Do I Have Carpal Tunnel Syndrome?

Carpal tunnel syndrome (CTS) is a conditions caused by the compression of the median nerves beneath the transverse carpal ligament within the narrow confines of the carpal tunnel located in the wrist. The condition is very common and is due to pressure from trauma or edema caused by the inflammation of the tendon, neoplasm, rheumatoid synovial disease, or soft tissue masses.

Symptoms of CTS are more pronounced during the premenstrual cycle, pregnancy, and Carpal Tunnel Syndrome Treatment Denvermenopause in women. Diabetes mellitus, or type 2 diabetes, and thyroid dysfunction can aggravate the condition as well by increased fluid retention these diseases cause. Some occupations can cause carpal tunnel syndrome like:

– Hair dressers

– Dentists

– Seamstresses

– Machine operators

– Secretaries

– Bowlers

– Painters

– Other occupations with repetitious hand usage

A person will start feeling weakness, especially in the thumb, when CTS starts affecting the extremity. A burning pain and numbness will be felt or impaired sensation where there will be a sense of “clumsiness” in performing fine hand movements. Numbness and tingling may wake a person at night.

One way to test for CTS is to hold the wrist flexed back for 60 seconds. If a tingling and numbness is felt through the median nerve (center of the inner wrist), and through the palmar surface of the thumb, the index finger, the middle finger, and part of the ring finger, it could be indicative of CTS. It is call Phalen’s sign. If the inflamed median nerve is tapped and it causes prickling or other abnormal sensation, it is called Tinel’s sign and it is also a sign of CTS. In later stages of the CTS, there will be atrophy (decreased muscle mass due to prolonged immobilization) of the muscles around the thumb that results in recurrent pain and eventual dysfunction of the hand.

It is important to seek treatment sooner rather than later. The longer the nerve is compressed, the more pain a person will experience as well as loss of functioning in the hand and wrist. The treatment is more conservative for carpal tunnel syndrome when it is caught early. Seeing an orthopedic physician will be the first step towards healing from this condition.

The treatment for CTS is toward relieving the underlying cause of the compression of the medial nerve. If the condition is caught early, the hand and wrist can be put in a hand splint Denver Pain Management Doctorsto prevent movement and give the area a rest. Wearing the splint at night is especially important, so that the wrist stays straight and doesn’t flex for long periods at night. If the cause of the problem is inflammation, a corticosteroid injection may relief the symptoms for up to 6 months.

If the problem persists, the median nerve may need to be surgically decompressed. This is done with a longitudinal division of a ligament under regional anesthesia. The procedure is done in an outpatient patient basis. Another procedure entails an endoscopic carpal tunnel release. Decompression is performed through a small incision with local anesthesia.

Colorado Pain Network – Pain Clinics Offer Different Forms Of Therapy

One of the most common therapies for pain management that a pain clinic can offer is rehabilitation therapy. With therapy, patients with pain can go to a facility that is run by experts, and these men and women are therapists who have the training on how the human body works, and of course, its limitations. One of the main causes of pain is Denver Pain Clinicinactivity, and one of the main goals of the therapy is to relieve pain, but also to exercise the body, which will prevent things like muscle stiffness and swollen joints.

Different Therapies Offer Pain Management

Rehabilitation therapy is often mistaken for just going to a gym, and while there are a lot of similarities in terms of equipment, there is a big difference. People who go to the gym are going to exercise, and perhaps recover from an injury, but with rehab therapy, it is recovering with supervision and there may be more to do other than just walk on the treadmill or use weight machines. A pain clinic offers therapy to help deal with pain and strengthen the body, but it is also designed to help a person get back to a normal life, which will help them on a spiritual and psychological level as well:

•    Manipulation therapy: One pain management technique that a pain clinic can offer is a form of therapy called manipulation therapy. With this form of therapy, the muscles and joints are massaged by hand, and people can form a bond with their therapist, who understands what they are going through, which can be just as helpful the therapy itself. Manipulation therapy can help make sure muscles and joints get the attention they need, and people have reported less pain and more mobility with this form of therapy.

•    Spinal decompressiontherapy: This form of rehabilitation therapy involves a patient being on a special traction table. The table will stretch out the spine, and the goal of it is to help relieve pain in the back and the legs, and also to help when people have disks that are out of place. The motorized table will help put the spinal disks back where they belong, and the therapy is considered pretty successful because it can also promote healing of back problems.

