Distal bicep tendon rupture

Discussion in 'Health & Fitness' started by r2473, Jun 16, 2012.

  1. r2473

    r2473 Legend

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    Damn!! Suffered a complete rupture this morning of my bicep tendon in my elbow. I just hit a normal forehand and it snapped. But i heard a "pop" earlier this week in the gym,so i think that resulted in a partial tear.

    Will need surgery to reattach. Probably ~6 months for a full recovery.

    Anyone else ever do this? If so, can you let me know what i'm in for?

    Here's what i'm in for, except mine will be done immediately so i won't need the graft. and the procedure is a bit different now.

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1320378/?page=1

    http://www.youtube.com/watch?v=s3j9oehA-sk
     
    Last edited: Jun 16, 2012
    #1
  2. mikeler

    mikeler G.O.A.T.

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    I'm very sorry this happened to you. While I cannot help, I do hope you can recover sooner than the expected time they gave you. Good luck.
     
    #2
  3. El Diablo

    El Diablo Hall of Fame

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    Happened to a surgeon I know, he now plays tennis again though oddly collects disability, claiming he can't operate due to weakness in the arm. His tennis seems okay, though.
     
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  4. Say Chi Sin Lo

    Say Chi Sin Lo Legend

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    You heard a pop lifting weights, suspected a partial tear, and you go on to play tennis?

    :confused:

    Candidate, no actually, the award goes to you for idiot of the year.
     
    #4
  5. El Diablo

    El Diablo Hall of Fame

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    ^^ actually, it sounds like it was only in hindsight that the partial tear was suspected. Our bodies sometimes creak a bit as we get older, we don't always think it's something to be concerned about.
     
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  6. r2473

    r2473 Legend

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    I called the orthopedic center to make an appointment the day it happened. they scheduled me out 2 weeks. i also did my normal gym routine on friday with no issues or concerns. Ortho probably didn't have much of a concern because of how rare a distal rupture is.

    There's no real pain associated with this. The partial tear was just the popping sound, but I didn't feel a thing. When it snapped yesterday, it felt a bit weird, but not really painful. (This is actually not what I meant. You get a quick burst of pain when the tendon snaps. It almost feels like an electrical charge. But after that happens, there isn't much additional pain. Right now, I just feel a dull pain, but I can use my right arm just fine. Just can't support much weight and it hurts to move it in certain ranges of motion). I knew what had happened almost right away. My opponent and the few people watching at first thought I had broken a string. Then they figured I just felt a little pain in my arm or something, but they all expected that I was going to jump back out in play. In fact the guy running the thing said he'd give me 15 minutes if I need it. Given my almost non-reaction, nobody thought I had done anything too serious. There wasn't any bleeding, swelling, bruising. Really nothing. It even takes a little while for your bicep to move up you arm more toward you shoulder. Even now its not real noticeable.

    reading a bit more on this, i suspect that I actually caused damage last monday playing tennis. When I went to hit a forehand, I misjudged the ball due to a gust of wind and nearly missed it. It was a deep court floater and I swung pretty much as hard as I could at it. When it held up, I made an unconscious adjustment by reaching for the ball and straightened my arm. I felt quite a shock in my arm, but didn't think much of it. I just kept playing and everything was fine.

    The next day in the gym I was doing back levers (which I've been doing for over a year). This puts tremendous stress on your elbow. I heard the "pop" and thought I had torn the tendon, but hadn't. At least it didn't appear I had. I finished my gym routine that day too with no real issue or discomfort. I talked to ortho as well as a few friends and nobody seemed too concerned. Friday in the gym was fine. Hit several balls on saturday before snapping it.

    I wonder if ortho could have seen anything if I had gotten in sooner. I guess it depends on what had already happened. Also I have to wonder how much damage had already been done and if it could have healed non-surgically.

    In hindsight, playing tennis was obviously a bad idea, but it wasn't quite as obvious 24 hours ago. At least not to me.

    As Diablo says, from what I read, it looks like there is no reason to believe I won't make a full recovery. Its a pretty "simple" reattachment. Guess it beats having TE, shoulder, back etc. problems.
     
