relief - 4 Simple Steps to Relieve Your Back Pain

Are you seeking for upper back pain relief? Do you want it to happen now and wish that the pain will disappear in a second? Well, it can be. A relief from such pain is possible to achieve, provided that you are going to do your part in performing necessary treatment as advised. Most of all, make sure you are responsible enough to correct the causes of the upper back pain.

Do you hate that upper back pain that seems to control your life these days? Does the pain make yourself unproductive, leaving you sedentary and irritable? True, upper back pain can affect your day to day activities. Usually, when it happens to you, the pain is mostly felt in the bottom part of the neck up to the middle portion of the back, which is why the other term for upper back pain, is "middle back pain". The pain can make you miserable, such that you will not be able to perform household chores well, such as dish washing, laundry, mapping, gardening, etc. you see, even on simple things are affected with it. Your upper back pain could also be the reason of your missed workdays at the office.

Moreover, how people respond to upper back pain depends on how they perceived the pain and how they treat it. Mostly, the common mistake of people when dealing with the pain is that they consider it as the BEST indication for treatment. Pain is an unclear sign because it doesn't give you clear definition as where the pain originates, when it will last and how much is the pain. Remember, pain is but a subjective sign, it varies from person to person, so it is not a good basis for treatment. The best way to know how upper back pain is treated, is through knowing its causes. There are a lot of factors what causes upper back pain, and the main causes are

Imbalance of your muscles and joints brought about by improper posture and exhausting daily works and household chores.

Weak muscles due to aging and laborious work.

As one ages, the spine may undergo a wear and tear stage, thus causing the spine to degenerate and becomes weak.

Unused joints due to sedentary lifestyle.

The lower back can even caused upper back pain since the spine works as one system, so, when the lower back is twisted or damaged, the upper back is affected anyway.

Again, the biggest mistake a person can make in dealing with upper back pain is relying too much of the pain alone as the basis for treatment. It must be noted that the best way to approach a relief for upper back pain is by knowing the causes, and by knowing it, a long and effective relief is possible.

upper back pain

Upper back pain relief...

The different causes mentioned above can be approached with the following:

1) When you suddenly feel the pain on the upper back, give value to REST. When the pain happens when the time you are doing heavy works or sitting and standing for a long period, your body calls for a rest. When you at the home, you can lie down for a while to relax your back muscles. When you are at work, take some time to sit from long standing, and stand from long sitting. Do not overwork your back muscles, as this can cause strain and injury to the back. However, rest must not be done for more than 3 days, because our back may get weak when over rested. Our back needs to be active slightly, enough to strengthen the bone.

2) If the pain is less than 48 hours, hot and cold treatment can be done alternately:

Cold application always comes first than hot. This application can be in a form of ice pack which makes use crushed ice wrapped in a towel. This is then applied directly to the painful area for 15-20 minutes. This works by reducing pain and inflammation.

Hot treatment is done next. Then the pain already subsides, this is then applied to relax the area and increase the flow blood to the area, thus causing wound healing. With the use of hot bottle wrapped in a towel, apply to the injured area for 15-20 minutes.

Application should not exceed for more than 20 minutes as this may cause some bad effects to the body.

3) Anti-inflammatory drugs.

Ibuprofen is the most common anti-inflammatory drug used to relieve swelling and pain on the injured area, because of its lesser side effects.

The frequency, duration and dosage of the drug should be advised by your health care provider.

4) Upper back pain exercises

These exercises can correct all those causes mentioned above. When the spine is weak, we can strengthen it. When the spine is immobile because of sedentary lifestyle, we can work it out though exercises. When the spine is out of balance because of improper posture, we can align it and correct those bad postures. All those and more can be covered by upper back pain exercises.

Exercise One: Stand straight. Keep your lower back against the wall with your hands on your sides. Allow your palms to face outwards. Now, those arms on your side must take a slide up and down against the wall for about 15 to 20 counts. This will stretch both your back and arm muscles.

