Participants: Agatha Thrash, Don Miller
Series Code: HYTH
Program Code: HYTH000173
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!