Participants: Agatha Thrash, Don Miller
Series Code: HYTH
Program Code: HYTH000173
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00:01 Hello, I'm Agatha Thrash, a staff physician
00:04 at Uchee Pines Institute. 00:06 A large part of what we see as physicians is 00:10 skeletal injuries or problems with the skeleton because 00:14 of overuse, or some kind of industrial activity 00:21 that results in some kind of injury. 00:23 So we'd like to talk with you about a number of these 00:26 problems in the next half an hour. 00:28 We hope you will join us! 00:50 Welcome to "Help Yourself to Health" 00:52 with Dr. Agatha Thrash of Uchee Pines Institute 00:55 And now, here's your host, Dr. Thrash 01:01 Doctors in all ages have named diseases by the things 01:06 that interest them the most. 01:08 And I have enjoyed this little bit of history of how 01:12 doctors name disease. 01:14 For instance, I wrote down a number of diseases that 01:17 were named in the last century... 01:20 "Icing cake spleen," "nutmeg liver," 01:24 and "millet-like TB" 01:27 In our age, we name things differently than with foods. 01:33 I think maybe the old pathologists were hungry people. 01:36 Maybe they weren't paid enough.. which might be 01:39 the same way it is today. 01:40 But today, we name diseases by sports a lot... 01:47 Like, tennis elbow, and joggers high. 01:52 These are just some names of disorders 01:55 that have interested me through the years... in seeing what 01:59 physicians name the diseases that they see. 02:03 Now the skeletal problems that we see in our day 02:05 are innumerable! 02:07 And I've asked Dr. Winn Horsley, who is one of our 02:11 staff physicians at Uchee Pines, to join me to tell you about 02:15 these very important skeletal issues... Dr. Horsley 02:19 What shall we start with? 02:21 Something about the upper body? Sure! 02:23 A good place would be right at the hand... Okay. 02:26 Carpal tunnel... All right. Sure. 02:30 The hand is quite a mechanism. Yes. 02:35 I've heard it said that you could take either the 02:39 human brain, or the human hand and see that this 02:42 most marvelous creation couldn't have come about by itself. 02:45 I'm quite certain... Just take this movement right here... 02:49 Opposition of the thumb to... 02:52 And you can do it with each one... 02:53 You can do it fast, or you can do it slow... 02:55 And you can just do all sorts of things with the thumb. 02:58 And all sorts of things with your other fingers. 03:01 It's just AMAZING... 03:03 I don't know if you've ever watched a baby... 03:05 when he first discovers his hands... 03:07 He just looks at them like this... 03:09 I've seen it twice now. 03:12 It IS quite a thing... they begin to actually get 03:14 fascinated with that object out there. 03:17 And it is a most wonderful thing that we've got 5 fingers 03:21 on each hand... A most marvelous creation. 03:24 Well, the movements you were just showing with your fingers 03:27 have very much to do with carpal tunnel. 03:29 The carpal tunnel... we'll look first at the 03:31 normal structure here. 03:32 Of course, you can see the bones that are the upper extremity 03:36 ...the arm and hand of a person. 03:39 We're going to focus right down now on the carpal tunnel. 03:43 Carpal is from Latin, meaning wrist. 03:46 And, if you look at the hand here, perhaps this way 03:53 at the camera, you can see that right at the wrist, 03:56 you have these mounds of bone on each side... 04:01 one on the thumb side and one on the little finger side. 04:03 And, in-between, there is quite a trough... 04:05 and that is your carpal tunnel. 04:08 It's not a complete tunnel though when we have it 04:11 just in bone form, but there is a strong band of connective 04:15 tissue that overlies this and makes it a tunnel. 04:19 I see... So this tunnel goes right in through here 04:22 and the band comes right over it just like that... Exactly! 04:24 This is the flexor retinaculum that was there... 04:27 And what goes through the tunnel 04:29 are some very important structures. 04:32 You were showing the movement of the fingers... 04:34 a lot of that movement, the flexing movement, that is the 04:37 bending down like this, is in flexor tendons. 04:41 Well, we've got 4 fingers and 1 thumb... 04:44 You've got quite a number of tendons. 04:46 In fact, there's more than 1 to each digit that runs 04:49 through this carpal tunnel. 04:51 And so, you have 8 or 10 tendons running thru the carpal tunnel 04:59 there is an artery but the thing of most concern 05:02 that we want to look at now is the major nerve 05:06 that's running through it... the median nerve. 