Transcript: Back Pain | Oct 02, 2000

(music plays)
In animation, the title appears inside the shape of a house: “More to Health.”

The opening sequence shows a wooden table with a small lit candle as several words fly by: Nutrition, medicine, prevention, treatment, health.
Fast clips show different sets of hands performing activities on the table such as pulling petals from a daisy, drawing a big red heart, tuning a violin, flipping through the pages of a book, cooking, and pouring a glass of red wine.
In animation, the title appears inside the shape of a house: “More to life.”

Then, Maureen Taylor appears in a studio with yellow walls and a small TV set in the background, which reads “More to life.”

Maureen is in her late thirties, with wavy blond hair in a bob. She's wearing a black blazer over a patterned blouse.

She says HELLO AND WELCOME TO
“MORE TO LIFE.”
I'M MAUREEN TAYLOR.
ASIDE FROM BEING ATHLETIC,
BOBBY ORR, JOE NAME MATT AND --
THEY SUFFERED CREE-KNEE
INJURIES.
DOCTORS LIKE ORTHOPEDIC
SURGEON HAMILTON HALL.
Dr. HALL IS THE AUTHOR OF
“THE NEW BACK DOCTOR.”
HE'S HERE TODAY TO ANSWER
YOUR QUESTIONS ABOUT KNEES,
BACKS, NECKS AND OTHER
BONES.

Doctor Hall appears on screen. He’s in his late fifties, clean-shaven, with white hair gelled back. He’s wearing a gray suit, beige shirt, and patterned brown tie.
Then, a picture of his book appears briefly. The cover features a picture of a younger Doctor Hall posing next to a skeleton.

Maureen continues IF YOU HAVE A QUESTION FOR
Dr. HALL, GIVE US A CALL IN
TORONTO...

A caption appears on screen. It reads "416-484-2727. 1-888-411-1234."
It changes to “moretolife@tvo.org”

Maureen says Dr. HALL, WELCOME BACK.
HI.

Hall says PLEASURE.

Maureen says WHY ARE OUR KNEES TAKING
SUCH A BEATING.

The caption changes to "Doctor Hamilton Hall. Orthopedic Surgeon."

Hall says WELL, THEY ALWAYS DID.
THE PROBLEM IS THAT WE'VE
BEGUN TO ASK MORE OF THEM
THAN MANY OF US CAN SUSTAIN.
I MEAN, YOU MENTIONED THE
FAMOUS PEOPLE WITH BAD
KNEES.
BOBBY ORR, I GO BACK FAR
ENOUGH, THAT I LOOKED INTO
HIS KNEES WITH A PRIMITIVE
ARTHROSCOPE.
I LOOKED IN BOBBY ORR'S
KNEE.
IT WAS BAD THEN AND GOT
WORSE.
WHAT HAPPENED IN ALL THOSE
CASES IS THE KNEES WEAR OUT.
THEY JUST WEAR OUT EXTREMELY
QUICKLY BECAUSE OF THE
DEMANDS THAT ARE PUT ON
THEM.
IN FACT, I QUOTE THE BOBBY
ORR STORY MANY TIMES BECAUSE
HE KEPT SKATING UNTIL THE
VERY END ON NO KNEES.
I MEAN, HE HAD NO KNEES.
HE HAD BONE GRINDING ON
BONE.

Maureen says IT WOULD HAVE BEENPAINFUL?

Hall says TERRIBLY, BUT HE KEPT
GOING BECAUSE OF THE
STRENGTH OF HIS LEGS.
BOBBY ORR'S THIGH WAS BIGGER
AROUND THAN MY WAIST.
IT WAS ENORMOUS AND ALL
MUSCLE.
THAT STRENGTHEN ABLED HIM TO
CONTINUE TO SKATE.
NOW, WHEN HE STOPPED, WHEN
HE RETIRED, HE NOW HAS KNEE
REPLACEMENT, AS YOU KNOW,
VERY QUICKLY, OF COURSE,
WITHOUT THAT INCREDIBLE
AMOUNT OF STRENGTH, THE
MUSCLE WEAKENS AND THE PAIN
BECOMING INTOLERABLE.
STRENGTHEN YOUR THIGH
MUSCLES.
THE FIRST THING I TELL EVERY
KNEE PATIENT I SEE BEFORE WE
GO TO TOTAL KNEE REPLACEMENT
IS MAKE YOUR THIGHS
STRONGER.
I HAD ONE PATIENT WHO WOULD
EXERCISE FAITHFULLY FOR A
YEAR OR SO, COME BACK, TELL
ME, I'M GREAT, SLACK OFF,
COME BACK A YEAR LATER AND
SAY I'M TERRIBLE.
WE PLAYED THAT GAME FOR TEN
YEARS BEFORE WE FINALLY DID
SOMETHING.
THE SECOND THING ABOUT KNEES
IS THEY'RE THE MOST WEIGHT
SENSITIVE JOINT IN THE BODY.
BACKS ARE NOT SURPRISINGLY,
BUT KNEES ARE.
GAIN TEN POUNDS AND YOUR
KNEES WILL TELL YOU ABOUT
IT.
IF YOU WANT TO KEEP OUT OF
MY HANDS AS A SURGEON,
STRENGTHEN YOUR THIGH
MUSCLES, LOSE WEIGHT AND
YOUR KNEES WILL LOVE YOU.

Maureen says IF YOU SAW BEENY OR TODAY
WHAT WOULD YOU DO FOR HIM?

Hall says AT THE STAGES BACK THEN,
PROBABLY NOT MORE THAN WE
DEAD.
WE'RE BETTER THAN CLEANING
THE KNEE OUT WITH A SCOPE.
NOW WE CAN DO SOME AMAZING
THINGS WITH SHAVING AND
SMOOTHING.
THERE ARE NOW SOME
POSSIBILITIES, VERY EARLY
POSSIBILITIES FOR CARTILAGE
REPLACEMENT SURGERIES, STILL
VERY EXPERIMENTAL, SO NOBODY
RUSH OUT AND GET ONE.
THE CHEMICALS WE INJECT INTO
THE KNEES THAT MAY HELP IN
THE EARLY STAGES.
STILL QUITE EXPERIMENTAL.
WE'RE STILL NOT SURE.
WHERE WE'VE REALLY GOTTEN
BETTER IS IN THE END STAGES,
IN THE REPLACEMENT -- THE
TOTAL KNEE REPLACEMENTS NOW
ARE VERY GOOD.
FOR THOSE WHO HAVE GONE THAT
ROUTE AND LOOKING TOWARD
THAT SURGERY, THE GOOD NEWS
IS THAT OPERATION IS AN
EXCELLENT OUTCOME.
I'VE DONE TOTAL KNEES FOR
MANY YEARS.
I'VE WATCHED THE EVOLUTION
OF THESE, AND THEY REALLY
ARE NOW DOING VERY WELL.

Maureen says MOSTLY THAT'S PERFORMED
ON PEOPLE WHO HAVE
OSTEOARTHRITIS?

Hall says YES, THE KNEE WHERE THE
SURFACES ARE DESTROYED.
IT'S NOT THE OPERATION FOR A
YOUNG PERSON WITH THE
OCCASIONAL SORE KNEE.
IT'S NOT THE PERSON WHO GETS
THE BIT OF SWELLING ONCE IN
A WHILE.
IT'S THE PERSON WHO KNEES
HAVE REACHED THE END STAGE.
THAT'S WHEN THE REPLACEMENT
COME IN.

Maureen says ASK A KNEE RECONSTRUCTION
DIFFERENT THAN A LIGAMENT
RECONSTRUCTION?

Hall says THE LIGAMENT
RECONSTRUCTION TALKS ABOUT
ONE SPECIFIC SET OF
LIGAMENTS.
NOW, THE KNEE HAS SEVERAL
LIGAMENTS, BUT THE
REPLACEMENT OPERATIONS ARE
DUE TO THE INTERIOR LIGAMENT,
CALLED CRUCIATE.
THEY PREVENT THE KNEE FROM
SLIDING FORWARD AND BACKWARD,
AND IF THEY GO, THEY GO
OFTEN IN ATHLETES, THE KNEE
BECOMES UNSTABLE.
WHEN THEY GO TO PLANT, YOU
KNOW, PUT YOUR FOOT AND THEN
MOVE, THE KNEE BUCK ALSO AND
THEY WILL FALL DOWN.
NOW, WE'VE REACHED THE STAGE
NOW WHERE THIS LIGAMENT CAN
BE REPLACED.
WE USE SYNTHETICS FOR A
WHILE.
THEY TURNED OUT TO BE NOT AS
GOOD AS NATURAL TIRB SHOE.
WE'RE BORROWING LIGAMENTS
FROM OTHER AREAS.
THESE ARE REROUTED INTO THE
KNEE THROUGH THE X SHAPE AND
THEY RESTORE THE STABILITY.
IT'S DONE ARTHROSCOPICALLY.
WHEN WE STARTED THIS
OPERATION AND THE MAN WHO
REALLY INVENTED IT WAS A
CANADIAN, DAVE McINTOSH MANY
YEARS AGO, WHEN DAVE DID HIS,
THE CUT BEGAN SOMEWHERE
BELOW YOUR KNEE AND EXTENDED
PRETTY MUCH UP TO THE LINE
OF YOUR UNDERWEAR, AND IT
WAS AN INCREDIBLE INCISION
ALL THE WAY UP TO SIDE,
BECAUSE HE WES WAS
HARVESTING ALL THE MUSCLE
COVERING AND BRINGING IT
DOWN AND USING IT IN THE
KNEE JOINT.

Maureen says DO YOU NEED THAT MUCH NOW?

Hall says NO.
WHERE WE'VE GOB TO FROM AN
INCISION THAT MUST HAVE BEEN
TWO FEET LONG TO AN INCISION
THAT'S NO MORE THAN A COUPLE
OF INCHES OR MOST AND THE
RESULTS ARE AS GOOD OR
BETTER.
WE'VE COME A LONG WAY.
THE LIGAMENT REPLACEMENT
OPERATIONS ARE GOOD ONE.
THEY DO WELL.

Maureen says OKAY.
WE'RE TALKING ABOUT KNEES
AND BACKS, ESPECIALLY, AND
FEET AND BONES THIS
AFTERNOON WITH ORTHOPEDIC
SURGEON Dr. HAMILTON HALL.
GIVE US A CALL IF YOU HAVE A
QUESTION.
IN TORONTO...

The phone numbers and email reappear briefly.

Maureen continues FIRST IS KEVIN IN
SUDBURY.
HI, KEVIN.