    Last edited: Jun 18, 2012
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  7. r2473

    r2473 Legend

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    As rare as this injury is, oddly enough, there was a guy at the court that tore his distal bicep tendon playing basketball some years earlier. He is now about 55 or so I'd guess. He told me pretty much what I've read. About 6 months after surgery, I should be 100%.

    When he was looking at my arm after it happened, he didn't believe I had torn it because he said his bicep really sort of flopped to the side and mine really didn't do anything right away. But I did the "hook test" to try to find my tendon and there wasn't anything there, so it was pretty obvious what had happened.

    We figured that since I lift weights a bit, maybe I have developed enough supporting strength to compensate some. All that has happened now is that the bicep has retracted slightly from the elbow. I just have a rather dull pain in that area. Loss in strength. Hurts a bit to turn my hand palm up. But I'm not really too uncomfortable at all.
     
    Last edited: Jun 17, 2012
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  8. Chas Tennis

    Chas Tennis Hall of Fame

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    From the Manual of Structural Kinesiology, C. Thomson & also an Anatomy reference -

    The biceps inserts at two locations distally: 1) Tuberosity of the radius and 2) the bicipital aponeurosis. [Aponeurosis - flattened tendon into sheath]. I am not clear as to how the aponeurosis connects - diagrams do not show it inserting on a bone in the forearm but more connecting to more tendon or fascia. ?

    In any case, the biceps inserts at two connections in the forearm. That may be why your biceps did not pull up too much. Also, the fellow with the biceps injury might have injured the other tendon insertion. Ask your Dr where the rupture is.

    The reference says that for various arm orientations "the forearm should be fully pronated to achieve maximal lengthening of the biceps brachii." I interpret that to imply that pronation might stretch the tendon and excessive pronation might stress or injure it. Were you doing any curls with an 'easy bar' that might have put your forearm in pronation while lifting weights? It probably could also be stressed by a violent reversal in direction, coming out of a backswing?
     
    Last edited: Jun 18, 2012
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  9. scotus

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    I wish you a full and as-quick-as-possible recovery.
     
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  10. Posture Guy

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    Dang, man, crappy news. Really sorry to hear of it and I wish you a successful surgery and a quick and full recovery.

    Post-surgically, perhaps wrapping it in bacon might speed things along?
     
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  11. Chas Tennis

    Chas Tennis Hall of Fame

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    Speculating, maybe your violent tennis stroke played a part? The Manual of Structural Kinesiology - on stretching the biceps - The biceps may also be stretched by abducting a fully extended elbow to 70 to 110 of shoulder abduction. ?

    It is complicated because the biceps is a 3 joint muscle - shoulder, elbow, and radioular. I guess if all joints are oriented to stretch dynamically and forcefully it would put a lot of stress on one of the tendons. (The above reference is very useful for understanding the muscles, joints and their motions.)

    The top of the biceps connects above the shoulder at two originations. I spoke to two players who had had complete ruptures to one of these tendons originations. Neither had had surgery and had loss of strength. I played both and they did not seem too impaired. ?

    One described how his biceps had balled up in his arm, an obvious and serious injury. He had waited too long before seeing a Dr - I believe it was just a very short time, just days after the injury. ? He was told that he could no longer have it reattached. ? What he told me regarding the short window for surgery does not seem reasonable but that is what he said. ? I would consider this possibility for any tendon injury and see a Dr immediately. I don't see how any completely ruptured tendon can heal without surgery, do you?
     
    Last edited: Jun 18, 2012
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  12. charliefedererer

    charliefedererer Legend

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    What rotten luck.

    Best wishes for as quick a recovery as possible.
     
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  13. r2473

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    I got in this morning. Scheduled for surgery tomorrow. Here's the deal.

    1) You don't have to have surgery. Other things will compensate. You can get along fine. But, you will lose a lot of strength and some range of motion and flexibility. Basically, if you are young like me, you get it reattached surgically. If you are old, they don't bother.

    2) Now, if I had torn one of the two tendons connecting the bicep to the shoulder, they would not do surgery. Apparantly this is failry common. The resident I was talking with said it happened to John Elway for example and they didn't do surgery on him.

    3) As far as the window, if you wait to long, the area starts to heal, meaning the tendon gets scarred over so you can no longer just pull it down with forceps to the reattachment point. You need to get a graft. And yes, it also starts to retract, so it is also harder to grab. I imagine if you are too old, they have even more incentive not to do the surgery.