05:08 Now, let's say a person is typing... all day long. 05:15 Well, with every typing movement, you are using 05:17 one of those tendons. Um hm... Yes 05:20 And so, you're getting movement through 05:25 back and forth in that carpal tunnel 05:27 And, if a person continues that more than a reasonable 05:33 amount of time, you can get that tendon inflamed. 05:37 Just by the irritation of constant use... That's right. 05:40 Another thing that could bring it on 05:42 would be gripping firmly... 05:44 People in an assembly line that have to grip and twist something 05:48 will often get that because, again, they're doing 05:50 not with just 1 finger but several fingers at once. 05:53 So all those tendons are tightening 05:56 through the carpal tunnel... 05:57 Or people at a checkout line. 05:58 They have to get that and make the bar code 06:01 go just at the right place. 06:02 I think there are just so many things... 06:04 When there is repetitive use of the fingers, the hand, 06:08 you are possibly likely to get this problem. 06:11 This overuse leading to inflammation of the tendons 06:16 means that you're going to have trouble having enough 06:18 room in this carpal tunnel. 06:21 Everything is just nicely fit... 06:23 And if it swells any... 06:25 If you get swelling, say, in those tendons, 06:27 then you're going to start squeezing. Ah ha 06:31 Now, the squeezing could pinch a little bit on the artery 06:36 ...but the thing that shows it first usually is the nerve. 06:40 And so that median nerve will end up getting pinched 06:45 instead of being just a straight column, 06:48 it would get pinched in the center... 06:49 have an hourglass kind of effect if they ever do surgery on that 06:54 Well, what kind of things happen when a person has carpal tunnel? 06:57 What does he sense? 06:58 I've had a number of patients come to me complaining of 07:02 wrist pain, and someone said, 07:03 "Well the wrist, that's carpal tunnel. " 07:05 But wrist pain, if that's all there is, 07:09 it's more likely to be something else than carpal tunnel. 07:12 It COULD be carpal tunnel but... 07:14 More likely maybe even be, some of these muscles... 07:17 Muscles or ligaments right at the wrist is fairly common. 07:22 So, more commonly what happens is, there can be pain but 07:27 pain that's going down into the hand. 07:28 Remember the nerve, it goes and takes care of 07:33 fingers... it takes care of the palm side for the thumb, 07:36 the index finger, the long finger here... 07:38 even out to this 4th finger. 07:42 And so that, if you're pinching that nerve, 07:45 then you can get tingling, numbness 07:49 If it's an advanced degree, you can even get 07:52 loss of muscle function, particularly of this bulging 07:57 muscle at the base of the thumb. 07:59 Um hm. So it gets thinned and not very strong... 08:03 It can, it's not commonly seen with even prominent 08:06 carpal tunnel syndrome, but in someone, let's say, 08:09 that's older and may have had it for several years, 08:11 you can get loss of the muscle substance, 08:15 atrophy of that eminence there. 08:18 Now, for the final diagnosis of carpal tunnel syndrome, 08:26 I don't know if I'm a bit biased because of my specialty 08:30 where we do electrodiagnostic work, EMGs 08:34 I feel that you really need that, certainly before doing 08:38 any surgery, and there's lots of carpal tunnel surgery done. 08:42 That diagnoses nicely when that nerve is pinched... Um hm 08:48 then it does not conduct the nerve impulses quickly 08:51 as when everything is normal. 08:52 I see. So that's a definitive diagnosis? It really is. 08:57 Certainly I would want that if it were getting operating on. 09:00 Certainly... Um hm. 09:02 Now, is there anything you can do then for carpal tunnel 09:07 that would not be surgery? 09:10 Well, the simplest of things, and I saw a write up once 09:15 where they said... 95% of the time, it clears it up. 09:18 Is that right? It's as simple as 09:21 immobilizing the wrist. 09:23 Just stop the wrist from moving around so much... 09:26 And so a wrist splint will do it nicely... I see 09:30 You just put this on and get your thumb 09:34 out here like that... There you are. 09:36 And it holds my wrist in a position. 09:44 And we just Velcro that in place 09:47 And then I'm immobilized... That right! 09:50 Now you would wear this... 09:51 Now I could still move my fingers. 09:52 You can... you can do most things with this in place. 09:55 So I could type... it might be a little difficult typing but 09:58 you could still handle things. 