June 14th, 2014

Arms are pretty important things

Here’s an interesting article by Miles O’Brien about what it’s like living with only one arm after his had to be amputated.

Fortunately I haven’t had that experience. But readers of this blog may be aware that about 25 years ago I sustained serious nerve injuries to both arms, and underwent an arm surgery fifteen years ago that involved a very difficult recovery. I’ve written about the experience here, in case you missed it. But although I’m very lucky to have the use of both arms now, albeit with some restrictions and some pain and discomfort (especially if I exceed those restrictions), I well remember the years of extreme pain and disability, and the months of recovery when my right arm was nearly useless for most tasks.

It’s harder than most people might think. Even things you might not realize you need both arms for become very difficult—such as, for example, putting on one’s underwear. My elbow was completely frozen for several months, and in addition to terrible pain I couldn’t button my shirt or brush my teeth or touch my head or face with that arm or put deodorant under the other arm or…well, you get the idea. And my problem was merely temporary, although at the time it wasn’t clear that it wouldn’t be permanent.

Shortly after my surgery I had a vivid dream about my arm that I remember to this day. I dreamed it was a sort of Frankenstein-monster arm. In the dream it had been removed and another arm sewn on haphazardly, with those big jagged stitches you see in the movies. It was actually another person’s arm, not mine, and that was why it felt so alien and awful.

O’Brien had a different perception, one quite common among amputees: he had actually lost his arm and yet continued to feel it, and the sensations were often painful. This is the opposite of what happened to author and neurologist Oliver Sacks when he badly injured his leg: Sacks kept his leg but lost the feeling that he had it any more, or that it was attached to his body.

The mind is a funny thing, isn’t it? And yet these perceptions are not solely mental at all, they are interactions between mind and body after severe injury.

O’Brien also had the experience, post-amputation, of falling while running and then reaching out his phantom hand to break his fall. I’ll let him describe it:

It was nothing more than a slightly uneven sidewalk that took me down. No problem for a runner with two arms. In fact, this particular sidewalk is right behind my home, and I had negotiated it uneventfully for years. But here are two things you need to know about life after an arm amputation: First, your center of gravity changes dramatically when you are suddenly eight pounds lighter on one side of your body. Second, while my arm may be missing physically, it is there, just as it always has been, in my mind’s eye. I can feel every digit. I can even feel the watch that was always strapped to my left wrist. When I tripped, I reached reflexively to break my very real fall with my completely imaginary left hand. My fall was instead broken by my nose, and my nose was broken by my fall.

I’m not so sure it’s no problem for a runner—or walker—with two arms, either, because you may recall that something very similar happened to me about two years ago. It was an uneven sidewalk that took me down, too:

I was walking on a sidewalk that’s notoriously uneven, with periodic ridges where the blocks of pavement aren’t flush with each other, and then I was distracted by a group of four people walking nearby.

And so I tripped, with my toe catching on something-or-other. And for reasons I fail to understand even now—and probably wouldn’t be able to pinpoint unless I watched a slo-mo video of the proceedings—I fell hard and fast and was unable to effectively break my fall with my hands.

There was a strange moment when I sailed through the air, flailing a bit before I landed, knowing I was in a slight dive position with my head/face leading and probably likely to contact first. In that split-second, it was frightening to anticipate what might happen. My life didn’t flash through my mind, but questions like “will I have a concussion?” and “what will happen to my face?” certainly did.

I not only broke my nose but sustained other injuries to my face, most of which have healed better than I would have thought, although my already-deviated septum has departed even more than before from the straight and narrow. But although I fell with two arms, I completely failed to break my fall (except with my face), I think in part because I had to make a split-second decision and it is so deeply engrained in me over so many years not to put too much stress on my arms. My reflex now is not to use my arms, and I would have had to have somehow overriden that reflex.

But breaking your fall with your arms isn’t always such a hot idea, either. I have a friend who broke her fall—and her wrist—that way, and had to have surgery to repair the complex fracture and needed to wear a cast for many many months during her difficult recovery.

Best to be vigilant about those uneven sidewalks.

35 Responses to “Arms are pretty important things”

  1. Ray Says:

    I broke my left arm many years ago. I was amazed at all the things you couldn’t do with only one arm. For instance, putting on your trousers requires two hands. I had to get help to dress. I could put on my underpants with one hand but I couldn’t put on an undershirt.