The Caller says GOOD AFTERNOON.

Maureen says GOOD AFTERNOON.

The Caller says I'D LIKE TO ASK THE
DOCTOR ABOUT -- I'M IN THE
PROCESS OF GETTING -- OF
GOING TO MY PHYSICIAN AND
GETTING REDIAGNOSED BECAUSE
I HAVE A FORM OF ARTHRITIS
THAT ATTACKS MY BACK AND MY
HIPS.
I WAS -- I WANTED TO ASK, IS
THERE ANY TECHNOLOGY OUT
THERE -- LIKE, I WAS
DIAGNOSED WITH -- IT CAME UP
THROUGH THE BLOOD.
IS THERE ANY WAY TO DO
X-RAYS TO SEE WHAT'S GOING
ON WITH THE BONES, BECAUSE
WHEN PEOPLE ASK ME TO
DESCRIBE WHAT ARTHRITIS
FEELS LIKE THE ONLY WAY I
CAN PUT IT IS -- IT'S LIKE
PLAYING HOCKEY FOR THE FIRST
TIME AND YOU'RE USING
MUSCLES AND IT GETS ALL
STIFF.
WELL, THAT'S WHAT IT'S LIKE
FOR ME CONSTANTLY.
IT FEELS LIKE THE BONES ARE
MUSHY AND VERY SOFT.
IS THERE ANY WAY TO SEE,
LIKE, TO GET X RAYS OF
WHAT'S HAPPENING?

Hall says WELL, YOU CAN GET X RAYS.
DID THEY GIVE YOU A NAME FOR
THE TYPE OF ARTHRITIS THAT
YOU HAVE?

The Caller says YEAH IT'S --

Hall says AS.
THAT'S THE EASY WAY OUT.
AS IS A VERY PARTICULAR
DISEASE.
IT AFFECTS MEN MORE THAN
WOMEN, IT AFFECTS MEN
GENERALLY IN THE FIRST
HALVES OF THEIR LIFE.
IT'S UNUSUAL TO SEE AS
DEVELOP AFTER THE AGE OF 35
OR 40.
IT'S OFTEN A CONDITION OF
MEN IN THEIR 20s.
IT OCCURS FOR REASONS WE
DON'T REALLY FULLY
UNDERSTAND.
IT'S ONE OF THESE SO-CALLED
CAN AUTOIMMUNE DISEASES
WHERE THE BODY WANTS TO
ATTACK ITSELF.
AS AFFECTS THE SPINE SO IT
ALWAYS BEGINS AT THE BOTTOM.
IT AFFECTS THE BOTTOM OF THE
SPINE FIRST.
IT AFFECTS THE JOINTS THAT
JOIN THE SPINE TO THE PELVIS.
25 percent percent OF PATIENTS WITH AS
GET HIP ARTHRITIS AND KNEE
ARTHRITIS, LARGE JOINT
ARTHRITIS.
THE DISEASE TENZ TO PROGRESS
UP THE SPINE -- TENDS TO
PROGRESS UP THE SPINE AND
TENDS TO STIFFEN THE JOINTS.
THE JOINTS BECOME INFLAMED
AND THE DISEASE, IF YOU WILL,
BURNS OUT, BUT THE JOINTS
ARE LEFT STIFF.
THEY'RE LEFT WITH STIFF HIPS,
STIFF SPINES.
THE WHOLE SPINE CAN BECOME
STIFF RIGHT UP TO AND
INCLUDING THE NECK.
NOW, THE GOOD NEWS IS THAT
THE DISEASE TENDS TO BURN
OUT EARLY IN MOST PEOPLE.
IT DOESN'T PROGRESS TO A FUM
EXTENT.
SO THERE'S A GOOD DEAL OF
OPTIMISM, EVEN IN THE EARLY
GOING.
BECAUSE THE DISEASE ONLY HAS
A TEMPORARY ACUTE PHASE,
DEALING WITH IT WITH AN
ANTI INFLAMMATORY DRUG, AND
THERE ARE ALL THE NEW
ANTIINPOLICEMANTORIES ON THE
MARKET, OFTEN CUTS DOWN THE
PAIN.
THE STIFFNESS IS A VERY
COMMON COMPLAINT, MORNING
12I6NESS IN PARTICULAR.
A YOUNG MAN WITH MORNING
STIFFNESS IN THE BACK IS
IMMEDIATELY YOU START
WONDERING ABOUT AS.
THE MOST IMPORTANT LONG-TERM
THING IS TO MAINTAIN POSTURE
BECAUSE THE JOINTS THAT GET
INFLAMED IN THE BACK ARE THE
JOINTS AT THE BACK OF THE
SPINE.
THE COMFORTABLE POSITION,
THEREFORE, IS TO DO THIS.
I SIT THIS WAY BECAUSE IT
FEELS BETTER THEN THE JOINTS
STIFFEN UP AND I CAN'T
STRAIGHTEN UP.
I'M IN THIS WAY FOR THE REST
OF MY LIFE.
IN THE EXTREME CASES, SOME
OF THESE POOR PEOPLE WIND UP
TO THE POINT WHERE THEY
CAN'T SEE STRAIGHT AHEAD.
NOW, THERE IS SURGERY FOR
THOSE ADVANCED STAGES.
AGAIN, TORONTO, WE'RE
GETTING -- TORONTO IS DOING
WELL TODAY.
WE'VE GOT THE KNEE OPERATION
AND ONE OF THE LARGEST AND
CERTAINLY THE FIRST SERIES
OF AS OPERATIONS IN THE
WORLD WERE DONE IN TORONTO
MANY YEARS AGO,
STRAIGHTENING THE SPINES OF
PEOPLE WHO WERE SO BADLY
BENT.
THAT'S AN EXTREME SITUATION
THAT SHOULDN'T BE NECESSARY
IF YOU GET IT TO EARLY,
MAINTAIN POSTURE AND DO THE
MEDICAL CONTROL OF
INFLAMMATION.
X-RAYS WILL HELP MAKE THE
DIAGNOSIS BECAUSE THEY SHOW
IS SI JOINT HAS STIFFENED
UP.
THEY WILL NOT DO ANY MORE
THAN THAT.
IF THE BLOOD TEST, AND IT'S
A VERY SPECIFIC TEST I WON'T
BOTHER GIVING YOU THE
TECHNICAL DETAILS ON.
IF THAT TEST IS POSITIVE,
AND THERE'S A COUPLE OTHER
SECONDARY TESTS YOU DO AND
IF THE X-RAY OF THE PELVIS
IS POSITIVE, THEN IT'S
AVENUE S.
THERE -- AS.
THERE ARE OTHER DISEASES
THAT MIMIC AS.
BEFORE WE ALL RUSH OFF AND
HAVE IT, IT'S WORTH A LITTLE
INVESTIGATION.
YES, THE X-RAY IN A SPECIFIC
AREA IS USEFUL TO MAKE THE
DIAGNOSIS, YOUR BONES AREN'T
MUSHY.
THEY'RE NOT GETTING SOFT.
IN FACT, THEY GET A BIT
HARDER BECAUSE THEY GROW
EXTRA BONE AROUND THEM.
IN THE LONG TERM, AS I SAY
IF, YOU LOOK AFTER ALL THE
AREAS WE'VE TALKED ABOUT,
THERE'S A GOOD CHANCE YOU'LL
COME OUT OF THIS WITH GOOD
FUNCTION AND THE PAIN,
FORTUNATELY, DOES GO AWAY.

Maureen says THAT'S GOOD NEWS.
OKAY.
THANK YOU, KEVIN.
GOOD LUCK.
STELLA IS IN St. CATHARINES.
HI, STELLA.

The Caller says GOOD AFTERNOON.

Maureen says HI.

The Caller says I'VE BEEN TOLD BY MY
DOCTOR I HAVE OSTEOARTHRITIS
IN BOTH KNEES.
I'M 74 YEARS OLD.
I NEED REPLACEMENT AND THAT
BOTH NICE SHOULD BE DONE AT
THE SAME TIME.
OTHERWISE I'M A VERY ACTIVE
SENIOR.
I REQUEST WORK IN MY GARDEN,
DIG, ET CETERA AND DON'T
EVEN THINK ABOUT THEM.
YET THIS REALLY CONCERNS ME
THEY WOULD HAVE TO HAVE THEM
DONE AT THE SAME TIME IF I
WISH TO HAVE THEM DONE.

Hall says ALL RIGHT.
WELL, THERE'S SEVERAL ISSUES
IN TALKING TO PATIENTS WITH
WORK-OUT KNEES -- NOW,
OSTEOARTHRITIS IS A BIG WORD
THAT MEANS YOUR KNEES HAVE
WORN OUT.
IT MEANS, BASICALLY, YOUR
KNEES ARE 74 YARDS OLD.
THAT'S ALL IT MEANS.
DON'T LET THE NAME SCARE
YOU.
IT'S AS NATURAL, AS I SAY
ABOUT THE SPIRNTION IT'S AS
NATURAL IN THE KNEES AS GREY
HAIR.
IT'S A WEAR SIGN.
PATIENTS THAT COME TO ME
LOOKING FOR REPLACEMENT OF
THE KNEE THE FIRST QUESTION
AND THE QUESTION YOU REALLY
HAVE TO DEAL WITH YOURSELF
WHERE I TO GIVE YOU PAINLESS
KNEES, IF I WERE TO GIVE YOU
GOOD KNEES WOULD THAT BE A
MAJOR FACTOR IN RETURNING
YOUR LIFE TO NORMAL?
IN OTHER WORDS, ARE YOUR
KNEES THE LIMITING FACTOR IN
WHAT YOU DO.
I HAVE PEOPLE THAT SAY, WELL,
MY KNEES ARE BAD, BUT CAN I
HARDLY BREATHE.
WELL, IF I REPLACE YOUR
KNEES, HOW MUCH BETTER WILL
YOU BE?
WELL, NOT MUCH.
THE IDEAL CANDIDATE IS THE
HEALTHY SENIOR WHOSE KNEES
ARE REALLY THE CAUSE OF THE
LIMITATION.
THAT'S A GREAT PLACE TO PUT
IN JOINT.
LOSE SOME WEIGHT, STRENGTHEN
YOUR QUADS.
SAME RULES APPLY.
YOU CAN DO ONE KNEE AFTER
ANOTHER.
OCCASIONALLY, WHEN THE KNEES
AREN'T TOO BAD, WE'LL PICK
THE WORST KNEE, DO IT FIRST,
AND THE OTHER KNEE HAVING A
GOOD KNEE TO RELY ON STOPS
HURTING SO MUCH.
I HAVE SEVERAL PATIENTS THAT
HAVE AVOIDED SECOND KNEE
SURGERY.
I HAVE ONE WOMAN WHOSE
SECOND KNEE I DID 15 YEARS
AFTER THE FIRST.
SHE LASTED THAT LONG BECAUSE
THE GOOD KNEE, THE KNEE
REPLACED GAVE HE THAT -- HER
THAT ABILITY TO KEEP
WALKING.
CAN YOU DO THEM BOTH AT THE
SAME TIME?
YES, YOU CAN.
ARE THERE REASONS FOR IT?
MEDICALLY, IF YOU DON'T WANT
TO TAKE A SECOND ANAESTHETIC
I SUPPOSE YOU CAN PUSH IT
THERE.
IT'S A BIG OPERATION IN
TERMS OF YOUR BODY'S
RESPONSE.
THERE'S A LOT OF STRESS.
THE CUT IS NOT VERY BIG, BUT
YOUR GOES THROUGH QUITE A
BIT TO GET OVER IT.

