Kei te mamae tō pakihiwi? Tērā pea he pakaru o te hononga o te pokohiwi!

He uaua hoki ki a koe te hiki, te huri rānei i tō pakihiwi? He mamae rānei ina pērā koe? I ētahi wā ka moe koe i te pō, ka tino mamae koe, ā, kāore e taea e koe te whakatakoto i te taumaha ki runga i tō pakihiwi? Kei te ahua rānei koe kei te 'piri' tetahi mea ki roto i tō pakihiwi, kei te mau rānei? Kātahi ka tino hira tēnei kōrero ki a koe. I tēnei rā ka kōrero tātou mō tētahi raruraru pakihiwi e pāngia ana e te tini o te tangata, engari kāore i te tino mōhio. He haehae tēnā i te wāhanga o te pakihiwi e kiia nei ko te rotator cuff .

He aha te poroporo porotaka o te pakihiwi? He aha te pakaru?

Ki te kī māmā noa, ko te rotator cuff he kohinga o ngā uaua e whā me ō rātou uaua i roto i tō pakihiwi e hanga ana i tētahi 'cuff' iti, i tētahi poroporo rānei huri noa i te hononga pakihiwi.

Ko tāna mahi matua he āwhina i a koe ki te hiki, ki te whakaheke, ki te huri i tō ringa ki roto, ki waho hoki . Ka āwhina hoki ki te pupuri i te wāhanga rite-pōro o te wheua o tō ringa o runga (e kiia nei e tātou ko te humerus i roto i ngā kupu hauora) ki roto i tōna pūnga i roto i te mata o te pakihiwi. Whakaarohia he rite ki te pōro korowha i runga i te tī korowha. Koinei te mahi a tō tātou hononga pakihiwi. Ka āwhina te porotaka porotaka ki te pupuri i te pōro kei peke atu i te tī.

Nō reira, ko te haehae o te poroporo ringa ko te wā e motu katoa ana, e wehe wāhanga rānei tetahi, ētahi rānei o aua uaua i te wheua ringa o runga (tumuaki). Ka puta ohorere pea tēnei (pēnei i te hinganga), ka puta rānei i roto i te wā i te mea ka memeha haere te uaua i roto i te wā.

He momo roimata anō kei reira?

Ae, e rua ngā momo matua:

1. Haehae Wāhanga: Koinei te wā kāore te uaua e tino wehea mai i te wheua. Ko te tikanga kei te piri tonu te uaua ki te wheua ki tētahi wāhi. Engari kua paku haehae, kua ngoikore hoki. He rite ki tētahi wahi kakahu kua paku haehae, kāore i tino haehae.

2. Te Haehae Katoa, te Haehae Matotoru rānei: Koinei te wā e wehea katoatia ai te uaua i te wheua. Ina koa, te āhua nei he kōhao kei roto i te uaua, ka whati rānei kia rua.

He pēhea te noa o tēnei āhuatanga?

He nui ake te kitea o ngā pakaru o te ringaringa o te takahurihuri i tō whakaaro. He mea tino kitea i waenga i ngā kaumātua . E ai ki ētahi tatauranga, miriona tāngata huri noa i te ao e pāngia ana e tēnei raruraru o te ringaringa o te takahurihuri i ia tau.

Whakaarohia, kei ētahi tāngata tēnei roimata engari kāore he tohu, nō reira kāore rātou e mōhio kei a rātou! Tērā pea he tino puku i ētahi wā.

He aha ngā tohu? He aha ō whakaaro mō tēnei?