•    Sports rehabilitation therapy: When it comes to sports injuries that professional athletes get, their rehabilitation is special because it is not only helping them recover from their injuries, but also prevent the same injury from happening again. Sports injuries are so specific that there is a special branch of medicine that deals with sports injuries.

The human body is a complicated machine, and when there is something wrong with it, and the body experiences chronic pain, then something has to be done. A pain clinic can help people with problems that constantly cause them pain, and one technique to treat it is Chiropractor Denver Coto have rehabilitation therapy. There are many different types of therapy that can help people, and each one promises pain relief, exercise, and helping people with problems live as normal a life as possible.

 

Auto Accident Pain – Pain Management Denver

Automobiles weigh thousands of pounds, and when they are going 55 miles an hour or more down the road, and then impact with another, the force of it can be devastating both to the car and the human being that is driving it. Even if people have mild accidents, the sudden stopping of a car can cause forces to bend the human body in ways it was not designed to and cause injuries. The clinics involved in the Colorado Pain Network deal with people who have suffered from auto accidents and need their pain management expertise.

Pain Management For Car Accident Aftermath

After a car accident, people have to deal with a broken car and a broken body too. While Pain Management Denver Cothe most typical injury from the car crash may be whiplash, there are other injuries that can occur to the whole body. People may think they are fine after a car crash, but within a few days of an accident they may start to feel things, and here are some common injuries in which pain management will be needed because without proper treatment, people may end up with chronic problems that will never go away:

•    Headaches: Sometimes, the impact of one car into another does not necessarily result in whiplash because the car was not going very fast. However, even a small impact can still cause the body to be thrown forward enough to cause some muscles around the neck to become sore. While the neck might not be hurting, the clearest indication of a mild case of whiplash will be painful headaches that can sometimes be so bad that the pain radiates not only around the head, but down to the back of the neck. Pain management of such injuries are going to require things like a visit to a chiropractor, massage therapy, and physical rehabilitation to get the body back into shape.

•    Neck pain and stiffness: With a more serious accident, whiplash will occur, and when the body is thrown forward because of the impact, the head, neck, arms, and even back are all affected by the whip-like motion. Whiplash can be quite serious because the muscles in the head and neck are overly stretched and then put back into place. Some people have some movement in their head and neck, but others end up not being able to move their heads at all and will need a chiropractor in order to treat their neck and manage their pain.

•    Pain in the back: The head is at the top of the spine, and with whiplash, the spine can also be affected. One of the most common areas to be affected is along the spine. Some people can be affected with not only pain, but the inability to move certain parts of their bodies. Physical therapy is often required to help get the spine healthy again and restore Pain Clinic Denvermovement to previously immobile parts of the body.

Car accidents can destroy cars and cause serious injuries to the body. People may not think they are injured, but within a short period of time, people are going to notice they are experiencing things like headaches, neck pain, and back pain, and will seek out pain management Denver Co treatment with one of the clinics in the Colorado Pain Network.

Colorado Pain Network – Information Chiropractors

One doctor that understands all about dealing with chronic pain is a chiropractor. These medical experts primarily deal with the spine, and injuries associated with it such as whiplash from a car accident or a misalignment that can be caused by a fall at work. Chiropractor Denver CoPeople often want a way to deal with their pain other than medicine, and going to chiropractors is one option that they do have to deal with their pain.

Facts About A Chiropractor- Chiropractors Can Do More Than Fix Backs

While a chiropractor does deal with the spine, it is not the only part of the body that can benefit from a chiropractic adjustment. Chiropractors make it their mission to relieve the pain that people experience, and here are some facts about what these medical professionals that people may not be aware of:

•    Chiropractors deal with migraines: Migraines are worse than normal headaches because the pain can be more intense, and sometimes there are other symptoms like nausea, sensitivity to light, sensitivity to sound, vomiting, and dizziness. When people get a migraine, it can literally keep them out of commission for at least a few days especially if the pain is so severe they cannot do anything but try and rest. While sometimes the causes of migraines can be things like anxiety, another cause of them can be a misalignment of the spine and a nerve in the head and neck may be getting pinched, which would cause the migraines. Getting consistent readjustments of the spine, which means going to see chiropractors at least a few times a week, can resolve the issue without people having to rely on other methods such as medication.

