Hello, I'm Agatha
Thrash, a staff physician
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at Uchee Pines Institute.
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A large part of what
we see as physicians is
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skeletal injuries or problems
with the skeleton because
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of overuse, or some
kind of industrial activity
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that results in
some kind of injury.
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So we'd like to talk with
you about a number of these
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problems in the
next half an hour.
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We hope you will join us!
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Welcome to "Help
Yourself to Health"
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with Dr. Agatha Thrash
of Uchee Pines Institute
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And now, here's
your host, Dr. Thrash
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Doctors in all ages have
named diseases by the things
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that interest them the most.
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And I have enjoyed this
little bit of history of how
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doctors name disease.
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For instance, I wrote
down a number of diseases that
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were named in
the last century...
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"Icing cake
spleen," "nutmeg liver,"
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and "millet-like TB"
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In our age, we name things
differently than with foods.
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I think maybe the old
pathologists were hungry people.
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Maybe they weren't
paid enough.. which might be
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the same way it is today.
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But today, we name
diseases by sports a lot...
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Like, tennis
elbow, and joggers high.
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These are just
some names of disorders
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that have interested me through
the years... in seeing what
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physicians name the
diseases that they see.
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Now the skeletal
problems that we see in our day
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are innumerable!
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And I've asked Dr. Winn
Horsley, who is one of our
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staff physicians at Uchee Pines,
to join me to tell you about
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these very important
skeletal issues... Dr. Horsley
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What shall we start with?
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Something about
the upper body? Sure!
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A good place would be
right at the hand... Okay.
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Carpal
tunnel... All right. Sure.
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The hand is
quite a mechanism. Yes.
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I've heard it said that
you could take either the
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human brain, or the
human hand and see that this
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most marvelous creation couldn't
have come about by itself.
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I'm quite certain... Just
take this movement right here...
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Opposition of the thumb to...
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And you can do
it with each one...
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You can do it fast,
or you can do it slow...
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And you can just do all
sorts of things with the thumb.
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And all sorts of things
with your other fingers.
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It's just AMAZING...
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I don't know if
you've ever watched a baby...
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when he first
discovers his hands...
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He just looks at
them like this...
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I've seen it twice now.
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It IS quite a thing...
they begin to actually get
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fascinated with
that object out there.
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And it is a most wonderful
thing that we've got 5 fingers
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on each hand... A
most marvelous creation.
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Well, the movements you were
just showing with your fingers
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have very much to
do with carpal tunnel.
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The carpal tunnel...
we'll look first at the
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normal structure here.
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Of course, you can see the bones
that are the upper extremity
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...the arm and hand of a person.
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We're going to focus right
down now on the carpal tunnel.
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Carpal is from
Latin, meaning wrist.
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And, if you look at the
hand here, perhaps this way
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at the camera, you can
see that right at the wrist,
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you have these mounds
of bone on each side...
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one on the thumb side and
one on the little finger side.
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And, in-between,
there is quite a trough...
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and that is your carpal tunnel.
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It's not a complete
tunnel though when we have it
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just in bone form, but there
is a strong band of connective
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tissue that overlies
this and makes it a tunnel.
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I see... So this tunnel
goes right in through here
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and the band comes right over
it just like that... Exactly!
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This is the flexor
retinaculum that was there...
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And what goes through the tunnel
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are some very
important structures.
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You were showing the
movement of the fingers...
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a lot of that movement, the
flexing movement, that is the
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bending down like
this, is in flexor tendons.
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Well, we've got 4
fingers and 1 thumb...
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You've got quite
a number of tendons.
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In fact, there's more
than 1 to each digit that runs
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through this carpal tunnel.
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And so, you have 8 or 10 tendons
running thru the carpal tunnel
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there is an artery but
the thing of most concern
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that we want to look
at now is the major nerve
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that's running through
it... the median nerve.
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Now, let's say a person
is typing... all day long.
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Well, with every
typing movement, you are using
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one of those
tendons. Um hm... Yes
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And so, you're
getting movement through
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back and forth in
that carpal tunnel
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And, if a person continues
that more than a reasonable
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amount of time, you can
get that tendon inflamed.
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Just by the irritation of
constant use... That's right.
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Another thing
that could bring it on
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would be gripping firmly...
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People in an assembly line that
have to grip and twist something
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will often get that
because, again, they're doing
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not with just 1 finger
but several fingers at once.
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So all those
tendons are tightening
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through the carpal tunnel...
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Or people at a checkout line.
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They have to get
that and make the bar code
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go just at the right place.
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I think there are
just so many things...
