Who should consider physical therapy for their lower back pain?

Anyone experiencing acute or chronic lower back pain can benefit from physical therapy, whether it is due to injury, poor posture, or an unknown cause. This is especially true if you are seeking non-invasive treatment, want to avoid dependence on medication, are recovering from an injury, or want to prevent future episodes.

People suffering from acute lower back pain (those who have been experiencing pain for less than 12 weeks) are ideal candidates for physical therapy. Early intervention during the acute phase significantly improves your results. It reduces the risk of chronicity (the pain becoming chronic). If you have strained your back while lifting, twisting, or making sudden movements, a quick physiotherapy assessment will identify the extent of your injury. It will initiate the appropriate treatment. Research shows that early physiotherapy reduces both the duration of your pain and the likelihood of recurrence, compared to delayed treatment approaches.¹⁶ For severe pain or significant movement limitations, our physical therapists are trained to effectively assess and treat acute pain with techniques tailored to your tolerance. Some lower back pain involves radiation down your leg, such as lumbosciatica or lumbar radiculopathy. These conditions require a precise assessment to target the affected nerve structures.

Patients with chronic low back pain who experience symptoms for more than 12 weeks benefit from a comprehensive approach to physical therapy. Chronic pain often involves complex interactions between physical, psychological, and social factors. It requires multimodal management. Physical therapy addresses these multiple dimensions through manual treatment, exercise prescription, pain education, and functional restoration. If you are living with persistent back pain despite having tried various treatments, physical therapy offers structured rehabilitation focused on long-term self-management rather than temporary symptom relief.¹⁷ Pain that persists beyond three months often requires a specialized approach. Our program for persistent pain combines education on the science of pain, movement retraining, and self-management strategies to break the vicious cycle of chronic pain. Low back pain often coexists with other regional problems. Physical therapy also effectively treats neck pain, shoulder problems, and knee pain that may accompany your back problems.

People seeking to avoid dependence on medication find physical therapy particularly valuable. While medication provides temporary pain relief, it does not treat the underlying movement dysfunctions or the muscle imbalances that contribute to your pain. Physical therapy offers drug-free pain management through manual therapy and exercise. It reduces your dependence on anti-inflammatory drugs or painkillers. This becomes especially important if you are concerned about the long-term side effects of medication or if you have contraindications to common pain medications.¹⁸

People focused on prevention who want to reduce future episodes of pain benefit from the educational component of physical therapy. Even after your pain resolves, continuing targeted exercises and implementing the ergonomic changes learned during physical therapy significantly reduces the risk of recurrence. Your physical therapist teaches you body mechanics, proper lifting techniques, and maintenance exercises. This helps you stay pain-free long after formal treatment ends.¹⁹

Before starting physical therapy, certain red flags (warning signs) require medical clearance. If you experience severe pain that is not relieved by rest, pain accompanied by fever or unexplained weight loss, progressive weakness in the legs, numbness in the genital or perineal area, or loss of bladder or bowel control, consult a doctor immediately before undergoing a physical therapy assessment. Rest assured: these situations are rare and affect only a small minority of cases of lower back pain. In the vast majority of cases, back pain heals well with appropriate care. Physical therapy effectively treats several common lumbar conditions. These include lumbar disc herniation,lumbar osteoarthritis, spinal stenosis, andlumbar sprain. Consult our comprehensive guide to low back pain to identify your specific condition.

What happens during physical therapy sessions for lower back pain?

Physical therapy sessions typically begin with a comprehensive assessment. This includes an analysis of your movement and an evaluation of your pain. Next, your manual treatment combines manual therapy techniques, guided exercises, and education. Each 30- to 60-minute session progressively builds toward restoring your pain-free movement and function.

Understanding the structure of sessions maximizes your treatment benefits. Initial assessments last 45 to 60 minutes to allow for a thorough evaluation. Follow-up sessions last 30 to 45 minutes and focus on treatment progress. Your physical therapist balances manual treatment, active exercises, and education to keep you engaged throughout the recovery process.²⁰ For patients who are unable to travel to the clinic, telerehabilitation offers high-quality remote sessions with live video supervision.

The therapeutic relationship between you and your physical therapist significantly influences your results. Effective physical therapists explain what they are doing, involve you in decisions, and modify approaches based on your feedback. This collaboration ensures comfortable treatment while challenging you to progress. Open communication guides your physical therapist's clinical reasoning.²¹

What happens during your initial physical therapy assessment for back pain?