•    Chiropractors can help with car accident injuries: A car accident can cause injuries that do not go away for a long time unless people get treatment, and even then, more serious injuries can sometime be permanent even with a medical professional’s help. Some people end up feeling something like whiplash for years after the accident, and there may be permanent damage to the neck and spine. Chiropractors can recommend treatments for their patients such as alignments, medication, and physical therapy to help them recover from their car accident.

•    Chiropractors can help strengthen the immune system: Studies have shown that with regular chiropractic adjustments, the human body can actually have better defense against illness. With regular visits to a chiropractor, people will feel better physically, have increased circulation, and will have improved function, which will make the immune system do its job more effectively against organisms that invade the body.

A Chiropractor Denver Co does deal with the spinal cord, but it is not the only job that Chiropractor Denver Cothese medical professionals can deal with. Chiropractors are experts at pain management, and every clinic in the Colorado Pain Network will have several of them on staff. People typically go to chiropractors after things like a car accident or a fall, but people also go if they have problems like migraines, spinal issues, and regular adjustments can prove to be very useful for a person’s overall health and well-being.

Worker’s Compensation and Pain Management in Denver CO

No one wants to be injured on the job, but accidents do happen. The goal of this facility is to effectively provide treatment for employees, or clients, from the time of the initial hire, Workers Compensation Denverthroughout the entire treatment plan, and through the final discharge.

Having the most comprehensive pain management in Denver places emphasis on early and accurate diagnosis and the effective treatment of musculoskeletal trauma. This allows employees who have been injured on the job to return to work as safely and as quickly as possible.

Time and Vested Interest

Understanding that the situation of a work-related injury involves more than a patient and a medical care team means providing timely progress reports as necessary. Employers and insurance company representatives have a vested interest in the patient and their ability to return to work.

Denver work comp doctorIt is important for employers to plan production around the missing worker and accommodate for changing staffing needs. The excellent healthcare staff will regularly provide updated treatment plans and progress notes to both the employer and the insurance provider as requested.

When the time comes for an injured employee to return to work, there may be temporary restrictions or modified duty tasks as they reintegrate back into their employment position and the expectations of the role. This may include range of motion, weight lifting or mobility limitations as the healing process continues and the muscles are redeveloped. Follow-up care for post-injury rehabilitation is not only recommended, it is also expected.

Educating Employees on Accidents

Employees and employers should be educated on how accidents occur and how they can prevent many injuries that tend to happen often relative to the specific industry. A qualified and experienced medical treatment staff works closely with the injured worker, as well as the employer and other industry representatives to discuss ways to avoid accidents and provide effective preventative care.Pain Clinic Denver

Understanding the value of education and preventive measures, knowledgeable healthcare professionals explain such concepts as ergonomic furniture, posture, and proper body mechanics. In addition, safety gear and even footwear may need to be changed or adjusted to provide the most efficient and healthy environment for the worker and the workplace.

Conclusions

When seeking a partner in healthcare and treatment for work-related injuries, employers want to know that their employees will fully recover and return to work within a reasonable time frame.  This can only be accomplished when attending Denver pain management doctors and their supportive healthcare staff have received proper training in both the physiology of the body mechanics, but also in relevant workman’s compensation procedures and guidelines.

5 Things to Know about Medial Branch Blocks

A medial branch block is a procedure that is used to interrupt pain signals deriving from the facet joints. Medial branch nerves transport pain signals from the facet joints and surrounding muscles to the brain. If the nerves are numbed, they cannot transmit these pain signals to the Denver pain managementbrain and pain relief is achieved.

5 Things to Know about Medial Branch Blocks

1. Medial branch blocks can be used to treat back, neck and thoracic spine pain: The medial nerves are located at all spinal levels, and these include the cervical section which is the neck area, the thoracic region which is the upper/mid back and the lumbosacral region which is the lower back area.

When the facet joints are inflamed or arthritic, they often produce pain signals. The injection works to prevent pain by interrupting the signals from reaching the brain.

2. The injection is very safe: Although the medial branch nerves control small muscles throughout the spine, blocking them does not come with grave consequences. This is because the medial branch nerves have minimum control over major muscles. Interrupting the sensation is basically harmless.