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When there is repetitive
use of the fingers, the hand,
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you are possibly
likely to get this problem.
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This overuse leading to
inflammation of the tendons
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means that you're going
to have trouble having enough
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room in this carpal tunnel.
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Everything is just nicely fit...
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And if it swells any...
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If you get swelling,
say, in those tendons,
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then you're going to
start squeezing. Ah ha
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Now, the squeezing could
pinch a little bit on the artery
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...but the thing that shows
it first usually is the nerve.
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And so that median nerve
will end up getting pinched
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instead of being
just a straight column,
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it would get
pinched in the center...
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have an hourglass kind of effect
if they ever do surgery on that
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Well, what kind of things happen
when a person has carpal tunnel?
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What does he sense?
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I've had a number of patients
come to me complaining of
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wrist pain, and someone said,
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"Well the wrist,
that's carpal tunnel. "
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But wrist pain, if
that's all there is,
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it's more likely to be something
else than carpal tunnel.
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It COULD be carpal tunnel but...
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More likely maybe even
be, some of these muscles...
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Muscles or ligaments right
at the wrist is fairly common.
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So, more commonly what happens
is, there can be pain but
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pain that's going
down into the hand.
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Remember the nerve,
it goes and takes care of
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fingers... it takes care of
the palm side for the thumb,
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the index finger,
the long finger here...
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even out to this 4th finger.
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And so that, if
you're pinching that nerve,
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then you can get
tingling, numbness
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If it's an advanced
degree, you can even get
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loss of muscle function,
particularly of this bulging
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muscle at the base of the thumb.
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Um hm. So it gets
thinned and not very strong...
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It can, it's not commonly
seen with even prominent
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carpal tunnel syndrome,
but in someone, let's say,
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that's older and may
have had it for several years,
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you can get loss of
the muscle substance,
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atrophy of that eminence there.
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Now, for the final diagnosis
of carpal tunnel syndrome,
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I don't know if I'm a bit
biased because of my specialty
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where we do
electrodiagnostic work, EMGs
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I feel that you really need
that, certainly before doing
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any surgery, and there's lots
of carpal tunnel surgery done.
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That diagnoses nicely when
that nerve is pinched... Um hm
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then it does not conduct
the nerve impulses quickly
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as when everything is normal.
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I see. So that's a definitive
diagnosis? It really is.
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Certainly I would want that
if it were getting operating on.
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Certainly... Um hm.
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Now, is there anything you
can do then for carpal tunnel
00:09:02.12\00:09:07.13
that would not be surgery?
00:09:07.16\00:09:10.74
Well, the simplest of things,
and I saw a write up once
00:09:10.77\00:09:15.20
where they said... 95% of
the time, it clears it up.
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Is that right? It's as simple as
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immobilizing the wrist.
00:09:21.19\00:09:23.18
Just stop the wrist
from moving around so much...
00:09:23.19\00:09:26.06
And so a wrist splint
will do it nicely... I see
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You just put this
on and get your thumb
00:09:30.96\00:09:34.72
out here like
that... There you are.
00:09:34.75\00:09:36.54
And it holds my
wrist in a position.
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And we just Velcro that in place
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And then I'm
immobilized... That right!
00:09:47.27\00:09:50.18
Now you would wear this...
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Now I could
still move my fingers.
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You can... you can do
most things with this in place.
00:09:52.82\00:09:55.73
So I could type... it might
be a little difficult typing but
00:09:55.74\00:09:58.79
you could still handle things.
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It fit... if I made it there
pretty snug... Tighten that spot
00:10:00.76\00:10:05.21
It would pretty much
immobilize this movement.
00:10:05.24\00:10:09.06
That's right. It's
the actual wrist movements
00:10:09.09\00:10:11.54
that are the most immobilized.
00:10:11.57\00:10:13.06
A first trial might be
just wearing it at night.
00:10:13.09\00:10:18.19
If that's not enough, then
wear it all through the day
00:10:18.22\00:10:21.07
and night and only take
it off when you're showering
00:10:21.10\00:10:23.25
or washing your hands. Um hm
00:10:23.28\00:10:25.65
So, you know, if you can
take care of 95% of problem
00:10:25.68\00:10:30.07
with that, let's do it!
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Can you buy
these at a drug store?
00:10:32.33\00:10:35.07
I think quite a
number of drug stores...
00:10:35.10\00:10:36.54
and if not a drug store, a
regular medical equipment center
00:10:36.57\00:10:40.48
...Like a brace
shop or something. Sure
00:10:40.51\00:10:43.54
Well that's good... I like
anything that that will cure
00:10:43.57\00:10:48.99
90 to 95%... because
that sounds pretty good!
