{"id":294,"date":"2020-08-13T17:42:00","date_gmt":"2020-08-13T17:42:00","guid":{"rendered":"https:\/\/brooksidepress.org\/basic_obgyn\/?page_id=294"},"modified":"2020-08-13T17:42:00","modified_gmt":"2020-08-13T17:42:00","slug":"1-01-surgical-knot-tying","status":"publish","type":"page","link":"https:\/\/brooksidepress.org\/pa_obgyn\/technical-skills\/1-01-surgical-knot-tying\/","title":{"rendered":"1.01 Surgical Knot Tying"},"content":{"rendered":"<p><iframe loading=\"lazy\" width=\"560\" height=\"315\" src=\"https:\/\/www.youtube.com\/embed\/Q0iTD9cnwQE\" frameborder=\"0\" allow=\"accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture\" allowfullscreen><\/iframe><\/p>\n<p>Duration 15:35<\/p>\n<input type='hidden' bg_collapse_expand='69ea119868b2a2039876255' value='69ea119868b2a2039876255'><input type='hidden' id='bg-show-more-text-69ea119868b2a2039876255' value='Show Transcript'><input type='hidden' id='bg-show-less-text-69ea119868b2a2039876255' value='Hide Transcript'><button id='bg-showmore-action-69ea119868b2a2039876255' class='bg-showmore-plg-button bg-blue-button  '   style=\" color:#ffffff;\">Show Transcript<\/button><div id='bg-showmore-hidden-69ea119868b2a2039876255' ><\/p>\n<p>University of Connecticut School of<br \/>\n00:07<br \/>\nMedicine my name is Chris Morosky and<br \/>\n00:09<br \/>\nthank you for taking the time to watch<br \/>\n00:11<br \/>\nthis video on how to tie one and<br \/>\n00:12<br \/>\ntwo-handed knots over the next 15<br \/>\n00:15<br \/>\nminutes or so I&#8217;d like to introduce you<br \/>\n00:16<br \/>\nto a somewhat silly but memorable way of<br \/>\n00:19<br \/>\nlearning how to tie surgical knots after<br \/>\n00:21<br \/>\nwatching this video and with a little<br \/>\n00:23<br \/>\nbit of practice this will become basic<br \/>\n00:25<br \/>\nmuscle memory so get out your sneakers<br \/>\n00:27<br \/>\nand let&#8217;s get practicing because this<br \/>\n00:29<br \/>\nright here is how I learned how to tie<br \/>\n00:31<br \/>\nsurgical nuts okay so for starters we&#8217;re<br \/>\n00:39<br \/>\ngoing to talk about two-handed nuts now<br \/>\n00:41<br \/>\nthe simple concept here is that you need<br \/>\n00:43<br \/>\nto learn how to tie around both your<br \/>\n00:45<br \/>\nindex finger and tie around your thumb<br \/>\n00:47<br \/>\nthe other thing that&#8217;s important to keep<br \/>\n00:49<br \/>\nin mind is that you&#8217;re eventually going<br \/>\n00:50<br \/>\nto want to make a finger circle and then<br \/>\n00:53<br \/>\nyou&#8217;re going to also want to make<br \/>\n00:54<br \/>\nsomething called I like to call the<br \/>\n00:55<br \/>\nsuture circle you can see there&#8217;s kind<br \/>\n00:57<br \/>\nof a circle right here so to get started<br \/>\n01:00<br \/>\nI&#8217;m going to teach you how to tie around<br \/>\n01:01<br \/>\nyour index finger then I&#8217;m going to<br \/>\n01:04<br \/>\nteach you how to tie on your thumb these<br \/>\n01:06<br \/>\nwill not be flat knots and what we&#8217;ll do<br \/>\n01:08<br \/>\nis after that we&#8217;re going to alternate<br \/>\n01:10<br \/>\nback and forth from index finger to<br \/>\n01:12<br \/>\nthumb and then you put down flat knots<br \/>\n01:14<br \/>\nwith two flat knots going after each<br \/>\n01:16<br \/>\nother being a square now so for starters<br \/>\n01:23<br \/>\nyou want to start with the little<br \/>\n01:24<br \/>\nposition I like to