    4) The big danger with this surgery is that they could hit the big nerve in your arm. Then you couldn't move your fingers anymore. That's the major risk anyway. The other big one is that the bone could grow into the tendon and screw things up. I think this happened more in the past, but is not so common now.

    5) The procedure is the single incision procedure. Nobody does the double incision anymore. I provided a link to that above I believe. You can watch the procedure on youtube.

    6) In terms of healing, it takes a few weeks before you start moving your arm / fingers / shoulder, etc. You slowly get motion and strength back. You are back to 100% in 3-6 months. Apparantly the tendon does heal just as strong as if it was never unattached from the bone. Just like a bone break.

    http://www.sportsmd.com/SportsMD_Articles/id/281.aspx
     
    Last edited: Jun 18, 2012
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  14. Chas Tennis

    Chas Tennis Hall of Fame

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    All sounds reasonable.

    After your surgery look into the two distal insertions points that I mentioned. Of the two, maybe only the radius insertion tendon gets ruptured. ? The kinesiology book that I mentioned describes some other orientations that stretch the biceps & tendons. You might want to analyze your tennis and weight work to make sure your motions for both are not unusual in some way that stresses this injured tendon. (I'm always pitching high speed video for stroke analysis so let me know if you have any interested in that.)

    I read that most tendon injuries occur at the tendon-bone interface or at the tendon-muscle interface as opposed to within the tendon. Don't know how true that view is. ? You might ask if your injury turns out to be one of those two cases.

    Here's to a quick recovery.
     
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  15. r2473

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    I'd expect that the tendon simply came unattached from the bone. That is what happens nearly 100% of the time.

    I think it was more of a freak event. When I swung the racquet my arm violently straightened as I reached for the ball I had misjudged due to the wind. Thing is, I was pissed because the guy wall killing me. He sent a floater to the backcourt and I made up my mind to hit it as hard as I could. Out of anger more or less. So I was swinging as hard as I could and really didn't care if the ball was going in.

    This by itself probably wouldn't have been enough. In fact, I continued playing for at least 30 more minutes with an issue.

    But when I did the back lever the following day, I heard a "pop" (as I explained above). Looking back, those two events together were necessary. I don't think either by itself would have done it.

    http://www.youtube.com/watch?v=t_lFhzHLIGI

    Wow, there is an entire forum devoted to distal bicep tendon rupture:


    http://tendonsurgeryinfo.com/distalbiceps/index.php
     
    Last edited: Jun 18, 2012
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  16. tennisenthusiast

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    Have you tried applying greased bacon to the area? ;)
     
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  17. Pacific lefty

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    Hope your surgery goes well and you have a short and pain free recovery!
     
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  18. r2473

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    Looking at about ~6 months. I'm VERY risk averse, so I'll do all my rehab that the PT suggests, but won't go back to violent tennis swings or back lever hangs for ~ a year I'd guess. That's just how I do things. There are plenty of other things to be doing that aren't arm related. I want to be sure I'm 100% before gettng back. I hurt my shoulder a while back and took a full year (when I probably only needed 6 months or less). No shoulder surgery, but it took forever to heal. Which was fine.

    Lucky I just have a desk job. I'm pretty sure I can still yell at people with a bum wing. I just can't smack them around anymore.
     
    Last edited: Jun 18, 2012
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  19. Kevin T

    Kevin T Professional

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    For recovery, I would recommend the Paleo diet, 100,000 IU Vitamin D/day, as many supplements as you can afford and avoid any and all future vaccinations. Oh, and I hope you have an IPad :)

    In all seriousness, sorry to hear this r2. Best of luck with the surgery and a full and speedy recovery. With my history of lumbar disc issues, I know how tough being on the sidelines can be. Take care and get well.
     
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  20. r2473

    r2473 Legend

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    ^^ I'm looking at it as a great excuse to read a few more books.

    After the worst of it and I'm able to do "something", I'll probably up running mileage.

    Eh, there are always things to do. I had been doing too much tennis and gym stuff anyway. Be good to take a break. I grew up a "nerd", so I'm right at home with the books.