Your initial assessment includes a detailed medical history, a physical examination with movement screening, postural analysis, strength tests, and special tests to identify the sources of pain. This establishes baseline measurements and creates your personalized treatment plan based on your goals. For more details, see our guide on how a physical therapy assessment works.

The subjective history begins your first session. Your physical therapist will ask questions about the circumstances surrounding the onset of your pain, its location and quality, factors that aggravate or relieve it, and previous treatments. Be prepared to describe your pain patterns, functional limitations, and treatment goals. The more specific information you provide, the better the treatment will be tailored to your needs.²²

The physical examination follows the subjective history. Your physical therapist observes your posture and the quality of your movement, noting any asymmetries or compensatory movements. Active movement tests assess which movements cause or relieve your pain. Your physical therapist tests muscle strength, particularly in the trunk and hip muscles. Palpation identifies tender areas and restrictions in mobility. Special tests can identify specific pain generators.²³

Based on the assessment, your physical therapist develops a working diagnosis explaining the likely sources of your pain. The treatment plan outlines the recommended techniques, frequency of sessions, anticipated duration, and realistic expectations. This shared decision-making ensures that treatment aligns with your goals.²⁴

Many physical therapists initiate treatment during the first visit: gentle manual techniques, preliminary exercises, or education on activity modification. Starting immediately begins your recovery process without delay. If your presentation suggests a referral for imaging, your physical therapist will coordinate the appropriate next steps.

How do follow-up sessions advance your back pain treatment?

Follow-up sessions monitor your progress, adjust techniques based on your response, increase the difficulty of the exercises, and gradually increase your independence. Your physical therapist will modify the intensity and frequency based on your rate of improvement. Our article on how physical therapy treatment works explains the typical progression.

Each follow-up session begins with an assessment of progress: changes in pain, functional improvements, and adherence to exercises. Objective reassessment documents your progress quantitatively and guides treatment adjustments.

Treatment techniques evolve based on your responses. If certain manual techniques provide significant relief, your physical therapist will focus on those. If the exercises become easy, they will increase the difficulty with added resistance, additional repetitions, or more complex movements. This progressive approach ensures continuous improvement.²⁷

Education and self-management receive increasing emphasis as treatment progresses. Early sessions focus on manual techniques for relief, while later sessions develop your independence. This transition prepares you to manage your back health independently.²⁸

The frequency of sessions decreases as you improve. The initial phases may involve sessions twice a week, then they become weekly, then biweekly, and finally optional maintenance checks. This de-escalation reflects your growing independence and reduced need for professional guidance.

How long does physical therapy treatment for lower back pain last?

We understand that waiting can be difficult when pain affects your daily life. The good news is that most patients with acute lower back pain see significant improvement in 4 to 6 sessions over 2 to 4 weeks. Chronic pain may require 8 to 12 sessions over 6 to 8 weeks. The frequency of treatment decreases as you gain independence in your self-management strategies.

The duration of treatment varies depending on your pain presentation, severity, and individual factors. Acute low back pain responds quickly to physical therapy: many acute cases improve substantially in 4 to 6 sessions over 2 to 4 weeks.³⁰ This rapid response occurs because acute pain often involves specific tissue irritation without the complex neurophysiological changes of chronic pain.

Chronic low back pain requires longer periods of treatment. Symptoms persisting beyond 12 weeks often involve avoidance behaviors due to fear, altered movement patterns, and sensitization of the central nervous system. Most patients with chronic pain require 8 to 12 sessions over 6 to 8 weeks to achieve significant functional improvement.³¹

Your compliance with your duties significantly influences the duration of treatment. You progress more quickly when you perform the prescribed home exercises. Research shows that adherence to exercises correlates directly with successful outcomes.³² Your physical therapist assigns realistic programs tailored to your schedule and abilities.

Initial improvements typically appear after 2 to 3 sessions. If you have completed 3 to 4 sessions without improvement, discuss this with your physical therapist to modify the techniques or consider additional investigation.³³ For more information, see our article on what happens if I don't feel any improvement with physical therapy.