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What about tennis elbow
which I've had a lot of myself.
00:10:52.52\00:10:56.32
I want to hear YOUR story.
00:10:56.36\00:10:57.42
Ohh well I'll tell you my story!
00:10:57.46\00:11:00.18
We were digging
footings at Uchee Pines for our
00:11:00.21\00:11:04.36
very first building...
this was about 33-34 years ago.
00:11:04.39\00:11:08.73
And we were shoveling like this.
00:11:08.76\00:11:12.46
And, of course, we
were ALL doing it and it was
00:11:12.49\00:11:15.03
an enjoyable work but we would
do it from morning till night
00:11:15.06\00:11:19.81
...so after 2 or 3 days, I
realized that I was getting
00:11:19.84\00:11:22.62
a little sore there but
I'd never had tennis elbow
00:11:22.65\00:11:25.45
...didn't really believe that I
could get it as strong as I was
00:11:25.48\00:11:28.68
and athletic, so I
kept on doing this and then
00:11:28.71\00:11:31.51
one day, I couldn't do it
anymore... it was too painful.
00:11:31.54\00:11:33.80
I had pain ALL down in here
and exquisite pain right here
00:11:34.81\00:11:40.05
on this lateral epicondyle. Okay
00:11:40.08\00:11:42.66
Was I correct in
the diagnosis? OH YES!
00:11:42.69\00:11:45.30
Lateral epicondyle is the word.
00:11:45.33\00:11:47.20
Hold your punchline of the
treatment that worked so well.
00:11:47.23\00:11:50.39
I think you have something
to teach me about that.
00:11:50.42\00:11:53.11
The way you
describe the shoveling,
00:11:53.14\00:11:56.64
really fits with
a common problem.
00:11:56.67\00:11:59.16
In fact the word, the
expression, "tennis elbow"
00:11:59.19\00:12:01.89
has to do with playing a
game of tennis and the main
00:12:01.90\00:12:07.30
part of that game,
which would bring the problem,
00:12:07.33\00:12:09.46
is a backhand shot.
00:12:09.49\00:12:10.71
The person is going like
this, putting a lot of force
00:12:10.74\00:12:13.54
into extending
the wrist this way...
00:12:13.55\00:12:16.62
which is just what you were
doing with the shovel... you see
00:12:16.65\00:12:20.30
And that puts a strain on
this very spot where you get
00:12:20.33\00:12:25.10
what's the insertion of
these muscles of the forearm
00:12:25.13\00:12:29.48
coming from the wrist, where
you get extension of the wrist
00:12:29.51\00:12:32.87
it's where they
insert UP at this side of the
00:12:32.90\00:12:37.60
end of the humerus
bone, the upper arm bone.
00:12:37.63\00:12:40.66
This is the lateral epicondyle,
Oh, there we can show it...
00:12:40.69\00:12:43.19
very easily.
00:12:43.22\00:12:45.20
Now that's a left side,
so over here, we would be
00:12:45.21\00:12:49.72
showing it on this spot here.
00:12:49.75\00:12:54.19
Right there... that's it.
00:12:54.22\00:12:56.25
So this is the lateral...
this would be the medial
00:12:56.26\00:12:58.71
epicondyle... much
more rarely involved side.
00:12:58.74\00:13:04.42
Tennis elbow, a strain
where the tendon or an insertion
00:13:04.45\00:13:12.58
Or for that matter, a
ligament inserts in bone,
00:13:12.61\00:13:14.83
is really a very common
musculoskeletal problem.
00:13:14.86\00:13:19.06
...Causing tendinitis?
Yes, you can call it tendinitis.
00:13:19.09\00:13:23.41
Some people use a very
fancy term... "enthesitis"
00:13:23.44\00:13:26.23
Enthesis being
the insertion of that
00:13:26.26\00:13:28.20
connective tissue into bone.
00:13:28.23\00:13:30.16
Yes... Well I want to
know what helped you so much?
00:13:30.19\00:13:34.76
Well for some years, I
didn't know what would help.
00:13:34.79\00:13:37.84
We rubbed aloe vera
and all of that on my arm
00:13:37.87\00:13:41.64
and that would help,
and especially massaging
00:13:41.65\00:13:45.37
I think the massage may
have helped as much as the cream
00:13:45.40\00:13:51.99
but then finally, someone
told me about this elbow band.
00:13:52.02\00:13:57.96
And it simply
goes over the arm...
00:13:57.99\00:14:00.42
and since you've got
yours bared, I will just
00:14:00.45\00:14:03.52
show you it just goes
just below the elbow like this.
