| I remember back in physical therapy
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| | their body. First of all, how much is
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| school the importance of evaluating and
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| | significant? This question has been the
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| treating people with various problems
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| | source of much debate in recent decades.
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| that were often directly related to poor
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| | There have been numerous studies in the
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| posture. We remember as children hearing
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| | medical literature that examined the
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| from our mothers and grandmothers to "sit
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| | effects of leg length on various
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| up straight", or "don't slouch". Little
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| | structures, most notably in regards to
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| did they know that we physically could
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| | the lower extremities and the low back.
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| not do what they wanted us to do. For
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| | Leg length discrepancies break all of the
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| whatever reason, whether it was tight
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| | rules required for healthy joints in the
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| muscles, weak muscles, crooked spines,
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| | lower extremities and the spine. In
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| long or short legs, we just couldn't do
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| | response to the asymmetry, muscles will
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| what they wanted us to do. Then over
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| | structurally shorten or lengthen to adapt
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| time, these minor malformations continued
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| | to their new position. (See Figure)
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| to persist and even in some cases
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| | There are two types of leg length
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| worsened as we grew older.
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| | discrepancies that are present. A
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| The purpose of this article is to provide
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| | structural leg length discrepancy is the
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| you with some basic information regarding
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| | anatomical case in which one bone may be
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| your body. Most of you have had minor
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| | longer or shorter than the other. A
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| aches and pains, while others may have
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| | functional leg length discrepancy refers
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| experienced, unfortunately, more severe
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| | to the result of something occurring in
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| injuries. It's easy to understand when we
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| | your body such as a soft tissue
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| have a fall or trip and land funny on our
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| | contracture or abnormal joint mobility.
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| knee, or twist our ankle from uneven
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| | The most notable functional leg length
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| pavement, but it sure is quite confusing
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| | discrepancy involves the feet. When we
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| when we awake one day with that little
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| | say a foot is pronated we mean that it is
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| annoying hip pain. The truth of the
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| | flat (little to no arch integrity),
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| matter is that the surprising hip pain
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| | whereas a supinated foot refers to a foot
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| has been developing for quite some time.
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| | that has an arch. Generally speaking, a
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| It just decided to show its ugly head at
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| | pronated foot creates a short leg, and
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| this point in time. But why am I having
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| | supinated foot creates a long leg. Of
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| this pain now? I've never had this pain
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| | course, during the normal gait cycle,
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| before. Why all of a sudden does my hip
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| | there are appropriate amounts of
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| hurt? I haven't done anything out of the
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| | supination and pronation that must occur
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| ordinary. The importance lies within the
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| | in order to achieve efficient and
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| body's own adaptive potential.
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| | effective ambulation.
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| The basic premise here is that the body
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| | The most important role is being able to
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| functions as a single unit with many
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| | differentiate between the two.
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| components. Each component influences and
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| | Unfortunately, differentiating the two
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| is influenced by other components.
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| | can be quite difficult. In most cases,
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| Efficient and normal motion occurs from
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| | both situations occur simultaneously,
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| the complex integration of all
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| | with one masking the actual degree of the
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| components. Human movement is achieved
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| | other. Differentiating between the two
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| through the relationships of the kinetic
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| | scenarios requires an extensive
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| chain. The kinetic chain includes all
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| | evaluation that involves gathering
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| bones, muscles and joints of the human
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| | information from several manual tests
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| body, but more specifically the lower
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| | coupled with information gained from
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| half; the feet, ankles, legs, knees,
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| | weight-bearing x-ray measurements. Once
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| hips, pelvis, and low back. This linkage
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| | the proper diagnosis has been made, there
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| system is made up of many component
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| | are various treatment options that are
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| parts, each with their own set of
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| | available.
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| specifications. These specifications are
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| | When a structural leg length discrepancy
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| similar to what you might find for
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| | is present by itself, the most logical
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| certain machine parts. In a way, the
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| | option to equalize the leg length is
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| human body can be thought of as a
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| | simply by placing an appropriate lift
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| machine. However, unlike a machine that
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| | under the heel or under the entire foot
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| is comprised of right angles and nuts &
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| | itself, depending on the amount of the
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| bolts, the human body has the capacity to
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| | discrepancy. Most research reports more
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| compensate for a malfunctioning part, and
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| | than a 1/4 inch difference is
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| in most cases, in more than one area. The
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| | pathological. Some studies suggest that
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| human body seeks symmetry. It will do
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| | even an 1/8 inch difference can be
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| whatever it takes to achieve that and in
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| | detrimental especially for the running
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| doing so will compromise tissue health.
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| | athlete. Running causes the ground
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| In turn, it will wreak havoc on the
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| | reaction forces to increase up to
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| proper biomechanics of human movement,
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| | fourfold, as well as, increasing the
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| which will greatly affect performance.
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| | metabolic demand. The range of motion of
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| The human body is the "great
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| | all joints increases with greater muscle
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| compensator". It will seek and follow the
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| | activity required to control these
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| path of least resistance.
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| | motions.
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| The goal of any movement should seek the
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| | Treatment for the functional leg length
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| minimum amount of energy expenditure and
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| | discrepancy requires the skill of a
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| maximum joint stability. In human
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| | medical professional to address any soft
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| walking, the wide variety of structure
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| | tissue limitations. These are most
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| and control requires complex integrations
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| | notably present in which the pelvis may
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| for an efficient motor program. The most
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| | be tilted or twisted in an unusual
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| observable sign of this is a smooth
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| | position. This situation requires manual
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| progression of the body's center of mass
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| | therapy techniques to align joints
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| during ambulation.
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| | properly and to reduce any unwanted
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| Healthy tissue needs force in order to
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| | muscle activity. In addition to
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| remain healthy. It requires an optimal
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| | aggressive manual techniques, the use of
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| amount of stress. Too much or too little
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| | custom foot orthotics may be recommended
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| can be destructive! Remember we talked
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| | in either a structural or a functional
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| about how a tissue's specifications are
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| | leg length situation. Asymmetrical foot
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| similar to those of a machine? Well, when
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| | function may be causing the leg length
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| a tissue's tolerance to absorb force is
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| | discrepancy, therefore appropriate
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| exceeded, tissue breakdown occurs and
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| | application of an orthotic device will
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| inflammation and pain follow. When
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| | either correct or accommodate to the
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| inflammation and pain are present, one's
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| | asymmetry.
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| performance will surely suffer the
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| | It should be quite clear that any
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| consequences.
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| | treatment option chosen must be made only
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| One significant condition that impacts
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| | after a thorough examination has been
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| healthy tissue is a leg length
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| | completed. The examination should include
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| discrepancy. Oh, but that's normal isn't
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| | an analysis of gait, an assessment of
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| it? Everybody has one leg longer than the
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| | muscle length and strength, joint
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| other. Don't they? Sure, not everybody
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| | mobility, and careful evaluation of foot
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| has exact proportional measurements when
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| | function.
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| they compare the right and left sides of
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