Maureen says IS IT PAINFUL, THE RECOVERY?

Hall says EXTREMELY.
I REPLACED A COUPLE KNEES ON
ROGER WHITAKER.
HE WHISTLED THROUGH THE
WHOLE THING.
I DID HIS BOTH AT ONCE
BECAUSE HE HAD A VERY TIGHT
PERFORMANCE SCHEDULE AND HE
NEEDED TO BE IN GERMANY IN
SIX WEEKS.
FROM THE DATE OF HIS SURGERY,
HE HAD TO BE BACK ON STAGE
SIX WEEKS LATER SINGS, AND
HE MADE IT.
HE WORKED LIKE NO ONE I HAVE
EVER SEEN IN HIS REHAB.
THE KNEES WERE FINE.
THE THING THAT GOT HIM BACK
WAS THE AMOUNT OF EFFORT HE
PUT INTO REHABILITATION.
IT MEANS STRENGTH, RANGE OF
MOVEMENT AND FROM DAY ONE,
AND THIS IS PROBABLY THE
MOST THING WITH KNEES, THEY
HURT AND THEY HURT A LOT IN
THE EARLY GOING.
YOU LIE THERE IN BED WITH
BOTH KNEES DONE, YOU HAVEN'T
GOT, LITERALLY, A LEG TO
STAND ON.
YOU SAY, OKAY, I GOT TO
START MOVING THEM.
WELL, IT REALLY HURTS, I
THINK I'LL WAIT UNFILL
TOMORROW OR NEXT WEEK OR
NEXT MONTH.
THEN THE KNEES GET STIFF AND
THE RESULTS ARE POOR.
FROM DAY ONE OF THE SURGERY
YOU ARE MOVING THE KNEES AND
THAT, IF YOU CAN CONCENTRATE
ON BOTH AT WUJS, -- ONCE,
THAT'S A CHALLENGE.
I'M OPERATING ON A COUPLE OF
PATIENTS IN THE NEXT LITTLE
WHILE, BOTH OF WHOM NEED
BOTH KNEES DONE.
IN BOTH CASES I'VE ELECTED
TO DO ONE KNEE AND THEN THE
OTHER.
STAGE THEM SIX WEEKS APART
SO IT'S ALL ONE GO, BUT
GIVES THEM A CHANCE TO GET
RID OF ANY POSSIBILITY RISKS,
COMPLICATIONS AND GO TO
OTHER SIDE.
YOU KNOW, YOU CAN DO IT
EITHER WAY.
MY PREFERENCE IN MOST
CIRCUMSTANCES WHERE YOU
DON'T HAVE TO SINGING IN
GERMANY THE SIX WEEKS IS TO
DO ONE KNEE AT A TIME.

Maureen says OKAY.
GOOD LUCK, STELLA, THANKS.
MAYBE THIS IS A TIME TO TALK
ABOUT MY PERSONAL PROBLEM.
I PUT MY LIFE IN OUR HANDS
AND LET YOU TAKE A BUNION OFF.
WE DIDN'T HAVE MUCH OF A
FOLLOW-UP.
I WENT AWAY TO COTTAGE.

Maureen takes off her shoe and shows her foot.

Hall says YOU WERE THE TYPICAL
PATIENT AND SAID I'LL NEVER
BE BACK.

Maureen says IT'S -- I MUST SAY I GOT
RIGHT UP AND DOING THINGS AT
THE COTTAGE, TRYING TO KEEP
THE FOOT ELEVATED WHEN I
COULD, BUT I COULDN'T DO
THAT FOR LONG.
I HAVE NO PAIN LEFT.
I'M WALKING ON IT GREAT.
IT SEEMS A LITTLE WIDE,
DOCTOR, IT'S A LITTLE WIDER
THATEN THE LEFT FOOT.
WILL I HAVE IT BACK THE SAME
SIZE?

Hall says YES, YOU WILL.
WHAT YOU HAVE TO REALIZE
ABOUT FEET IS THERE'S NOT
MUCH FAT ON FEET, EVEN IN
FAT PEOPLE THERE ISN'T MUCH
FAT, AND YOU'RE NOT A FAT
PERSON.

Maureen says THANK YOU.

Hall points at her foot and says WHAT YOU HAVE IS THE
THICKENING IN HERE THAT
COMES FROM THE SCAR.
THE SCAR YOU GOT ON TOP,
WHICH IS A NICE LITTLE SCAR
HERE, ACTUALLY ALLOWS ME TO
TURN THE SKIN ALL THE WAY TO
THE SOLE OF YOUR FOOT.

Maureen says IS THAT WHAT YOU DID?

Hall says YES, I DID.
THE WORK IS DONE HERE.
NOTHING IS DONE AT HERE AT
ALL.
THIS IS JUST THE DOOR THAT
LETS ME.
IN WHEN WE PUT IT BACK UP
AND SEW IT DOWN, WE'VE
THICKENED THIS WITH THE SCAR
TISSUE.
THE SECOND THING, YOU NOTICE
THE TOE HAS GOT THAT NICE
SORT OF COME TO A POINT
SHAPE, WHICH IS WHAT IT'S
SUPPOSED TO HAVE.

Maureen says IT USED TO BE A LOT MORE LIKE THAT.

Hall says IN DOING THE SURGERY,
WHEN I TEACH THE RESIDENTS
AT THE UNIVERSITY, WE LAUGH
ABOUT THIS BECAUSE I'VE SAID
FOR ALL MY TIME IN SURGERY,
YOU CAN OVERCORRECT THESE.
THE OVERCORRECTION PUTS IT
WAY OVER HERE.
PEOPLE HATE THAT.
THE FACT IS THAT WITH THIS
OPERATION, IT ALWAYS -- IF
YOU ALLOW TO, IT WILL ALWAYS
GO BACK.
BEFORE WE GOT ON AIR, IF
IT'S A LITTLE TIGHT THIS WAY,
YOU PUT ON A COTTON SOCK AND
HOLD IT THAT WAY.
IT SHAPES UP BEAUTIFULLY.
IF YOU MAKE IT TOO LOOSE,
THEN WITHIN SIX WEEKS, IT'S
RIGHT BACK WHERE IT WAS.
THE THICKNESS THIS WAY WILL
THIN.
THIS SCAR WILL DIMINISH.
YOU HAVE NO PAIN.

Maureen says NO.

Hall says IF I GRAB YOU AND GIVE
YOU A GOOD FIRM SQUEEZE,
YOU'LL BE AWARE IT'S A
LITTLE TENDER.
THAT, OF COURSE, IS NORMAL.
PUTTING ON A SNUG SHOE AND
LEAVING IT THAT WAY -- IT'S
NOT JUST THE APPARENT
THICKNESS, IT'S ALSO THAT
EXTRA TENDERNESS.
IT WILL TAKE ANYWHERE FROM
SIX TO 12 MONTHS BEFORE THE
FOOT GOES BACK TO WHAT IT
WAS, BUT, YOU KNOW, AND I
FOLLOW THESE UP -- NOT WITH
YOU, YOU'LL NEVER COME BACK.
I CAN GET YOU HERE.

Maureen says THAT'S RIGHT.
MOST PATIENTS WE FOLLOW THEM
OUT FOR A YEAR.
BY THAT TIME THEY'RE BACK TO
NORMAL.

Maureen says IS MY BIG TOE SHORTER?

Hall says YES, IT IS.

Maureen says WHAT DID YOU DO DA WITH
THE REST OF THE TOE?

Hall says WE ACTUALLY REPOSITIONED
THE LONG BONE.
TO DO THAT, WE MAKE A V-CUT.
WE TAKE A SAW AND WE V-CUT
THE BONE AND THEN WE SLIDE
IT OVER SO THAT IT SLIDES
ALONG THE V.
THIS END BONE HAS BEEN MOVED
IN.
THAT WAS TO BRING THE TOE
WITH.
IT THE SHORTENING OF THE TOE
IS THE AMOUNT OF BONE I HAD
TO REMOVE THE MAKE THE
V-CUT.

Maureen says PEOPLE NOTICE IT BECAUSE
THE TOE SEEMS A LITTLE SHORTER.

Hall says IT'S OKAY.
I DON'T MISS IT.

Maureen says I REMEMBER THE HOSPITAL
HAD ASKED ME IF I WANTED TO
DONATE ANY EXTRA BONE TO THE
HOSPITAL?

Hall says THAT'S A ROUTINE
QUESTION.
THERE WASN'T ANY BONE TO
DONATE.
I'M SORRY I COULDN'T HELP
YOU.

Maureen says OKAY.
QUICKLY.
THAT'S ANOTHER THING
SOMETIMES PEOPLE WANT BOTH
DONE AT THE SAME TIME.
I GOT MY DONE 15 YEARS
APART.
WHAT DO YOU RECOMMEND?

Hall says IN BUNIONS, I OFTEN WILL
DO THEM BOTH.
IF YOU CAN GET OFF YOUR FEET
IN A FEW DAYS -- YOU'RE ABLE
TO TESTIFY HOW QUICKLY YOU
CAN WALK.
YOU'RE NOT IN A JOB YOU HAVE
TO STAND UP ALL DAY EVERY
DAY, I WOULD SAY GET IT OVER
WITH.
THEY'RE NOT PAINFUL,
PARTICULARLY, THE FIRST 24
HOURS.

Maureen says OH, THE FIRST 24 HOURS
HURTS LIKE THE DICKENS.

