(Two-)Armed and ready.

I mentioned a few days ago that I was going in to see a sports medicine specialist about my old wrist injury to find out whether it had any implications for starting a strength training program.

I had called my dad and asked him if he still had my medical records from the surgery; indeed he did, and Fed Exed them to me in time for me to carry them to my appointment. It was interesting to read the surgeon's report and compare it to my memory of the event. Yes, the medial nerve (which goes to the thumb, first, and second finger) had been completely severed and reattached; the ulnar nerve had not been severed. Two tendons completely severed, one partly severed. I had really done a number on that one.

"Was your injury a fracture?" asked the nurse. He was clad in scrubs that were doing their best to imitate a Hawaiian shirt and beachcomber pants. "No? Oh good then, we won't need an x-ray."

"I have my medical records," I said. I was carrying them in a yellow folder that the baby kept grabbing for and trying to eat; I shifted them, plus the carseat and the diaper bag, to the other arm and disentangled my hair from his grip as I followed the nurse down the hall.

"That will help a lot," he said. We had reached the examination room and he was sitting down at a computer, executing a rapid, practiced password entry. "Now, let's see... how to put this... you're not here for an injury exactly...Patient about to start exercise program... needs consultation..."

"You could maybe put that I am concerned about whether I should modify my exercise program because of my old injury?"

"I have to decide which category to put you in. I don't write the categories, it's whoever came up with this data entry program." He scanned down the list. "Let's call this a 'consultation prior to beginning exercise program.'" He chucked the baby on the chin, said "Two shakes" and headed back out the door to fetch the doctor.

I bounced the baby on my lap and looked around. The sports med doctor's office displayed two shadow boxes on the wall; each contained a race number and a marathon finisher's medal. There wasn't anything else to look at. I set the carseat on the floor, buckled the baby into it, and played peek-a-boo with the baby from behind my yellow folder until the doctor came in.

She was a slight woman, with dark pixie cut hair and a Spanish last name, no taller or older than me. She listened to my story, how the injury happened, how I easily drop things in my right hand, how I am afraid of re-injuring the wrist every time I lift something heavy. She took the surgeon's report and read it all the way through in front of me -- which is, now that I think of it, the first time that a doctor has ever read any material that I brought along with me, and it isn't the first time I have brought any along.

Then she scooted her chair over to me and said, "Show me your hands. No, not that one, both of them." She put out her own hands expectantly.

I put my hands out. She examined them together, the normal, dominant left one, the injured right one. She pinched the muscles at the bases of the thumb. She asked me to spread my fingers, and resisted them by applying force with her own fingers. She had me touch each finger to the thumb in turn, and resist her as she hooked her own finger in mine to pull finger and thumb apart She moved each finger, murmuring approvingly: "They did a good job with you. Where was this hospital?"

"Dayton, Ohio. Well, a bit south of there."

"They must have got you in soon after the injury. The tendons..."

"I think so... I think maybe six hours or so afterward. It was a Friday afternoon, after school."

"Your range of motion is almost totally normal. At least, it is the same as the other. Squeeze my hands." I did. "Grip strength is the same too."

I stared, and tried again, this time one hand at a time. Same. "You're kidding. I was sure it was much weaker!"

She rummaged in her desk drawer and took out a tiny probe, nothing more than a wand with a single plastic fiber emerging the tip. "Can you feel this? No, don't look. Tell me when you feel this." She pressed it into my fingers, asking. Then she put it away and brought out a business card. "Pinch this between your left index finger and thumb. Hold tight." I gripped the card as she tugged, my three other fingers outstretched in an OK sign. "Okay, other hand." She tugged and laughed: "There's the difference."

I watched: when she tugged at the card I was gripping between my right index finger and thumb, my middle, ring, and pinky fingers snapped down and clutched involuntarily at the card, silently assisting, a reflex I didn't know I had.