3. The injection is primarily diagnostic: A lot of people identify the medial branch block Best Denver pain centerinjection as pain relief therapy. While it does indeed work to provide pain relief, the primary purpose of this injection is to provide diagnosis.

If a patient experiences pain relief after the injection, they may be required to undergo a subsequent procedure to deal with the main underlying issue and gain long term pain relief. The purpose of the injection is to identify whether or not the facet joints are the cause of the back pain.

4. The entire procedure takes about 30 minutes: This is an uncomplicated procedure that should take no more than half an hour. Usually, the injection will take a few minutes but there are other processes involved. These include the preparation stage where the patient Pain Clinic Denvercould be sedated if they wish to. Application of numbing medicine is also done before the procedure as well as a contrast dye test which is undertaken to ensure that the medication is directed to the right area and that it is on the targeted medial branch nerve.

The injection consists of a local anesthetic: Medial branch blocks contain only a small amount of local anesthetic such as lidocaine. The medication takes immediate effect and depending on the anesthetic injected, the medication could last from an hour to six hours or even a much longer duration.

Medial Branch Blocks: What Are The Results?

A medial branch block injection may not necessarily provide immediate pain relief and this will Pain Clinic Denverdepend on whether or not the targeted nerves are the ones carrying the pain signals. However, if the patient obtains pain relief, the Denver pain management doctor will have found the appropriate nerves.

If the block provides considerable pain relief four to six hours after the injection, the patient may have to undergo another procedure that will provide a longer duration of pain relief. Radiofrequency ablation or radiofrequency neurotomy could be considered after the medial branch block.

RF ablation has been shown to offer anywhere from 6 to 18 months in over 75% of patients. It’s been a revolutionary procedure in pain management.

Efficacy Of Spinal Decompression Therapy

Spinal decompression therapy is a form of treatment intended to relieve a patient from back or neck pain. The therapy stretches the spinal cord using a traction table or a similar motorized device Traction therapy is applied to the spine in order to exert a negative intradiscal pressure to promote retraction or repositioning of the herniated or bulging disc material. The pressure exerted on the herniated disc also results in releasing nutrients into the bulging disc. Spinal decompression has been found to be an effective form of treatment for treating lower back pain and leg pain.

Clinical Evidence for Spinal Decompression

A study on spinal decompression was conducted in Canada in November 2003 and the spinal decompression therapyresulting findings were published as part of the “Orth Tech Review.”(Glonis T, Groteke E. Spinal Decompression. Orth Tech Review 5(6):36-39; Nov-Dec 2003).As part of the study, 219 patients with herniated disc and degenerated disk who underwent spinal decompression were studied. In the group, 86% of the patients who completed the full therapy treatment showed immediate improvement in their condition. 92% of the patients who underwent the treatment showed an overall improvement in their condition. Only in 2% of the patients did back pain relapsed within 90 days of the initial treatment.

Spinal Decompression Treatment Details

A typical course of spinal decompression consists of 20 sittings that can be undergone in the form of daily or weekly sittings. Each session will usually last for 30 minutes. Patients undergoing this treatment are fully clothed and ice can be applied at the end of the treatment. The therapist providing the treatment can vary the amount of force applied and also the position of the spine in order to target the right spinal points.

Range of Medical Conditions Treated

As spinal decompression has the capability to relieve pressure on the spinal nerve caused by a herniated disc, it is extremely useful for conditions like sciatica and facet syndrome. This therapy has been found to be effective in treating acute neck and lower back pain and the associated neurological disorders. For people who have found no benefits from other forms of treatment, compression therapy can offer a permanent cure for their long-standing ailment. People suffering from acute pain for at least four consecutive weeks due to a bulging disc or herniated disk can use this treatment to get immediate relief. Also people with recurring back pain in the past six months due to a failed back surgery can find effective relief from back pain from spinal decompression.

The majority of patients with back or neck pain have responded positively to the spinal decompression treatment method. These long term chronic back patients have been able to resume their normal activities within two months of undergoing this decompression Spinal Decompression Therapy Denvertherapy. As this therapy is comfortable and painless in nature, more and more people with lower back and neck pain complaints are turning towards decompression therapy for much needed relief. In recent times, medical caregivers advise the patients undergo decompression therapy first, as it provides the required relief in more than 80% of the cases.

