Musculoskeletal Syndrome of Menopause

Written by: Dr Fiona Lovely, DC

Many women are arriving in clinic with complaints of stiffness, sore, achey muscles and joints without experiencing this previously.  These women tend to be 40+ in age and lack an injury to cause the discomfort.  It’s important to consider how your hormones at midlife may be affecting your body.  

Menopause is not only characterized by hormonal changes and reproductive system adjustments but also by various musculoskeletal symptoms that can significantly impact a woman's quality of life. This is called the Musculoskeletal Syndrome of Menopause (MSM).  This encompasses a range of symptoms affecting the bones, joints, and muscles, which can be attributed to hormonal fluctuations.  

One of the most common musculoskeletal symptoms experienced during menopause is osteopenia and osteoporosis, a condition characterized by decreased bone density and increased risk of fractures. Estrogen plays a crucial role in maintaining bone health by inhibiting bone resorption and promoting bone formation. However, during menopause, declining estrogen levels lead to accelerated bone loss, especially in weight-bearing bones like the spine, hips, and wrists.

Menopausal women frequently report joint pain and stiffness, commonly attributed to osteoarthritis. Estrogen has anti-inflammatory properties that help protect joint cartilage and maintain joint function. As estrogen levels decline, inflammation increases, contributing to the development and progression of osteoarthritis, particularly in weight-bearing joints like the knees and hips.

I like to say that estrogen is a lubricator of all tissues, this is especially true with joints.  For example: I see many women in their 40’s and 50’s with new shoulder complaints which can be attributed to the estrogen decline.  The shoulder is the most freely moveable joint in the body and when it isn’t working well, you notice!

Muscle weakness and decreased muscle mass, known as sarcopenia, are also prevalent musculoskeletal symptoms of menopause. Estrogen has anabolic effects on skeletal muscle, promoting muscle growth and strength. Declining estrogen levels during menopause can accelerate muscle loss and impair muscle function, leading to decreased mobility, flexibility and function.

Menopause-associated hormonal changes can trigger new onset musculoskeletal symptoms, including tendonitis and bursitis.

Understanding the musculoskeletal implications of menopause is crucial for implementing preventive measures, such as regular weight-bearing exercise, maintaining flexibility with daily stretching, keeping your spine healthy with regular chiropractic treatments, adequate magnesium glycinate and vitamin D intake, and hormonal therapy when appropriate, to mitigate the impact of these symptoms and promote musculoskeletal health and well-being in menopausal women.

Dr. Fiona Lovely is a Chiropractor at AST Willow Park and can help you with your perimenopause and menopause-related concerns. In addition to her practice at Active Sports Therapy Dr. Fiona Lovely is the host of the wildly popular podcast "Not Your Mother's Menopause" which can be found on all of your favourite podcast platforms.

Disc Herniations and Schmorl’s Nodes

Written By: Dr. Evan Steinke, B.Sc, DC.

Lower back pain can stem from a wide range of issues including disc herniations, however, not all herniations are the same. Schmorl’s nodes, named after the pathologist Christian Schmorl, were first described in 1927 and are a form of herniation. While they can occur in any part of the spine, they are most common in the middle and lower regions.

To better understand what a disc herniation is let’s first look at the structure of the spine. The spine is made of a series of vertebrae, bony structures with a hollow channel running down the back side that encases our spinal cord. Vertebrae by themselves we be extremely rigid and cause our backs to be stiff and unable to bend. To be flexible, the bones are connected to each other by a series of discs. The discs are made of a fibrous outer layer that allows for some movement between bony levels and an inner gelatinous layer that allows for shock absorption.

Disc herniations, sometimes referred to as “slipped discs”, are when the disc sandwiched between the two bony vertebrae is ruptured in such a way that the inner gelatinous fluid is released. The most common form is when the posterior aspect of the disc is ruptured, and the fluid pushes out towards the spinal cord. This can trigger nerve irritation that leads to symptoms such as pain, numbness, or weakness wherever the affected nerve travels (often down the leg).

Schmorl’s nodes differ in that they are a vertical type of herniation. Rather than the inner fluid of a disc being pushed out the front or back it is pushed up or down into the bony vertebrae. Despite their first description nearly a hundred years ago there is still no consensus on the cause of Schmorl’s nodes. Some researchers view Schmorl’s nodes as a secondary finding of an underlying disease such as Scheuermann’s disease or lumbar disc degeneration. In fact, most Schmorl’s nodes are asymptomatic, and they are often incidental findings on imaging reports such as Xray or MRI. However, in some patients they can cause significant chronic pain and lead to reduced quality of life.