    On a funny note, the orthopedic doctor that looked at me today gave me a small lecture on how steroid use has been shown to be one of the things that cause a bicep tendon tear. He then asked me if I had ever done steroids. When I told him no, he continued on with a bit more of a lecture and asked me again.

    I told him "thanks for the compliment" :)
     
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  21. Fee

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    Well, that sucks, but you seem to be relatively upbeat and optimistic about it so you've got that going for you. Please keep us updated as you progress. Speedy recovery, you'll need to be able to lift your luggage when you go to IW next year. :)


    Have you tried magnets? You might be able to avoid surgery.
     
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  22. Kevin T

    Kevin T Professional

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    Oh geez, how could I have forgotten magnets!!?? Thanks for having my back, Fee.

    r2,

    You might want to call the Doc and cancel...I think we've got this thing 'whupped.
     
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  23. Kevin T

    Kevin T Professional

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    Probably all those years of creatine. By the way, have you PMed the 'elbows of steel' guy? You might want to include him in your rehab plans.
     
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  24. r2473

    r2473 Legend

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    As crazy as the elbows of steel guy is, I used a modified version of his technique when I was experiencing some pretty bad pain in my elbow due to lifting too heavy on tricep exercises. It actually worked :shock: Seriously. The pain went away in a few months and never came back. And I dropped the tricep exercise.

    I've never had surgery before. Somehow I don't think I'm going to enjoy 4-8 weeks of pain and trouble sleeping.

    From what I've read, if I was "lucky" enough to have a job that required me to lift heavy stuff, I would be "on vacation" for at least 4 months, but probably more like 6 months. But with this stupid desk job, I'll be back by next Monday :(

    I actually have a surprising amount of strength and pretty much full range of motion in my arm now, just 48 hours after the event. This surgery better work perfectly, because I think I could get along just fine without it. I'd always be somewhat weak, but that's it.

    If this guy hits a nerve tomorrow, I'm going to be pissed (and disabled).
     
    Last edited: Jun 18, 2012
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  25. Fee

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    Forget magnets, that's total BS. What you need is some really good sunscreen, with the right ingredients, and you have to put it on before you get dressed. That will take care of this injury. Along with some gluten free vitamin D. All the best luck for your recovery. :)


    (laughter is the best medicine, right? ;) )
     
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  26. Kevin T

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    If he does hit a nerve, just think of all the fun you'll have with your wife. "Honey, I need to go to the bathroom again...Honey, could you open another beer...Honey, it's bath time". Same goes for your nurse post-surgery..."Excuse me, nurse, I need to go to the bathroom again". :) And if you're a righty, you can transform your tennis game as a lefty...second coming of Nadal. Sounds good to me.
     
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  27. r2473

    r2473 Legend

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    I'd better yuck it up now, because something tells me that I won't be laughing too hard 24 hours from now.

    Well, off the the library to get a 3 month supply of novels. Guess I could read Taubes' book.

    This is my surgeon:

    http://healthcare.utah.edu/fad/mddetail.php?physicianID=FM00002540
     
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  28. Fee

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    You can still ride a stationary bike to keep up some level of fitness can't you? Or even a treadmill?

    If you really do read the Taubes book, please start a new thread with your thoughts on it. I recommend the entire Harry Potter series. :)

    Good luck tomorrow. Fingers crossed for you.
     
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  29. mikeler

    mikeler G.O.A.T.

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    Are you kidding? Sunscreen has all those chemicals that are horrible and will kill you. Much better just to get large chunks of skin cut out when you find a suspicious spot. :)
     
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  30. mikeler

    mikeler G.O.A.T.

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    I'd go out and hit balls left handed if I had to.
     
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  31. Posture Guy

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    I have a hitting partner, she's a 5.0 woman, plays to a strong male 4.0/weak 4.5 level. She blew out a tendon in her elbow 2 years ago, couldn't play for about 6-8 months, so took lessons and learned to play left handed. Got to about a 3.5 from what I'm told. I could never do that. My left hand is just stupid.
     
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  32. mikeler

    mikeler G.O.A.T.

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    I used to play the lower ranked high school players on my team lefty. I could probably play at 3.5 with my left hand.
     