Treatment shifts to maintenance management as your symptoms resolve. Continuing targeted exercises for several months reduces the risk of recurrence. This long-term perspective prevents the common pattern of pain returning after treatment ends.³⁴

Does physical therapy for back pain hurt during treatment?

Physical therapy should not cause significant pain. However, you may experience mild, temporary discomfort during certain techniques or exercises. Your physical therapist constantly monitors your response. He or she adjusts the intensity of the treatment to remain within comfortable and therapeutic ranges that promote healing without aggravation.

Understanding the difference between therapeutic discomfort and harmful pain helps you participate effectively in treatment. Therapeutic discomfort feels like a gentle stretch. A slight muscle strain during exercise. Or brief tenderness during manual therapy that quickly subsides. This sensation indicates that you are working within appropriate intensity ranges. Harmful pain feels like something sharp and intense. Or it causes your symptoms to spread beyond the treatment area. If the treatment causes this type of pain, communicate immediately. Your physical therapist can modify their approach.³⁵

Communication during treatment sessions ensures your comfort while maintaining therapeutic effectiveness. Your physical therapist regularly checks your pain level during the techniques. He or she asks you to rate your discomfort on a scale and describe the sensations you are experiencing. Honest feedback allows your physical therapist to find the "therapeutic window." This is where treatment remains comfortable but effective. Do not endure significant pain in the hope that it will lead to better results. Research shows that excessively painful treatment often produces worse results than an appropriately dosed intervention.³⁶

The physiotherapy approach contrasts with the aggressive manipulations that some patients have experienced. Physiotherapists mainly use gentle mobilizations rather than high-velocity thrusts (rapid movements). This allows for precise control of the application of force. Soft tissue techniques apply gradually increasing pressure, which you can easily indicate if adjustment is needed. Exercise progressions start conservatively and advance based on your tolerance. This gradual approach minimizes treatment pain while achieving therapeutic goals.³⁷

Post-treatment pain sometimes occurs, particularly after new exercises or manual techniques. This delayed onset muscle pain is similar to the mild pain experienced after returning to exercise following a period of inactivity. It typically appears 24 to 48 hours after treatment and resolves within a day or two. Your physical therapist will distinguish between expected post-treatment pain and increases in pain that are cause for concern. He or she will provide advice on managing normal pain versus symptoms that require a change in treatment.³⁸

You always have the right to refuse any technique that causes excessive discomfort. Physical therapy involves a collaborative partnership between you and your therapist. It is not passive submission to predetermined protocols. If a technique seems too uncomfortable, speak up. Effective physical therapists respect your limits. They explain why certain techniques may involve temporary discomfort. They discuss alternative approaches when necessary. This collaborative approach builds trust. It optimizes the effectiveness of treatment.³⁹

What is the difference between physical therapy and chiropractic care for back pain?

Physical therapy emphasizes multimodal treatment. It combines education, exercise, and various manual techniques. With a focus on long-term self-management. Whereas chiropractic traditionally focuses on spinal adjustments. However, modern practices overlap significantly. Physical therapy generally takes a more conservative and evidence-based approach to treatment progression.

Differences in professional training influence treatment philosophies. Physiotherapists in Quebec complete university programs leading to Bachelor's or Master's degrees in physiotherapy. This is followed by mandatory registration with the OPPQ. Their training emphasizes assessment, therapeutic exercise prescription, and various treatment modalities. This includes, but is not limited to, manual therapy.⁴⁰ Chiropractors complete Doctor of Chiropractic programs. These programs focus extensively on spinal manipulation techniques. Both professions require rigorous training, but the educational emphases differ significantly.

The differences in treatment philosophy reflect these differences in training. Physical therapy embraces a biopsychosocial model, recognizing that your experiences of pain involve physical, psychological, and social factors. Treatment addresses multiple dimensions through manual therapy, exercise, education, and functional retraining. Traditional chiropractic philosophy focuses on correcting subluxation (misalignment) through spinal adjustments. However, many modern chiropractors adopt multimodal approaches, incorporating exercise and education similar to physical therapy.⁴¹

The selection of manual therapy techniques differs between professions. Physical therapists predominantly use gentle joint mobilizations. These are gradual, controlled movements that can be stopped at any time. Chiropractors frequently use high-velocity, low-amplitude thrusts (adjustments). These produce audible pops. Both techniques can effectively improve joint mobility. However, mobilizations offer a more gradual and controllable application of force, which some patients prefer. Research suggests similar effectiveness between the approaches for many conditions, with mobilizations having slightly lower risk profiles.⁴²