Treatment for Schmorl’s nodes often begins with conservative care, such as chiropractic, as they are often seen in conjunction with other spinal conditions. If unresponsive more invasive treatments such as nerve blocking or surgery can be considered.

If you suspect that you might have a Schmorl’s node mention this article to your chiropractor or physician. Expect your doctor to do a thorough examination and to rule out other possible causes of your symptoms first and be ready for possible imaging such as X-ray or MRI.

Contact AST to schedule your appointment today.

References:
1) Kyere KA, Than KD, Wang AC, Rahman SU, Valdivia-Valdivia JM, La Marca F, Park P.
Schmorl's nodes. Eur Spine J. 2012 Nov;21(11):2115-21. doi: 10.1007/s00586-012-2325-9. Epub
2012 Apr 28. PMID: 22544358; PMCID: PMC3481099.
2) https://radiopaedia.org/articles/schmorl-nodes-3?lang=us

Knee Injuries & Skiing

Written By: Rachel Grant, MScPT, B.Kin,

It’s that time of year again and whether it's your first time clipping into your bindings or you are a seasoned skier, prevention of knee injuries should be at the top of your mind.

The knee joint is composed of bones, cartilage, ligaments and tendons. The most common knee injuries related to skiing include damage to the ligaments; a ligament is a short band of tough fibrous tissue that connects bone to bone. Meniscus or cartilage injuries within the knee itself are the second most most common injuries. The four primary ligaments in your knee hold the bones together to help stabilize your knee. The knee can become easily injured because it relies heavily on the ligaments, meniscus, cartilage and the surrounding musculature for stability.

Skiing is a sport that tests the ligaments and supporting structures in the knee through quick changes of direction and constant muscle contraction to maneuver down snow or ice. Strength training and targeting every muscle group of the lower limb is one way to set yourself up for a successful ski season!

Below are some examples of each lower limb area to focus on, along with an exercise example:

Hamstrings:

-Bridges, single leg bridges, Nordic curls

Quads:

-a combo of closed chain exercises where both legs are on the ground such as squats, along with open chain exercises like controlled step downs and lunges.

Hip Strengthening for Gluteus Medius and Maximus:

-Clamshells, side lying hip abduction, single leg squats

Other Important Knee Injury Prevention Tips:

-Learn proper technique with a professional if you are new to the sport

-Choose suitable runs (green, blue, black) comparable to your ability level.

-Ensure you have properly fitted equipment. Including ski's bindings, and poles. Most importantly, check your bindings are fitted to the boot you will be wearing. Non-release of bindings has been reported to be a contributor of skiing injuries in youths and adults. Release bindings which can be adjusted to a skiers ability and weight can help to prevent knee injuries.

-Lastly, add dynamic stretching to your ski routine. Warm up and general movement with short hold stretching (10-15 seconds) pre-skiing, such as when you are gearing up in the parking lot gets your muscles ready for the day. Finishing the day are-ski with static stretching will prevent possible injuries the following day.

Sadly, despite our best efforts, injuries may still happen. If you experience an injury skiing or maybe you want to ensure you are strong leading into the ski season, our team at Active Sports Therapy can design a treatment program for your specific goals today! Call the office at 403-278-1405 today to book in with our team of experts.

*This blog is not intended to officially establish a physician-patient relationship, to replace the services of a trained physician, naturopathic doctor, physical therapist or chiropractor or otherwise to be a substitute for professional medical advice, diagnosis, or treatment.

Sciatica or Piriformis Syndrome

Written By: Dr. Evan Steinke, B.Sc, DC

Many of us have heard of sciatica (SI), a painful compression of the nerve running down the back of your leg, however, not many have heard of Piriformis Syndrome. To understand the difference it helps to first understand what the sciatic nerve is and where it travels.