See Also: Alleviate Spinal Compression With Spinal Decompression Therapy

Physical Therapy For Lower Back Pain Relief

Lower back pain is the most common musculoskeletal problem to present to healthcare providers, with 85% of all people experiencing lower back pain at some point during their lifetime.

In the acute stage of lower back pain, conservative management is indicated with over the Chiropractor Denver Cocounter pain medications and patient education for further options of care including physical therapy, chiropractor care, pain clinic management, and surgery. Exercise therapy should be implemented after the patient has experienced constant lower back pain for greater than four weeks or experiences frequent recurrences of lower back pain.

Physical therapy and chiropractor care is contraindicated in those patients with “red flags” for a potentially serious underlying cause of lower back pain. Both physicians and physical therapists should monitor for trauma, unexplained weight loss, osteoporosis, history of cancer, IV drug use, steroid use, focal neurologic deficits, prior surgery, and history of abdominal aortic aneurysm.

If the physician is able to rule out any serious causes of lower back pain, the patient will benefit from a referral to a chiropractor or physical therapy. The goals of physical therapy are to decrease back pain, increase function, and provide education on a maintenance program to prevent further recurrences.

The physical therapist typically implements passive physical therapy that focuses on reducing muscle spasms and inflammation by applying heat or ice, TENS (transcutaneous electrical nerve stimulator), lontophoresis, and ultrasound. Heat and ice therapy can be alternated applying for ten to twenty minutes every two hours with the best results during the first few days of lower back pain.

Lontophoresis is sending steroids through the skin via an electrical current to produce an anti-inflammatory effect in the area of the back that is causing pain. TENS also uses electrical stimulation to override the painful signals that are sent to the brain from the lower back which may be used at home long term if the treatment is successful. Ultrasound can also be performed on the lower back to deliver deep heating via sound waves to relieve acute episodes of back pain and possibly enhance tissue healing.

Active or exercise-based therapy should be used in combination with passive therapy for stretching and strengthening for back pain and low impact aerobic conditioning. Studies have shown that patients with the highest and lowest degrees of physical activity are at risk for more serious back problems but that moderate physical loading of the spine has a protective effect.

Home exercises can be individualized for each patient and taught by physical therapists for self-management of mild to moderate back pain. Almost all patients with lower back pain should stretch their hamstring muscles twice per day even if there is little or no pain. Low impact aerobics should be done for thirty to forty minutes three times a week. Patients should work to increase their flexibility to provide both immediate and long-term Physical Therapy in Denverrelief in the lumbar region of the back. Those with lower back pain may also benefit from core strengthening exercises for control of the muscles involved in spinal stability. Therefore, those patients suffering from acute lower back pain, it is best to remain active rather than bed rest for the best outcomes and relief of lower back pain.

Also Read: Chiropractor Denver

Chiropractic Treatment For Shoulder Arthritis

The shoulder joint is a highly sophisticated combination of bone structures. The head of the humerus and the glenoid portion of the scapula is connected through the clavicle and stabilized by numerous ligaments and small joint-supporting muscles that preserve the anatomical integrity of the shoulder. Unfortunately, shoulder arthritis is very common among athletes who engage in sports that involve repetitive arm movements, which may lead to an overuse of the cartilage that covers the bones of the joint.

Arthritis in the shoulder is essentially an inflammation and damage of the cartilage or Shoulder Arthritis Denverconnective tissue that covers the bones, which prevents their direct contact during movements. This “soft” bone tissue can become inflamed or eroded by continuous movements of the arms, or during training with heavy weights. Shoulder arthritis is also very common among the elderly due to degenerative changes occurring in the cartilage of the bones that form the joint.

Shoulder arthritis is essentially a swollen joint that is associated with cartilage or bone damage and accompanied by pain and difficulty of arm rotation. Chronic shoulder arthritis that is not responding to anti-inflammatory remedies is frequently eligible for surgery. However, an experienced chiropractor may be able to address the joint inflammation and the anatomical changes through a carefully executed physical therapy, mobilization of the joint and targeted massage of the shoulder joint elements, depending on the precise area of the dysfunction.

Shoulder Arthritis Unresponsive to Drug Treatment can be Relieved through Gentle Physical Therapy

The pain associated with shoulder arthritis may be severe. Moreover, shoulder arthritis may impair the individual’s ability to work or train in a satisfactory manner. In extreme cases, adequate arm movement is almost impossible, since all the joint structures are swollen and the compressed tendons or nerves create intense pain upon movement or arm rotation.