Hall says YES.
ANY TIME YOU BREAK BONE,
IT HURTS.
IF I'M SURGICALLY BREAKING
THE BONE, IT'S STILL A
BROKEN BONE.
HOW MUCH WOULD IT HURT IF I
DROPPED A PIANO ON THE HURT?
IT WOULD HURT A LOT.
I DID IT WITH A POWER SAW.
THERE'S NO DIFFERENCE THERE.
NOW, BECAUSE THERE ISN'T A
LOT OF PAIN BEYOND THE FIRST
24, 48 AND BECAUSE THERE'S
NO REHAB OTHER THAN WALKING,
THEN YOU MIGHT AS WELL GET
THEM BOTH DONE AS ONCE.
YOU AND I HAVE HAD THIS
PERSONAL CONVERSATION.
THE BUNION LECTURE, AS I
CALL IT, TO EVERYONE
CONSIDERING BUNION SURGERY.
NUMBER ONE, NOTHING CORRECTS
BUNIONS EXCEPT SURGERY, SO
DON'T WASTE YOUR MONEY ON
THINGS TO SPREAD YOUR TOES.
IT WON'T WORK.
NUMBER TWO, PEOPLE WITH
BUNIONS DON'T NEED SURGERY
UNLESS THE BUNION GETS IN
THE WAY.
DON'T RUSH OFF AND HAVE IT
DONE BECAUSE IT'S A LITTLE
BUMPY.
NUMBER THREE, BUNION SURGERY
ONLY FIXES BUNIONS, IT
DOESN'T MAKE YOUR FOOT
PRETTY, MAKE IT THIN, CHANGE
YOUR HAIR COLOUR, IT JUST
FIXES THE BUMP.
PEOPLE HAVE THE MOST AMAZING
EXPECTATIONS OF WHAT THEY'RE
GOING TO BE LIKE WHEN THE
BUNION'S DONE AND THEY'RE
DISAPPOINTED BECAUSE IT
DOESN'T HAPPEN.
MOST IMPORTANT, YOU OPERATE
FOR CURRENT PROBLEMS.
I HAVE YOUNG WOMEN --

Maureen says NOT FOR FUTURE PROBLEMS.

Hall says YOUNG WOMEN SAY, MY
MOTHER IS 72, SHE HAS
TERRIBLE PROBLEMS, OPERATE
NOW AND I WON'T HAVE TO DO
IT NOW.
OPERATE ON AN ESTABLISHED
BUNION.
THE SURGERY ON BACKS AND
FEET IS ACTUALLY QUITE GOOD
IF YOU PICK YOUR PEOPLE
CAREFULLY AND THE TIMING IS
RIGHT AND THE EXPECTATIONS
ARE RIGHT.
YOU KNEW WHAT YOU WERE GOING
TO GET OUT OF IT AND THAT
MADE US BOTH SATISFIED.

Maureen says NOPE.
I'M HAPPY.
OKAY.
ANOTHER SATISFIED CUSTOMER.
WE'LL GO TO COLLEEN IN
GUELPH.

The Caller says HI.

Maureen says HI.

The Caller says I LOVE YOUR SHOW.

Maureen says THANK YOU.

The Caller says OKAY.
MY QUESTION.
I HAVE ARTHRITIS IN THE
SPINE, AND IT'S ENCROACHING
ON THE SCIATIC NERVE.
I HAD A MISSTEP ABOUT THREE
MONTHS AGO.
SINCE THEN, I HAVE SEVERE
PAIN AND NUMBNESS ON MY LEFT
LEG.
I'VE BEEN ON
ANTI-INFLAMMATORIES.
IS IT GOING TO SORT OF WEAR
DOWN ON ITS OWN AND GO BACK
TO FULL PAIN?

Hall says OKAY.
OBVIOUSLY, WE'VE HAD THIS
CONVERSATION.
I CAN'T DIAGNOSIS --
DIAGNOSE AND TREAT.
ALL I CAN LOOK AT IS A
CAMERA.
IT'S HARD TO SEE THE
PATIENTS.
THERE ARE A COUPLE
QUESTIONS.
IF I COULD BE SO BOLD, HOW
OLD ARE YOU?

Maureen says COLLEEN?

The Caller says EARLY 50s.

Maureen says OKAY.

Hall says THE PAIN YOU'RE HAVING IN
THE LEG, SKITTLES IN YOUR
BACK OR JUST IN YOUR LEG?

The Caller says TIRED THEN IT'S
DEFINITELY IN MY BACK.

Hall says ALL RIGHT.
IF I MAKE YOU CHOOSE BETWEEN
THE PAIN IN YOUR BACK AND
THE PAIN IN YOUR LEG, AND I
KNOW YOU HAVE BOTH NOW, IF I
MAKE YOU CHOOSE, WHICH ONE
WOULD YOU SAY WAS THE WORST
PAIN, THE DOMINANT PAIN?
THE BACK SPREAD TO THE LEG
FOR LEG PAIN IS WORSE THAN
THE BACK?

The Caller says MOST OF THE TIME, THE LEG
PAIN IS WORSE.

Hall says ALL RIGHT.
IF I COULD STOP ONLY ONE
PAIN, NOT BOTH, WHICH ONE
WOULD YOU WANT ME TO GET RID OF?

The Caller says AT THIS TIME, THE LEG PAIN.

Hall says ALL RIGHT.
THAT PROBABLY -- AND THIS IS
A CONTRACTOR CRITICAL
QUESTION.
THAT PROBABLY INDICATES
THERE IS A DEGREE OF NERVE
IRRITATION.
THAT ISN'T AS SCARY AS IT
SOUNDS.
MOST PEOPLE WITH BACK PAIN
HAVE SOME LEG PAIN, AND MOST
OF THAT LEG PAIN IS NOTHING
MORE THAN THE SPREAD OF JUST
ORDINARY RUBBING TOGETHER
BACK PAIN AND THAT'S NOT --
NOTHING TO WORRY ABOUT.
FOR THE PERCENT, IT'S ABOUT
10 percent THAT HAVE PINCH-NERVE
PAIN, THE LEG PAIN IS
ACTUALLY WORSE THAN THE BACK
PAIN.
IN THAT GROUP, FULLY 80 percent GET
BETTER, ALL BETTER, WITHOUT
SURGERY, WITHOUT ANYTHING
TERRIBLE HAVING TO BE DONE.
THE ODDS AT THREE MONTHS OF
MAKING IT BACK 100 percent IS VERY,
VERY HIGH.
NO GUARANTEES.
I CAN TELL YOU THAT PLAYING
THE ODDS, AND THIS IS A GAME
OF ODDS, REALLY, THE ODDS
ARE YOU WILL GET BETTER.
THE ACUTE LEG PAIN IS OFTEN
BEST TREATED WITH NOTHING
MORE COMPLICATED THAN REST
POSITIONS.
FINDING POSITIONS IN WHICH
THE LEG PAIN FEELS BETTER,
HOW YOU SIT, HOW YOU LIE,
HOW YOU STAND.
THESE ARE THINGS YOU AND THE
THERAPIST SHOULD HAVE GONE
OVER IN GREAT DETAIL, YOUR
SLEEPING POSITIONS, THE USE
OF CUSHIONS AND ROLLS.
I'VE TALKED ABOUT THEM MANY
TIMES.
THERE ARE MANY THINGS THAT
CAN BE DONE TO HELP REDUCE
THE LEG PAIN.
IF THE PAIN DOES NOT SUBSIDE,
AND IT HAS -- HASN'T CHANGED,
HASN'T IMPROVED IS HOLDING
ON OVER A PERIOD OF LET'S
SAY ANOTHER MONTH, SO FOUR
MONTHS, THEN IT IS WORTH AN
INVESTIGATION, A LOOK FROM
SOMEONE WHO KNOWS SPINES.
THAT DOESN'T MEAN YOU'RE
HEADING FOR SURGERY.
IT DOESN'T MEAN ANYTHING BAD
IS GOING TO HAPPEN, BUT IT
MIGHT BE THERE ARE
CONDITIONS THAT COULD BE
ADDRESSED MORE DIRECTLY.
IN THE EARLY GOING, FIRST
TWO, THREE MONTHS, CHANCES
ARE GOOD YOU'LL GET BETTER.
WHEN YOU'RE AT FOUR, MAYBE
FIVE MONTHS OF LEG PAIN.
THE LEG PAIN IS THE DOMINANT
PAIN, THEN I THINK IT'S TIME
TO HAVE SOMEBODY HAVE A
LOOKSY.

Maureen says OKAY.
COLLEEN THANK YOU.

She reads from a nearby computer screen and says
E-MAIL FROM JACKIE.
BOTH OF MY KNEES LOCK WHICH
IS VERY PAINFUL.
I THEREFORE, DO NOT KNEEL
OUR BEND AT MY KNEES.
I'M ON A WAITING LIST TO SEE
A SPECIALIST.
WHAT CAN CAUSE THIS?
COULD SURGERY HELP ME?
I'M 35 YEARS OLD?

Hall says THAT'S A WONDERFUL QUESTION.
WHEN I TEACH THE MEDICAL
STUDENTS ABOUT KNEE PAIN,
THERE ARE TWO TERMS THAT
PATIENTS WITH KNEES USE ALL
THE TIME.
ONE IS LOCKING AND THE OTHER
IS GIVING WAY.

Maureen says OKAY.