The sciatic nerve is the thickest nerve in our body and is the result of several nerve roots from the lower back and sacrum coming together to form one larger nerve bundle. This bundle is formed around the level of our hip joint and runs the entirety of our leg, from glutes to feet. Nerves branch off to supply everything from the muscles of our legs to the skin and joints. Therefore, any irritation or compression to the sciatic nerve, or the nerve roots it is comprised of, can cause symptoms along its length. In fact, this is what sciatica is in reference to, pain and other symptoms that affect the nerve roots or sciatic nerve. Typically we think of disk herniations, degeneration, or joint narrowing that compresses and irritate the nerve roots that form the sciatic nerve as the cause of sciatica. However, this is not always the cause, in some cases, the sciatic nerve itself can be compressed by muscles which leads us to piriformis syndrome.

Piriformis syndrome gets its name from the piriformis muscle, a slender muscle running from the sacrum to the hip. The location of the muscle places it dead center in the gluteal region and also right over the top of the infamous sciatic nerve. As a result, tension and tightness or inflammation in the piriformis muscle can lead to compression and irritation of the sciatic nerve which in turn may cause sciatica. This could include pain in the gluteal region with possible radiation along the length of the nerve as it travels down the leg to the foot. It can also be characterized by feelings of numbness, tingling, or weakness in the leg and/or foot. Due to its position and function, you may feel increased irritation with sitting for a sustained period or with exercises such as squats.

In any case, if you are experiencing pain along the back of your leg or feelings of numbness or weakness it is best to see your practitioner and have the exact cause determined. From here an appropriate treatment and management plan can be implemented to help you.

If you are interested in booking an assessment call Active Sports Therapy today.

Dr. Evan Steinke, BSc. DC recently hosted a webinar where you can learn more about Sciatica and Piriformis Syndrome. You can check it out here.

*This blog is not intended to officially establish a physician-patient relationship, to replace the services of a trained physician, naturopathic doctor, physical therapist or chiropractor or otherwise to be a substitute for professional medical advice, diagnosis, or treatment.

The Top 4 Most Common Golf Injuries

By: Active Sports Therapy

As golfing is a seasonal sport, people often jump into it quickly and with high frequency. Since 18 holes are the most common way to play, overuse injuries can occur. If you develop an injury, it can result in a frustrating experience out on the links as injuries affect your swing, and ultimately, your game.

The most common injuries include:

Golfers Elbow - Will cause pain and inflammation in the tendons that connect the forearm to the elbow. The pain may radiate into the forearm.

Wrist Pain - Can occur and is usually related to the wrist flexor or extensor tendons. Impingement syndrome and tendonitis can also occur.

Shoulder Pain – The lead shoulder is most often the one to be injured in a golfer with the rotator cuff is the most likely to become injured and it is often related to the style and form of the golfer's backswing.

Back Pain- In the upper, mid, or most commonly, the lower back can occur. Golf involves twisting, bending, and reaching down to get the ball out of the cup, all of which can add up to back pain for some.

Tips for Prevention

Swing Mechanics. Even the best golfers are taking 70-90 swings and putts per game. Considering that you can see how easily an overuse injury can occur. Learning proper posture from a golf pro might give you the corrections you need to prevent injury.

Avoid trying to hit the ball too hard. This is common for ‘new golfers’ as they opt for power over the form. Again, a lesson or two might teach you the proper pace required for a mechanically correct swing.

Be sure to use proper mechanics when lifting or carrying your bag, even if it’s just taking them out of the trunk of your car.

Just because golf isn’t a fast, contact sport, it doesn’t mean that you don’t have to stretch it out a bit before you play. Stretch your shoulders, chest, triceps, back, and lower body.

Here is a great resource from Golf Digest

How Can your Chiropractor Help with These Injuries?

ART stands for Active Release Techniques.  It is a new and highly successful hands-on treatment method to address problems in the soft tissues of the body, including the muscles, ligaments, fascia, and nerves.  ART treatment is highly successful in dealing with overuse injuries because it is specifically designed to locate and treat scar tissue adhesions that accumulate in the muscles and surrounding soft tissues.

By locating and treating the soft-tissue adhesions with ART, it allows the practitioner to, 1) break up restrictive adhesions, 2) reinstate normal tissue flexibility and movement, and 3) more completely restore flexibility, balance, and stability to the injured area and the entire kinetic chain.

This style of treatment can be applied to all of your common golf injuries. We can also help you to learn how to prevent further damage through exercises and stretches. Our physiotherapy area has specialized equipment to help speed healing with laser therapy and Game Ready ice machines. We can assign the proper stabilizing brace or suggest supplements if needed.

