Started using one a few seasons ago. Now I have one on both of the sleds in my garage. I had a pretty good case of tennis elbow (from racquetball) that would not clear up a few winters ago. I was told to take at least 2-3 months off from playing rball but refused to take the sledding season off so suffered through most of a season being miserable at night after a ride, not being able to lift anything with my right arm, etc. Put an Isovibe on my sled and while the tennis elbow didn't clear up, the discomfort after riding was markedly better for me. Some rest and rehab in the spring cleared up the issue. Since that occurred I've had an Isovibe on my rigs, still play a lot of rball, and have not had the issue reoccur. I use whatever inserts come with the riser, run them kind of loose but not sloppy at all, my elbow and hands feel much better after a day of riding. I jump on a sled without one and immediately notice the difference. Won't own a sled without one.