Physical Therapy Archives - Moving Into Harmony

Got pain? Want to be at your best? Get back out on the trail with the right help.

June 18, 2023 by harmony

Recently a prolific content producer on backpacking had a series of incidents that led to, in my observation, a cascade of the body’s inability to adapt well and heal itself. A myriad of symptoms have presented themselves that in his video published as a health update, he stated he is receiving medical care, they are not related symptoms, and most concerning were his comments he makes about his age, his body’s capacities and what he must now do in the face of his struggles.

To me this is a bad case of the blues, false belief and despair.

To me this is a case of not getting the right guidance or help, in looking wholesomely at him instead of the symptoms he is suffering with. It’s a different way of getting back on the trail with sound guidance from those who understand the inter-related body and the body-mind complex that loves to hike and backpack!

I’d like to breakdown what I saw in the video and where you might find better answers and individual solutions to meet your need and desire, instead of falling trap to false beliefs and into despair.

First major whammy: Trauma, Survival, Rescue & Breakdown

The inability of the body to handle the demands, pressure and lack of attention often leads to the body saying NO WAY in some way. Recovery from a survival situation requires proper down-time, proper guidance and follow through with the right help. The right help is not managing symptoms. The right help goes beyond just getting over an body shutting down event.

Also facing the unexpected breakdown of one’s own body is a challenge physically, mentally and emotionally. It’s even more difficult when you work with a trainer, or coach, and trust the program to be “fit” for the adventure. Being “fit” for an adventure has specific measures and require an individualized program, just like having the right gear for the adventure. If a program focuses mainly on strengthening your legs, core and “cardio” you are in for a huge disadvantage. This is because being capable and confident in the wilderness requires other variables that typical trainer styled programs don’t address. These include functional mobility and movement standards, physiological parameters of how your body adapts to stressors (and yes exercise is a stressor), your recovery and resilience capacities, your daily routine and habits, and the condition you bring yourself to train and to the trail. Let’s break these down a little bit to know what to look for in a skilled trainer or coach (or in my experience, someone with some therapeutic and wilderness experience).

Functional mobility and movement is about how the entire body collaborates for your time on the trails. This includes more than the legs. For example, it is well known in functional movement assessments that the shoulders and neck can limit the mobility in the hips, knees and ankles. May I add, flexibility is not functional when one joint is measured for a range of motion. Also the challenges of carrying a pack, and your spinal health, are more about diaphragm function than your core muscles of the abdomen. Also the diaphragm plays a key role in force transfer and lower leg fluid motion. In addition, I would hope the person you hire to help you get further well, at a minimum assesses your body behavior with the loaded pack you will be carrying.

Physiological parameters that are important for your confidence and enjoyment on the trail include the traditional – heart rate and intensity ranges, and also measures many do not test for (and don’t understand how to interpret the assessment). These include measuring gas exchange potential – without drawing your blood, circulation dynamics (why most rely on hot and stinky compression socks is because of this factor many long distance backpackers and hikers suffer from), adaptations to environmental stressors – cold and altitude, recovery and resilience, nutritional states (oral and gut health), sleep respiratory function, and nasal breathing optimization.

Recovery and Resilience do not happen by chance. The body needs to be trained and supported for the day in, day out rigors of multi-day adventures on the trail. Understanding your body’s signaling language, importance of sleep states, morning felt-sense measures, and mental resilience are essential to your adventure.

Daily routines and habits are essential to know before you get on the trail. For example if you sleep in, or eat late, you can not expect your body and mind (and your physiology) to just switch to a different pattern. I hope you know eating late and sleeping in are dangerous for your overall health and well-being, and even more so on the trails. Other routines include a flexibility, or warm up, prime before the trail day begins, and sometimes a warm-down, work out the kinks, evening routine goes a long ways to being on those long trail adventures.

And lastly, your current state of health, fitness and other performance based capacities as you enter a training program are critical to the right program for you. Having an understanding of what you are working with with your body and mind will make for a successful training program and time on the trail. This includes disclosing history – injuries (if you have injured an ankle there is more of a chance you will injure it again unless it is addressed functionally, not just the symptoms go away), health status (this includes any known conditions that may impact your training and your time on the trail – heart, lung, circulation, digestion, immune, joints and other tissues, sleep, mental/emotional). And knowing who you want to be when you hit the trail is also incredibly important, as getting the right help can include if a stress or strain shows up once your on the trail, you know what you can do to keep you on the trail.