00:14:03.55\00:14:06.73
And, you can see this one
has had a good bit of wear
00:14:06.76\00:14:09.56
because it's my very own and
then it just comes around here
00:14:09.59\00:14:13.04
like this and you just use
this doing what ever you do
00:14:13.07\00:14:16.19
and just wear it during the day.
00:14:16.22\00:14:18.40
I don't know if I have
thinner arms than you but
00:14:18.43\00:14:20.35
...yours is a little bit thinner
00:14:20.38\00:14:22.39
One would want to have a
moderate amount of pressure
00:14:22.40\00:14:26.52
would it be rather
snug or not? Not too much.
00:14:26.55\00:14:29.03
Not too snug... just a little
bracing, that's all you need.
00:14:29.06\00:14:32.58
And even sometimes it
will slide off, and if so,
00:14:32.61\00:14:37.94
you'd make it a
little more snug...
00:14:37.97\00:14:39.81
But if it's too snug, then
it cuts off the flow of blood
00:14:39.84\00:14:43.51
to it... Oh sure, sure.
00:14:43.54\00:14:45.43
And you can buy these
at an ordinary pharmacy
00:14:45.46\00:14:47.96
Well I've seen a number
of patients that have brought
00:14:47.99\00:14:51.66
that in when having the tennis
elbow problems and it certainly
00:14:51.69\00:14:55.56
seems to be helpful.
00:14:55.59\00:14:56.83
If I can remember to put it
on, before I'm doing shoveling,
00:14:56.86\00:15:01.31
or anything that has
this kind of movement to it,
00:15:01.34\00:15:04.09
then I won't get
the tennis elbow...
00:15:04.12\00:15:05.67
But once you get it, I
think you've got a vulnerability
00:15:05.70\00:15:09.39
to it for the rest of your life.
00:15:09.42\00:15:10.62
And even the more advanced
treatments aren't always
00:15:10.65\00:15:15.58
that successful.
00:15:15.61\00:15:17.05
You know, injections
are used and so on...
00:15:17.08\00:15:20.42
And some extreme
cases, even go to surgery
00:15:20.45\00:15:23.12
with no guarantee of success.
00:15:23.15\00:15:26.10
One technique that I have
learned is using what's called
00:15:26.13\00:15:30.86
transverse friction massage.
00:15:30.89\00:15:32.80
The tendon would come in
along parallel to the forearm
00:15:32.83\00:15:41.16
and you need to go against
the fibers at 90 degrees.
00:15:41.19\00:15:44.61
So one would go up and down
like this for 10-15 minutes.
00:15:44.64\00:15:48.68
I have done that
some and I have to admit,
00:15:48.71\00:15:53.06
it hasn't been any
tremendous success.
00:15:53.09\00:15:55.58
Well, let me tell
you that it can be...
00:15:55.61\00:15:58.98
because I had that too one
time but it was not 15 minutes.
00:15:59.01\00:16:03.98
I think it was a massage
therapist... came to Uchee Pines
00:16:04.01\00:16:08.87
and I was really
suffering with my tennis elbow.
00:16:08.90\00:16:12.34
Had lots of inflammation
all the way down and especially
00:16:12.37\00:16:15.81
in-between these bones.
00:16:15.84\00:16:17.47
I was just having an
enormous amount of pain...
00:16:17.50\00:16:20.07
And so she said,
"Well let me work on you. "
00:16:20.10\00:16:23.37
And she did and she worked
on my hand and arm, and forearm
00:16:23.40\00:16:29.39
and shoulder and back
back there... 3-1/2 hours
00:16:29.42\00:16:35.48
she worked on it.
00:16:35.51\00:16:36.87
Now I don't know if ALL massage
therapists leave their patients
00:16:36.90\00:16:41.53
black and blue, but the next
day, I did have some blue places
00:16:41.54\00:16:45.44
here and I even began
to pray she would stop
00:16:45.47\00:16:51.37
because it hurt so much.
00:16:51.40\00:16:52.59
The next day, I
was totally paralyzed.
00:16:52.62\00:16:54.82
I thought, "Well, she's
probably ruined my arm. "
00:16:54.85\00:16:57.68
But the next day, I was
well. And no recurrences?
00:16:57.71\00:17:01.00
Never had a
recurrence since then.
00:17:01.03\00:17:02.99
But since that one terrible
episode, I've been very careful
00:17:03.02\00:17:06.31
with my tennis elbow band.
00:17:06.34\00:17:08.32
And I've worn it when
I've been doing some...