Exercise Two: Sit straight on the floor and stretch your legs in front of you. As you do this, hold your thighs with your hands and lower down your head going towards your chest. Hold in such position as long as you can, and go back to the starting position and repeat 5 times. By doing so, it can help relax the upper back muscles.

Exercise Three: Stand straight and feet apart. Slowly stretch your hands making it parallel to the ground. Slowly turn to your left gently moving your upper body and waist; go back to the starting position and do it again on the other side. You can do this exercise, 10 times. These are great stretches for upper back pain relief.

How to Diagnose Lower Back Pain

Lower back pain is a common affliction, with millions each year visiting physicians for relief. Not only will they seek relief, they will want a diagnosis.

It is not always easy to diagnose lower back pain. Many body structures can cause it. There are muscles, ligaments, and tendons; spinal column bones; joints, discs and nerves. In addition to these structures, there may be underlying medical conditions your physician needs to evaluate.

Whether you initially diagnose lower back pain yourself, or leave that to your physician, the diagnosis will need to consider both the location and symptoms of your pain.

Lower Back Pain

Step 1 - Location

The first step is to decide the location. "Where does it hurt?"

1. Axial lower back pain: This lower back pain hurts only in the low back. Pain does not travel into any other area.
2. Radicular lower back pain: This lower back pain hurts in the low back, and also radiates down the backs of the thighs into one or both legs.
3. Lower back pain with referred pain: Diagnose lower back pain with referred pain if it hurts in the low back area, and tends to radiate into the groin, buttocks, and upper thighs. The pain will rarely radiate below the knee, but may seem to move around.

Step 2 - Symptoms

Once you diagnose lower back pain as to location, you will consider symptoms. "How does it feel?"

1. Worsens with certain activities: If you play football, for example, the pain is worse.
2. Worsens in certain positions: Perhaps it gets worse if you stand for too long. Or it is more painful after you sit in a car.
3. Feels better after rest: Resting from the activity or position usually reduces the lower back pain.
4. Deep and steady: Not a sharp muscle catch, this pain is constant and deep within the affected areas.
5. Severe: The pain is excruciating, possibly more so in the calf than the lower back.
6. Numbness and tingling: There may be "pins and needles" within the area.
7. Fleeting pain: Pain may seem to come and go, leaving you unsure at times just how it feels.
8. Achy and dull: Like the flu, this pain is sore and dull, though sometimes intensifying.
9. Migratory: It hurts in one spot, then another.

Diagnosis

AXIAL: If location is best described by number 1 above, and symptoms are a combination of 1, 2, and 3, you can probably diagnose lower back pain as being axial - the most common type. This is also called "mechanical" lower back pain. A variety of back structures can cause axial lower back pain, and it is difficult to identify which is the cause. Axial pain gets better on its own, and about 90% of patients recover within six weeks.

RADICULAR: If location is best described by number 2 above, and symptoms are a combination of 4, 5, and 6, you can probably diagnose lower back pain as being radicular - commonly called sciatica. This lower back pain is caused by compression of a lower spinal nerve, usually the sciatica nerve that runs from the spinal column, down the back of the thighs to the feet. Doctors usually recommend conservative treatment such as physical therapy exercises, medications, and possibly spinal injections, for six to eight weeks.

REFERRED: If location is best described by number 3 above, and symptoms are a combination of 7, 8, and 9, you can probably diagnose your pain as being lower back pain with referred pain - the least common type. This lower back pain is treated the same as axial back pain and frequently goes away as the problem resolves on its own.

How do you diagnose lower back pain?

Diagnose lower back pain with care. You need an accurate diagnosis, which your physician can best make, to be sure no underlying causes need attention. It is not enough to know you have sciatica. You need to know the underlying cause of the sciatica to determine treatment options.

If you do diagnose lower back pain, check the diagnosis with your physician.

What Is Causing My Lower Back Pain?

Lower back pain is one of the leading reasons people in the United States visit their doctors. It will inhibit the lives of millions of Americans this year. In fact, an average four out of five adults will experience low back pain at some point in their lives. So the question, "What is causing my lower back pain?" is not uncommon.