    #32
  33. dParis

    dParis Hall of Fame

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    If you can move your hand, just hit the home keys...

    Sorry to read about your injury. I hope surgery went well and your recovery is speedy. This might be a good time to test the effectiveness of medical marijuana.
    He looks competent enough. Did you notice if he had any tattoos?
     
    #33
  34. Kobble

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    Scaring the **** out of me. I have bicep pain in my left arm when it is stressed wrong. Getting better, but I do bodyweight work like you. No back levers, though.
     
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  35. red rook

    red rook Rookie

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    Sorry to hear that. Good luck in your rehab.
     
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  36. r2473

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    everything went great as far as i can tell. from what i read, most people have lots of pain after the surgery meds wear off for at least 48-72 hours. i've been virtually pain free, though i am taking loritab. i've had absolutely no trouble sleeping, getting 8 solid hours the past 2 nights. thinking about doing some deadlifting tomorrow.

    they recorded my heartrate at 42 bpm just before the surgery. she was going to do a heart test, but bought my story that i used to be / am a runner. not bad considering it was the middle of th day and i was pretty nervous thinking about the surgery.
     
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  37. Posture Guy

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    awesome, so glad to hear you're doing well.

    Onward and upward.
     
    #37
  38. WildVolley

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    Good luck with your recovery.

    Did you ask your surgeon, after the surgery, how soon before you can start juicing again? That would have been funny!:twisted:
     
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  39. Kevin T

    Kevin T Professional

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    Glad to hear all went well. Positive vibes your way. By the way, I noticed your surgeon was accomplished in Pediatrics...do you have small appendages? :)

    Hopefully that made you laugh and helps stave off any depression. :0
     
    #39
  40. Cindysphinx

    Cindysphinx G.O.A.T.

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    Hey, I'm sorry about the bad news.

    Do remember to take lots of supplements!
     
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  41. mikeler

    mikeler G.O.A.T.

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    I liked the joke. :)
     
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  42. Fee

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    Hooray! Sent you some magnetic Vitamin D sunscreen, let me know if you don't get it. :)
     
    #42
  43. charliefedererer

    charliefedererer Legend

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    Glad to hear that the surgery seems to have gone well, and you are not in too much pain.

    Continued best wishes for a speedy recovery.
     
    #43
  44. r2473

    r2473 Legend

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    it made no difference. a tendon tear isnt the kind of thing that can heal on its own.

    everything is going great. just about one week post surgery and im off the pain meds and feeling no pain. cast should be off next tuesday.
     
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  45. Posture Guy

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    Sounds like you're making great progress!
     
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  46. dParis

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    R2, congratulations on receiving the Idiot of the Year award. Honestly, I don't know what kind of weight or status Say Chi Sin Lo's recognitions carry, but irregardless, it's quite an accomplishment considering the strong era we are living in.

    Good to hear your surgery went well.
     
    #46
  47. Fee

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    Excellent. :)
     
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  48. Kevin T

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    Hah! Fave post of the day.

    GOAT idiot of the year on TW was probably '99-01...oldies but goodies. This era is weak in comparison. I mean, these days we know all the comments are coming from those with strange new sprigs of hair growth. But back then, we thought TW and other chat boards were the 'pubs' of the 21st century...adults only. :) Nothing like someone offering to meet you for a 'throw down' in some airport in flyover country. :)

    Wife: "What's this!? $300 flight to Wichita last Wednesday?"

    Me: "Yeah, sorry babe. Got into a heated argument about guys with two-handed backhands being cooters and was challenged to a fight on the TW boards. The guy was from the east coast, so we arranged a meet-up halfway".
     
    Last edited: Jun 25, 2012
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  49. r2473

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    thanks everyone.

    once the cast comes off ill probably start "cycling" on the stationary bike. then switch over to running when im ok to swing my arm like that.

    i can still do pistol squats and something like bicycles for my mid-section. guess ill investigate other things i can safely do with mt pt when that time comes.
     
    #49
  50. dParis

    dParis Hall of Fame

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    Wow! You (and TW) go back that far? Time - she is a'flyin'. If someone could direct me to an archive of the early days of Talk Tennis (I gave it a short, unfruitful effort), I'd have no problem blowing thirty minutes or an hour reading the ancient script.
     
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