Hall says NOW, THEY ARE CRITICALLY
IMPORTANT TO UNDERSTAND WHAT
IS ACTUALLY MEANT BY THE
TERM.
TRUE LOCKING IS LIKE PUTTING
A DOORSTOP BEHIND A DOOR.
YOU GO TO OPEN IT, AND IT
WILL NOT OPEN.
IT ISN'T NECESSARY PAINFUL.
IT JUST WENT MOVE.
IT'S LOCKED, AND NOTHING YOU
CAN DO -- NOTHING ANYONE
ELSE CAN DO CAN STRAIGHTEN.
ONE REASON A KNEE LOCKS IS A
TORN CARTILAGE, TORN LIGAMENT
AND A LOOSE PIECE OF
SOMETHING FLOATING AROUND
INSIDE.
TRUE LOCKING IS SOMETHING
WHICH OFTEN REQUIRES A
SURGICAL CORRECTION.
THESE DAYS IT'S
ARTHROSCOPIC.
WE CAN FIX THE THINGS
WITHOUT GOING IN, AT LEAST
WITHOUT A BIG CUT.
MORE OFTEN, MUCH MORE OFTEN.
I SUSPECT HEARING THE LITTLE
STORY FROM THE E-MAIL HERE
IS NOT LOCKING AT ALL.
IT'S A SUDDEN, PAINFUL GRAB.
YOU GO TO MOVE THE KNEE AND,
BOY, DOES IT HURT.
I'M NOT GOING TO MOVE THAT.
IF I SAID TO YOU, CAN YOU --
OR IF I FORCED YOU, IT WOULD
STILL MOVE, AS PAINFUL AS
THAT MIGHT BE.
SIT IN A THEATRE FOR TWO
HOURS IN A TIGHT ROW, GO TO
STAND UP AND THE KNEE IS
VERY PAINFUL AND YOU GO TO
STRAIGHTEN IT, I CAN'T
STRAIGHTEN MY KNEE, IT'S TOO
PAIN.
IT'S NOT LOCKED, IT'S PAIN,
INHIBITED BY PAIN.
THAT'S A VERY DIFFERENT
SITUATION.
THE COMMONEST CAUSE OF THAT
IN A WOMAN IN HER 30s IS A
RUBBING BETWEEN THE KNEECAP
AND THE FRONT OF THIGH BONE.
WHEN THE KNEECAP SLIDES BACK
AND FORTH IT GRATES AND
THESE PEOPLE GET A PAIN
THAT'S AGGRAVATED BY
KNEELING, PARTICULARLY BAD
WHEN THEY'VE BEEN SITTING OR
IMMOBILE FOR A LONG PERIOD
OF TIME.
THEY GO TO MOVE IT AND, BOY,
DOES IT HURT.
AS THEY LOOSEN UP AND
EXERCISE IT TENDS TO GET
BETTER UNTIL NEXT TIME.
IT'S A RECURRENT, CONSTANT
THING.
SIMPLE ANTI-INFLAMMATORIES
HELP, ALTHOUGH THEY'RE OFTEN
NOT EVEN NECESSARY.
WHAT HELPS MOST OF ALL --
THIS TAKES ME BACK TO WHERE
WE STARTED IS STRENGTHENING
THE QUAD, PARTICULARLY THE
MUSCLE ON THE INSIDE OF
THIGH.
THE TECHNICAL TERM IS THE --
IT MEANS THE MUSS 8 ON THE --
MUSCLE ON THE INSIDE OF YOUR
THIGH.
STRENGTHEN THAT MUSCLE AND
IT DOES WONDERING TOWARD
THIS KNEECAP TYPE OF LOCKING
PAIN.
INCIDENTALLY THE SECOND TERM
I MENTIONED, GIVING WAY.
IT'S ANOTHER ONE PEOPLE
MISUSE.
PEOPLE SAY, MY KNEE GIVES
WAY.
TRUE GIVING WAY MEANS
THERE'S SOMETHING TERRIBLY
LOOSE IN THERE, AGAIN, A
LIGAMENT, LOOSE BODY,
SOMETHING'S HAPPENED.
MOST PEOPLE'S KNEES DON'T
ACTUALLY GIVE WAY, THEY JUST
FEEL WOBBLY.
THAT CAN BE CAUSED FROM THE
SAME SORT OF KNEECAP PAIN OR
A NUMBER OF OTHER THINGS.
WHAT I TELL THE STUDENTS AND
WHAT I ASK THE PATIENTS.
I SAY, TRUE GIVING WAY OF
THE KNEE MEANS YOU HAVE
GRAVEL MARKS ON YOUR
FOREHEAD BECAUSE YOU HAVE TO
GO ALL THE WAY DOWN.
IF YOU CATCH YOURSELF -- YOU
KNOW, IT GIVES WAYS SIX
TIMES A DAY, BUT I NEVER
FALL.
SIX TIMES A DAY YOU GET THAT
WOBBLE, BUT IT'S NOT TRUE
GIVING WAY.
THE TRUE USE OF THOSE WORDS,
LOCKING AND GIVING WAY, ARE
CRITICALLY IMPORTANT BECAUSE
IT CHANGES EVERYTHING ON THE
TREATMENT.

Maureen says OKAY.
WE'RE TALKING WITH THE
BECOME DOCTOR, Dr. HAMILTON
HALL THIS AFTERNOON.
WE'RE TALKING ABOUT.
NECKS, KNEES AND BACK.
CALL US IN TORONTO AT
416-484-2327.
LONG DISTANCE, IT'S
1-888-411-1234.
Email is moretolife@tvo.org
ROB IS IN TORONTO. HI, ROB.

The Caller says HI THERE.
HOW ARE YOU?

Hall says GOOD, THANKS.

The Caller says Dr. HAMILTON.
I HAVE A BACK PROBLEM I HAVE
A LONG TIME AGO BASED ON MY
WORKING AS A RENAULTVATER.
I HAVE A DISPLACED HIP,
MEANING ONE MUSCLE HAD
GOTTEN SHORTER AND ONE
LONGER.
HE CORRECTED IT OVER AND
OVER AGAIN.
SINCE THEN I'VE SEEN TWO
OTHER CHIROPRACTORS.
I'VE SEEN A BACK SPECIALIST
AS WELL.
AT THE TIME IT DOESN'T
BOTHERING ME.
HE SAID, COME BACK WHEN IT
WAS.
I'M A RUNNER.
I LIKE TO RUN FOR MY
EXERCISE.
I THINK YOU SAID THE VERY,
VERY BASE OF MY SPINE, WHEN
I RUN, I TEND TO GET REALLY
TIGHT BACK THERE AND SITTING
AND GETTING UP, I'M REALLY,
REALLY TIGHT EVEN THOUGH I'M
FAIRLY FIT, I FIND THAT WHEN
I SIT FOR TOO LONG, WHEN I
GO TO GET UP, I'M LEANING
FORWARD, IT TAKES ME A WHILE
TO STRANGEEN OUT.
I'M WONDERING WHY IT'S
OCCURRING?

Hall says NUMBER ONE, IT'S NOT YOUR HIP.
WHATEVER THE HIP IS DOING,
IT'S NOT CAUSING YOU TO GET
STIFF WHEN YOU SIT AND BEND
FORWARD WHEN YOU STAND UP.
THE HIP JOINT IS A VERY
STABLE JOINT.
ALTHOUGH MANY PEOPLE TALK
ABOUT THEIR HIPS COMING OUT
OR BEING DISLOCATED OR -- OR
WHATEVER TERM IS USED, THE
REALITY IS THAT THE HIP
JOINT IS EXTREMELY DIFFICULT
TO CHANGE AND IT CAN WEAR
OUT, CERTAINLY, BUT THIS
IDEA IT POPS IN AND OUT OF
PLACE IS NOT TRUE.
I OFTEN SAY, WELL, MY ELBOW
IS VERY UNSTABLE AND MY ARM
IS FALLING OFF.
PEOPLE THINK THAT'S FUNNY,
BUT IT'S NO MORE FUNNY
THINKING THAT YOUR HIP GOES
IN AND OUT OF JOINT.
THE STIFFNESS AFTER SITTING
IS ALMOST CERTAINLY TO BE
DISK-TYPE BACK PAIN.
PATTERN ONE BECAUSE IT'S THE
MOST PATTERN PAIN.
IT'S A PATTERN OF PAIN THAT
IS AGGRAVATED BY SITTING, BY
FORWARD BENDING.
IF YOU WORK AT A LOW LEVEL
FOR A PERIOD OF TIME, YOUR
BACK WILL BOTHER YOU.
PEOPLE SAY, I CAN'T DO
DISHES OVER THE SINK FOR ANY
LENGTH OF TIME.
CERTAINLY, IF YOU'RE WORKING
IN RENOVATION AND YOU FIND
YOURSELF HAVING TO WORK AT A
LOW LEVEL AT THE END OF THAT
PERIOD, YOUR BACK WILL BE
SORE.
RUN WILLING AGGRAVATE IT
SIMPLY BECAUSE YOU'RE
JARRING THE DISK.
IF YOU'RE OUT THERE POUNDING
THE PAVEMENT, THE DISC WILL
TAKE THE SHOCK AND IT CAN,
OVER TIME, GET SORE.
YOU ARE NOT HARMING YOUR
BACK.
THAT'S THE MOST IMPORTANT
SINGLE THING TO HEAR.
YOU'RE DOING NO DAMAGE.
NATURE WILL WEAR THE DISC
OUT, NATURE WILL FIX THE
DISC AGAIN AS YOU GET OLDER,
THAT'S NA. THERE'S NOTHING
YOU CAN DO, SHORT OF GETTING
HIT BY A BUS, THAT IS GOING
TO DAMAGE YOUR SPINE.
IF YOU WANT AN EXERCISE
ROUTINE TO GO WITH YOUR
RUNNING, THE FIRST AND
FOREMOST THING IS YOU GOT TO
DEVELOP YOUR ABDOMINAL
STRENGTH.
IF YOU CAN'T DO 30 OR 40
WITHOUT YOUR FEET BEING HELD
DOWN, THEN I WOULD SUGGEST
THAT PART OF THE RUNNING
FITNESS PROGRAMME ADDS THAT.
NUMBER TWO, YOU NEED TO HAVE
STRONG MUSCLES ALONG THE
SPINE.
THERE'S A SERIES OF
EXERCISES WHERE YOU LIE FACE
DOWN, USUALLY OVER THE END
OF A BENCH OR A MACHINE, AND
YOU COME UP TO HORIZONTAL SO
YOU'RE RAISING YOURSELF UP
TO STRAIGHT STRENGTHENING
THE MUSCLES ALONG THE BACK.
INCORPORATE THAT INTO YOUR
FITNESS PROGRAMME, YOU'LL
FIND RUNNING IS EASIER AND,
NO, YOUR NOT HARMING
YOURSELF.
IT'S NOT THE HIP TO BEGIN
WITH NOR LIKELY IS IT THE SI
JOINT.
PEOPLE BLAME THE SI FOR A
LOT OF THINGS.
THAT'S PROBABLY THE ONLY
TIME WE'RE GOING TO HAVE TO
TALK ABOUT IT TODAY.

Maureen says IF HE LIKES RUNNING, YES,
IT MIGHT AGGRAVATE THE PAIN,
BUT HE'S NOT HARMING THE
BACK.

Hall says THE EXERCISES WILL REDUCE
THE PAIN.

Maureen says OKAY.
THANK YOU VERY MUCH.
WARD IN St. CATHARINES IS
NEXT.
HI, WARD.

The Caller says HI THERE.

Maureen says HI.