00:17:08.35\00:17:10.69
Or is it just that you
now have experienced this
00:17:10.72\00:17:13.80
and you don't want to ever
complain about tennis elbow
00:17:13.83\00:17:15.52
and have a treatment again...
00:17:15.55\00:17:16.66
That's what Dr. Calvin said.
00:17:16.69\00:17:18.08
He said it hurt so bad
that I'm going to ever let
00:17:18.11\00:17:19.93
that happen again.
00:17:19.96\00:17:21.89
But that did help me a lot.
00:17:21.92\00:17:24.58
I don't know if it really helped
00:17:24.61\00:17:26.20
There is one
further thing to do...
00:17:26.23\00:17:28.89
if you do this... Now what I
learned was directly to the spot
00:17:28.92\00:17:33.11
After doing a fair bit
of this friction massage,
00:17:33.14\00:17:36.87
one can then do a manipulative
treatment where you stretch
00:17:36.90\00:17:41.37
those fibers...
almost overstretch them
00:17:41.40\00:17:44.84
And that will,
at times, help too.
00:17:44.87\00:17:47.48
I didn't get into one
aspect of the problem.
00:17:47.51\00:17:50.71
It's felt that 2 of
these muscles insert together
00:17:50.74\00:17:54.46
and sometimes you get
scarring between them.
00:17:54.49\00:17:56.40
And you need to
somehow break up those scars.
00:17:56.41\00:17:59.68
Maybe she did some
of that... I don't know.
00:17:59.69\00:18:01.17
That might be what she did.
00:18:01.20\00:18:02.83
But at any rate, I
know it was VERY effective.
00:18:02.86\00:18:05.84
But very painful.
00:18:05.87\00:18:06.99
I felt I needed an anesthetic to
actually go thru the treatment
00:18:07.02\00:18:11.86
Okay, so what about
something that's pretty common
00:18:11.89\00:18:17.49
and that's a
rotator cuff problem.
00:18:17.52\00:18:19.65
This is not a rare problem...
in fact, I would put it
00:18:19.68\00:18:23.36
right up there with
a very common problems
00:18:23.39\00:18:25.58
of joints and so on
that happen to people...
00:18:25.59\00:18:29.24
And especially as we get older.
00:18:29.27\00:18:31.74
Rotator cuff is an
overuse syndrome...
00:18:31.77\00:18:35.06
just like we were talking
about carpal tunnel... overuse
00:18:35.09\00:18:37.92
In fact, tennis elbow.
00:18:37.95\00:18:39.15
A lot of these are when
you're overdoing it on a
00:18:39.16\00:18:41.38
particular joint and activity.
00:18:41.41\00:18:43.98
Now one group of people
who get a lot of trouble
00:18:44.01\00:18:47.40
with shoulders... with rotator
cuff problems is swimmers.
00:18:47.43\00:18:51.82
You know for hours
going... Australian crawl...
00:18:51.85\00:18:55.19
There ya are! And
that kind of thing.
00:18:55.22\00:18:56.84
Well, here's a
model of the shoulder.
00:18:56.87\00:19:01.82
I understand Don Miller...
has something to tell us.
00:19:01.85\00:19:06.51
He's had it...
He's had it! Okay!
00:19:06.54\00:19:08.17
He has had a
rotator cuff problem...
00:19:08.20\00:19:10.07
This is Don Miller, who
is a Lifestyle counselor
00:19:10.10\00:19:13.12
at Uchee Pines.
00:19:13.15\00:19:14.71
And I think we're
being typecast, Dr. Thrash.
00:19:14.74\00:19:16.86
You're talking
about your tennis elbow...
00:19:16.89\00:19:18.43
and you've got that,
and I've got a lot of
00:19:18.46\00:19:20.95
rotator cuff problems.
00:19:20.98\00:19:22.69
And I've found, over
my experience in my life
00:19:22.72\00:19:25.25
that once you've got
it, you've got it forever...
00:19:25.28\00:19:27.56
But there are
some things you can do.
00:19:27.59\00:19:29.65
Like the tennis elbow.
I'm afraid that's the truth!
00:19:29.68\00:19:31.87
There are 2 things that we need
00:19:31.90\00:19:33.89
to make a point,
though, about this.
00:19:33.93\00:19:35.71
#1... We need to
take care of ourselves.
00:19:35.75\00:19:37.50
And there are things
we can do to take care
00:19:37.51\00:19:39.27
of our rotator cuff, or
our elbows, or our wrist,
00:19:39.30\00:19:42.03
or any other part of our body.