Exercise prescription receives greater emphasis in physical therapy treatment plans. While some chiropractors incorporate exercise extensively, physical therapy programs typically dedicate substantial session time to supervised exercise. Home program instruction. Progressive exercise advancement. This exercise focus supports long-term self-management. Prevention of recurrence. Research consistently shows that combining manual therapy with exercise produces superior long-term results compared to manual therapy alone, regardless of the profession.⁴³

The evidence base and treatment approaches vary more between individual practitioners than between professions. Many modern chiropractors practice evidence-based care, incorporating exercise and education, similar to physiotherapy approaches. Similarly, some physical therapists emphasize manual therapy extensively, with less focus on exercise. When choosing providers, ask about their specific treatment approach rather than assuming that the profession alone determines the treatment philosophy. Look for practitioners who emphasize active patient participation, realistic outcome expectations, and multimodal treatment strategies, regardless of professional designation.⁴⁴

The scope of practice and opportunities for collaboration differ in the Quebec healthcare system. Physical therapists can treat patients directly without a physician's referral. They commonly work in multidisciplinary teams in hospitals and rehabilitation centers. Both professions can serve as first-contact practitioners for musculoskeletal complaints. Insurance coverage varies by plan. Most cover both physical therapy and chiropractic care. However, sometimes with different reimbursement rates or visit limits. Check your specific insurance benefits when deciding between professions.⁴⁵

How much does physical therapy for lower back pain cost in Quebec?

Private physical therapy sessions in Quebec typically range from $85 to $120 per session. Many insurance plans cover 80% to 100% of the costs. Meanwhile, the CNESST and SAAQ provide full coverage for work-related or auto-related injuries. This makes physical therapy an accessible treatment option for most patients.

Comparative table of physiotherapy costs in Quebec

Factors that influence the price:

• Location of the clinic (urban vs. community)
• Level of experience of your therapist
• Specialized certifications
• Specialized services offered

Private insurance coverage

Most health insurance plans provided by your employer cover physical therapy. At reimbursement rates ranging from 80% to 100%. However, annual limits vary widely between plans. Some plans cap coverage at $500 annually, while others provide $1,500 to $2,000 or more. Review your specific insurance policy to understand your coverage limits and any requirements such as a medical referral or pre-authorization. Many clinics bill insurance companies directly, which minimizes your upfront payment requirements.⁴⁷

CNESST coverage

CNESST coverage applies when your lower back pain is the result of a work-related injury. If you injured your back while performing work duties, file a CNESST claim through your employer. Approved claims cover the full cost of your physical therapy treatment. There is no limit on the number of sessions. This continues until you reach maximum medical improvement. Your employer cannot require you to use your private insurance. When CNESST coverage applies. Make sure your physiotherapist is familiar with CNESST documentation requirements. This will ensure that coverage remains approved throughout your treatment.⁴⁸ Work-related injuries require specialized expertise in occupational rehabilitation. Discover our comprehensive program for CNESST workplace accidents. It includes coordination with your employer and administrative management of your file.

SAAQ coverage

The SAAQ provides comprehensive coverage for injuries related to motor vehicle accidents. If your lower back pain is the result of a motor vehicle accident in Quebec, the SAAQ will cover your physical therapy costs. Regardless of fault. This coverage continues for medically necessary treatment. Without arbitrary session limits. SAAQ coverage includes not only your treatment costs. It also covers your travel expenses to attend appointments. Your physiotherapist submits treatment reports directly to the SAAQ, minimizing the administrative burden on you.⁴⁹ Car accidents often cause complex lumbar injuries that require a specialized approach. Our SAAQ car accident program offers comprehensive rehabilitation with administrative and medical follow-up management.

Cost-effectiveness

The cost-effectiveness extends beyond your direct treatment expenses. Consider the value of physical therapy in preventing prolonged disability. Absence from work. Your lost income due to ongoing back pain, especially if you do physically demanding work, often exceeds the cost of physical therapy many times over. Research shows that early physical therapy reduces both the duration of pain and disability. This potentially saves substantial indirect costs through a faster return to work and a reduced need for costly interventions such as imaging or surgery.