The Caller says Dr. HALL, I HAVE TWO
PROBLEMS, ONE, A
LONG-STANDING PROBLEM WITH
MY SPINE.
I ALSO HAVE AN OLD BACK
INJURY AND AN MRI HAS SHOWN
I HAVE A BULGING DISC AND
NERVE PINCH AT L OF 4 AND
L-5.
I'VE HEARD DISCUSSED ON
AMERICAN TELEVISION THEY
HAVE A NEW HEAT PROCESS
CALLED ENTER DISCAL THERMAL
THERAPY WRITE THEY INJECT A
WIRE INTO THE DISC, HEAT THE
DISC UP TO 10 DEGREES AND
THE DISC WILL SHA RINK BACK
INTO ITS ORIGINAL SIZE OR
LOCATION.
OVER 80 percent SUCCESS RATE.
I CAN'T FIND ANYBODY THAT
KNOWS ANYTHING ABOUT THIS
HERE IN ONTARIO.
I'M WONDERING IF YOU'VE
HEARD AND IF YOU KNOW WRITE
MIGHT GO TO TRY TO FIND SOME
HELP HERE.

Hall says WELL, IT'S CALLED --
DOCTORS HAVE TROUBLE
PRONOUNCING THESE BIG WORDS.
IT'S A SYSTEM OF TREATMENT
THAT'S COME OUT OF
CALIFORNIA AND I KNOW A
GREAT DEAL ABOUT IT.

Maureen says WHY?

Hall says MUCH MORE THAN I WANT TO KNOW.
BECAUSE IT'S BECOME A VERY
HOT TOPIC.
IT WAS PUBLISHED IN “TIME.”
MAGAZINE BEFORE IT WAS EVER
PUBLISHED IN THE SCIENTIFIC
LITERATURE.

Maureen says IS THAT A WARNING SIGN?

Hall says YES, IT IS A WARNING SIGN.
THE RESEARCH ON IT IS JUST
NOW BEING DONE.
THERE'S NEVER BEEN A GOOD
PROSPECT, THAT IS TO SAY,
PLAN AHEAD, CONTROLLED TRIAL
WHERE ONE GROUP DOES AND ONE
GROUP DOESN'T.
ALL PUBLISHED STUDIES, AND
THERE AREN'T MANY, HAVE
TAKEN PEOPLE ALREADY HAVING
HAD IT AND SAID, WHAT DO YOU
THINK ABOUT IT?
HALF SAID, I FELT PRETTY
GOOD.
THERE'S NO LONG-TERM OUTCOME
YET.
THERE'S A GROUP IN THE
STATES -- I WANT TO BE
CAREFUL HERE BECAUSE THIS IS
POLITICALLY A HOT TOPIC.
THERE ARE A LOT OF LAWYERS
BUZZING AROUND THIS THING.
THERE'S A GROUP IN THE
STATES WHO HAVE NOT YET
PUBLISHED THEIR RESULTS, BUT
WHO HAVE COME OUT WITH THE
FACT THAT LONG TERM, AND
THIS IS OVER 18 MONTHS, IT
DOES NOT WORK.
SORT OF USUAL QUESTIONS.
WOULD I DO IT MYSELF, WOULD
I HAVE IT DONE TO ME, WOULD
I LET MY MOTHER HAVE IT
DONE?
THE ANSWER IS, NO.

Maureen says WHO'S DOING IT?

Hall says IT'S ACTUALLY BEING DONE
BY RADIOLOGISTS.
ALL THAT IS REQUIRED IS A
NEEDLE TO BE PUT INTO THE
DISC.
THEY NEED A WIRE LEAD
THROUGH IT.
THE WIRE CURLS UP INSIDE THE
DISC.
THE CALLER ACTUALLY
DESCRIBED IT QUITE WELL AND
THEN THEY HEAT THE WIRE.
NOW, THERE'S A COUPLE OF
THINGS TO CONSIDER.
HEATING THE PROTEIN IN THE
DISC IS VERY MUCH LIKE
COOKING AN EGG.
IT CHANGES THE NATURE OF THE
PROTEIN, BUT IT DOES NOT
NECESSARILY MAKE IT
STRONGER.
YOU KNOW, THERE'S NO PROOF
THAT I-DEBT ACTUALLY DOES
SHRINK THE DISC.
IT JUST CHANGES THE CHEMICAL
COMPOSITION.
ALTHOUGH THAT CHANGE MAY
TEMPORARILY KILL OFF THE
PAIN ENDS, DOESN'T DO
ANYTHING TO STRENGTHEN THE
DISC.
IT MIGHT, IN FACT, WEAKEN
IT.

Maureen says IS IT APPROVED IN CANADA?

Hall says NO.
IT'S EXPERIMENTAL IN BOTH
THE STATES AND CANADA.
IT'S BEING WIDELY DONE IN
THE STATES.

Maureen says IF WARD WANTED TO BE PART
OF A CLINICAL TRIAL OR
SOMETHING, DOES HE HAVE ANY
OPTIONS THERE?

Hall says NOT IN THIS COUNTRY.
IF HE WANTS TO BE PART OF A
CLINICAL I-DEBT TRIAL, HE'D
HAVE TO GO DOWN TO THE U.S.
IT'S 7,000 U.S. TO HAVE A
NEEDLE PUT.
IN IT'S A LOT OF MONEY FOR A
TREATMENT THAT MAYBE DOESN'T
HAVE ANY LASTING VALUE.

Maureen says OKAY.
THANK YOU, WARD FOR THE
QUESTION.
SPEAKING OF SORT OF CLINICAL
TRIALS, ALONG THOSE LINES,
CLAUS IN ETOBICOKE HEARD YOU
SAY GROWING CARTILAGE IN THE
LAB.
I HAVE A TEAR IN THE -- I
VERY MUCH APPRECIATE OR BE
INTERESTED IN A NEW
TREATMENT?

Hall says WELL tissue REGROWING OF
CARTILAGE IS FOR THE SURFACE
OF THE BONE, NOT THE
CARTILAGE OF THE MENISCUS.
THE FELLOW WHO
SPEARHEADED IS NOW WORKING
IN THE STATES.
THE REPLACEMENT OF MENISCUS
IS BEING DONE IN THE RIGHT
INDICATIONS.
THIS IS A LIMITED
INDICATION.
WE NOW CAN, NOT ONLY SEW IT
UP, INSTEAD OF TAKING IT OUT,
WE CAN ACTUALLY REPLACE IT
WITH A CADAVER.
THE GROUP AT THE TORONTO
HOSPITAL, WESTERN HOSPITAL
AND THE GROUP AT THE
ORTHOPEDIC AND ARTHRITIC
HOSPITAL ARE BOTH DOING
THOSE.
THE O and A AND TORONTO
WESTERN ARE DOING IT.
NOW, LET ME STRESS THIS IS
USEFUL ONLY IN A VERY
PARTICULAR TYPE OF PATIENT
AT A VERY PARTICULAR TIME.
EVERYBODY WITH SORE KNEES
DOESN'T RUSH IN AND HAVE IT
PUT BACK.
IN THERE'S A PLACE FOR IT
AND THERE ARE AT LEAST TWO
CENTRES IN THE UNIVERSITY
THAT ARE ACTIVELY DOING THIS
NOW.

Maureen says OKAY.
THANKS A LOT FOR QUESTION.
MATTHEW IS IN KINGSTON.
HI, MATTHEW.

The Caller says HOW ARE YOU?

Maureen says GOOD, THANKS.
YOUR QUESTION FOR Dr. HALL?

The Caller says MY QUESTION IS IN APRIL I
HAD KNEE SURGERY.
I WAS PLAYING HOCKEY AND I
TORE MY ACL AND MY MCL.
I CAN'T -- DISH COULDN'T GET
TO PHYSIO ALL THE TIME
BECAUSE I WORK, I'M JUST A
STUDENT.
I HAD TO SKIP OUT ON PHYSIO
AND I'VE BEEN DOING A
HOME-DAY CARE.
WHEN I SQUAT DOWN, I CAN'T
GET THE ONE BAD LEG OR THE
BAD KNEE TO GO ALL WAY TO MY
BUTTOCKS.
I'M WONDERING IF IT WILL
EVENTUALLY BEND BACK TO ITS
NORMAL --

Hall says DO YOU KNOW WHAT SURGERY
YOU HAD DONE?

The Caller says I HAD THREE HOLES IN MY KNEE.

Hall says WELL, YOU SEE,
UNFORTUNATELY, I CAN'T TELL
YOU, FOR SURE, BECAUSE I
DON'T KNOW WHAT THEY DID.
THEY MAY HAVE REPAIRED THE
LIGAMENT, ALTHOUGH NORMALLY
THESE DAYS WE REPLACE THEM,
WE DON'T REPAIR THEM.
THE MCL, WHICH IS THE
LIGAMENT ON THE INSIDE OF
THE KNEE, OUTSIDE THE JOINT
THAT, ONE HEALS BY ITSELF.
THERE'S A LOT OF EVIDENCE
YOU DON'T HAVE TO OPERATE ON
THE MCL.
THEY GET BETTER.
THEY MAY HAVE GONE IN AND
CLEANED UP THE TORN BITS AND
LET NATURE DO THE REST, AND
THAT'S PERFECTLY ACCEPTABLE,
TOO.
THE THING THAT MOST PEOPLE
LOSE AFTER ANY KIND OF KNEE
SURGERY IS THE LAST FEW
DEGREES OF GOING PERFECTLY
STRAIGHT SO THAT INSTEAD OF
THE KNEE GOING OUT STRAKTLY
STRAIGHT IT STOPS FIVE
DEGREES SHONCHT -- SHORT.
THAT'S SOMETHING YOU NEED TO
REALLY WORK AT.
YOU CAN DO THAT BY PRESSING
DOWN ON IT OR LIE ON YOUR
STOMACH AND TRY TO FORCE IT
TO GO STRAIGHT.
THE OTHER IS THE LAST FULL
DEGREES OF FULL BEND.
ONCE YOU GO PAST 120 DEGREES
OF FLEXION WHICH IS WELL
PAST A RIGHT AINGE 8, IT'S
WELL UP.
MOST KNEES ARE functional.
UNLESS YOU GOT UNUSUAL
REQUIREMENT, MOST OF US CAN
LIVE WITHOUT THAT ABILITY.
WILL YOU GET IT BACK.
IT WILL REQUIRE A GREAT DEAL
OF STRETCHING.
THE SECRET TO STRETCHING IS
YOU DO IT OFTEN.
MOST PEOPLE GET A STRETCHING
PROGRAMME WHERE THEY TRY TO
BEND THEIR KNEE FULLY AND
YOU GET IT STARTED.
THEY DO IT ONCE A DAY.
THAT'S A WASTE OF TIME.
IF YOU'RE GOING TO STRETCH,
YOU STRETCH ALMOST HOURLY
FOR SEVERAL REPETITIONS, SAY
TEN, YOU DO THIS ONCE AN
HOUR ALL DAY LONG.
YOU'LL FIND EVEN THE COURSE
OVER THE COURSE OF A WEEK OR
TWO, THERE WILL BE A GAIN
AND YOU WILL GET SOME
INCREASED RANGE.
WHETHER IT COMES ALL WAY
BACK DEPENDS ON THE DAMAGE
AND DEPENDS ON WHAT THEY DID
TO REPAIR IT.
YOU DON'T NEED TO GO TO
PHYSIO TO DO THE STRETCHING.
THEY ENCOURAGE, THEY EDUCATE
AND THEY MAKE SURE YOU'RE
DOING WHAT YOU'RE SUPPOSED
TO DO.
IF YOU'RE WILLING TO TAKE ON
THAT RESPONSIBILITY, THEN DO
IT YOURSELF BUT DO IT OFTEN
AND FREQUENTLY ENOUGH THAT
THE STRETCH CARRIES FROM ONE
SESSION TO THE NEXT.