He rerekē ngā tohu o te haehae o te rotator cuff i ia tangata, engari he maha ngā tohu noa:

• He uaua, he mamae, ā, e rite ana ki te kore he kaha o te ringa ina hiki, ina whakaheke, ina hurihia rānei.Tērā pea ka puta tēnei mamae ina heru koe i ō makawe, ina rakuraku koe i tō tuara, ina totoro atu rānei tō ringa ki te tiki i tētahi mea.
• Ina nekehia e au tōku ringa i tētahi ara , ka rongo ahau i te tangi 'tiki-toki' 'chiri-chiri' rānei e puta mai ana i roto i tōku pakihiwi, ka rongo rānei ahau me te mea kei te miro tetahi mea, kei te mau rānei i roto.
• Ka kino haere te mamae o te pakihiwi i te pō. Ka tino kino te mamae ina moe ana i te taha whara. Ka pāngia ētahi tāngata e te mamae ahakoa ka okioki noa ō rātou ringa ki tō rātou taha.
• He ngoikore ō pakihiwi, ā, he uaua ki te hapai i ngā mea, ki te whakatuwhera i ngā tatau, me ērā atu mea. Tērā pea ka uaua ki a koe te mahi i ngā mea ngāwari i mua.

He aha rawa te āhua o tēnei mamae?

He rerekē anō hoki tēnei mō ia tangata. Tērā pea ka pāngia ētahi e te mamae puhoi, pumau, me te mea kei roto i te pakihiwi tetahi mea e mau ana, me te taumaha hoki . Tērā pea ka pāngia ētahi e te mamae koi, e te wero .

• Ki te puta te haehae i roto i tētahi aituā ohorere (te haehae nui) , pērā i te hinganga, ka pāngia pea koe e te mamae pakihiwi e kore e taea te whakamanawanui, me te ngaronga katoa o te kaha o te ringa.
• I roto i te haehae pirau , tera pea he ngawari te mamae i te tīmatanga. Tērā pea ka whakamamahia mā te whakamahi i ngā rongoā mamae kore-tohu (ngā rongoā mamae OTC). Heoi, i roto i te wā, ka kaha ake te mamae, ā, kāore pea e whakamamahia e te rongoā.
• Ko te mea nui, ehara i te mea ka pāngia te katoa e te mamae, engari ko te nuinga o te tangata ka tino pāngia e te ngoikore o ō rātou ringa me ō rātou pakihiwi.

He aha tēnei e tupu nei? He aha ngā take mō tēnei?

He maha ngā take pea ka pakaru te rotator cuff.

1. Whara Whakamataku:

Ka pakaru pea te uaua i te hinganga, i te whiunga kaha ki te pakihiwi, i te pēhanga ohorere rānei o te pakihiwi i te wā e hiki ana i tētahi mea taumaha. I ētahi wā, ka pakaru hoki te poroporo porotaka ina heke te pakihiwi, ina whati rānei te wheua kara.

2. Ngā Roimata Whakaheke:

Koinei te tino take. He tino nui tēnei mōrearea i roto i te hunga neke atu i te 40 tau te pakeke. He maha ngā take ka pā mai ai tēnei:

• Ngā Wheua Wheua: Ka puta he wheua wheua iti ki ētahi tāngata ("(Bone spurs)") i runga i te wheua pakihiwi, te wāhi e haere atu ai te uaua. Ina ara ake tō tātou ringa, ka mirimiri ēnei wheua wheua ki te uaua. Ka kiia tēnei ko te "Shoulder Impingement". Ina mirimiri tonu tēnei, pērā i te taura e mirimiri ana ki te toka, ka ngoikore te uaua, ka haehae.
• Te Rere o te Toto i te Heke:I a tātou e pakeke haere ana, ka heke te rere o te toto ki ngā uaua o te poroporo. Ina whara tētahi wāhanga o tō tātou tinana, he mea nui te rere pai o te toto kia ora ai. Nō reira, ki te kore e ranea te rere o te toto, ka ngoikore te uaua, ā, ahakoa he whara iti noa iho, kāore e tere te ora, ā, ka taea te haere mārire ki te haehae nui.
• Te Whakamahinga Nui me ngā Nekehanga Whakahoki:

Ahakoa he takaro hākinakina, he mahi rānei o ia rā, ki te whakamahia tō pakihiwi i taua ara anō, ka nui te taumahatanga ki ngā uaua me ngā uaua. Ka taea hoki e tēnei te ngoikore o te uaua, ka haehae. Whakaarohia tētahi e titiro ake tonu ana i a ia e peita ana, tētahi e mahi kāmura ana, tētahi rānei e pōro tonu ana i te pōro tere i a ia e takaro kirikiti ana, poipapa rānei. He nui ake te mōrearea mō rātou.