Being capable in the back-country wilderness in challenging environmental conditions that force the body to adapt for function is not about a “suffer-fest.” Thrive over Survive any time out there! Surviving something does not make for a special-ness, or some superhuman capacity. Survival is actually a weakened, sub-optimal state often leaving a person not accessible to many factors related to rest, recover, restore and regain capacities that make one ready and “fit” for their next adventure.

Article by Shawn M Flot, MPT. He is an experience Certified Oxygen Advantage® Instructor. Combined with his 30 years of experience in Exercise Physiology, Physical Therapist for health and performance, and a dedicated Yoga practitioner is making for a power-house to help many people succeed in re-discovering their own health and healing, being optimally fit for their adventures and living well.

Breathe through your nose – Your Body-Mind will love you!

June 13, 2023 by harmony

30 functions of the Nose

Promotes Relaxation & Balancing the Nervous System

Nasal breathing has a naturally greater resistance than mouth breathing to how air enters and exits the body. This promotes a slower breathing rate, a lower breath with greater recruitment of the diaphragm and brings about balancing nervous system’s response to activities of daily living. The perceived effort or demand of any activity can be met with greater internal stability.

Boosts Brain Functions

Nasal breathing helps to bring greater clarity with all functions of the human brain. This includes task prioritization, orientation, interpretation of information, recall and memory, intuitive integration, perception and so much more. The brain is one of the greatest consumers of oxygen. Proper nasal breathing stimulates and optimizes oxygen delivery for all functions. Furthermore, nasal breathing during sleep has shown to help the brain circulate all fluids for rest, recovery and restoration of brain tissues, especially the glial-lymph tissue responsible for removal of metabolites and keeping a healthy environment for all brain cells and tissues.

Expand Visual-Spatial Field

The eyes are directly linked to nasal breathing. With a greater expanse in the visual field – seeing the forest through the trees – promotes a neurological circuit of more relaxed breathing. When the eyes are looking at something specific – a big redwood in the forest – then the breath changes to slightly more rapid as the concentration, often with a greater work load to focus, and stimulates survival mechanism internally.

In 2019, researchers at the Weizmann Institute in Israel suggested that nasal inhalation could be linked to part of an evolutionary survival mechanism. We see this in nature with other mammals using their nose in environments, and can sense the state of safety. The Weizmann team theorized that nasal breathing in modern life and competitive sports might trigger the brain for visual-spatial focus. They demonstrated that nasal breathing synchronized electrical activity in the brain on a wavelength that helped to maximize visual-spatial (VS) awareness.

Mediates Smell & Behavioral Response

The nose and its functions shape our behavior, memory, and emotional responses.

The sense of smell is directly linked to the gateway of our emotional and survival systems – the limbic complex which includes the amygdala and hippocampus centers. The amygdala is responsible for the emotional processing of essences, with the smelling information providing positive and negative feedback in the associative learning process. Brain imaging studies have found that activation of the amygdala correlates with pleasant and unpleasant odors, reflecting the link between odors and emotions.

The hippocampus, which is also closely linked to the sense of smell, assists with the learning process and is associated with memory, specifically experiential episodes. This is how a specific smell can stimulate the retrieval of a specific memory.

Optimizes Vocal Effort

It is important for anyone who speaks, or sings, for a living – teachers, presenters, news and sports broadcasters, leadership roles – to maintain nasal breathing during their everyday life, including exercise, rest and sleep.

The voice relies upon many functions. Sound is a vibration of the vocal cords. This physical and physiological activity is optimized with proper nasal passage health. A plugged nose makes the pressure distribution for sound much more on the vocal folds. The vocal cords rely heavily on the health of the nasal passages for the proper pressure distribution. With a stuffy nose the vocal cords can be more susceptible to pressures and forces that can cause irritation and inflammation. In addition, nasal breathing naturally humidifies, warms and filters incoming air. This prevents contraction of the tissues inside the throat due to cold, dry and polluted air. Therefore, breathing through the nose can help reduce the vocal effort required during speech.