  2. Ymarsakar Says:

    Normally I would use ukemi, break falls. If you have enough time, you can use an arm or shoulder as the beginning of a sphere rotation for your body. Thus your kinetic force from earth’s gravity is converted to rotational energy, and the impact damage is lost. It’s easier to do on grass than concrete, but it’s better than falling on concrete directly.

    In emergencies, tactical falls can also be used, such as where you spin on your butt or side hip joint. The rotational energy sucks out the impact energy, saving the joints.

    One time I was beam walking along this curb of a concrete separation, a few inches above the concrete. Putting one foot in front of the other. When I put one of my feet down, it slipped on the slightly wet surface or some moss, but because I’m used to balancing on one leg I merely automatically lowered my center of gravity via my connecting leg. This ended up with my butt on the concrete, but I didn’t fall left or right, even though I had my left hand ready to push down at the ground. It wasn’t necessary, it turned out.

    Tactical exercises allows the body to recover from catastrophic falls or unbalances, because it etches new motor control patterns in the brain, which the body’s instincts can use when it feels gravity’s danger.

    Because all the joints of the body and the body’s core is accessed to nullify the impact or momentum, a single joint like the wrist isn’t taking all the impact damage. For people that cannot use their arms, they’ll have to adapt existing methods to their current body, via practice.

  3. Jack Says:

    About ten years ago there was an ice storm here in Memphis, Tennessee. My girlfriend was determined to drive to work and I was just as determined that it was too dangerous. After the fight I decided that I’d drive her, seeing as how I’m a driving master and she … well … wasn’t. I slipped and slid across the parking lot and got to my car. I was trying to make the key go into an iced over lock with my feet slipped out from under me. Instead of putting my arms forward to catch my fall on the ground, I tried to break my fall by spreading my arms out and catching myself between my car and the car next to it.

    Big mistake. Both cars were totally iced and I did a face plant into the iced asphalt. When you put your arms out and expect to catch yourself and suddenly realize it’s not working a split second before impact, you don’t have time to be frightened. You don’t really even have time to brace yourself. You do have plenty of time to regret damned fate.

  4. Charles Says:

    ” . . . I couldn’t button my shirt or brush my teeth or touch my head or face with that arm or put deodorant under the other arm or…well, you get the idea.”

    I’m not sure if this is the idea that you are referring to or not, Neo; But, “cleaning yourself” is the worst thing that you cannot do. The absolute worst! And I was NOT going to ask someone else to clean me down there.

  5. neo-neocon Says:

    Charles:

    Actually, I could still do that. I still had one functional arm and hand, and that was all that was necessary.

    One of my problems, though, that I didn’t mention in the post, was that since my arm injuries were bilateral, my good arm that was also injured got very very stressed because it bore the brunt of all my arm activity during the time I was recuperating from the surgery. So the pain in my good arm flared up a lot.

  6. Jenk Says:

    Ymarkasar has a point–in a sudden fall it’s helpful if you have training you can rely upon. I used to play football and was trained to take hits and fall in such a way as to minimize injuries.

    About a year ago I tripped over an uneven portion of the sidewalk and fell face forward. Without thinking I broke the fall with my shoulder and rolled. The roll is the important part, as it dissipated the energy of the fall and helped to prevent a serious injury.

    Problem there was that I was carrying a briefcase; damn thing got between me and the pavement as I rolled. Ended up with some bruised ribs that hurt like Hell or about a week, but it could have been worse. I’m getting too old for this crap….

  7. Beverly Says:

    I was on crutches for a few weeks after foot surgery, and man, oh, man, there were things I didn’t think of.

    For instance: you make coffee in the morning, and you have to get it from the kitchen to the table. You need both hands for the crutch handles. You live alone. What do you do?

    I figured out some “workarounds”: if I had to get something from one end of my apartment to the other, I’d tie it in a sock and throw it, and crip along after. The coffee was solved by getting a closeable container and using a bag.

    But another thing I didn’t bargain on was how strenuous it is to use crutches to travel: you need to put your weight on your arms and hands and shoulders every other step, so just going the one long avenue block to the bank was like doing pushups all the way! I seriously wondered if I’d be able to get back to my apartment without collapsing! (I live in Manhattan; no car.)