Ko wai te mea ka nui ake te tūponotanga ka pāngia e tēnei? (Ngā Take Tūpono)

Ina hoki, ka taea e te tangata katoa te pakaru te poroporo o te ringaringa. Heoi, he nui ake te mōrearea o ētahi tāngata. Tirohia mēnā e pā ana ēnei kōrero ki a koe:

• Tau: He nui ake te mōrearea o te hunga neke atu i te 40 tau te pakeke nā te mea ka heke te kaha me te ngāwari o ngā uaua i te pakeketanga.
• Hītori whānau: Mena kua pāngia tetahi o tō whānau (whaea, pāpā, tuākana/teina) e ngā raruraru pakihiwi, pērā i te pakaru o te pokohiwi, tera pea he nui ake tō mōrearea.
• Te Kaipaipa: He puhoi ake te whakaora o ngā uaua o te hunga kaipaipa, ā, ka ngoikore pea ō rātou uaua.
• Tūnga Kino: Ko te hunga e mahi ana i runga i te rorohiko, e whakamahi ana i ā rātou waea pūkoro, e piko ana rānei i ō rātou pakihiwi ki mua i a rātou e tū ana, e noho ana rānei, ka pēhi pea i te hononga pakihiwi.
• Ngā mahi me ngā hākinakina: E ai ki te kōrero i mua ake nei, ko te hunga e mahi ana i ngā nekehanga pakihiwi auau ka nui ake te tūponotanga ka pāngia e ēnei roimata pirau. Hei tauira:
• Ngā kāmura
• Ngā kaipeita
• Ngā tohunga hangarau waka
• Ngā tāngata e mahi ana i ngā mahi amo taumaha
• Ngā kaitākaro: Ina koa ko te hunga e tākaro ana i ngā hākinakina pēnei i te pēhipōro, te whutupōro ngohengohe, te tēnehi, te kauhoe, te hoe. Ko te hunga e tākaro ana i ngā hākinakina pēnei i te kirikiti (ina koa ko ngā kaiporo), te poipapa, me te pētiminitini, he mea rongonui i tō tātou whenua, kei roto hoki i te mōrearea.

Ka aha mēnā kāore e tukuna he maimoatanga? (Ngā raruraru)

He pātai tēnei e pātaihia ana e te tini tāngata. Ehara i te mea pai te whakaaro, "Kāore he aha mēnā he mamae paku, ka ora ake ." Nā te mea, ki te kore e rongoatia, ka kino haere te pakaru o te poroporo.

• Ahakoa he haehae iti noa iho , ka taea tonu te haehae katoa mēnā ka whakamahia tonutia te pakihiwi.
• Mena kua haehae katoatia, ka tae pea ki te wāhi e kore e taea e koe te neke, te hapai rānei i tō ringa.
• >Ki te kore e rongoatia mō te wā roa, ka pāngia koe e te mamae pakihiwi mau tonu, ka ngoikore rawa koe, ā, kāore e taea e koe te whakamahi i te ringa kua whara mō ngā mahi o ia rā, ā, ka pāngia hoki koe e ētahi atu raruraru, pērā i te mate rumatiki i roto i te hononga pakihiwi.

Me pēhea te tautuhi tika i tēnei?

Ki te mamae tō pakihiwi, ki te kore rānei e pai te noho, ko te mea tuatahi me mahi e koe ko te toro atu ki te tākuta. Ka pātai atu ia ki a koe, ka tirotirohia hoki koe.