She took a couple of paper clips out of her desk and started to unbend them. "Is this the do you feel one or two pokes test?" I asked. I looked at the ceiling while she prodded the pads of my fingers with one paper clip point, then with two of them at the same time. I could distinguish two on all five fingers of my left hand, and on my right pinky finger and my ring finger. Two felt like one on my middle finger and thumb, and the index finger could not even feel a poke, just a gentle pressure, as if she had put her fingertip on my fingertip and pressed. I looked down to see the paper clip pressing deeply into the pad of the fingertip, leaving a dent.

"So. That's different too." She quizzed me about the sensations, about heat and cold, pressure and pain and texture. And then she asked about my plans.

I told her that I was hoping to start training with free weights. She said, "The wrist isn't any more likely to be injured than your other wrist because of strength or flexibility. But the neurological damage, the loss of sensation, the proprioception, that could cause a problem. So.

"I don't want you to try to do pullups or chinups or negative pullups. Too easy for you to lose your grip, and you might drop yourself. Now, the lat pulldown, that is a machine, but that will be an okay substitute. The weight is too heavy, you just let go. It's the weight that falls. You can't hurt yourself."

"What about the pain I used to get with the lat pulldown?" I asked, remembering the shooting sensation that scared me off that machine several years ago.

"You just back off the weight, stay at the same weight till you are stronger and the pain doesn't happen. You are afraid of hurting yourself. But you will let go before you hurt yourself. It isn't going to tear.

"Another thing. I want you to tape your wrists, both of them. For support."

I didn't understand; I encircled my right wrist with my left thumb and forefinger, squeezed, wondered, "How does that help?" it isn't as if my wrist will come apart by bursting outward.

"It will keep your wrists from flexing forward." She demonstrated a biceps curl, with a straight wrist. "You want all the work to be done with your arms." Then she repeated it, curling her fist inwards at the wrist: "But some people will involuntarily try to lift by bending the wrists. The tape keeps the wrist stiff. This is a way to avoid wrist injuries."

"What about pushups?" I asked. "Do I need some special handle thing because I can't put my hand flat on the floor?"

"You can put your hand flat on the floor."

"I can?"

"Yes. The range of motion is the same. Go on, see."

Drop and give me twenty. (Okay, one.) I set down my bag, knelt next to the carseat on the carpet in the examination room -- the baby looked at me quizzically -- and put my hands down flat on the floor for a girlie pushup.

"Your arms aren't parallel," she pointed out.

I corrected that, then lowered myself to the floor, bending at the elbows.

She was right. The range of motion was the same. The right felt tighter, harder to flex. But although the left one didn't hurt or feel stretched, it stopped flexing at the same place.

I had been saying I couldn't do pushups because of the range of motion limitation for 25 years longer than I needed to.

I began to wonder if this idea had originated as an excuse to get out of trying too hard in gym class, and if it had been that long ago that I started to believe it.

She advised me not to increase the pulling force on the wrist by more than 5 lbs. every two weeks (meaning I will have to get some one-pound plates to bring to the gym), and sent me on my way clutching a card full of notes from the appointment.

I mused as I left that it was possibly the single most valuable "well adult" exam I'd ever had. And here I am, cleared to start lifting, sooner than I expected. I don't even have a notebook yet, let alone micro plates and some tape. Looking forward to it, though.

 

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Comments

[Kelly]

Hooray! I hope you'll update how the lifting goes. It sounds like the doctor knows her stuff about what your body is capable of and how much to push yourself. It sounds like you're glad you went, and I'm happy for you. :)

[bearing]

I could not believe how much time she spent with me. I have had midwife appointments shorter than that.

[Amber]

Sounds like a fantastic and worthwhile appointment, hooray! Enjoy your weight training.

[GretchenJoanna]

What an interesting post. The body is so complicated and wonderful, I'm thankful we have specialists who are experts and also conscientious and thorough. I have a PT who has helped me so much because she is like that. And you are wise to start strength-training, because as the book says, "Strong Women Stay Young". God bless you.

[RealMom4Life]

A great doctor and great news! It is hard to find a doctor that will spend time with you - not impossible - but hard!