Harmonize Vocal Sounds

The vocal folds, or chords, rely upon the nose for proper distribution of forces and pressures when they vibrate to make sound. The rate of vibration determines the frequency, which are perceived by the ear as specific sounds, tones, and rhythms. This may often be referred to as a resonance with the nasal passages. Compare your own voice with clear nasal passages vs. a stuffy nose voice. There tends to be a hollow, monotone and shallow sound to the voice when the nasal passages are not clear. In addition, the nose provides moisture that is specific to lubricating the vocal fold tissues.

Article by Shawn M Flot, MPT. He is now a Certified Oxygen Advantage® Instructor. Combined with his 25year experience in Exercise Physiology, Physical Therapist for health and performance, and a dedicated Yoga practitioner is making for a power-house to help many people succeed in re-discovering their own health, healing and well-being.

Nasal Breathing has greatest impact on your health & fitness sustainability

June 10, 2023 by harmony

If you did one thing to dramatically impact your whole body-mind’s health and fitness – make nasal breathing a priority. According to leading experts in the fields of ear/nose/throat, cardiopulmonary, psychiatry and physical rehabilitative health care, nasal breathing is by far the most impactful natural action one can incorporate to positively impact their health and optimize fitness.

Why?

Because over 30 vital actions of the body-mind rely upon proper breathing. If you are concerned for your health and fitness from the food you eat and gut health, sleeping well, sustaining mental capacities, being apart of healthy relationships, ease with sustaining sexual functions, exercise for all it’s benefits, and optimizing your health span, then it’s even more important to realize the only way for this is breathing through you nose during all daily activities* and night.
*exception – high intensity exercise (which is less than 5% of your daily life)

Here are some HUGE benefits of nasal breathing:

Nitric Oxide (NO) is a bio-active gas that is produced by the lining of the para-nasal sinuses. It has a short existence, and is circulated to the lungs, heart and brain for the primary purpose of increasing oxygen delivery. Oxygen availability is the primary necessity of all organs, tissues and cells for healthy function.

Nitric Oxide was discovered in 1992 as a “miracle” substance naturally occurring in the human body that aid in all body function, health and longevity. And in 1998 scientist were given a Nobel Prize in medicine for it’s role in health, and now over 200 discovered benefits are known.

In addition, the benefits of nasal breathing far out-weigh any benefit of mouth breathing. Mouth breathing destroys the internal environment and endothelial layer – a mucousal membrane that hosts the microbiome (beneficial bacteria) responsible for turning inorganic Nitrates from the food we eat, primarily dark leafy green vegetables, into available Nitrite which is converted into available Nitric Oxide (NO) in the digestive tract. So a double benefit of nasal breathing incredibly impacts all organs, tissues and cells for a healthy life span.

AND you need the right amount of oxygen delivered to the blood vessels and organs for Nitric Oxide Synthase (NOS) to have the transformation for available NO. It’s a two way dependent process. And you need the right amount of Carbon Dioxide (CO2) to break the bond of Oxygen to Hemoglobin so Oxygen can be released into the tissues for the process. Over-breathing, very likely with mouth breathing, lessens the amount of CO2 for proper Oxygen delivery to the cells. This is respiration, cellular respiration, which is the life giving process and sustainability for health, fitness and performance.

Check out this article for more on Nitric Oxide.

The nose has an incredible innate immune capacities to ward off and mitigate incoming pathogens (virus and bacteria) and environmental toxins through its series of channels and membranes before reaching your lungs. There are many envelopes that have a specialized lining to help move and take care of things that come in that are not for you. The passage of air and particulates has a long ways to go before it hits the back of your throat, and is lined with the best defense for your health. It requires a healthy membrane, endothelial membrane, for these functions to be a full capacity.

Also your immune system is supported with the circulation of Nitric Oxide that is produced in the para-nasal sinuses. NO has significant viral and pathogen mediation properties, as well as inflammatory responses (which go hand in hand with immune function). See Nitric Oxide above for more information.

Hydration is important for a robust immune system. Nasal breathing has its own way of warming and moistening the air coming in. And you don’t get dehydrated as you would breathing through your mouth. In addition, to have resilience against environmental stressors – hot, cold, dry, smoky, pollution, etc. – the nasal membranes must be supported. See this article on Nasya practices, a 3000 year tradition daily health practice.