Book in today at www.activesportstherapy.ca and we’ll help you Get Back to Your Game!

Golf

The Humble Yet Important Wrist.

By Sarah Kuindersma, M.A.T Muscle Activation Techniques, PTS,

Our hands are in high demand and often taken for granted. We type, we text, we lift, and grip throughout the day, without taking a moment to appreciate the humble wrist. This humble wrist makes most of our day-to-day activities possible. It is important that we make sure that our wrists and elbows have adequate strength and mobility, similar to other parts of our bodies such as knees and shoulders. Without this strength and mobility we are vulnerable to stiff wrists or worse nagging pain with simple activities.   

The wrist is an elaborate structure which allows for the broad range of movements it can perform. To avoid pain and recover quickly from a wrist injury, focus on developing strength in your wrists while maintaining excellent range of motion. How does one do this? 

This is where we are here to help, below are a few exercises that can help improve wrist mobility, release tension quickly, and build grip strength to keep your wrists healthy and pain free. 

Wrist Mobility Drills 

The following is an easy 5 minute routine you can do at your desk for your wrist.  

  1. Fist revs: visualize revving your motor bike. Have your elbows bent forearms parallel to the floor. Make a fist, and slowly pull the wrists up hold for a second before curling the wrists down. Perform 8-10 times  
  2. Fist extension to finger extension: start in the same position, with your fists closed, pull the fists up hold while you extend the fingers up to the ceiling, hold for a second make a fist and return the start. Perform 8-10 times  
  3. Wrist Flexion Pulls: Start in the same position, this time have your fingers straight, point your hand to the floor, from here curl your fingers into a fist. Use your opposite hand to gently pull. Hold for 2-3 seconds before releasing and repeating. Perform 4-5 reps/side  
  4. Hammer Curls: Start in the same position, this time turn your wrists made into fists to face each other. Slowly pull the thumbs towards you then push them away. Perform 4-5 reps. After you can then curl the fists in towards each other and then away. Perform 4-5 reps.  
  5. Open Palm Wrist Circles: hold onto one wrist, open your hand and start to make a full circle at the wrist. Perform 3-4 circles one way then rev direction and repeat.  
  6. Prayer hands: Place your hands in the praying position, then slowly lower the hands pressed into each other. Hold the stretch for 2-3 seconds repeat 4 times then repeat with the hands flipped in a rev pray. This time you are slowly raising the wrists up to feel a stretch.  
  7. Clench and release: squeeze your fist tight hold 2-3 seconds then shake the hands out. Repeat 4-5 times.

Watch these exercises for a visual reference:

Experiencing wrist pain ? Try these exercises - YouTube 

*Disclaimer: Always consult with your doctor before starting any exercise program. If you experience any numbness, tingling or reproduction of your symptoms, please contact your doctor or physiotherapist .  

Median Nerve Floss  

If you are experiencing numbness down the hand, it could be due to pressure on the median nerve, usually due to repetitive usage of the wrist. 

The following exercise is a nerve mobilization exercise to help decrease inflammation and pain by alleviating the pressure on the never. You can do this seated or standing.  

  1. Bring one arm up like you are going to flex your bicep. Relax the bicep and turn the palm of your hand towards your ear.  
  2. Imagine there is a string attached from your middle finger to the top of your ear. As you straighten your elbow your ear moves down to your shoulder.  
  3. To start keep your hand in line with your wrist, to advance this exercise you can pull your fingers and palm back like your spiderman about to shoot a web.  

Watch Median Nerve Floss : January 20, 2022 - YouTube

Relieving Wrist Pain with Muscle Activation Techniques  

Wanting to alleviate wrist pain in a different way? Have you tried M.A.T. Muscle Activation Techniques?

M.A.T. assess your movement mechanics to identify potential faulty movement mechanics leading to chronic strain creating the pain. M.A.T. then activates the muscles or rather creates a repatterning of movement patterns so your wrist can better handle the force applied to it through everyday movements and exercises.  

Call to book in with our in house M.A.T. Specialist Sarah Kuindersma today, at Active Sports Therapy 403-278-1405

Prefer to book online? Take advantage of our online booking system at www.activesportstherapy.ca.