call shooting guns<br \/>\n01:26<br \/>\nnow if you ever in the operating room<br \/>\n01:28<br \/>\nyou have to do this and you&#8217;re getting<br \/>\n01:29<br \/>\nnervous just now come back to shooting<br \/>\n01:31<br \/>\nguns because this is the starting point<br \/>\n01:33<br \/>\nso with your fingers making two little<br \/>\n01:36<br \/>\nguns you&#8217;re going to hold the suture and<br \/>\n01:37<br \/>\nwith your other three fingers now you do<br \/>\n01:40<br \/>\nwant to learn how to tie with both your<br \/>\n01:41<br \/>\nleft hand and your right hand but I&#8217;m<br \/>\n01:43<br \/>\njust going to show you how to do this<br \/>\n01:44<br \/>\nwith your right hand for starters so<br \/>\n01:46<br \/>\nlet&#8217;s start with the index finger so<br \/>\n01:48<br \/>\nwith the index finger you&#8217;re going to do<br \/>\n01:49<br \/>\nwhat I call internal rotation you&#8217;re<br \/>\n01:52<br \/>\ngoing to create half the suture circle<br \/>\n01:54<br \/>\nwith with that you&#8217;re now going to do<br \/>\n01:56<br \/>\nthe other half of the suture circle to<br \/>\n01:58<br \/>\nmake you can see there&#8217;s a loop of<br \/>\n01:59<br \/>\nsuture around my index finger with that<br \/>\n02:02<br \/>\nyou make a very nice finger circle and<br \/>\n02:05<br \/>\nthen you push your opposite finger so in<br \/>\n02:07<br \/>\nthis case the thumb through the suture<br \/>\n02:10<br \/>\ncircle you then pick up your tail<br \/>\n02:13<br \/>\npinched it in between your finger and<br \/>\n02:14<br \/>\nthumb and push the tail back through the<br \/>\n02:17<br \/>\nsuture circle and tie it down<br \/>\n02:20<br \/>\nyou&#8217;ve now tighten that it&#8217;s not a flat<br \/>\n02:22<br \/>\nknot which is okay<br \/>\n02:23<br \/>\nso I just want you to practice doing the<br \/>\n02:26<br \/>\nindex finger over and over and over<br \/>\n02:28<br \/>\nagain until that becomes Messel muscle<br \/>\n02:30<br \/>\nmemory so something like this down<br \/>\n02:38<br \/>\ninternal rotation suit your circle close<br \/>\n02:41<br \/>\nyour finger and thumb push your thumb<br \/>\n02:43<br \/>\nthrough the suture circle really push it<br \/>\n02:45<br \/>\nthrough like over do this at first pinch<br \/>\n02:47<br \/>\nthe tail push the tail back through your<br \/>\n02:49<br \/>\nsuture circle and down internal rotation<br \/>\n02:53<br \/>\nsuit your circle finger circle put your<br \/>\n02:57<br \/>\nthumb through grab the tail push it back<br \/>\n03:00<br \/>\nand down and one more time internal<br \/>\n03:03<br \/>\nrotation suit your circle close the<br \/>\n03:06<br \/>\nfinger circle push your thumb through<br \/>\n03:09<br \/>\ngrab the tail push it back and down okay<br \/>\n03:19<br \/>\nso now we&#8217;re going to work on the thumb<br \/>\n03:21<br \/>\nside of things so again start with<br \/>\n03:23<br \/>\nshooting guns and where as the index<br \/>\n03:25<br \/>\nfinger was an internal rotation you&#8217;re<br \/>\n03:27<br \/>\ngoing to kind of externally rotate with<br \/>\n03:28<br \/>\nyour thumb but same concept you&#8217;re going<br \/>\n03:30<br \/>\nto create half the suture circle here<br \/>\n03:32<br \/>\nyou&#8217;re going to bring the other loop<br \/>\n03:34<br \/>\naround to create that whole suture<br \/>\n03:36<br \/>\ncircle like you can see then you close<br \/>\n03:38<br \/>\nyour index finger and thumb put your<br \/>\n03:40<br \/>\nindex finger through grab the tail pinch<br \/>\n03:43<br \/>\nit between your fingers push that tail<br \/>\n03:45<br \/>\nthrough your suture circle and put it<br \/>\n03:47<br \/>\ndown again in slow motion shooting guns<br \/>\n03:52<br \/>\nexternal rotation suit your circle<br \/>\n03:56<br \/>\naround your thumb close your index<br \/>\n03:58<br \/>\nfinger and thumb push your index finger<br \/>\n04:00<br \/>\nthrough pinch the tail push it through<br \/>\n04:03<br \/>\nthe search suture circle down external<br \/>\n04:07<br \/>\nrotation suture circle index finger and<br \/>\n04:10<br \/>\nthumb to make your finger circle push<br \/>\n04:12<br \/>\nthat index finger through pinch the tail<br \/>\n04:14<br \/>\npush it back through the loop and down<br \/>\n04:16<br \/>\nand one more time<br \/>\n04:18<br \/>\nexternal rotation suit your circle<br \/>\n04:21<br \/>\nfinger circle push that index finger<br \/>\n04:23<br \/>\nthrough pinch the tail push it through<br \/>\n04:26<br \/>\nand down okay so now we&#8217;re going to<br \/>\n04:31<br \/>\npractice going back and forth from our<br \/>\n04:32<br \/>\nindex finger to our thumb so back from<br \/>\n04:35<br \/>\nindex finger to thumb there&#8217;s one more<br \/>\n04:37<br \/>\nthing you need to do to be able to tie<br \/>\n04:39<br \/>\nsquare notch which is crossing but we&#8217;re<br \/>\n04:41<br \/>\ngoing to get to that in a second so tie<br \/>\n04:43<br \/>\nflat knots or granny knots here that&#8217;s<br \/>\n04:45<br \/>\nokay but just go back and forth so here<br \/>\n04:48<br \/>\nwe go<br \/>\n04:48<br \/>\nindex finger through down thumb through<br \/>\n04:55<br \/>\ndown index finger a little slower this<br \/>\n04:58<br \/>\ntime through pinch it down thumb push<br \/>\n05:05<br \/>\nyour finger through pull the tail<br \/>\n05:07<br \/>\nthrough down index finger down thumb<br \/>\n05:13<br \/>\ndown the more you practice this the<br \/>\n05:16<br \/>\nfaster you&#8217;re going to get but make sure<br \/>\n05:19<br \/>\nyou maintain good technique because<br \/>\n05:20<br \/>\nyou&#8217;re going to teach yourself how to<br \/>\n05:21<br \/>\ntype bad knots if you don&#8217;t do this<br \/>\n05:23<br \/>\nfluidly and smoothly and make sure<br \/>\n05:25<br \/>\nyou&#8217;re going back and forth from index<br \/>\n05:27<br \/>\nfinger to thumb each time okay and now<br \/>\n05:35<br \/>\nto finally tie our square knots<br \/>\n05:37<br \/>\nnow with this you&#8217;re going to have to<br \/>\n05:39<br \/>\nknow about the concept of crossing your<br \/>\n05:41<br \/>\ntails to make this work so for starters<br \/>\n05:44<br \/>\nwhen you tie it up the first thing you<br \/>\n05:46<br \/>\nwant to do is cross your tails now<br \/>\n05:47<br \/>\ndepending on which tail you cross you&#8217;re<br \/>\n05:49<br \/>\ngoing to start with either your index<br \/>\n05:51<br \/>\nfinger or your thumb also depending on<br \/>\n05:53<br \/>\nwhich hand you&#8217;re using but let&#8217;s stick<br \/>\n05:55<br \/>\nwith the right hand so with my right<br \/>\n05:57<br \/>\nhand if I take my right tail and cross<br \/>\n05:59<br \/>\nit over the left I have to start here<br \/>\n06:01<br \/>\nwith my thumb to make this not go down<br \/>\n06:04<br \/>\nflat now if I were to cross my left tail<br \/>\n06:10<br \/>\nover my right I would have to start with<br \/>\n06:13<br \/>\nmy