Your diaphragm is the most important muscle. Not only for respiratory function, or breathing, it is the nexus in all movement. And it is most effective when using the nose to breathe. Mouth breathing is primarily upper chest breathing for highest intensity activity, or maximal, breathing. Whereas nasal breathing because of the resistance in the nasal cavity engages the diaphragm more effectively thus accessing the lower lobes of the lungs for greatest oxygen carrying capacity. There is also better coordination of movement when the diaphragm is taking part in all functional movements.

Lower chest/lung breaths are most important because the majority of the gas exchange of oxygen (O2) and carbon dioxide (CO2) occurs in the lower lobes of the lungs. The use of the nose to engage the diaphragm the best also helps to mobilize the tissues and fluids of the lower lung chambers (pneumonia often exists in the lower lobes and is often seen greater in people who primarily breathe in their upper chest).

Not only for breathing, the diaphragm functions as a suspender for all the abdominal organs and tissue below, therefore it assists in:

optimizing digestion of food and water,
core strength and spinal health,
moving fluids back up to the heart (including venous blood and lymph),
massaging and mobilizing the organs for proper circulation to and from organs,
regulating pressures,
regulate fluids to and from the brain,
and more – see this article for more on diaphragms’ role in health and fitness.

Nasal breathing has an overall calming affect when the breath is soft, quiet and regular rhythm. Breathing through the nose allows for a depth of the breath, accessing the lower lobes of the lungs, producing a grounding, centered feeling that gives feedback to the brain of ease and calm. On the other hand, upper chest breathing (and mouth breathing) signals to the brain as state of alertness, fixation, tense feelings, and unable to rest and recover.

Nose breathing provides best function with the diaphragm created more of a balanced state in the nervous system. Many will tell you it stimulates the vagus nerve. This may be true, and what part of the vagus nerve is being stimulated? I believe it brings back a state of balance, where the body-mind complex has more options and less reactivity to any experience. It can aid in the vehicle, your body-mind complex, not speeding on high RPMs all day long diminishing any chance of accessing your healthy capacities. Nasal breathing allows for a slower, smoother and more rhythmic state of being that open the range of possibilities for your health.

If you have any interest in eating well, absorbing nutrition, eliminating waste, sexual function and reproduction potentials, mental capacities for success in school or work (or play like succeeding in a game requiring strategy and thinking on point), memory, sleep and more the daily active life balancer within the autonomic nervous system will support these very important functions. My teacher always said “you can eat, pee, poop, or make love when you are running from the tiger.” Stimulating the vagus nerve helps regulate the systems that rely on the autonomic nervous system. Your body is connected and inter-dependently supported in more ways than we can realize.

When you breathe through your nose easily you feel begin to feel an downward movement of support. You will feel the lower ribs move as you engage the diaphragm with nasal breathing. This massages the organs where emotional and mental stressors are stored. It mobilizes the spine in a snake like motion, giving the regulator in the brain a sense of connectiveness and access to all limbs for optimal movement in daily life. Stress creates withdrawl of vital circulation (and oxygenation to our furthest points) often resulting in cold hands and feet, thus giving information to the brain of an unsafe environment which then creates a cyclic downward spiral in one’s health – stress kills.

With a downward feeling, it produces a dropping down of your low center of support. This has it’s own inherent medicine that stabilizes many functions of the body. It gives feedback to the brain and nervous system as a true supportive center. It is the best counter-balance to stress, helping you to lessen the tendency to react intensely with uprooted-unsupported feelings that create more stress responses with your life.

Warning! Trying to get fit is now a health risk.

March 10, 2023 by harmony

Don’t get me wrong. Physical Activity and Exercise have incredible benefits…..when done in synch within your capacities to respond and adapt positively to a demand, or load (used in scientific literature as a measure of “workload”).

The benefits of physical activity and exercise are well documented as investigators compare these to inactive, or sedentary, lifestyles. Across the board there are great improvements in health markers. And most of these references are from very controlled physical activity environments and variables, for a short period of time. It isn’t til recently have there been long-range observations of populations and lifestyles to really see what happens outside the short time in a laboratory setting. And these are highlighting the great benefits of physical activity.

Notice I say – physical activity.

Physical Activity is often defined in general populations as not sedentary. Each person observed had a regular walking activity during each day of the long-range time observed. They participated in regular physical activity – walking, gardening, dancing, and other outside activities involving their joys of moving about on their feet. This is physical active, NOT exercise.

Many confuse the two terms. We as a species, with two legs are built and organized to move….on our feet.