Maureen says YEAH, YOU KNOW, WHEN YOU
TALK ABOUT PHYSIO AND THE
COMMITMENT, IT SEEMS WE HAVE
A WHOLE RANGE OF PEOPLE WE
CAN SEE.
PHYSIO IS FOR PEOPLE WHO ARE
WILLING TO WORK AT IT AT
HOME.
SURGERY IS WHAT A LOT OF --
OH, I DON'T WANT TO DO ALL
THAT.
JUST OPERATE ON ME.
CHIROPRACTORS WANT US TO
COME BACK EVERY TWO WEEKS
AND THEY'LL DO IT FOR US.

Hall says THERE'S THIS BIG
DIFFERENCE BETWEEN PASSIVE
AND ACTIVE THERAPY.
WHAT PEOPLE DON'T REALIZE IS
THAT SURGERY IS THE ULTIMATE
PASSIVE THERAPY.
ALL YOU DO IS GO TO SLEEP
AND I'LL DO EVERYTHING ELSE
FOR YOU.
UNFORTUNATELY, IT WORKS FOR
WHAT'S IT'S SUPPOSED TO DO
LIKE FIXING A BUNION, BUT IT
DOESN'T DO REHAB.
PEOPLE HAVE TO TAKE THAT
RESPONSIBILITY.
LIKE THE KNEES, YOU KNOW IF,
YOU WANT A GOOD RESULT FROM
A KNEE REPLACEMENT, THEN YOU
COMMITMENT YOURSELF TO
MONTHS OF DILIGENT, HARD
WORK AND, YOU KNOW, I HAD A
PATIENT NOT THAT LONG AGO
WHO LEFT THE HOSPITAL WITH
LESS THAN SATISFACTORY RANGE
AND EVERY DAY I'D GO IN AND
SAY -- HE'D SAY, I'LL DO IT
TOMORROW.
TOMORROW WILL BE GOOD
ENOUGH.
IN THE END, HE BEGAN TO
STIFFEN.
THERE WAS NOTHING WE COULD
DO -- I COULD PUT HIM TO
SLEEP AND I CAN MOVE IT FOR
HIM.

Maureen says I DON'T KNOW THAT'S A
GOOD USE OF OUR HEALTH-CARE
DOLLARS.

Hall says WELL, IT'S OCCASIONALLY
NECESSARY.
OF COURSE, WHEN HE WAKES UP,
HIS KNEE IS VERY PAINFUL
BECAUSE I PUT IT THROUGH A
FULL RANGE OF MOVEMENT AND
GUESS WHAT?
HE HAS TO START MOVING IT.

Maureen says HOW LONG IS THE HOSPITAL
STAY FOR A KNEE REPLACEMENT?

Hall says THE ACUTE-BED STAY IS NO
MORE THAN THREE OR FOUR DAY.
IT'S VERY QUICK.
THE REHAB DEPENDS ON YOU.
IT CAN BE DONE AS AN
OUTPATIENT.
WE HAVE A FACILITY AT THE
ORTHOPEDIC AND ARTHRITIC
WHERE YOU CAN GO TO THE
CONVALESCENT SIDE.
YOU SPEND YOUR DAY
EXERCISING.

Maureen says YEAH.

Hall says FOR A KNEE AND FOR HIP, TOO.
ACTIVE-TREATMENT BEDS STAY
FOUR DAYS IS PLENTY.

Maureen says I'M SURPRISED YOU LET
THEM STAY THAT LONG.
WITH MY BUNION IT WAS, LIKE,
YOU'RE AWAKE, GOOD-BYE.

Hall says THAT WAS A BUNION.

Maureen says LET'S GO TO RICHARD IN
MISSISSAUGA.
HI, RICHARD.

The Caller says HI.

Maureen says HI.

The Caller says I'VE HAD REALLY SEVERE
LOWER BACK PAIN FOR THE PAST
TWO WEEKS.
I FINALLY WENT TO MY DOCTOR
TODAY AND HE GAVE ME
ANTI-INFLAMMATORIES.
WHAT'S THE BEST THING I CAN
DO TO GET OVER THIS AND WHAT
CAN I DO TO PREVENT IT FROM
HAPPENING AGAIN?

Hall says YOU CAN'T PREVENT IT FROM
HAPPENING AGAIN.
EVEN GOOD DRIVERS HAVE
ACCIDENTS.
I CAN'T PROMISE YOU'LL NEVER
HAVE AN ATTACK OF BACK PAIN
AGAIN.
FIRST QUESTION, THAT DEPENDS
VERY MUCH ON WHAT THE
MOVEMENT IS THAT MAKES THE
PAIN WORSE.
MY FIRST QUESTION THE TO YOU
IS says IS YOUR BACK PAIN MORE
AGGRAVATED WHEN YOU TRY TO
TOUCH YOUR TOES OR WHEN YOU
WANT TO LOOK UP AT THE
CEILING?

The Caller says NEITHER ONE.
IT'S A CONSTANT THROBBING
LIKE A HEADACHE, IF YOU WILL,
BUT IN THE BACK, CONSTANTLY
ON THE LOWER RIGHT SIDE.

Hall says WHEN YOU SIT?

The Caller says SITTING IS WORSE, DRIVING
IS NIGHTMARE.
YOU'RE A PATTERN ONE.
THAT'S AN EASY THING.
WHAT YOU DO IS YOU LIE ON
THE FLOOR ON YOUR STOMACH.
THAT'S STEP ONE.
YOU REST THAT WAY -- IF
YOU'RE VERY ACUTE, YOU MAY
ACTUALLY HAVE TO LIE OVER A
PILLOW AND PUT YOUR PELVIS
OVER THE PILLOW SO YOU'RE
LYING OVER A HUMP.
YOU GET INTO THAT POSITION
AND GRADUALLY PUSH YOUR
SHOULDERS UP, USING YOUR
HANDS.
YOU PUSH YOUR SHOULDERS UP
LIKE PUSHING DOWN ON THE
FLOOR EXCEPT DON'T LET YOU
HIPS COME OFF THE FLOOR.
YOU GOT TO FORCE YOUR BACK
TO ARCH.
IN THE ACUTE GOING, FOR SOME,
IT WORKS AMAZINGLY WELL,
VERY QUICKLY.
THEY DO THIS A FEW TIMES AND
THEY PAIN STARTS TO SUBSIDE.
FOR OTHERS, YOU GOT TO GO
SLOWLY BECAUSE IT HURTS EVEN
TO TRY TO MOVE IT'S SO
STIFF.
YOU CAN'T HARM IT.
THIS IS, AGAIN, STRETCHING
IS HOURLY, YOU KNOW, SEVERAL
REPS FIVE TO TEN IN AN HOUR.
IT WILL BE MORE EFFECTIVE
THAN THE ANTI-INFLAMMATORY
MEDICATION.
I SEE A LOT OF BACK PAIN
JUST LIKE THIS AND I RARELY
DO THE DRUGS BECAUSE IN MOST
CASES WITH UNDERSTANDING OF
WHAT YOU HAVE TO DO, YOU CAN
BREAK THE CYCLE QUITE
QUICKLY.
I'M A PATTERN ONE BACK.
MY BACK PAIN IS PATTERN ONE,
SO I DO EXACTLY THE EXERCISE
I'M DESCRIBING TO YOU.
I HAD A BAD RUN AT THE START
OF THE SUMMER AND I CAN
BREAK THE CYCLE QUICKLY IF I
DO THE EXERCISES.

Maureen says PEOPLE DON'T REALIZE -- I
HAD TO DO THIS AS WELL --
YOU HAVE TO PUT A TOWEL TO
WORK AND PUT IT ON THE FLOOR
AND GET OFF YOUR SEAT AND
GET ON THE FLOOR AND DO THIS
EVERY HOUR NO MATTER WHAT
PEOPLE THINK YOU'RE DOING
DOWN THERE.

Hall says THE THING IS -- YOU,
MAUREEN, YOU KNOW THIS.
CHOICE ONE IS TO DO IT AND
GET BETTER.
CHOICE TWO IS NOT TO DO IT
AND KEEP HURTING.
YOU'RE NOT HARMING, YOUR
BACK IS NOT IN DANGER,
YOU'RE NOT GOING TO BE
CRIPPLED FOREVER.
YES, NATURE WILL GET IT
BETTER IN ITS OWN GOOD TIME.
SOME PEOPLE JUST ELECT NOT
TO DO THIS.
IT'S TOO MUCH TROUBLE; IT'S
TOO EMBARRASSING SO THEY
HAVE TO PAY THE PRICE OF
HURTING LONGER.
IF YOU WANT -- AND YOUR
QUESTION WAS, HOW DO I GET
OUT OF IT?
THIS IS HOW YOU GET OUT OF
IT.
WATCH YOUR SITTING POSTURE.
YOU NEED A CUSHION, A SPONGE
ROLL IN THE SMALL OF YOUR
BACK TO ARCH YOUR BACK WHEN
YOU SIT AND DRIVE.
YOU DON'T NEED TO BY AN
EXPENSIVE DEVICE.
YOU NEED TO BE ABLE TO
MAINTAIN THAT POSITION, THAT
PROPER ARCHED POSITION ALL
DAY LONG.
THE MORE YOU DO THAT AND THE
MORE YOU STRETCH, THE
QUICKER YOU BREAK OUT OF
THIS TYPICAL PATTERN-ONE
PAIN.