00:19:42.06\00:19:43.70
#2... That sign that you got
pain tells you something's wrong
00:19:43.73\00:19:47.76
And, if you've got a pain...
00:19:47.79\00:19:49.52
I was raised in the
mindset that if it hurts,
00:19:49.55\00:19:53.29
it must be good... You know,
many years in the Marine Corps
00:19:53.32\00:19:55.39
Ay, it must be good
because it's hurting you.
00:19:55.42\00:19:57.14
But when it starts hurting
you, that's when you've got to
00:19:57.18\00:19:59.18
back off and quit doing that...
00:19:59.21\00:20:00.74
And find out why it's hurting
and what you can do to help that
00:20:00.78\00:20:03.74
I think if I had stopped
doing the shoveling when I first
00:20:03.77\00:20:06.56
started feeling pain, I
wouldn't have had 35 years
00:20:06.57\00:20:10.26
of off and on having the tennis
elbow... And I don't doubt that.
00:20:10.29\00:20:14.45
And what I would do each year...
00:20:14.48\00:20:16.06
I guess of all sports
injuries, the most common
00:20:16.09\00:20:20.05
sports injury is
probably the knee.
00:20:20.08\00:20:22.18
That's your 2
million dollar injury.
00:20:22.21\00:20:24.44
Well, this will be your
1 million dollar injury.
00:20:24.47\00:20:26.26
You get baseball
pitchers getting this problem.
00:20:26.29\00:20:29.82
And it was the first day
of softball season every year
00:20:29.85\00:20:33.47
I'd get out
there... I didn't warm up
00:20:33.48\00:20:35.32
I'd pick up that large ball and
I'd whale it as hard as I could
00:20:35.35\00:20:38.85
Now this is a very movable
multiple axial joint that
00:20:38.86\00:20:44.84
is supposed to move all
over the place, but that one
00:20:44.87\00:20:47.11
whaling throw, I'd feel
like someone had stabbed my
00:20:47.14\00:20:50.27
shoulder with a knife.
00:20:50.30\00:20:51.70
And once I got
that knife-like feeling,
00:20:51.73\00:20:53.59
well, this was the first
day of softball practice...
00:20:53.62\00:20:56.33
I had a whole
season ahead of me.
00:20:56.34\00:20:58.04
And I would play
the entire season.
00:20:58.07\00:21:00.77
And I should have
stopped at that point.
00:21:00.80\00:21:02.49
Ice to my shoulder
and rested my shoulder.
00:21:02.52\00:21:05.29
What's happening in the shoulder
there... you've got a few parts
00:21:05.32\00:21:09.58
to the shoulder... we
can sort of show these
00:21:09.59\00:21:11.19
This is the humerus,
or the upper arm bone.
00:21:11.22\00:21:13.71
You've got the
head of the humerus here
00:21:13.74\00:21:15.58
You've got the scapula and
you've got the glenoid process
00:21:15.61\00:21:20.12
of the scapula coming here,
00:21:20.15\00:21:21.59
and, of course,
here's the clavicle,
00:21:21.62\00:21:22.86
so I suspect this will be my
right shoulder which is the one
00:21:22.89\00:21:26.64
I always messed up every year...
00:21:26.67\00:21:28.02
sorting sitting here, my
clavicle or my collarbone
00:21:28.05\00:21:30.48
coming here, my
humerus coming down...
00:21:30.51\00:21:32.79
And it's that motion of
taking this ball and throwing
00:21:32.82\00:21:35.99
it with all my might in
this direction, which would
00:21:36.00\00:21:39.26
hurt my supraspinatus
which comes underneath
00:21:39.29\00:21:42.26
the glenoid
process of my scapula,
00:21:42.29\00:21:45.01
and either tear it, or
somehow making it inflamed
00:21:45.04\00:21:47.98
I guess some people
completely break the thing off
00:21:48.01\00:21:49.90
But there's that tearing
which would cause me a lot of
00:21:49.93\00:21:52.54
pain at the
beginning of the season.
00:21:52.57\00:21:54.17
And I would not stop at that.
00:21:54.20\00:21:55.82
I would play the
next 4 or 5 months
00:21:55.83\00:21:58.25
every time I threw the ball.
00:21:58.28\00:21:59.64
If I tried to throw this
thing across the room right now,
00:21:59.67\00:22:03.04
I would get that shooting pain.
00:22:03.07\00:22:05.16
It not only hurts...
it not only keeps you from
00:22:05.17\00:22:08.20
playing softball or any type
of throwing sport after a while,
00:22:08.23\00:22:11.22
it cuts down on your mobility...