  8. Beverly Says:

    Also, I was in my thirties at the time and lighter on my feet. It’d be a lot rougher now.

  9. AesopFan Says:

    A note on the positive side, for someone who does have permanent appendage problems: I fenced (in college; not well; but it was fun and got me some off-campus trips) – the top competitor in our area was pushing (or already over) 60 and only had one arm.
    He was nearly unbeatable. So, training and will-power can do a tremendous job of compensating.

  10. Ymarsakar Says:

    Both cars were totally iced and I did a face plant into the iced asphalt.

    If you got time to spread your arms wide, it’s often easier to to lock your forearms in front of your chest or throat, with palms connected at the palm and fingers pointing up.

    This is bio technically difficult for most people (that don’t do the exercise drills) because the arm can’t move that close to the center of the chest that way normally, due to the chest muscles.

    But that’s a landing platform that will protect the throat, chest, and face when falling straight down.

    The forearms will distribute the impact force to the elbow, and then the shoulders without the use of strength, so it is purely leverage based and doesn’t need reflexes or grip on objects. The palms or the back of the hand protects the eyes from fragments and edges, so there’s a few inches of hand tissue to stop blades from going into your face/eyes.

    The human body uses whatever it is most successful with, so if you have never successfully done this maneuver but you have caught things with your arm and stabilized yourself, your body naturally chooses what it remembers having used before, even if it isn’t the most effective tool.

    Modern fencing is designed to fight on one side of the body, using the left or right side as a direct line towards the foe. So long as you have two legs and one strong side, it can be specialized.

    Jenk,

    https://www.youtube.com/watch?v=7wV49Q9mpUI

    That’s the video I used to practice rolling, before I went on the aiki mats and had to do it at speed.

    Some people, for some strange reason, can’t easily control their center of gravity and rolling is uncontrolled for them.

    You may have done a barrel roll, so you were rolling over a rectangular suitcase. The aikido roll is designed to work with things in your hand. I’ve done it while holding a staff. Normally it’s supposed to be done holding a knife or sword. Modernly, it’s done holding nothing.

  11. Ymarsakar Says:

    One of the things I noticed myself doing when running (jogging) was that I looked at the ground all the time, especially when I was tired. That was my instinct saying “check for barbed wire, check for mines, check for holes, check for traps, and check for other dangerous things”. But physically, that’s the body language of someone not paying attention, for observers from afar. Someone who is always looking down is usually seen as being afraid to make eye contact with threats in the environment.

    My instincts and habits are often sourced from DNA evolution, which I’ve learned has good stuff, but I never know why it is the way it is. There’s no explanation coming from it.

  12. Jenk Says:

    If by “barrel roll” you meant hitting the ground with the shoulder and rolling with the impact to land flat on your back then that’s exactly what I did. I’m not sure how the aikido roll differs, but I’m glad I wasn’t carrying a sharp object–involuntary seppuku isn’t what I want on my death certificate…:)

  13. Ymarsakar Says:

    Jenk, wouldn’t that put the briefcase in your left or right hand, on top of you at the finish of the movement? How did it get caught under your ribs?

  14. br549 Says:

    Life can be devoid of things that make sense. A friend I knew in TN had a next door neighbor who was painting the gutters over his garage from a ladder. He slipped somehow, falling from his ladder to the concrete drive below him. Breaking his fall with his right hand caused a terrible break in his fore arm. The bones broke clean through, and stabbed his heart killing him right there. True story, that doesn’t make a particle of sense.

  15. Jenk Says:

    Slung over my shoulder by the strap–it stuck me as I rolled. Had it just been in my hand I probably would have just dropped it….

  16. Don Carlos Says:

    Rolling is key. It has to be done instinctively, reflexively, rapidly.

    One of my dogs tripped me up on my patio last year, ran into me while I was mid-step. As best I recall, I started my roll before I hit shoulder-first. If I’d not rolled, I would have fractured my shoulder at my rather advanced age. But I was uninjured.

  17. neo-neocon Says:

    Don Carlos:

    But when you’re diving with substantial force and speed face/head first to the pavement from not very far above it, and you have a tiny fraction of a second to do anything about it, I don’t see that there’s any way you can land on a shoulder instead and roll. There just doesn’t seem to be enough time to make the adjustment.