Maureen says THANKS, RICHARD.
E-MAIL FROM JOHN says LIFE
EXPECTANCY OF A REPLACEMENT
KNEE.
I'M 49 AND FRACTURED MY KNEE
TEN YEARS AGO AND ALSO HAD
COMPLICATIONS OF COMPARTMENT
SYNDROME IN THE CALF.
CAN I NOT LOCK THE KNEE WHEN
WALKING.
MY THIGH MUSCLES HAVE
ATROPHIED.
WOULD A KNEE REPLACEMENT
LAST 25 YEARS?

Hall says THE ANSWER TO THE SECOND
PART IS PROBABLY.
THE ANSWER TO THE FIRST PART
IS IT'S PROBABLY NOT THE
RIGHT OPERATION.
THERE'S A LOT GOING ON IN
THAT KNEE.
THE COMPARTMENT SYNDROME IS
THE DEATH OF MUSCLE DUE TO
SWELLING.
IT DOESN'T COME BACK,
UNFORTUNATELY.
THE INABILITY OF THE KNEE TO
LOCK -- YOU SEE THE KNEE
REPLACEMENT, IN EFFECT,
REPLACES THE KNEE YOU HAVE
NOW.
IF I WERE TO PUT IN A KNEE
REPLACEMENT, IT WOULD LOCK
EITHER.

Maureen says NO?

Hall says NO.
IT ISN'T MAGIC.
IT'S RESURFACING.
ALL WE DO WHEN WE REPLACE A
KNEE IS REPLACE THE
SURFACES.
A KNEE THAT HURTS A LOT AND
GETS A NEW JOINT DOES
EXTREMELY WELL.
A KNEE THAT'S STIFF AND GETS
A NEW JOINT STAYS STIFF.
A KNEE THAT'S UNSTABLE AND
GETS A NEW JOINT TENDS TO
STAY UNSTABLE.
YES, IT CAN BE DONE.
TECHNICALLY WE CAN PUT THEM
IN ANYBODY.
IN THAT PARTICULAR KNEE,
FROM WHAT LITTLE WE'VE HEARD,
WOULD BY OPTIMISTIC OF 25
YEARS?
NO.
IN FACT THERE WOULD BE
ARGUMENT IT PROBABLY ISN'T
THE RIGHT THING TO DO AT
ALL.
IF I TAKE JUST IN ISLATION,
DO TOTAL KNEES LAST?
YES THEY DO.
BOTH THE HIPS AND KNEES ARE
BETTER AND BETTER.
THE REALLY EXCITING NEWS AND
THIS IS SOMETHING I TELL ALL
PATIENTS, THE REPLACEMENT --
LIKE, WHEN YOU GO BACK AND
HAVE YOUR SECOND ONE, IF
YOUR FIRST ONE WEARS OUT,
THE REPLACEMENT KNEE AND HIP
SURGERY IS ALMOST AS GOOD
NOW AS THE FIRST TIME.

Maureen says THEY CALL IT A RE-DO?

Hall says YEAH.
THE RE-DOS, BACK WHEN WE
STARTED THIS MANY YEARS
ORGANIZATION WEREN'T VERY
GOOD.
THE RE-DOS NOW ARE GOOD
ENOUGH THAT IF I CAN GET YOU
15 YEARS ON YOUR FIRST ONE,
CAN I PRETTY MUCH TELL YOU
YOU'RE GOING TO GET 15 YEARS
ON YOUR SECOND ONE.

Maureen says IN JOHN'S CASE, WHAT'S
HIS FIRST STEP?
WHAT DOES HE IS A DOCTOR?

Hall says WELL, IT ISN'T SO MUCH --
HE'S GOT A BAD KNEE.
THE KNEE IS HELD TOGETHER
WITH PLATES AND SCREWS THE
SURFACES HAVE BEEN
DESTROYED.
IF HE WERE TO HAVE IT
REPLACED, THE KIND OF
SURGERY INVOLVED HERE IS NOT
THE SIMPLE RESURFACING.
WE GOT FANCY HINGES WE CAN
PUT.
IN THEY DON'T WORK WELL.
THE KNEE IS A COMPLICATED
MOVEMENT, MUCH MORE THAN
HINGING.
THE HINGE JOINTS AREN'T AS
GOOD.
IF HE'S TO THE POINT WHERE
THAT KNEE IS THE THING -- HE
JUST CAN'T WALK AT ALL, THEN
YOU'RE LOOKING AT SOME
PRETTY DRAMATIC SURGERY,
INCLUDING IN THE OLD DAYS,
CERTAINLY, FUSING IT.
JUST GETTING RID OF THE
MOVEMENT COMPLETELY, BUT
GIVING HIM A STIFF LEG THAT
DOESN'T HURT.
THAT'S A DRAMATIC AND
TERMINAL STEP AND NOT ONE I
WOULD EASILY RECOMMEND.
I GUESS WHAT I'M SAYING IS
IN THAT STORY THERE IS NO
SIMPLE, LET'S GO HAVE A
TOTAL KNEE AND I'LL BE FINE
AT 49.
WHETHER THAT KNEE MIGHT HAVE
LASTED 25 YEARS OR NOT IS
ALMOST IRRELEVANT.

Maureen says GOTCHA.
SHARON IN MISSISSAUGA.
HI, SHARON.

The Caller says HI.

Maureen says HI.

The Caller says I HAD A DISCOTOMY JULY 10th.
I HAD SEVERE SPASMS AFTER
THE SURGERY.
I'VE BEEN SWIMMING -- MY
NEUROSURGEON TOLD ME TO
SWIM.
HE DOESN'T WANT ME TO GO TO
PHYSIO.
I'M STILL WORSE THAN I WAS
BEFORE THE SURGERY.
I'M NOT UNDERSTANDING WHY.
HE SAYS HE THINKS I'LL JUST
AGGRAVATE IT.

Hall says WELL, FIRST OF ALL, HE'S
A GOOD NEUROSURGEON.
HE AND I TRAINED TOGETHER.
IT'S HARD TO BELIEVE, I LOOK
SO YOUNG AND HE'S SO MUCH
OLDER THAN I AM.
HE AND I ACTUALLY TRAINED AT
THE SAME TIME.
I'VE KNOWN HIM FOR MANY,
MANY YEARS.
HE'S AN OLD-SCHOOL
NEUROSURGEON THAT DOESN'T
BELIEVE IN NEUROSURGERY.
IN HIS DAY, PHYSIO WAS A HOT
PACK AND A THERAPIST THAT
DEPUTY KNOW WHAT TO DO.
MANY SURGEONS SHIED AWAY
FROM SENDING THEIR BACKS TO
PHYSIO.
NOW, IN THE CURRENT
SITUATION WHERE I THINK
PHYSIO CERTAINLY IN THE ONES
I WORK WITH ARE MORE SGNT
ABOUT WHAT NEEDS TO BE DONE.
IT'S A TRAINING ISSUE NOW.
IT'S AN EDUCATION ISSUE NOW.
I THINK PHYSIO HAS HAS A
ROLE TO PLAY.
I SEND MY SIMPLE DISCECTOMIES
TO ONE IN A WEEK.
I HAVE NO HESITATION ABOUT
SENDING.
IF YOU'RE NOT RESPONDING
WELL, THEN THERE MAY BE
SOMETHING ELSE HE'S
CONCERNED ABOUT OR SOMETHING
SUSPECT QUITE AS GOOD AS HE
HOPED IT WOULD BE.
IN THAT INSTANCE, MAYBE
PHYSIOISN'T GOING TO MAKE A
DIFFERENCE.
THE SPATIONM YOU TALK
ABOUT -- THE SPASM YOU TALK
ABOUT -- BACK SPASM?

The Caller says THEY WERE TORTURE.

Hall says IN YOUR BACK, NOT YOUR LEG?

The Caller says YEAH.

Hall says THAT HAPPENS IN 10 percent OF CASES.
WE ALL GET THEM.
THEY'RE JUST AWFUL.
THERE IS A POSSIBILITY OF AN
UNDERLYING PROBLEM, WHICH I
WOULD ASSUME HE'S RULED OUT
BY NOW.
NEVER THE ABSOLUTELY
UNCOMPLICATED, EVERYTHING
WENT GREAT SURGERY, 10 percent GET
THESE TERRIBLE BACK SPASMS
WHICH LAST ANYWHERE FROM A
COUPLE WEEKS TO A MONTH AND
THEN THEY DISAPPEAR.
BOY, THEY ARE NASTY AND YOU
JUST SORT OF RIDE IT OUT.
YOU SAY NOW YOU'RE NO BETTER
OR WORSE BEFORE THE SURGERY.
MY PRESUMPTION IS THE
SURGERY WAS DONE FOR LEG
BANE?

The Caller says YES.

Hall says BUT TO BE A GOOD
OPERATION -- OR TO WORK
WELL, THE LEG SHOULD BE
WORSE THAN THE BACK.
WE TALKED ABOUT THIS
EARLIER.
PINCHED-NERVE PAIN IS LEG
PAIN MORE THAN BACK PAIN.
IF IT'S BACK PAIN MORE THAN
LEG PAIN, THE SURGERY NOT
NEARLY AS EFFECTIVE.
I'M CAREFUL ON WHO I WILL DO
MY SURGERIES ON BECAUSE I
WANT THEIR LEG TO BE THEIR
TRUE SYMPTOM.

The Caller says THE LEG PAIN IS GONE.

Hall says OKAY.
IF THE LEG PAIN IS GONE, THE
SURGERY IS GOOD, HE'S DONE
THE RIGHT THING.
NOW, I THINK, AND YOU MIGHT
TELL HIM YOU HEARD ME SAY
THIS ON THE TELEVISION THAT,
A GOOD THERAPY, SOMEONE WHO
CAN EDUCATE AND TRAIN MIGHT
BE THE WAY TO GO AT THIS
LATE STAGE.

Maureen says OKAY.
WELL, GOOD.
WE DON'T OFTEN GET YOU TO
TALK TO YOUR COLLEAGUES
RIGHT OVER THE AIR, BUT
THAT'S GREAT.
THANK YOU FOR COMING IN.
Dr. HAMILTON HALL IS AN
ORTHOPEDIC SURGEON AND
AUTHOR OF “THE NEW BACK
DOCTOR.”
IT'S PUBLISHED BY BANTAM.
CONTACT THE CANADIAN BACK INSTITUTE.
THE PHONE NUMBER IS...

A slate reads “Canadian Back Institute. 1-800-463-2225. www.cbi.ca”

Maureen continues
And that’s our program for today. Thank you for your questions and for watching.
This is More to Life and we’re here Monday through Friday at 1 o’clock.

Watch: Back Pain