10:00 It fit... if I made it there pretty snug... Tighten that spot 10:05 It would pretty much immobilize this movement. 10:09 That's right. It's the actual wrist movements 10:11 that are the most immobilized. 10:13 A first trial might be just wearing it at night. 10:18 If that's not enough, then wear it all through the day 10:21 and night and only take it off when you're showering 10:23 or washing your hands. Um hm 10:25 So, you know, if you can take care of 95% of problem 10:30 with that, let's do it! 10:32 Can you buy these at a drug store? 10:35 I think quite a number of drug stores... 10:36 and if not a drug store, a regular medical equipment center 10:40 ...Like a brace shop or something. Sure 10:43 Well that's good... I like anything that that will cure 10:49 90 to 95%... because that sounds pretty good! 10:52 What about tennis elbow which I've had a lot of myself. 10:56 I want to hear YOUR story. 10:57 Ohh well I'll tell you my story! 11:00 We were digging footings at Uchee Pines for our 11:04 very first building... this was about 33-34 years ago. 11:08 And we were shoveling like this. 11:12 And, of course, we were ALL doing it and it was 11:15 an enjoyable work but we would do it from morning till night 11:19 ...so after 2 or 3 days, I realized that I was getting 11:22 a little sore there but I'd never had tennis elbow 11:25 ...didn't really believe that I could get it as strong as I was 11:28 and athletic, so I kept on doing this and then 11:31 one day, I couldn't do it anymore... it was too painful. 11:34 I had pain ALL down in here and exquisite pain right here 11:40 on this lateral epicondyle. Okay 11:42 Was I correct in the diagnosis? OH YES! 11:45 Lateral epicondyle is the word. 11:47 Hold your punchline of the treatment that worked so well. 11:50 I think you have something to teach me about that. 11:53 The way you describe the shoveling, 11:56 really fits with a common problem. 11:59 In fact the word, the expression, "tennis elbow" 12:01 has to do with playing a game of tennis and the main 12:07 part of that game, which would bring the problem, 12:09 is a backhand shot. 12:10 The person is going like this, putting a lot of force 12:13 into extending the wrist this way... 12:16 which is just what you were doing with the shovel... you see 12:20 And that puts a strain on this very spot where you get 12:25 what's the insertion of these muscles of the forearm 12:29 coming from the wrist, where you get extension of the wrist 12:32 it's where they insert UP at this side of the 12:37 end of the humerus bone, the upper arm bone. 12:40 This is the lateral epicondyle, Oh, there we can show it... 12:43 very easily. 12:45 Now that's a left side, so over here, we would be 12:49 showing it on this spot here. 12:54 Right there... that's it. 12:56 So this is the lateral... this would be the medial 12:58 epicondyle... much more rarely involved side. 13:04 Tennis elbow, a strain where the tendon or an insertion 13:12 Or for that matter, a ligament inserts in bone, 13:14 is really a very common musculoskeletal problem. 13:19 ...Causing tendinitis? Yes, you can call it tendinitis. 13:23 Some people use a very fancy term... "enthesitis" 13:26 Enthesis being the insertion of that 13:28 connective tissue into bone. 13:30 Yes... Well I want to know what helped you so much? 13:34 Well for some years, I didn't know what would help. 13:37 We rubbed aloe vera and all of that on my arm 13:41 and that would help, and especially massaging 13:45 I think the massage may have helped as much as the cream 13:52 but then finally, someone told me about this elbow band. 13:57 And it simply goes over the arm... 14:00 and since you've got yours bared, I will just 14:03 show you it just goes just below the elbow like this. 14:06 And, you can see this one has had a good bit of wear 14:09 because it's my very own and then it just comes around here 14:13 like this and you just use this doing what ever you do 14:16 and just wear it during the day. 14:18 I don't know if I have thinner arms than you but 14:20 ...yours is a little bit thinner 14:22 One would want to have a moderate amount of pressure 14:26 would it be rather snug or not? Not too much. 14:29 Not too snug... just a little bracing, that's all you need. 14:32 And even sometimes it will slide off, and if so, 14:37 you'd make it a little more snug... 14:39 But if it's too snug, then it cuts off the flow of blood 14:43 to it... Oh sure, sure. 14:45 And you can buy these at an ordinary pharmacy 14:47 Well I've seen a number of patients that have brought 14:51 that in when having the tennis elbow problems and it certainly 14:55 seems to be helpful. 