  18. Ymarsakar Says:

    and you have a tiny fraction of a second to do anything about it, I don’t see that there’s any way you can land on a shoulder instead and roll. There just doesn’t seem to be enough time to make the adjustment.

    In those situations the technique is to rotate on your side or hips. Instead of a circle starting from below with the legs and going over the shoulders, it is a horizontal spin, rotating the body on the axis or center of gravity of the hips. This is not ideal as it puts a significant amount of soft tissue into contact with the ground, grinding and creating friction.

    There are 3 general methods to dissipating kinetic force after it has been transformed from potential energy.

    1. Apply counter force by slap or movement in the opposite direction. The ground will apply this to whatever part of the body hits it, aka hitting the ground and stopping. If applied by the arms or limbs, the counter force reduces the impact force by negating gravity’s vector. The untrained method is to use whatever is available, but the technique can be refined and improved. Like slapping the ground just before one hits, while rotating, while distributing impact over a large surface area.

    2. Transforming vertical movement into the earth, into rotational movement. Because nothing’s stopping the rotation, the energy bleeds out in time instead of an impulse shock that delivers all kinetic energy in half a second.

    3. Internal breathing. By providing a sharp breath outwards, the lungs send a burst of oxygen to the muscles and guts, producing a cushion effect and reducing the transmission of force into the body’s water balloon like structure. So instead of a water balloon hitting the concrete and exploding, it instead just rolls around like a jelly.

    In the aikido roll, the arm is used to guide the body into a circular movement. Thus rolling on the shoulder that way requires more leg power to get the body started. But if you angle your arms, it doesn’t apply much force to the arms, and the arms begin the roll. So instead of using the palm to stop your entire body mass’s momentum down, the palm sends a reverse vector back into your body, your body starts leaning into the shoulder roll, and gravity takes care of the rest. This is often non intuitive, because you use the legs to pick forward, which would normally plant you into the ground faster, but with this, merely turns it into a circular movement.

    With a bit of training, so long as a person’s motor controls are average or above average in the brain center, this becomes pretty automatic. If a person starts consciously thinking of what to do when they are falling, it’s already too late for them. Even if their conscious mind figures out what is going on and how to apply the counter force, it’s too late to send the signals to the muscles.

  19. Don Carlos Says:

    That’s why it has to be instinctive; thinking is too slow. I was actually quite proud I could still be so quick!

    Of course, sometimes there is simply no way of escaping a bad outcome. It happens.

  20. waltj Says:

    If you’ve had the training, then ukemi is the way to go. The specific intent of the technique is to enable you to hit the ground, without the ground hitting back, so to speak. But even without training, the reflex to reach for the ground is a bad idea, and often results in a broken bone, or worse, ligament damage.

    Sammy Davis Jr. had a similar experience to Miles O’Brien, except it was his eye that he lost instead of his arm. Among his varied entertainment talents, Davis was a dancer, and when he lost his eye in an auto accident, he discovered his lack of stereoscopic vision so badly affected his balance, he couldn’t dance anymore. His solution was to lock himself in a room and practice until his routines came back, no matter how many times he fell or how many bruises he sustained. People often don’t realize how much they rely on two eyes for perspective and balance until they can use only one. Then it’s learning from scratch all over again.

  21. neo-neocon Says:

    Ymarsakar:

    I still don’t see how even someone trained could have done it from the position I was in when falling. My foot caught in such a way that it flipped me forward with pretty great force (I had been walking very fast at the time, so my forward momentum was strong) face and head first toward the pavement, falling hard and fast in a slight dive. I could not seem to get my hands/arms in front of me in time, although perhaps someone else might have done it. I don’t see how I could have gotten my shoulder or the side of my body there first either–my face was downward of my shoulder and my body.

    I’m curious—could it be done from that position? Could a trained person right him/herself in time? I was falling from my 5’4″ height, too, without much time before I hit (maybe a taller person would have more time??)

  22. Don Carlos Says:

    Neo- you’re not a Newton apple dropping from 5″4′vs 6″4″!
    One does it by pushing with the foot on the ground and rotating one’s trunk.