Flexible payment options

Many clinics offer flexible payment arrangements. For you if you don't have insurance coverage. Or if you are experiencing financial hardship. Some provide sliding scale fees based on your income. Community health centers and university teaching clinics sometimes offer services at reduced cost. If cost concerns may prevent you from accessing physical therapy, discuss options with the clinic administration. Solutions often exist beyond the posted rates.⁵¹

Your investment in prevention generates long-term value. Even after your acute pain has been resolved, occasional maintenance sessions or continuing the independent exercises learned during physical therapy reduce your risk of recurrence. The cost of proactive management through periodic check-ups or ongoing exercise programs This represents substantially less expense than treating recurring acute episodes.⁵²

How do I choose the right physical therapist for my back pain?

Select a physical therapist with specialized musculoskeletal training. Experience in treating back pain. Evidence-based approach. Clear communication style. Convenient location. Verify their OPPQ registration. Consider factors such as alignment with treatment philosophy, availability, and positive patient reviews. Or professional references.

Choosing the right physical therapist significantly influences your treatment experience. Your results. While all licensed physical therapists meet minimum competency standards, individual therapists vary in their areas of specialization. Treatment approaches. Communication styles. Finding a good match between your needs and a therapist's expertise optimizes your recovery process. This decision deserves careful consideration. Rather than simply selecting the closest clinic.

For detailed advice on selecting a physical therapist, including specific questions to ask during the initial consultation and references to check, consult our comprehensive resource: Find your perfect physical therapist in 4 easy steps. In addition, learn how to recognize quality physical therapy care by reviewing our guide on How to know if I am receiving good physical therapy.

Key factors to consider include OPPQ registration verification. All practicing physical therapists must appear in the OPPQ public registry. Specialized training in manual therapy or orthopedics. Evidence-based treatment philosophy. Emphasis on your active participation. Clear communication during assessment and treatment. Convenient location and schedule availability. Positive reviews from patients with similar conditions. Trust your instincts during the initial consultation. The quality of the therapeutic relationship significantly impacts your treatment outcomes.⁵³

Can I do physical therapy exercises at home for my back pain?

Home exercises are an essential part of physical therapy treatment. Your physical therapist prescribes specific movements tailored to your condition. He or she teaches you the proper technique. He or she gradually increases the difficulty. However, the initial professional assessment ensures that the exercises are appropriate and safe for your particular back pain condition.

Home exercise programs support your recovery between clinic sessions. While manual treatment during appointments provides significant benefits, the exercise work you do independently is the main driver of long-term improvement. Research consistently shows that you achieve better results. You maintain improvements for longer when you adhere to prescribed home exercise programs than those who rely solely on clinic treatment. Your physical therapist designs home programs tailored to your abilities, gradually increasing the difficulty as you improve.⁵⁴

Professional guidance before starting exercises ensures safety and appropriateness. Self-prescribed exercises from internet searches or general fitness advice may not be suitable for your specific condition. They could potentially worsen symptoms if poorly adapted to your presentation. An initial professional assessment identifies your particular movement limitations, pain patterns, and functional restrictions. This allows your physical therapist to prescribe exercises that address your specific needs. This personalized approach maximizes benefit while minimizing risk. and functional restrictions. This allows your physical therapist to prescribe exercises that address your specific needs. This personalized approach maximizes the benefit while minimizing the risk.⁵⁵

Common exercise categories for lower back pain include mobility exercises, which restore normal spinal movement; core stabilization exercises, which strengthen the deep abdominal muscles and back muscles that support your spine; hip strengthening, which targets the gluteal muscles and reduces spinal stress; and functional movement training, which prepares you for your daily activities. Your specific program depends entirely on the assessment findings. Some patients need more mobility work, while others require mainly strengthening. Many need combinations that address multiple limitations.⁵⁶ Strengthening the deep core muscles is the foundation of lumbar stability. Ourexercise programfor stabilizing muscles specifically targets these essential muscles to protect your spine.