index finger on my right hand to make<br \/>\n06:15<br \/>\nthis not go down flat the last concept<br \/>\n06:19<br \/>\nhere is that as you&#8217;re tying not only do<br \/>\n06:22<br \/>\nyou have to alternate back between index<br \/>\n06:24<br \/>\nfinger and thumb you also need to<br \/>\n06:26<br \/>\nalternate on which direction you pull<br \/>\n06:27<br \/>\ndown your knife so for example if I<br \/>\n06:30<br \/>\ncross with my right over my left tail<br \/>\n06:33<br \/>\nand I start with my right hand I&#8217;m<br \/>\n06:35<br \/>\nactually going to start with my thumb<br \/>\n06:36<br \/>\nand I&#8217;m going to pull my right tail down<br \/>\n06:39<br \/>\nso that&#8217;s thumb down as I come back up<br \/>\n06:42<br \/>\nand do my index finger I now want to tie<br \/>\n06:44<br \/>\nwith my right hand up<br \/>\n06:46<br \/>\nwe&#8217;ll go thumb down index finger up<br \/>\n06:52<br \/>\nthumb down index finger up and you can<br \/>\n06:57<br \/>\nsee I&#8217;m not going to full 90 degrees or<br \/>\n07:00<br \/>\n180 degrees in each direction<br \/>\n07:02<br \/>\nit&#8217;s just 90 it&#8217;s a little off skew but<br \/>\n07:04<br \/>\nyou do have to pull you&#8217;re not down in<br \/>\n07:06<br \/>\nthat direction if you do this<br \/>\n07:10<br \/>\nalternating back and forth and you<br \/>\n07:12<br \/>\nalternate between your index finger and<br \/>\n07:13<br \/>\nyour thumb you&#8217;ll find that you tie what<br \/>\n07:15<br \/>\nlooks like a chain-link or square knots<br \/>\n07:24<br \/>\nokay so the final step here is to show<br \/>\n07:27<br \/>\nyou how to do this on one of these<br \/>\n07:28<br \/>\npractice boards a lot of you guys are<br \/>\n07:30<br \/>\ngoing to get this at your schools<br \/>\n07:31<br \/>\nthere&#8217;s one dark string and one light<br \/>\n07:32<br \/>\nstring these are kind of nice because<br \/>\n07:34<br \/>\nonce you tie square knots you can kind<br \/>\n07:36<br \/>\nof see a weave back and forth to tie a<br \/>\n07:37<br \/>\nsquare knot what I really want everybody<br \/>\n07:39<br \/>\ninto practice though is this whole<br \/>\n07:41<br \/>\nconcept of crossing and doing this one<br \/>\n07:44<br \/>\nwith your right hand and then if you get<br \/>\n07:45<br \/>\ngood at right hand do it with your left<br \/>\n07:47<br \/>\nhand so I&#8217;m going to show you what this<br \/>\n07:48<br \/>\nlooks like with the left hand so if I<br \/>\n07:50<br \/>\ncross again with my right over my left<br \/>\n07:51<br \/>\nand I have to use my index finger to<br \/>\n07:54<br \/>\nmake this first not go down flat I&#8217;m<br \/>\n07:56<br \/>\ngonna take my right hand and go up here<br \/>\n07:58<br \/>\nnow I come back and I do my thumb and<br \/>\n08:02<br \/>\nwith my thumb my right hand is going to<br \/>\n08:04<br \/>\ngo down index finger right hand up thumb<br \/>\n08:10<br \/>\nright hand down index finger right hand<br \/>\n08:14<br \/>\nup thumb right hand down<br \/>\n08:19<br \/>\nit doesn&#8217;t matter really what hand you<br \/>\n08:20<br \/>\npick as long as you consistently go back<br \/>\n08:22<br \/>\nand forth between your index finger and<br \/>\n08:25<br \/>\nthumb and then cross your hands and<br \/>\n08:27<br \/>\nagain like I said what&#8217;s nice about<br \/>\n08:29<br \/>\nthese practice boards is that when<br \/>\n08:30<br \/>\nyou&#8217;re done if you&#8217;ve tied score