  23. neo-neocon Says:

    Don Carlos:

    Foot? My feet were flipped up and my head down. My head hit before my feet, at least that’s my perception of it. I’m not trying to be argumentative, I’m just trying to imagine how I could have pushed with the foot on the ground.

  24. Ymarsakar Says:

    face and head first toward the pavement, falling hard and fast in a slight dive.

    That’s what people have to do to do a shoulder roll to begin with. They can’t “slowly” fall down with their chest and stomach touching the mat. So they need to fall hard and fast in a 45 or lower angle dive before they can even do the circle roll.

    The ability to change your center of gravity, by twisting your core or limbs around, will actually rotate you while in mid air. Even skateboarders that went up one side of the 50 foot wall and came down without their skateboard, can rotate in mid air to take the shock of the landing by preparing the right body position.

    If a person’s foot is caught in something, and their forward momentum is going forward, then they would normally launch themselves Higher Up in the air via their other foot. Obviously this has to be done soon after the catch, cause otherwise you’re just thrusting yourself into the ground or horizontally across the ground with your other foot.

    Of course if a person can’t dip their head to their left knee, then kicking out with their left foot may sprain something as they go into a mid air circle. But they would still go into a mid air circle as they fall. It just wouldn’t be pretty. They’ll probably hit the ground using their palm and chests, then start skidding. Although technically that’s better than face planting.

    https://www.youtube.com/watch?v=sOWtFZeeLKw

    This is why I said it was counter intuitive. The normal muscle response is to “stop your momentum”. Rolling means to “accelerate your momentum first” so that you can then control it. In weird situations, this doesn’t look like a circular roll. You may put your head to your knee, and then suddenly your foot launches your body sideways and now you’re spinning in the air like a top. But so long as you contact the ground using a wide body area, and circularly roll across it, you get less impact, even though you might have fallen faster and at a higher height than normally.

    So the key principle is free control of center of gravity while in air, using a number of methods. The forward roll through arm and shoulder, is merely one technique. One technique is just one technique. It’s like a hammer. Good for some things, not so good for others. The principles of self control allows for free form movement, no matter what. Normally these things are done in battle, to defeat enemies and to prevent being killed, so merely fighting gravity is supposed to be simple.

    Most of these things you can only acquire confidence through physical mastery. Thus try the roll in the first video I linked, and slowly barrel roll around on the bed or something soft. If a person can do it slow, they can do it fast, and if something starts hurting, you can stop the roll using other arm, or body.

  25. Ymarsakar Says:

    I’m curious—could it be done from that position? Could a trained person right him/herself in time? I was falling from my 5’4″ height, too, without much time before I hit

    Probably, the easiest rolls I’ve done is when I dip my head down past my hips, near the knees, then just kick off with my feet (only one, otherwise it becomes a summersault or hand spring, and that can break the achilles for non gymnasts)

    The video I recommend you try to emulate is the one where the person is kneeling down on the ground. This is the same mechanics, basically. Then you roll forward when you tuck your head closer to the ground, and angle it so your neck doesn’t break. Normally humans don’t do that, because they protect the head and neck first. But in order to control your center of gravity, one limb must move out, to produce centrifugal force. (the head qualifies as a limb)

    In terms of physical training, I’ve used words to train myself and other people, before and after the physical events. So normally these things aren’t easily described or understood via text alone. That’s not something that can be much improved on.

    So definitely feasible. But understanding why will require some practice, slow practice.

    https://www.youtube.com/watch?v=5hgiYBrB7Yo

    If both of your feet were already in the air, then you lost your chance. And the only thing you could do to recover while in mid air is to somehow torque your torso so you land differently, or use your hands in front like the video to spring over the load. The load being face planted on concrete that is.

    If I am reconstructing this correctly, Neo, you initially were planning on using the arms instinctively, so you probably didn’t kick down hard enough when you were still in contact to get a shoulder roll landing. Instead you were planning on going straight down in a dive and catching yourself with the arms, so launching yourself higher up would actually make it harder .Then as you were doing this, your arms decided they weren’t ready for it and then froze, and as your brain was deciding Plan B, time ran out.

    So there were definitely options, even if one assumes mistakes were made in the beginning. But due to the time constraint, few people can “magically” come up with new movements they have never trained. Certain autistic savants, perhaps, or high level genius athletes.