14:56 If I can remember to put it on, before I'm doing shoveling, 15:01 or anything that has this kind of movement to it, 15:04 then I won't get the tennis elbow... 15:05 But once you get it, I think you've got a vulnerability 15:09 to it for the rest of your life. 15:10 And even the more advanced treatments aren't always 15:15 that successful. 15:17 You know, injections are used and so on... 15:20 And some extreme cases, even go to surgery 15:23 with no guarantee of success. 15:26 One technique that I have learned is using what's called 15:30 transverse friction massage. 15:32 The tendon would come in along parallel to the forearm 15:41 and you need to go against the fibers at 90 degrees. 15:44 So one would go up and down like this for 10-15 minutes. 15:48 I have done that some and I have to admit, 15:53 it hasn't been any tremendous success. 15:55 Well, let me tell you that it can be... 15:59 because I had that too one time but it was not 15 minutes. 16:04 I think it was a massage therapist... came to Uchee Pines 16:08 and I was really suffering with my tennis elbow. 16:12 Had lots of inflammation all the way down and especially 16:15 in-between these bones. 16:17 I was just having an enormous amount of pain... 16:20 And so she said, "Well let me work on you. " 16:23 And she did and she worked on my hand and arm, and forearm 16:29 and shoulder and back back there... 3-1/2 hours 16:35 she worked on it. 16:36 Now I don't know if ALL massage therapists leave their patients 16:41 black and blue, but the next day, I did have some blue places 16:45 here and I even began to pray she would stop 16:51 because it hurt so much. 16:52 The next day, I was totally paralyzed. 16:54 I thought, "Well, she's probably ruined my arm. " 16:57 But the next day, I was well. And no recurrences? 17:01 Never had a recurrence since then. 17:03 But since that one terrible episode, I've been very careful 17:06 with my tennis elbow band. 17:08 And I've worn it when I've been doing some... 17:10 Or is it just that you now have experienced this 17:13 and you don't want to ever complain about tennis elbow 17:15 and have a treatment again... 17:16 That's what Dr. Calvin said. 17:18 He said it hurt so bad that I'm going to ever let 17:19 that happen again. 17:21 But that did help me a lot. 17:24 I don't know if it really helped 17:26 There is one further thing to do... 17:28 if you do this... Now what I learned was directly to the spot 17:33 After doing a fair bit of this friction massage, 17:36 one can then do a manipulative treatment where you stretch 17:41 those fibers... almost overstretch them 17:44 And that will, at times, help too. 17:47 I didn't get into one aspect of the problem. 17:50 It's felt that 2 of these muscles insert together 17:54 and sometimes you get scarring between them. 17:56 And you need to somehow break up those scars. 17:59 Maybe she did some of that... I don't know. 18:01 That might be what she did. 18:02 But at any rate, I know it was VERY effective. 18:05 But very painful. 18:07 I felt I needed an anesthetic to actually go thru the treatment 18:11 Okay, so what about something that's pretty common 18:17 and that's a rotator cuff problem. 18:19 This is not a rare problem... in fact, I would put it 18:23 right up there with a very common problems 18:25 of joints and so on that happen to people... 18:29 And especially as we get older. 18:31 Rotator cuff is an overuse syndrome... 18:35 just like we were talking about carpal tunnel... overuse 18:37 In fact, tennis elbow. 18:39 A lot of these are when you're overdoing it on a 18:41 particular joint and activity. 18:44 Now one group of people who get a lot of trouble 18:47 with shoulders... with rotator cuff problems is swimmers. 18:51 You know for hours going... Australian crawl... 18:55 There ya are! And that kind of thing. 18:56 Well, here's a model of the shoulder. 19:01 I understand Don Miller... has something to tell us. 19:06 He's had it... He's had it! Okay! 19:08 He has had a rotator cuff problem... 19:10 This is Don Miller, who is a Lifestyle counselor 19:13 at Uchee Pines. 19:14 And I think we're being typecast, Dr. Thrash. 19:16 You're talking about your tennis elbow... 19:18 and you've got that, and I've got a lot of 19:20 rotator cuff problems. 19:22 And I've found, over my experience in my life 19:25 that once you've got it, you've got it forever... 19:27 But there are some things you can do. 19:29 Like the tennis elbow. I'm afraid that's the truth! 