nuts<br \/>\n08:32<br \/>\nyou can see this darker half of the<br \/>\n08:35<br \/>\nsuture going back and forth and you can<br \/>\n08:39<br \/>\nknow that it looks like a chain link and<br \/>\n08:40<br \/>\nthose are square knots okay so now into<br \/>\n08:49<br \/>\nan introduction to one-handed knots so<br \/>\n08:51<br \/>\none-handed knots are kind of nice<br \/>\n08:53<br \/>\nbecause if you&#8217;ve got something on one<br \/>\n08:54<br \/>\nof your suture ends or if you&#8217;re just in<br \/>\n08:57<br \/>\na tight space and need to tighten knots<br \/>\n08:58<br \/>\nyou can do one hit and that&#8217;s pretty<br \/>\n09:00<br \/>\nnicely a lot of people tell you that you<br \/>\n09:03<br \/>\ncan&#8217;t tie one-handed knots as square<br \/>\n09:05<br \/>\nknots but you certainly can as long as<br \/>\n09:07<br \/>\nyou alternate back and forth between<br \/>\n09:09<br \/>\nwhat I like to call the karate chop and<br \/>\n09:11<br \/>\nthe figure-four and pay attention to<br \/>\n09:14<br \/>\ncrossing up and down as you tie it on<br \/>\n09:17<br \/>\nyour nuts<br \/>\n09:17<br \/>\nso I&#8217;ll break this down and first we&#8217;re<br \/>\n09:19<br \/>\ngoing to learn about the karate chop<br \/>\n09:25<br \/>\nokay so for starters an introduction to<br \/>\n09:28<br \/>\nthe karate chop so just like with two<br \/>\n09:30<br \/>\nhanded knots you start off with shooting<br \/>\n09:32<br \/>\nguns with the karate chop your starting<br \/>\n09:34<br \/>\nposition is a figure four now again<br \/>\n09:36<br \/>\nwe&#8217;re only using one hand so your other<br \/>\n09:38<br \/>\nhand can pretty much be doing nothing so<br \/>\n09:40<br \/>\nfor the karate chop you make the letter<br \/>\n09:42<br \/>\nD I usually pull in my finger and just<br \/>\n09:44<br \/>\nhold my middle finger and my ring figure<br \/>\n09:46<br \/>\nout with this you want to do an internal<br \/>\n09:48<br \/>\nrotation or karate chop down on your<br \/>\n09:51<br \/>\nsuture that you&#8217;re holding your tying in<br \/>\n09:53<br \/>\nyou can see this is going to create half<br \/>\n09:55<br \/>\nof your suture circle you want to bring<br \/>\n09:58<br \/>\nthe other suture around to create the<br \/>\n09:59<br \/>\nfull suture sort suture circle around<br \/>\n10:02<br \/>\nboth your fingers and then you need to<br \/>\n10:04<br \/>\nbend your middle finger back over the<br \/>\n10:06<br \/>\nLupus suture grab this little part<br \/>\n10:09<br \/>\nthat&#8217;s being held between your middle<br \/>\n10:10<br \/>\nfinger and pinched in between your index<br \/>\n10:12<br \/>\nfinger and thumb pinch it and then flick<br \/>\n10:15<br \/>\nthat little part through which is how<br \/>\n10:18<br \/>\nyou bring it through the loop of suture<br \/>\n10:20<br \/>\ncircle so again a slightly sped up<br \/>\n10:22<br \/>\nkarate chop down this is<br \/>\n10:24<br \/>\nan internal chop bring the looper suture<br \/>\n10:28<br \/>\nover grasp a little part of suture on<br \/>\n10:30<br \/>\ntension pinch it in between your middle<br \/>\n10:33<br \/>\nfinger and your in your ring finger<br \/>\n10:35<br \/>\nflick the tail through pull it down<br \/>\n10:39<br \/>\nkarate chop suit your circle grab that<br \/>\n10:43<br \/>\ntail flick it through one more time<br \/>\n10:46<br \/>\nkarate chop suture circle<br \/>\n10:49<br \/>\ngrab that tail flick it through and one<br \/>\n10:53<br \/>\nmore time karate chop suture circle grab<br \/>\n10:57<br \/>\nthe tail flick it through you&#8217;re halfway<br \/>\n11:00<br \/>\nthere<br \/>\n11:01<br \/>\nthat&#8217;s the karate ten okay so now on to<br \/>\n11:09<br \/>\nthe figure form so whereas the karate<br \/>\n11:11<br \/>\nchop was an internal rotation the figure<br \/>\n11:13<br \/>\nfour you have to think of an external<br \/>\n11:15<br \/>\nrotation you want to create a little<br \/>\n11:17<br \/>\nbridge with your index finger and your<br \/>\n11:19<br \/>\nthumb and you want to come out and<br \/>\n11:21<br \/>\naround educate a little trapeze across<br \/>\n11:24<br \/>\nthese two fingers and you want to make<br \/>\n11:25<br \/>\nthat pretty big okay you can see that<br \/>\n11:29<br \/>\nthis also creates half of your suture<br \/>\n11:30<br \/>\ncircle so now bring the little trapeze<br \/>\n11:34<br \/>\npart over your your other side of your<br \/>\n11:37<br \/>\nsuture the part that you&#8217;re holding on<br \/>\n11:38<br \/>\ntension and you&#8217;re going to create what<br \/>\n11:40<br \/>\nlooks like a figure four again starting<br \/>\n11:43<br \/>\nposition for the karate chop is here for<br \/>\n11:47<br \/>\nthe figure four you&#8217;re going to hold the<br \/>\n11:49<br \/>\nsuture back down in these three fingers<br \/>\n11:50<br \/>\nalmost like shooting guns form this<br \/>\n11:52<br \/>\nlittle pincher external rotation to<br \/>\n11:54<br \/>\ncreate your little bridge across the two<br \/>\n11:56<br \/>\nfingers bring this over your suture on<br \/>\n11:59<br \/>\ntension to create your suture circle now<br \/>\n12:02<br \/>\nyou&#8217;re going to bend your finger and you<br \/>\n12:04<br \/>\ngot to flick that little part that&#8217;s<br \/>\n12:05<br \/>\nsort of like the trapeze there which is<br \/>\n12:07<br \/>\nwhy you need it to be nice and big and<br \/>\n12:08<br \/>\non tension and they&#8217;re going to flick<br \/>\n12:10<br \/>\nthat through the suture circle pull it<br \/>\n12:13<br \/>\nthrough then all right so now a little<br \/>\n12:17<br \/>\nmore fluently pincher trapeze here&#8217;s the<br \/>\n12:22<br \/>\nfigure four you&#8217;re going to grab it<br \/>\n12:24<br \/>\nlittle trippy&#8217;s and flick it through the<br \/>\n12:26<br \/>\nloop of suture circle down starting<br \/>\n12:29<br \/>\nposition pincher little trapeze right<br \/>\n12:33<br \/>\nhere make that figure four that&#8217;s<br \/>\n12:35<br \/>\nactually how you make your suture circle<br \/>\n12:37<br \/>\ngrab that little trapeze part on tension<br \/>\n12:39<br \/>\nthis takes some practice and then you&#8217;re<br \/>\n12:41<br \/>\ngoing to want to flick it through pull<br \/>\n12:43<br \/>\nthe tail through one more time pincher<br \/>\n12:47<br \/>\ntrapeze figure four flick that tail<br \/>\n12:51<br \/>\nright through and down okay so now<br \/>\n13:00<br \/>\nputting this all back together again<br \/>\n13:02<br \/>\nyou&#8217;re going to have to alternate back<br \/>\n13:03<br \/>\nand forth between your karate chop and<br \/>\n13:05<br \/>\nyour figure four and just like with the<br \/>\n13:07<br \/>\ntwo-handed nuts you&#8217;re also going to<br \/>\n13:08<br \/>\nhave to alternate between one your right<br \/>\n13:10<br \/>\nhand goes up and your right hand goes to<br \/>\n13:11<br \/>\ndown so to put this together here we go<br \/>\n13:14<br \/>\nkarate chop grab it and for this I&#8217;m<br \/>\n13:18<br \/>\ngoing to have my right hand go up come<br \/>\n13:21<br \/>\nback to figure four pull the tail<br \/>\n13:23<br \/>\nthrough my right hand goes down<br \/>\n13:26<br \/>\nkarate chop right hand goes up to your<br \/>\n13:31<br \/>\nfour right hand goes down karate chop<br \/>\n13:35<br \/>\nright hand goes up figure four right<br \/>\n13:39<br \/>\nhand goes down karate chop right hand<br \/>\n13:42<br \/>\ngoes up figure four<br \/>\n13:45<br \/>\nright hand goes bending it&#8217;s a little<br \/>\n13:47<br \/>\nharder to see this on the shoe then on<br \/>\n13:49<br \/>\nyour practice board but if you look at<br \/>\n13:51<br \/>\nit it does look like a little bit of a<br \/>\n13:52<br \/>\nchain rope here and that&#8217;s how you know<br \/>\n13:55<br \/>\nthese are square knots even with<br \/>\n13:57<br \/>\none-handed knots okay and this is how it<br \/>\n14:04<br \/>\nwould look like if you use it on the<br \/>\n14:05<br \/>\npractice board so again<br \/>\n14:07<br \/>\nkarate chop down actually we&#8217;re going to<br \/>\n14:11<br \/>\ngo up figure four down<br \/>\n14:17<br \/>\nkarate chop up figure-four then karate<br \/>\n14:25<br \/>\nchop up figure-four down variety chop up<br \/>\n14:32<br \/>\nfigure-four down and you can see these<br \/>\n14:36<br \/>\nare nice square nuts with the purple<br \/>\n14:38<br \/>\nkind of winding back and forth okay and<br \/>\n14:42<br \/>\nso that&#8217;s about it<br \/>\n14:43<br \/>\nso once you get this down it&#8217;s going to<br \/>\n14:45<br \/>\ngo about this fast this basically<br \/>\n14:50<br \/>\nbecomes muscle memory and then when<br \/>\n14:53<br \/>\npeople are distracting you or if you&#8217;re<br \/>\n14:55<br \/>\na little nervous you don&#8217;t even have to<br \/>\n14:57<br \/>\nthink about it it&#8217;s just something that<br \/>\n14:58<br \/>\nyou kind of do automatically and the key<br \/>\n15:01<br \/>\nhere really is you want to do this with<br \/>\n15:02<br \/>\nsomething big like your shoelace or your<br \/>\n15:04<br \/>\npractice board because you want to make<br \/>\n15:05<br \/>\nsure you get the muscle memory down of<br \/>\n15:07<br \/>\ntying good square knots before you move<br \/>\n15:09<br \/>\non to small suture because if you<br \/>\n15:11<br \/>\npractice with small suture at first you<br \/>\n15:13<br \/>\nwon&#8217;t be able to see your nuts may end<br \/>\n15:14<br \/>\nup teaching yourself some bad habits<br \/>\n15:16<br \/>\nthat you don&#8217;t really want to propagate<br \/>\n15:18<br \/>\nall the way through so grab your shoe<br \/>\n15:21<br \/>\ngive us a practice have some fun and I<br \/>\n15:23<br \/>\nhope you find this video to be helpful<\/p>\n<p><\/div>\n","protected":false},"excerpt":{"rendered":"<p>Duration 15:35<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":781,"menu_order":101,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-294","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/294","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/comments?post=294"}],"version-history":[{"count":0,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/294\/revisions"}],"up":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/781"}],"wp:attachment":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/media?parent=294"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}