  26. Don Carlos Says:

    I agree with Ymar’s How To Fall, though brevity is the soul of wit.
    Roll, baby, roll!

  27. Ymarsakar Says:

    Apathy is the soul of brevity.

  28. Mrs Whatsit Says:

    Trained or untrained, Neo, there are times when a fall is just a fall and the consequences are fate. The patch of unexpected ice under a doormat, the feet slipping out from under the balance of the body too fast for thought, flinging up higher than the head and the center of gravity too swiftly for anything but the thought: no matter how I move this is going to hurt, hip hitting concrete first no matter what head and body might do. As best i could I controlled my landing: the result, head safe, hands safe, legs and feet safe, hip smashed. People want to say there is always some way to reassert control. I understand the impulse and wish it were so, but time, gravity, and speed have a truth of their own. Wishing that we were always in control is only a wish. Because of surgeons and knowledge and technology in the days before Obamacare I still walk, but if I work for hours I ache and limp. To prevent it? Just don’t fall in the first place. Miss the ice, see the misstep, avoid the fate.

  29. Ymarsakar Says:

    Conscious thought is not necessary for movement impulses.

    It’s why hard wired responses in combat can occur even if the body is destroyed or if the brain takes a fatal shot, the nerves still respond to the conditioned sequence until it physically cannot.

    The very center of the brain calculates motor controls, while the front part and other parts handle emotion, sound, and visual cortex with conscious thoughts.

    Being able to shut down unnecessary parts of the brain to reroute the energy to the necessary parts, is part of what specialized training or natural gifts provide. It’s why a trained soldier (when an order is given) or a trained warrior, is much more effective than their equivalent untrained counterparts.

    What a normal person takes 10 seconds to figure out how to do, operant training and conditioning can do in less than .3 seconds.

  30. Don Carlos Says:

    Give it a rest, Ymar. What you apparently don’t know about neuroanatomy and neurophysiology will fill textbooks on those subjects.
    “The very center of the brain calculates motor controls” is utter mumbo-jumbo. And you go on from there.

  31. Ymarsakar Says:

    Are you under the impression that I give a damn what you think DC?

    Did you forget when I wrote that I didn’t like people agreeing with me as well as those in disagreement. Do you understand what that means?

    In the past I might have attempted to “prove my position”, but these days the masses of human ignorance isn’t worth my time.

    So given that apathy is the soul of brevity, I’ll keep it short since getting additional work for your sake, DC, would be harming my rest.

    Eventually, you’ll get a basic education in anatomy, DC, but it’s not something I need to give out. I suggest you read a basic modern research summary of the human brain DC, but since your opinion is likened to the wind, utterly invisible, it’s not necessary.

    What I know is that one DC head here thinks it can tell me what to do. Go ahead and see what happens when you do.

  32. Don Carlos Says:

    Just give a literature reference to your claim that “The very center of the brain calculates motor controls”. That is a request, not a command, Oh Learned One.

  33. Ymarsakar Says:

    Since DC obviously thinks he’s an expert on this subject, demonstrate for all of us here, how you know I am wrong. Or is that something that a copycat of other people’s writing is incapable of?

    –Brevity is the soul of wit.– Do you think you came up with that line yourself, but just can’t explain the thinking behind them?

    neuroanatomy and neurophysiology

    Did you come up with those words yourself, or did you have to look them up? And at the place you looked them up, did they explain how I was wrong?

  34. Don Carlos Says:

    As an MD with a formidable knowledge of neurologic disease, I have Board-certified knowledge of these subjects, and was listed in Best Doctors in America from that publication’s inception onward, Ymar. Regrettably you do not. You’d best look them up yourself; and look up Polonius too, slow your descent into snarkiness.

  35. Ymarsakar Says:

    Wow, the De Chucklehead wants me to go to work for the certified board there. Yet still can’t explain anything, not even in a single thesis sentence. The elite eggheads must think they know everything, the science is settled.

    I don’t argue with ants, DChimpster, I step on them.

    Now I’m going to take my deserved break and rest, as stepping on ants is tiresome.

    You must think your credential very powerful, to be able get me to look things up and do as you say, merely by typing words on the internet. Ya think it’s some magick spell from Mr Shakespeare that you plagiarized?

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