Lower back pain can be excruciating. It can be caused by a large variety of injuries or conditions, such as:

* lower back muscles may be strained

* discs between the vertebrae may be injured

* large nerve roots extending to arms and legs may be irritated

* smaller nerves that supply the lower back spine may be irritated

* joints, ligaments, or even bones may be injured

When lower back pain occurs with other symptoms such as fever and chills, a serious medical condition may be present. You should see a doctor immediately.

Three categories of lower back pain

Your lower back pain will fall into one of three categories, which your doctor bases on your description of the pain.

1. Axial lower back pain - mechanical or simple back pain

2. Radicular lower back pain - sciatica

3. Lower back pain with referred pain

Lower Back Pain

1. Axial Lower Back Pain

Axial lower back pain is the most common of the three. It is felt only in the lower back area with no pain radiating to other parts of the body. It is sometimes called mechanical back pain or simple back pain.

* Description: Axial lower back pain can vary greatly. It may be sharp or dull, constant or intermittent. On a scale of 1 to 10, you may rate its intensity #1 or a full #10. It may increase with certain activity - when playing tennis, for example. It may worsen in certain positions - such as sitting at a desk. It may or may not be relieved by rest.

* Diagnosis: Axial lower back pain might be diagnosed by you rather than your physician. You know it started when you were helping a friend move a heavy couch. On the other hand, it may be your doctor who determines that you have strained or otherwise damaged back muscles, have a degenerated disc, etc.

* Treatment: The cause of your axial lower back pain does not matter when it comes to treatment. You will want to rest for a day or two. Follow this by gentle back pain exercises and stretching. If you have more pain after exercise, use a heating pad on low or medium setting. Take an appropriate over-the-counter pain medication. Follow your doctor's advice.

* Prognosis: Symptoms of axial lower back pain disappear with time, and about 90% of patients recover within four to six weeks. If you do not feel better within six to eight weeks, additional testing and/or injections may be needed to diagnose and treat the source of the pain.

* Caution: If your pain is chronic, or so severe that it awakens you during the night, see your doctor.

2. Radicular Lower Back Pain

Radicular lower back pain is commonly referred to as sciatica. It is felt in the lower back area, thighs, and legs.

* Description: Radicular lower back pain often begins in the lower back, and then follows a specific nerve path into the thighs and legs. Your leg pain may be much worse than your back pain. It is often deep and steady. It may readily be reproduced with certain activities and positions, such as sitting or walking.

* Diagnosis: Radicular lower back pain is caused by compression of the lower spinal nerve. The most common cause is a herniated disc with compression of the nerve. Other causes might be diabetes or injury to the nerve root. If you had previous back surgery, scar tissue may be affecting the nerve root. Elderly adults may have a narrowing of the hole through which the spinal nerve exits.

* Treatment: Conservative treatment is the best place to begin. Rest for a few days in a bed or chair. Follow this by gradual introduction of gentle exercises specifically for back pain relief. Follow your exercise with additional rest, applying a heating pad on low to medium setting. Soak daily in Epsom salts baths. Take an appropriate over-the-counter pain medication. Your doctor may want to use selective spinal injections.

* Prognosis: Symptoms of radicular low back pain may decrease with the conservative treatment outlined above. Give your back and legs six to eight weeks to improve. If surgery is needed after that, it typically provides relief of the leg pain for 85% to 90% of patients. The back pain itself is more difficult to relieve.

* Caution: If an MRI or CT-myelogram does not definitely confirm nerve compression, back surgery is unlikely to be successful.

3. Lower Back Pain with Referred Pain

Lower back pain with referred pain is not as common as axial or radicular back pain. This pain, which does not radiate down the thighs and legs, may be caused by the same conditions that cause axial lower back pain.

* Description: You will usually feel referred pain in the low back area, radiating into your groin, buttocks, and upper thigh. The pain may move around, but it will rarely go below your knee. It often is an achy, dull pain. It tends to come and go. Sometimes it is very sharp, but other times it is only a dull sensation. It can be caused by the identical injury or problem that causes simple axial back pain. Often, it is no more serious.