Exercise is a different activity, as defined by the language. It is a load, a stressor, for the purpose of creating a change in the body. The challenge is if there are negative impacts – unhealthy breathing habits, stiff joints, and a driven mind – one can promote a negative outcome to the stressor, and thus leading to strain on the system….ALL systems. The main four that you might begin to experience are:

Muscle, Tendon, Joint – aches and pains, even injury if the accumulation of strain is not addressed.
Cardiopulmonary Malfunctions – heart rhythm issues, shortness of breath, loss of stamina – the main culprit here is too high intensity for too many times. And intensity is not measured by how good you feel after….you need more direct feedback about how the body responded.
Loss of Motivation – often associated with the body-mind’s ability to continue the want because of many factors – not progressing like you want, difficulty in doing, or too much time, and internal brakes that the body is trying to get you to stop strain it that then the mind says “what? why?”
Loss of Sleep Quality – disturbances and lack of good quality are signs the body is too strained.

Good measurable feedback helps you understand yourself better and bring some guardrails to the driver behind the wheel of exercising. It is a major factor in staying healthy is exercising well for what capacities you have. Does not help to stress a stressed body-mind complex.

Why? Because this re-occurring circumstances with the people who seek help and guidance from me are showing this to me. And very often these clients have seen me after being seen by many clinicians and when shown has never been addressed related to their condition, or setbacks in their fitness and performance progress.

It’s been the primary variables I see over and over again that are limiting a person’s potential for healing, fitness and performance. It has not been identified, understood, addressed or placed importance on what I consider minimal standards for real progress and success.

Here are the top 5 variables:

The Ankle, and the Foot (below discussion), are the most important area for proper movement in any shape for health, fitness and performance. The mobility of the ankle in particular have a profound influence on what occurs up the chain of motion….all the way to the head. Good balance strategies, good multi-directional movement, stability and impulses from the huge sensory portion of what the foot feels in relationship to the ground all coordinate on an integrated, beyond attention, the pattern of mobility and motion you accomplish. Your ankle mobility also affects how you sit AND how well you breathe!

In-person sessions can easily identify if this needs to be addressed based on the activities and demands you place on your body for health, fitness and performance.

In all motions, especially ones that you do with walking or use of one hand require a coordination of motion and flexibility to accomplish even simple acts of walking. Then add running, hiking and other more demanding activities and you have the necessity for both capacities. In addition, when you use your hands for any activity, then this same coordination of freedom of movement is essential to promote healthy patterns of movement, instead of deteriorating patterns of movement that lead to illness, injury and degeneration.

And a very simple measure is done in a very safe way to better look into this capacity, and what to address if not in a range for proper movement to the activities you do.

I would say 75% of the people in the last 5 years who have come for help demonstrate a overuse pattern of engaging their core for daily activities, recovery from injury, fitness and recreational activities. And this is because the myth of the core being something one needs to voluntarily contract to prevent something from happening that they are afraid of, or experienced before……..such as back pain.

The message to people from misguidance is the assumption that they are weak at the core. Now, just say that to yourself and what does that really feel like? “You are weak to the core.” In my clinic, and online assistance, I debunk this false belief and embedded concept and replace it will feelings of proper engagement and understanding how each individual can uniquely empower themselves beyond fear, apprehension and un-coordinated mechanical movement to be at their best.

And there is a simple measure, actually three that I use to identify where to link in the true core.

The arrangement of how you use your hands and feet in exercise can impact your core stability, spinal health and your breathing. Especially if when you raise your hands overhead…and notice I guided you right there to raise your hands not your arms (this can have good positive impact on the mentioned capacities).

Do you rise up in the ribs and torso, does your navel lift upward toward your heart when you raise your hands? Not a good way to move. Notice when you raise your hands what the quality of your breath is compared to when you don’t rise out of your base…..naturally, not bind something else like your abdomen to keep from rising!…but rising out of your base what is your breath like compared to raising your hands differently and staying home in your base and legs?

How your breath is driven is from the metabolic process. If there is accumulated strain – or the opposite, congestion and immobility of fluids inside – then the breath is usually faster, louder, heavier and more forceful to get good breath. And the breath often becomes over-breathing when you exercise. The BOLT score, or comfortable pause measure, can give you an indication into the physiological capacities of how your exercises impacts you. It also directly relates to blood pressure, heart rate variability and tissue integrity. This article goes into a bit more detail.