A physician may attempt to address shoulder arthritis through anti-inflammatory medication, such as ibuprofen or diclofenac. However, not all patients will achieve a good response in terms of swelling reduction and a regeneration of the shoulder connective tissue.

A chiropractor may step in and solve the problem through multiple sessions of precisely targeted manual physical therapy aimed at mobilizing the shoulder joint gently and correcting the anatomical displacements that result in pain and inflammation.

Surgery for Shoulder Arthritis Should Be Reserved as a Last Option

There is no need to rush into surgery if you have not tried a non-invasive treatment applied by a skilled chiropractor (http://www.medicalnewstoday.com/releases/57468.php). In many individuals, the shoulder joint can exhibit less inflammation over time if chiropractic treatment is gently applied over multiple physical therapy sessions. The physical therapy specialist will evaluate the swelling and mobilize the shoulder joint in a manner that increases the blood flow and facilitates the normal healing powers of your body.

If your doctor prescribed pain-relief drugs or anti-inflammatory medication, rest assured Pain Management Denverthat they won’t interfere with the carefully planned chiropractic treatment. In fact, these strategies may work together towards restoring the normal function of the shoulder joint that allows for a full range of motion and adequate arm strength.

If you are based in Denver Co, you may visit the following website: Chiropractor Denver Co.

Also Read: Shoulder Pain

Also Read: Joint Pain

Epidural Steroid Injections Facilitate Spinal Rehabilitation In Patients With Recurring Back Pain

Epidural steroid injections are a therapeutic tool that is frequently utilized by pain management doctors when they are treating patients who complain about severe pain in their spine. Back pain can be mild, but it can also be debilitating and disabling to the point that the patient is not able to walk, bend forward, or perform even the basic household chores.

Chronic back pain is a subject of intense medical research, which aims to reveal the precise spinal dysfunction causes and how each individual spinal disease should be Epidural Steroid Injectionsapproached medically. Pain management doctors recommend and use epidural steroid injections only after a carefully analysis of the patient’s medical history. The injections are used only when physical therapy or mild pain-relief drugs have failed to address the spinal pain.

Epidural Steroid Injections Work by Reducing Inflammation and Alleviating Pain

What is the precise medical purpose of these injections? This is a question frequently asked by individuals who come to the pain management clinic and are afraid of any invasive procedure. Fortunately, these injections are not painful. Their aim is to deliver a precise dose of a steroid anti-inflammatory drug near the spinal nerves and the compressed vertebrae, which is how they reduce the swelling and the pain associated with anatomical abnormalities in the spine.

Medical studies revealed that one epidural injection can reduce pain for between one week up to one year, depending on the specific spinal condition experienced by the patient. Besides the pain relief benefits, epidural injections allow the patient to initiate physical therapy and rehabilitation exercises, which would otherwise be impossible to start due to the severe pain. The epidural steroid drug injected in the epidural space near the vertebrae is great for pain relief for chronic back pain caused by an inflammation of the spinal nerves, by compression generated by bulging discs or by irritation of the nerves that innervate the legs, also known as sciatic nerves.

Physical Rehabilitation Is Possible After Epidural Steroid Injections

The benefits of these injections have been investigated in numerous studies , which revealed their effectiveness for radiculitis, which is the inflammation of the nerves exiting from the vertebrae, and short-term relief for herniated discs. Even though the main purpose of steroid injections is to relieve inflamed spinal vertebrae and the associated pain, the obtained pain reduction is actually beneficial when it comes to starting a gradual physical rehabilitation of the patient. Once the individual is able to walk, move his or her legs, and perform simple exercises, a physical therapist is able to start designing a back muscle strengthening program, correct the misaligned vertebrae or adjust the patient’s posture.

Pain management doctors try to use epidural steroid injections only as long as they are critically necessary and then proceed with less invasive procedures aimed at restoring the functional integrity of the spine. The relief experienced after a session of epidural steroid drug administration can last up to a year, which is enough time to allow the spine to Pain Management Denverbecome stronger and to diminish the nerve swelling that may have occurred as a result of incorrect posture, compressive effects of displaced vertebral discs or scoliosis that alters the normal spinal configuration.