1. Whakamātautau Tinana: Ka pā te tākuta ki tō pakihiwi, ka tirohia mēnā he ngawari, he pupuhi rānei. Kātahi ka tono ia kia nekehia tō ringa ki ngā ahunga rerekē (te whānuitanga o te nekehanga) me te tirotiro i te kaha o tō ringa. Mā ēnei whakamātautau ka taea te whakaatu mēnā he raruraru tō te rotator cuff.

2. Ngā whakamātautau motuhake (Ngā Whakamātautau Whakaahua): Hei whakaū i te mate, ka taea te whakahaere i ēnei whakamātautau:

• X-ray: Kāore e taea e tēnei te whakaatu tika i te uaua kua pakaru. Heoi, ka taea e ia te tirotiro mō ngā mea pēnei i te whēkau wheua, te mate rumatiki, me ētahi atu raruraru wheua.
• MRI (Atahanga Āhua Aukume): Koinei te whakamātautau pai rawa atu hei tirotiro i ngā pakaru o te hononga o te ringa. Ka taea te whakaatu mārama i te nui o te pakaru o te uaua me te momo pakaru (wāhanga, pakaru katoa rānei).
• Matawai Ultrasound: Ka taea hoki te whakamahi i tēnei hei tirotiro i ngā mea pēnei i te pakaru o te uaua me te pupuhi. He whakamātautau ka taea te mahi tere ake, ā, he iti ake te utu i te MRI.

He aha te rongoā mō tēnei?

Ko te rongo pai, he maha ngā maimoatanga mō te haehae o te ringaringa takahuri. Mā tō tākuta e whakatau te maimoatanga pai rawa atu māu i runga i ngā āhuatanga pēnei i te āhua o tō haehae, tō tau, me tō taumata mahi.

Ka taea te wehewehe i ngā tikanga maimoatanga ki ngā wāhanga matua e rua:

1. Ngā Kōwhiringa Kore-Pokanga

He mea nui tēnei mō te tini o te tangata: Kāore e ora katoa ngā pakaru o te poroporo (ka piri anō te uaua) me te kore he pokanga. Heoi, he maha ngā tāngata (ina koa ko te hunga he pakaru wāhanga, ko te hunga kua kaumātua rānei) ka taea te whakaiti i te mamae, te whakapai ake i te mahi a te pakihiwi, me te hoki ki te taumata e taea ai e rātou te mahi i ngā mahi o ia rā me te kore he pokanga.

Ina hoki, kua whakaatuhia e ngā rangahau e waru i roto i te tekau ngā tāngata he roimata wāhanga ka taea te ora pai mā te maimoatanga kore-pokanga . Heoi, ka roa pea ngā marama, tae atu ki ngā tau, kia pai ake ai tēnei āhuatanga. Me manawanui koe ki te maimoatanga.

He aha ēnei maimoatanga kore-pokanga?

• Te Okiokinga me te Whakarerekētanga Mahi:He mea tino nui kia okioki tō pakihiwi. Me mutu pea, me whakaiti rānei i ngā mahi, i ngā hākinakina rānei e mamae ana mō tētahi wā. Tērā pea ka tūtohu tō tākuta kia mau koe i te whitiki ringa mō ētahi rā.
• Ngā rongoā whakamamae mamae: Ka tūtohu pea tō tākuta i ngā rongoā mai i te rōpū rongoā whakamamae e kiia nei ko ngā NSAID (hei tauira, Ibuprofen, Diclofenac) hei whakaiti i te mamae me te pupuhi.
• Whakaora Tinana: Koinei te wāhanga tino nui o te maimoatanga kore-pokanga. Mā te kaiwhakaora tinana whai tohu koe e ako ki ngā mahi whakapakari tinana hei whakapakari i ngā uaua o tō pakihiwi me ngā mahi totoro hei whakanui ake i te whānuitanga o te nekehanga o tō pakihiwi. Mā te mahi tika i ēnei mahi ka āwhina i te whakaiti i te mamae me te whakapai ake i te mahi a tō pakihiwi.
• Werohanga Steroid: Mena he nui te mamae me te pupuhi, ka whakatau pea tō tākuta ki te werohanga steroid (hei tauira, he werohanga cortisone) ki roto i tō hononga pakihiwi. Ahakoa ka tere pea te whakaora i tēnei, he otinga rangitahi noa iho. Ehara i te mea pai kia mau tonu te tango i ēnei werohanga.