Acquire the right capacities with the right guidance. Your capacities of Moving and Breathing Well will fundamentally support every activity you do for daily life, recovery and healing, health, fitness and performance.

Your Health span is more important than Life span!

February 26, 2023 by harmony

Explore this essential value from someone who has been around a while.

I’ve been around a while in the arena of health, fitness, performance, and wellness. And I’ve come to realize many things.

HealthSpan is the time having the capacity of wholesome balanced body and mind that is maintained over a period of time. Often health is defined as the state without a condition of disease or dysfunction. I see it differently – I see potential. In my arena of health and fitness, health is the foundational status as the spring-board for furthering one’s capacities. The foundations are based in measures of functional mobility and breath function from which fitness, wellness and performance rise from. Healthy foundations allow a person to stress the body-mind complex in the pursuit of promoting positive adaptations and furthering capacities. These strengthen, or cultivated, capacities are then available to ward-off degenerative and dysfunctional imbalances, and fostering resourceful supports for what a person wants to do in their lives.

Unfortunately most health systems and practitioners focus on treating people’s pain, dysfunction and/or illness and all attempts go toward prolonging life and preventing pain. This happens under a narrow scope of services aimed at the dysfunction or disease, rather than on the promotion of one’s available and attainable resources to surround the healing process. Results of limiting pain, illness or disease leave a person dependent on the given remedies and practitioner for the answers to their suffering. Dependency on a system that does not promote health and life, and little faith in one’s own capabilities. Few are given the opportunity to move beyond just being less in pain, or illness. And thus health is seen as a baseline level of living, instead of the vast capacities possible with the right actions. Little or no guidance is offered, referred or given to what the next steps are beyond maintaining a low-level status quo. Very few are encouraged to seek potentiating their own capacities for a more vital life experience.

As I look around on the trails, in the gyms, and in the movement studios of Pilates and Yoga, I see more flawed and debilitating movement and breathing patterns than proper and strong patterns. And I don’t blame people. I point to the lack of proper guidance and body-breath awareness that is essential to exercising well. So instead of exercise to promote health and fitness, people are exercise to promote un-necessary stress and imbalances. And then the exercise becomes the “injurer” of the injured. Instead, it was the person performing without the proper guidance that injures themselves.

In addition, there is incredible confusion and misguidance as to how to exercise for promoting health and fitness. And from all angles – the doctor who is not a professional in the movement and breathing arts, the therapist who can only focus on the body part in pain for multiple forces placed on them to provide therapeutics, the trainer who is choose to go for strength in power and core moves, the psychologists who encourages a deep breath every time one experiences a stress situation, the motivated fitness pursuer who is inundated and manipulated with images and messages in the fitness world market, the false quick fix promises that project from the bullhorns of the so-called know the best thing without backing, the messages of weakness and stiffness are the problem, and the unattainable goals set by self or other. The confusion is the poison that sickens the one who wants to be healthier through some form of exercise or stimulating activity.

I am not promoting my approach is for everyone. My approach requires a desire to move and breathe toward the best self. My approach puts the responsibility on you to put in your best effort, your best feet forward, and the hunger for experiencing your life from your best self.

I do have over 35 years of personal, educational and professional experience. Personally tested many ways for periods of time to see their benefits over time – more than 3 or 4 weeks. I’ve also invested time in being with the top professionals in the fields of movement and breath to potentiate my practical knowledge and implement the well tested methods – clinically, scientifically and longevity (practices that have withstood time and evolution 500-1000year wisdom).

I also have seen time and time and time again the results of participating in their health and well-being. With the clients who have followed their individual guidance AND participated to the best of their ability in the suggested program(s) given – even simple, minimal time methods – they ALL have experienced the change they’ve wanted, experienced life changing possibilities by furthering their capacities for what they want to do in their lives.

From my own disabling injuries and painful experiences that I overcame and grew tremendously from, I feel I have some idea of what it takes. From the many fortunate years of clinical practice, not manipulate by the industry or 3rd-party influences, and being able to see a multitude of people with a wide spectrum of challenges I trust my ability to assess and figure out best ways forward. And with the passion to both be at my best with each client, AND offer the best that I know (or get them to someone who does) I believe I have something very supportive, valuable and effective to offer.