Want to learn more about M. A. T. ? Watch this video   

Wrist Pain

Preventing Injuries When Shovelling Snow

One of the most common winter injuries that we see in our clinic is lower back injuries from snow removal. If you’re not careful, this snowy chore can lead to serious pain and injury. As a Canadian, shovelling is just part of life so take a minute to read our winter shovelling tips.

Shovelling snow is considered an exercise. Think of shovelling snow the same way you think of any other exercise or physical activity. Which is great… if you’re ready for it.

Problems can arise if your body is recovering from injury, or you are not exercising regularly. If this is the case you might find a session of shovelling to be overwhelming to your body, especially after large amounts of snow have fallen and need removal. Here are a few tips on how to make the best of this regular winter activity.

Lastly don’t be afraid to ask for help!

Your family, your neighbour or a nearby friend. Everyone needs a little help sometimes and don’t be afraid to ask if you feel your body is not up to the challenge. You could also assign the task to someone else entirely!

If an injury does occur, our Unified Team Care approach is here to help.

Any of our Chiropractors, Physiotherapists, Massage Therapists and more, are here to help keep your body safe and moving well this winter. 

Call 403-278-1405 or book online today at www.activesportstherapy.ca

 

Recovering From an Injury

[vc_row][vc_column width="1/1"][vc_column_text]By: Active Sports Therapy

There are no two ways around it. Injuries are hard! They can knock you off of your exercise and training routines, leave you side lined from your favourite sport, have you missing work, and experiencing down time from day to day life. At Active Sports Therapy we’re committed to helping you get back to doing the things you love as soon as possible, safely and effectively. With so many injury related services under one roof, we try to simplify the process of needing multiple practitioners to help with you with your injury.

In addition to seeing specialists that can help you get back to your game, we’ve also compiled a few tips to help you when recovering from an injury.

Nutrition

Recovering from an injury requires a person to pay special attention to what they’re putting in their bodies in terms of food, drink, and supplements.

You’ll want to learn about anti-inflamatory foods during recovery and ensure you’re getting enough of these foods. Things like avocado, olive oil, nuts, fish oil, pineapple and turmeric can all help your body lessen inflammation. Ditch the processed foods that are high in saturated fats, vegetable oils, and sugar.

Eat an adequate amount of protein from non-processed meats, legumes, eggs, or plant-based proteins. A rainbow of fruits and vegetables are important and don’t forget to include some healthy carbs as well, like oats or quinoa.

Talk to your practitioner about supplements if you’re interested as Vitamin C has many properties that can help with injuries because of its ability to help your body produce collagen. Omega 3 has been shown to help with inflammation and Zinc includes a component related to wound healing. Talk to your Doctor before launching into a new routine involving supplements.

Take Care of Your Mind as Well as Your Body

Injuries can be emotional events and depending on the situation or prognosis. A person can have various levels of emotional reactions to their injuries ranging from disappointment to PTSD and there are many things that can help with this.

Some athletes find it helpful to stay connected with their teammates by watching practices and still going to team meetings and outings.

Utilizing your support network of family and friends to help take you to appointments, help you when you’re feeling down, or to check in on you from time to time can be great emotionally supports.

If you are feeling depressed or overwhelmed by an injury, it can be helpful to seek professional counselling. If you are an athlete, a sport psychologist will be well versed in assisting with the impacts that an injury can have on ones’ mental health and provide a healthy tool kit to help you through it.

Follow the Plan

Going to your appointments as scheduled and taking your doctor or therapists advice in between appointments is essential. With any injury there is the in-clinic work which will consist of assessments, treatments, patient education, and assignments of homework. This homework is usually essential to help you recover and might consist of hot or cold treatments, stretches, strengthening, working on flexibility and more. Sometimes it can be easy to forget these steps so it’s essential to ensure you complete the homework tasks with diligence. To help you remember to do your homework you can add an alert in your phone, create a chart that you can check off, put a calendar entry into your work calendar, write a reminder on your bathroom mirror with dry-erase marker, or ask a friend or spouse to hold you accountable. If you’re a competitive individual, create a game or a reward system. Also, focusing on why you want to get better,(E.g. be ready in time for the playoffs, get back to work for incomes sake, coaching our child’s team, or regaining your independence), instead of the task at hand can be a real motivator. Ultimately, the success level of your recovery can differ based on your commitment to the at-home portion.

If you’re reading this article you’re likely dealing with an injury so we hope you’ll put these tips into practice and wish you the best of luck with your recovery!