19:31 There are 2 things that we need 19:33 to make a point, though, about this. 19:35 #1... We need to take care of ourselves. 19:37 And there are things we can do to take care 19:39 of our rotator cuff, or our elbows, or our wrist, 19:42 or any other part of our body. 19:43 #2... That sign that you got pain tells you something's wrong 19:47 And, if you've got a pain... 19:49 I was raised in the mindset that if it hurts, 19:53 it must be good... You know, many years in the Marine Corps 19:55 Ay, it must be good because it's hurting you. 19:57 But when it starts hurting you, that's when you've got to 19:59 back off and quit doing that... 20:00 And find out why it's hurting and what you can do to help that 20:03 I think if I had stopped doing the shoveling when I first 20:06 started feeling pain, I wouldn't have had 35 years 20:10 of off and on having the tennis elbow... And I don't doubt that. 20:14 And what I would do each year... 20:16 I guess of all sports injuries, the most common 20:20 sports injury is probably the knee. 20:22 That's your 2 million dollar injury. 20:24 Well, this will be your 1 million dollar injury. 20:26 You get baseball pitchers getting this problem. 20:29 And it was the first day of softball season every year 20:33 I'd get out there... I didn't warm up 20:35 I'd pick up that large ball and I'd whale it as hard as I could 20:38 Now this is a very movable multiple axial joint that 20:44 is supposed to move all over the place, but that one 20:47 whaling throw, I'd feel like someone had stabbed my 20:50 shoulder with a knife. 20:51 And once I got that knife-like feeling, 20:53 well, this was the first day of softball practice... 20:56 I had a whole season ahead of me. 20:58 And I would play the entire season. 21:00 And I should have stopped at that point. 21:02 Ice to my shoulder and rested my shoulder. 21:05 What's happening in the shoulder there... you've got a few parts 21:09 to the shoulder... we can sort of show these 21:11 This is the humerus, or the upper arm bone. 21:13 You've got the head of the humerus here 21:15 You've got the scapula and you've got the glenoid process 21:20 of the scapula coming here, 21:21 and, of course, here's the clavicle, 21:22 so I suspect this will be my right shoulder which is the one 21:26 I always messed up every year... 21:28 sorting sitting here, my clavicle or my collarbone 21:30 coming here, my humerus coming down... 21:32 And it's that motion of taking this ball and throwing 21:36 it with all my might in this direction, which would 21:39 hurt my supraspinatus which comes underneath 21:42 the glenoid process of my scapula, 21:45 and either tear it, or somehow making it inflamed 21:48 I guess some people completely break the thing off 21:49 But there's that tearing which would cause me a lot of 21:52 pain at the beginning of the season. 21:54 And I would not stop at that. 21:55 I would play the next 4 or 5 months 21:58 every time I threw the ball. 21:59 If I tried to throw this thing across the room right now, 22:03 I would get that shooting pain. 22:05 It not only hurts... it not only keeps you from 22:08 playing softball or any type of throwing sport after a while, 22:11 it cuts down on your mobility... 22:13 And that's what hurts when you get older 22:14 because I'm not out there playing softball anymore 22:16 but I don't have the mobility, or I should say I didn't have it 22:20 until I did, what I would consider to be the treatments. 22:22 The treatments for anything is to slowly start building up 22:26 the strength and the muscles. 22:27 It's like the back muscles. 22:29 If you can sit there and start strengthening 22:31 the back muscles, even though you have back problems, 22:33 you're not going to hurt your back anymore. 22:35 Same thing here... 22:36 So I started, oh, some months ago, doing a special 22:41 set of exercises... basically exercise was 22:44 lightweights for my arms, and all the different 22:47 directions of my arm. 22:48 At the beginning of my exercise period, 22:50 I probably could not raise my arm higher than about 22:53 my waist, as I put it back here. 22:55 I could not more think about washing my back 22:57 with my right arm, than flapping my right arm... 22:59 and flying across the room. 23:01 Now I can take this right arm, and I can touch the 23:03 nape of my neck with it. 23:04 And that's ONLY because I did some good exercises 23:09 but key to any exercise program is warming up. 23:12 People go out there and they'll 23:13 just jump right down and start doing it. 23:15 We need to warm up... these joints we need to warm... 23:18 I think... this is a MARVELOUS piece of mechanism 23:22 I mean, I look and I'm just amazed at all these tendons 23:24 and ligaments and muscles, and bones articulating and 23:27 working in unison... 