* Diagnosis: It is very important to have a physician determine whether your pain is lower back pain with referred pain or radicular lower back pain, since the treatment varies considerably.

* Treatment: Once you know for sure that yours is lower back pain with referred pain, you can follow the treatment for axial lower back pain.

* Prognosis: Symptoms of lower back pain with referred pain disappear with time, usually within four to six weeks. If you do not feel better within six to eight weeks, ask your physician if additional testing and/or injections are needed.

* Caution: If your lower back pain is chronic, or so severe it awakens you during the night, you should see your doctor.

Physical Therapy for the Lower Back: How to Prevent and Treat Lower Back Pain

Lower back pain is one of the most common causes of job-related disability and why some people miss work. It is also the second most common neurological ailment in the United States, second only to headache. In fact, approximately 80% of adults in Western countries have, at some point, experienced lower back pain.

For some fortunate people, pain in the lower back may be resolved by itself or with the aid of medication within two to four weeks. However, there are some cases of lower back pain that may last for more than a few weeks, during which case the condition is termed as "chronic" and "progressive," meaning it can only grow worse over time.

Moreover, 60-80% of those patients who suffer their first episode of lower back pain may experience recurring pain within one year.

According to current research, there are certain muscles in the back that work to stabilize the spine. When the spine or the back suffers an injury, these muscles are reflexively inhibited or shutdown. Worse still, these muscles do not spontaneously recover, and this is true even if patients do not feel pain and are able to return to normal activity levels.

As a result of the inhibition of these muscles, called lumbar multifidi and the transversus abdominus, lower back pain occurs. However, there are steps you can take to prevent the same thing from happening to you.

Lower Back Pain

Lower Back Pain and Physical Therapy

One way to prevent the inhibition of the lumbar multifidi and transversus abdominus is through a series of physical therapy exercises.

Designed to strengthen the muscles of the lower back and keep the spine healthy, these physical therapy exercises may range from back stabilization exercises to muscle strength development and several wide variety of techniques.

In addition, a physical therapist may also recommend such methods as heat therapy, ultrasound, massage, mobilization, and education about posture and body mechanics in order to prevent lower back pain from recurring.

Some of these methods will be discussed later on. You will also find some practical self-help tips provided by experts to help you avoid lower back pain or prevent the condition from worsening.

However, before we head on to learning how lower back pain is treated through physical therapy, it is important that we first understand what causes lower back pain.

Lower Back Pain: CAUSES

There are actually many types of back pain, but the most common is pain in the lower back. Why? You might ask. The reason is simple: you carry most of your weight in the lower back. Thus, it is highly likely that a person would suffer pain in that area.

There is no definitive cause of lower back pain. Sometimes, the causes of the condition are so complex that it is difficult to pinpoint just a single one.

However, physical therapists and other healthcare professionals have observed that lower back pain is often a result of strained back muscles and ligaments due to any of the following activities:

o Improper posture

o Heavy lifting

o Sudden awkward movement

o Muscle spasm

o Stress

We could all be guilty of the above activities. We may not suffer any back pains now, but it is likely that as we get older and the degree of inhibition of the back muscles as a result of these activities increases, back pain becomes a very distinct possibility.

In addition to these common activities, lower back pain may also result from specific conditions, such as:

o Herniated disk (when the disk material presses on a nerve)

o Sciatica (when a herniated disk presses on the sciatic nerve. The condition causes sharp, shooting pain through the buttocks and the back of the leg.)

o Spinal stenosis (when the space around the spinal cord and nerve roots becomes narrow. This is caused by arthritis and bone overgrowth, the pain resulting from when a nerve gets pinched in the narrow space.)

o Spondylosis (a type of arthritis affecting the spine due to degenerative changes brought on by aging)

o Spondylolisthesis (when one vertebra in the spinal column slips forward over another)

Lower Back Pain: TREATMENT

The treatment of lower back pain depends on several factors, including the specific type of lower back pain (whether it is chronic or acute) and the purported cause.

