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I discussed the presentation with the patient to ensure he had a good understanding of the problem and the likely outcome of treatment. I treated to the weak and painful tendons with soft tissue mobilisation, massage, stretching, a graduated strengthening programme. His strengthening programmers consisted of to the series of weight and theraband work, as well as using a Powerball. as these generally require stronger evidence.

• Starchy foods are a key food group in healthy eating
• People are sleeping much less than they did in the past
• Don’t smoke or use drugs, and only drink in moderation
• Your body is full of trillions of bacteria, viruses and fungi

The muscles in his forearms were wasted and his shoulders were protracted. There were no signs of bone abnormality, nerve or significant soft a tissue injury. He had good movement, but his strength was reduced on both sides on grip and wrist strength in particular. His shoulder were also slightly weak in the rotator cuff. He had pain on palpation of his forearms generally, particularly pronator teres.