23:28 And the direction that all these can go. 23:30 I mean, this one... look it just goes all over the place 23:33 I mean, nothing else is quite as mobile as this joint. 23:37 Therefore, when it has that much elasticity, that much 23:41 mobility... it's got that much more chance of being injured. 23:45 So, we need to learn how to warm ourselves up, 23:48 and then always be doing strengthening exercises. 23:51 It's those people who never do any exercise... 23:55 Their muscles are just sort of flabby, sitting around 23:57 And then one day, for some reason, they get really active, 24:00 and they do something, and that's when you start 24:03 tearing ligaments, and tendons and hurting your muscles 24:06 So, my recommendation is, for anyone of the joint problems 24:09 is we need to be stretching, warming up, 24:12 and when we do hurt them... when we feel that pain, 24:14 that's when your body is saying STOP... 24:16 Tissue is being damaged, stop what you're doing 24:19 rest it up, ice it for now, rest it... 24:22 And before long, it will be strengthened. 24:24 Then start slowly building that exercise program up. 24:28 And you will get it all back, I believe. 24:30 Now I know why I see you going into the exercise room 24:34 every once in a while where those weights are. That's right! 24:37 Every once in a while. Okay... very good! 24:39 Well thank you so much. 24:40 I do appreciate that. 24:41 Now I'd like us to discuss some of the kind of 24:45 treatments that you can do for various skeletal problems 24:49 And Dr. Winn Horsley is going to tell us about the various 24:54 treatments that are the most common for the use 24:58 in skeletal injuries and to induce healing. 25:02 Well, I would like to come back to what Don said 25:08 about exercise and I didn't say anything 25:11 in my first part about exercise. 25:13 That really is crucial for stabilizing things. 25:17 Now I would put it closer to the end of a 25:20 rehabilitation program. 25:21 At first, you might want to rest the joint and do things 25:26 that will favor blood flow into the area. 25:28 By the way, there is a whole issue regarding inflammation 25:34 that we should deal with. 25:37 When an area has just been hurt, 25:40 you will generally have inflammation. 25:44 Inflammation is... Four cardinal signs that we 25:47 learned in medical school, and I think nurses learn them... 25:50 Yes... 4 Latin words. That's right! 25:53 "Tumere" which just means it's swollen. 25:55 "Dolor" is pain. 25:57 "Calor" is heat. 26:00 "Rubor" is the redness. 26:02 So, you've got more blood in that area. 26:04 Now... Everyone thinks of inflammation as an enemy. 26:08 They think of inflammation as being the injury. 26:11 And it's quite a misconception. 26:12 Oh yes, it's the reverse, it's the healing... That's right! 26:16 And so, you actually do NOT want to interfere, 26:20 in any severe way, with inflammation UNLESS, 26:24 and this is not that common... UNLESS that inflammation 26:27 is SO severe... the swelling is so severe, 26:30 that you're not getting more blood flow into the area. 26:32 If you get so much swelling, that the skin gets kind of 26:35 shiny and glassy, maybe that would be a time 26:38 to start doing something. 26:39 But here I'm talking not even about drugs, 26:41 which are used all the time, nonsteroidal anti-inflammatory 26:45 ...they're trying to take away inflammation 26:46 But even of the simple treatments that we use, 26:49 ice and especially compression, don't overdo it. 26:55 If we overdo it, then we block the body's own 27:01 response... That's right. 27:02 Now I heard you say... "Rest... 27:05 I heard you say, "Ice" That's right. 27:09 And "Compression" 27:10 And then "Elevation" 27:11 In some cases, will be a good way to do it, and take care 27:14 of that inflammation. 27:16 Well, that's a good way to remember that... 27:19 "RICE"... rest, ice, compression and elevation. 27:24 I'm glad to know that little way to remember how to 27:29 treat a skeletal injury. 27:33 All skeletal injuries can be treated in this way 27:35 and then, of course, comes the period of rehabilitation 27:38 where you strengthen or mobilize the part 27:42 that has been damaged. 27:43 Well I hope this very BRIEF discussion of these very 27:48 FEW problems of the skeleton will be of 27:51 eternal blessing to you. 27:52 May God give you 27:54 His special blessing! |
Revised 2014-12-17