00:22:11.25\00:22:13.15
And that's what
hurts when you get older
00:22:13.18\00:22:14.59
because I'm not out
there playing softball anymore
00:22:14.62\00:22:16.88
but I don't have the mobility,
or I should say I didn't have it
00:22:16.91\00:22:20.41
until I did, what I would
consider to be the treatments.
00:22:20.44\00:22:22.78
The treatments for anything
is to slowly start building up
00:22:22.81\00:22:26.25
the strength and the muscles.
00:22:26.28\00:22:27.79
It's like the back muscles.
00:22:27.82\00:22:29.62
If you can sit there
and start strengthening
00:22:29.65\00:22:31.73
the back muscles, even
though you have back problems,
00:22:31.76\00:22:33.96
you're not going to
hurt your back anymore.
00:22:33.99\00:22:35.71
Same thing here...
00:22:35.74\00:22:36.85
So I started, oh, some
months ago, doing a special
00:22:36.88\00:22:41.08
set of exercises...
basically exercise was
00:22:41.11\00:22:44.44
lightweights for my
arms, and all the different
00:22:44.47\00:22:46.97
directions of my arm.
00:22:47.00\00:22:48.28
At the beginning
of my exercise period,
00:22:48.31\00:22:50.53
I probably could not
raise my arm higher than about
00:22:50.56\00:22:53.68
my waist, as I put it back here.
00:22:53.71\00:22:55.22
I could not more
think about washing my back
00:22:55.25\00:22:57.42
with my right arm, than
flapping my right arm...
00:22:57.45\00:22:59.91
and flying across the room.
00:22:59.94\00:23:01.50
Now I can take this
right arm, and I can touch the
00:23:01.53\00:23:03.82
nape of my neck with it.
00:23:03.85\00:23:04.96
And that's ONLY because
I did some good exercises
00:23:04.99\00:23:09.29
but key to any
exercise program is warming up.
00:23:09.32\00:23:12.53
People go out there and they'll
00:23:12.56\00:23:13.82
just jump right
down and start doing it.
00:23:13.86\00:23:15.33
We need to warm up...
these joints we need to warm...
00:23:15.36\00:23:18.74
I think... this is a
MARVELOUS piece of mechanism
00:23:18.77\00:23:21.97
I mean, I look and I'm
just amazed at all these tendons
00:23:22.00\00:23:24.60
and ligaments and muscles,
and bones articulating and
00:23:24.63\00:23:27.11
working in unison...
00:23:27.14\00:23:28.55
And the direction
that all these can go.
00:23:28.58\00:23:30.70
I mean, this one... look it
just goes all over the place
00:23:30.73\00:23:33.74
I mean, nothing else is
quite as mobile as this joint.
00:23:33.77\00:23:37.16
Therefore, when it has
that much elasticity, that much
00:23:37.19\00:23:41.83
mobility... it's got that much
more chance of being injured.
00:23:41.84\00:23:45.12
So, we need to learn
how to warm ourselves up,
00:23:45.15\00:23:48.20
and then always be
doing strengthening exercises.
00:23:48.23\00:23:51.26
It's those people who
never do any exercise...
00:23:51.29\00:23:54.99
Their muscles are just
sort of flabby, sitting around
00:23:55.02\00:23:57.75
And then one day, for some
reason, they get really active,
00:23:57.78\00:24:00.88
and they do something,
and that's when you start
00:24:00.91\00:24:03.23
tearing ligaments, and
tendons and hurting your muscles
00:24:03.26\00:24:06.29
So, my recommendation is,
for anyone of the joint problems
00:24:06.32\00:24:09.78
is we need to be
stretching, warming up,
00:24:09.79\00:24:12.31
and when we do hurt
them... when we feel that pain,
00:24:12.34\00:24:14.42
that's when your
body is saying STOP...
00:24:14.45\00:24:16.89
Tissue is being
damaged, stop what you're doing
00:24:16.90\00:24:19.10
rest it up, ice it
for now, rest it...
00:24:19.13\00:24:22.27
And before long, it
will be strengthened.
00:24:22.30\00:24:24.46
Then start slowly building
that exercise program up.
00:24:24.49\00:24:28.74
And you will get it
all back, I believe.
00:24:28.77\00:24:30.75
Now I know why I see you
going into the exercise room
00:24:30.78\00:24:34.67
every once in a while where
those weights are. That's right!
00:24:34.70\00:24:37.55
Every once in a
while. Okay... very good!
00:24:37.58\00:24:39.59
Well thank you so much.
00:24:39.62\00:24:40.63
I do appreciate that.