Progression principles guide the advancement of exercises throughout recovery. Exercises begin conservatively, within comfortable ranges, gradually increasing in difficulty through added repetitions, increased resistance, or more challenging positions. Your physical therapist monitors your response during follow-up sessions, ensuring that progression occurs at an appropriate rate—not so fast that you experience flare-ups of symptoms, but not so slow that you fail to make adequate progress. This balanced progression optimizes recovery while maintaining safety.⁵⁷

Understanding when to modify or stop exercises allows you to practice safely on your own. Mild, temporary discomfort during exercises is normal. But sharp pain, symptoms that spread beyond the original area, or pain that persists for hours after exercise This indicates excessive intensity that needs to be modified. Your physical therapist will provide clear guidelines on acceptable levels of discomfort versus symptoms of concern. When in doubt, err on the side of caution. Consult your physical therapist before continuing exercises that have caused symptoms of concern.⁵⁸

Continuing exercise over the long term maintains the benefits. Prevents recurrence. Even after your formal physical therapy treatment ends, continue with core exercises. The movement routines learned during treatment. This significantly reduces the likelihood of future episodes of pain. Consider your home exercise program not as temporary rehabilitation, but as ongoing maintenance that supports your long-term back health. Many patients benefit from transitioning to general fitness activities or specific exercise classes, now that they have gained strength and mobility through physical therapy.⁵⁹

Should I start physical therapy for my lower back pain now?

Starting physical therapy early for your lower back pain leads to faster recovery. Prevents chronicity. Reduces the risk of recurrence. Evidence shows better results when treatment begins within the first few weeks. This makes a quick professional assessment invaluable. For your optimal recovery path.

The benefits of early intervention extend beyond faster symptom resolution. Research shows that receiving physical therapy in the first few weeks of low back pain significantly reduces the likelihood that your symptoms will become chronic. One study found that delayed physical therapy (starting after 90 days) was associated with higher rates of persistent symptoms and greater long-term disability compared to early treatment initiation.⁶⁰ The longer your pain persists without appropriate intervention, the more likely it is to become entrenched through neurophysiological changes and movement alterations.

Delaying treatment carries multiple risks. Beyond the simple persistence of symptoms. As your pain continues, you may develop compensatory movements. Protecting painful areas. Ultimately creating secondary problems in other areas of the body. Fear-based avoidance behaviors often develop when pain persists. This can lead you to limit your activities unnecessarily, potentially causing deconditioning that complicates eventual recovery. Delayed treatment also means prolonged functional limitation, affecting your performance at work, your recreational activities, and your quality of life.⁶¹

The conservative nature of physical therapy makes it an appropriate first-line intervention for most presentations of low back pain. Unlike more invasive options that carry significant risks, physical therapy involves minimal risk While offering substantial potential benefits. Starting with conservative care is in line with clinical practice guidelines. Which recommend non-invasive interventions before considering injections. Or surgical options. Even if physical therapy alone does not completely resolve your symptoms, it often improves your condition enough. To avoid more aggressive interventions.⁶²

Starting physical therapy provides clarity about your condition and your prognosis. A professional assessment identifies specific factors contributing to your pain and establishes realistic expectations for recovery. This information reduces the anxiety that often accompanies uncertain diagnoses and provides a clear plan of action. Many patients report that simply understanding their condition and having a structured approach to treatment reduces distress, even before physical symptoms improve significantly. Having a structured treatment approach reduces distress, even before physical symptoms improve significantly.⁶³

The next practical steps involve scheduling an initial assessment with a qualified physical therapist. Most clinics can accommodate new patients within a few days to a week, especially for acute conditions. During this first visit, your physical therapist will conduct a comprehensive assessment, answer your questions, and initiate the appropriate treatment. Come prepared with information about your symptoms, your relevant medical history, and your current insurance coverage details. Wear comfortable clothing that allows for easy movement and shoes that you can easily remove. Allow access to your back.⁶⁴ Your current insurance coverage details. Wear comfortable clothing that allows for easy movement and shoes that you can easily remove. Access to your back.⁶⁴ If you are currently experiencing lower back pain that is affecting your daily activities, don't let your condition worsen. Visit our page on managing back pain to start your recovery process today.

Recovery requires active participation. Commitment. While your physical therapist guides the treatment, your commitment through adherence to exercises and modification of activities significantly influences your results. Approach physical therapy as a collaborative partnership rather than a passive treatment you receive. Realistic expectations, consistent effort, and open communication with your physical therapist create optimal conditions for successful recovery. You are not alone on this journey: your commitment to the process, combined with expert guidance, provides the best opportunity to return to pain-free function.⁶⁵

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