For instance, acute lower back pain is commonly treated with pain relieving drugs, such as analgesics, or some forms of exercises that can help relax the muscles.

On the other hand, chronic back pain - or one that lasts for more than two weeks and is progressive - may be caused by some underlying condition, during which case the treatment plan may consist of resolving the underlying condition to treat the back pain.

Lower Back Pain and Physical Therapy Exercise

Physical therapy exercise is one of the most common methods of treating lower back pain. In fact, many home remedies for lower back pain consist of exercise, because the general theory is that if you remain active, you remain healthy. This is true in most cases.

However, for purposes of this article, the exercises featured here will be those that are practiced by physical therapists to treat patients with lower back pain.

Generally, in physical therapy exercises, the exercise program for back pain should encompass a set of stretching exercises, strengthening exercises, and low impact aerobics. Read below for more on these exercises:

-Stretching

The back of a person is composed of the spinal column and contiguous muscles, ligaments and tendons. All these are designed to move in consonance with each other so that any limitation in the range of motion in any of these components of the back result in back pain.

Stretching for lower back pain specifically targets soft tissues, such as muscles, ligaments and tendons, found in the back and around the spine. By stretching, the spine and soft tissues are mobilized, increasing motion and thus, relieving pain.

There are many kinds of stretching exercises employed by physical therapists. One is the Hamstring Stretching Exercise which works to relax tight hamstrings, a common symptom of lower back pain. This exercise is said to help decrease the intensity of lower back pain among sufferers.

-Strengthening

Physical therapists generally use two forms of strengthening and back pain relief exercises, usually depending on the specific condition of the patient. These are the McKenzie exercises and dynamic lumbar stabilization exercises. However, the two forms of strengthening exercises may also be combined should the therapist find it appropriate to do so.

-McKenzie Exercises

Named after a physical therapist in New Zealand, McKenzie exercises are primarily extension exercises that could help reduce pain generated from the disc space and also may help reduce the symptoms of herniated disc by reducing pressure on a nerve root.

For acute pain, the McKenzie exercises should be done frequently, at least once every two hours. In addition, patients are advised to avoid flexing their spine when exercising.

-Dynamic Lumbar Stabilization Exercises

Using this back exercise technique, the first thing that a physical therapist does is to look for the patient's "neutral" spine. This refers to the position that allows the patient to feel the most comfortable.

Afterwards, when the patient is in that position, the back muscles are then exercised in order to "teach" the spine how to stay in this position.

Performing these exercises on a regular basis can help strengthen the back muscles and keep the spine well-positioned.

Low Impact Aerobic Exercises

The purpose of low impact aerobic exercise is to recondition the back. Patients who undergo reconditioning of the back through low impact aerobic exercise will have fewer episodes of lower back pain.

In addition, whenever an episode of lower back pain does occur, the pain is less intense and lasts only for a short period.

Another benefit of low impact aerobic exercise is that patients tend to stay functional - that is, they can continue with their regular work and carry on with recreational activities. In contrast, patients who do not undergo low impact aerobic exercises typically experience the gradual loss of their functional abilities.

For low impact aerobic exercises to achieve their desired results, they should be continuous. This will increase the heart rate and keep it elevated as well as increase the production of endorphins, which are pain fighting hormones released by the body.

Here are some examples of low impact aerobic exercises that you may want to try in order to lessen or reduce lower back pain:

-Walking

One of the simplest forms of aerobic exercises, walking is generally considered as very gentle on the back. To get the maximum benefit from walking as a form of low impact aerobic exercise, walk two to three miles three times per week.

-Stationary Bicycling

This form of aerobic exercise is less painful on the back since there is lower impact produced. This is beneficial for patients with lower back pain who may find walking too painful.

-Water Therapy

Sometimes referred to as aquatherapy, water therapy is simply doing exercise in the water. The buoyancy works to provide effective conditioning at the same time stress on the back is reduced.