*This blog is not intended to officially establish a physician-patient relationship, to replace the services of a trained physician, naturopathic doctor, physical therapist or chiropractor or otherwise to be a substitute for professional medical advice, diagnosis, or treatment.  [/vc_column_text][/vc_column][/vc_row]

Active Release Techniques (ART) For Athletes

[vc_row][vc_column width="1/1"][vc_column_text]By: Active Sports Therapy

Athletes who are training hard at their sport often experience extremely demanding training schedules. Because of their high volume training, athletes can often experience overuse injuries in different areas of the body. After training, it’s normal to experience sore muscles, but when pain is consistently there even after the athlete’s typical rest and recovery period, it’s time to have an expert take a closer look.

An athlete may develop an Acute Condition, which means that there was a sudden injury that happened, such as a sprain or a strain. This can be associated with a traumatic event, such as falling off of your bike or being hit with a hockey puck.

A Chronic Injury is one that can result from overusing an area of the body, or from a long standing condition. Chronic injuries can be labeled as overuse injuries, arthritis, tendonitis or repetitive strain, just to name a few. Sometimes the symptoms of a chronic injury are mild enough to ignore, allowing the athlete to continue on with their sport. Over time, if not treated, these injuries can affect lifestyle, athletic performance, and have negative long term affects on your body.

When muscles are tight and rigid they can cause limited range of motion, pain and weakness, as well as negative compensation patterns as other muscles are forced to step up and do the job required by the injured muscles.

How ART Works

Active Release Techniqes or ART has proven to be very effective in treating athletic and movement related injuries. During an ART treatment, tension is applied to affected muscles, ligaments, and tendons. As the tension is applied, the practitioner or an assistant will then move the affected area and thus releasing tension and breaking up adhesions. This works to restore normal range of motion. This unique combination of direct pressure and specific guided movement patterns are the key to ART’s success in treating pain and injuries.

If you're an athlete, consult on of our chiropractors today. Each chiropractor at Active Sports Therapy is fully trained in Active Release Techniques. You may find that a nagging area of your body can be restored to it’s normal function in just a handful of treatments.[/vc_column_text][/vc_column][/vc_row]

Is Your Check Engine Light On? How Muscle Activation Technique can Help

[vc_row][vc_column width="1/1"][vc_column_text]By: Sarah Kuindersma, MATm, PTS

Question: What would you do if your check engine light came on while you were driving?

a) Ignore it and keep driving

b) Stick some tape over the warning light

c) Unplug the wires top the bulb

d) Stop immediately and call a specialist

Question: What would you do if you felt pain while training?

a) Ignore it and keep training

b) Stick some tape or support bandages on it

c) Take pain killers

d) Stop immediately and call a specialist

Did you answer D for both questions? 

Even though we may view the check engine light or pain as an annoying and irritating inconvenience, we need to take them both seriously as they are indicating there is something that needs our attention before it turns into a more serious issue.

Whether it’s our car or our body, respecting the system and calling a specialist to assess and diagnose the system is a necessary step on the road to restoring it to optimal function.

Think of pain as your check engine light. It’s signaling to you that something is wrong in your system. It is not telling you what the exact problem is; the site of pain doesn't necessarily indicate where the problem is. The pain is just an indicator that there is a problem just like the check engine light on your car is indicating there's a problem with your engine that needs to be assessed ASAP before serious damage occurs.

MAT specialists can diagnose your muscular system to get to the root cause of the pain just like a mechanic runs a diagnostic check on your engine.

Stop guessing and start assessing.

The MAT Philosophy

MAT is a non-invasive technique designed to balance the muscular system of people of all ages. With an approach that can assess and correct muscular imbalances, joint instability, and limitations in range of motion, it uses a systematic approach to help muscles function with maximum efficiency.

Who Will Benefit

MAT is effective for anyone from an elite athlete to a patient who is recovering from an injury to those dealing with the effects of aging and arthritis. This technique has been successfully used in professional athlete settings, in personal training environments and of course in rehabilitation situations. MAT is great on it’s own, or as a compliment to other injury treatments you are seeking. Often patients find the MAT can help them reach the next level of recovery.

See for yourself by calling AST to book in for a free 15 minute meet and greet with Sarah Kuindersma, MAT Practitioner.[/vc_column_text][/vc_column][/vc_row]