00:24:40.66\00:24:41.63
Now I'd like us to
discuss some of the kind of
00:24:41.66\00:24:45.51
treatments that you can do
for various skeletal problems
00:24:45.54\00:24:49.39
And Dr. Winn Horsley is going
to tell us about the various
00:24:49.42\00:24:54.91
treatments that are
the most common for the use
00:24:54.94\00:24:58.58
in skeletal injuries
and to induce healing.
00:24:58.61\00:25:02.89
Well, I would like to
come back to what Don said
00:25:02.92\00:25:08.07
about exercise and
I didn't say anything
00:25:08.10\00:25:11.25
in my first part about exercise.
00:25:11.28\00:25:13.07
That really is crucial
for stabilizing things.
00:25:13.10\00:25:17.51
Now I would put it
closer to the end of a
00:25:17.54\00:25:20.49
rehabilitation program.
00:25:20.52\00:25:21.83
At first, you might want to
rest the joint and do things
00:25:21.86\00:25:26.43
that will favor
blood flow into the area.
00:25:26.46\00:25:28.67
By the way, there is a whole
issue regarding inflammation
00:25:28.70\00:25:34.16
that we should deal with.
00:25:34.19\00:25:37.34
When an area has just been hurt,
00:25:37.37\00:25:40.03
you will
generally have inflammation.
00:25:40.06\00:25:44.21
Inflammation is...
Four cardinal signs that we
00:25:44.24\00:25:47.45
learned in medical school,
and I think nurses learn them...
00:25:47.48\00:25:50.09
Yes... 4 Latin
words. That's right!
00:25:50.12\00:25:53.12
"Tumere" which
just means it's swollen.
00:25:53.15\00:25:55.04
"Dolor" is pain.
00:25:55.07\00:25:57.44
"Calor" is heat.
00:25:57.47\00:26:00.35
"Rubor" is the redness.
00:26:00.36\00:26:02.33
So, you've got
more blood in that area.
00:26:02.36\00:26:04.95
Now... Everyone thinks
of inflammation as an enemy.
00:26:04.98\00:26:08.20
They think of inflammation
as being the injury.
00:26:08.23\00:26:11.18
And it's quite a misconception.
00:26:11.21\00:26:12.92
Oh yes, it's the reverse, it's
the healing... That's right!
00:26:12.95\00:26:15.32
And so, you actually
do NOT want to interfere,
00:26:16.29\00:26:20.47
in any severe way,
with inflammation UNLESS,
00:26:20.50\00:26:24.74
and this is not that common...
UNLESS that inflammation
00:26:24.77\00:26:27.55
is SO severe... the
swelling is so severe,
00:26:27.58\00:26:30.06
that you're not getting
more blood flow into the area.
00:26:30.09\00:26:32.13
If you get so much swelling,
that the skin gets kind of
00:26:32.16\00:26:35.71
shiny and glassy,
maybe that would be a time
00:26:35.74\00:26:38.08
to start doing something.
00:26:38.11\00:26:39.19
But here I'm talking
not even about drugs,
00:26:39.22\00:26:41.96
which are used all the time,
nonsteroidal anti-inflammatory
00:26:41.99\00:26:45.13
...they're trying to
take away inflammation
00:26:45.16\00:26:46.70
But even of the simple
treatments that we use,
00:26:46.73\00:26:49.80
ice and especially
compression, don't overdo it.
00:26:49.83\00:26:55.27
If we overdo it, then
we block the body's own
00:26:55.30\00:27:01.37
response... That's right.
00:27:01.40\00:27:02.72
Now I heard you say... "Rest...
00:27:02.75\00:27:05.51
I heard you say,
"Ice" That's right.
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And "Compression"
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And then "Elevation"
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In some cases, will be a
good way to do it, and take care
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of that inflammation.
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Well, that's a good
way to remember that...
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"RICE"... rest, ice,
compression and elevation.
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I'm glad to know that
little way to remember how to
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treat a skeletal injury.
00:27:29.36\00:27:33.09
All skeletal injuries
can be treated in this way
00:27:33.12\00:27:35.55
and then, of course, comes
the period of rehabilitation
00:27:35.56\00:27:38.42
where you
strengthen or mobilize the part
00:27:38.45\00:27:42.64
that has been damaged.
00:27:42.67\00:27:43.88
Well I hope this very
BRIEF discussion of these very
00:27:43.91\00:27:48.27
FEW problems of
the skeleton will be of
00:27:48.30\00:27:51.18
eternal blessing to you.
00:27:51.21\00:27:52.94
May God give you
00:27:52.97\00:27:54.32
His special blessing!
00:27:54.35\00:27:56.42