2. Ngā Kōwhiringa Pokanga

E hiahiatia ana te pokanga i roto i ngā take e whai ake nei:

• Mena he haehae katoa tōu (ina koa he haehae nui).
• Ahakoa he haehae wāhanga noa iho, kāore he whakapainga e kitea i muri i ngā marama 6-12 o te maimoatanga kore-pokanga.
• Mena he taitamariki koe, he kaha te hihiri, kei runga rānei i ō pakihiwi tō mahi, ō hākinakina rānei.
• Mena he pakaru nui nā te whara nui.

Ko te nuinga o ngā pokanga mō te whitiki takahuri ka mahia mā te arthroscopic . Ko te tikanga o tēnei ka whakauruhia he kāmera iti (arthroscope) me ngā taputapu pokanga mā roto i ētahi tapahi iti i te pakihiwi. He iti ake te mamae me te tere o te whakaora i tēnei tikanga nā te mea kāore e hiahiatia he tapahi nui. Heoi, i ētahi wā, ki te nui rawa, he uaua rānei te haehae, ka taea e te taote pokanga te mahi pokanga tuwhera (he tikanga e hiahiatia ana he tapahi nui ake).

Ko te whāinga matua o te pokanga he whakahoki i te uaua kua pakaru ki te wheua. I ētahi wā, mēnā he whēkau wheua, ka tangohia atu hoki.

• Mēnā he pakaru wāhanga , ko ētahi noa iho o ngā wahi kua pakaru, he rite ki te miro, me tapahia e te taote pokanga. Ka kiia tēnei ko te tango i te kiri .
• Tērā pea ētahi haehae he haehae kore e taea te whakatika nā te rahi, te roa o te haehae, me te āhua o te uaua. I ēnei āhuatanga, me whakaaro pea ki ētahi atu pokanga. Hei tauira, ko te "Whakakapinga pakihiwi whakamuri" (he pokanga motuhake hei whakakapi i te hononga pakihiwi) te "Whakawhitinga uaua" rānei (ka haria mai he uaua hauora mai i tētahi atu wāhi ka whakatikahia).

Ko te tikanga ka mahia tēnei pokanga i taua rā anō, i te rā i muri mai rānei (he 'tikanga tūroro', he noho poto rānei). Heoi, he roa te wā ka ora katoa i tēnei pokanga, pea kotahi tau, neke atu rānei.

Kia pēhea te roa o te wā e ora ai? (Te Wā Whakaora)

He mea tēnei e pātaihia ana e te tini me te āwangawanga.

• Ki te kore he pokanga, tera pea ka roa ētahi marama ka heke te mamae, ka piki haere hoki te mahi mā te whakaora tinana me ētahi atu maimoatanga.
• Mena ka pokangahia koe,
• I muri i te pokanga, me mau koe i te whitiki mō te 4 ki te 6 wiki hei ārai i te nekenekehanga o tō ringa. He mea nui kia okioki tō pakihiwi i tēnei wā.
• Kātahi ka tīmata koe i te whakaora tinana . He mea tino tika tēnei kia mahia. Ka tīmata mārire koe mā te neke haere i ngā pakihiwi, kātahi ka neke atu ki ngā mahi whakapakari tinana.
• Ka hoki anō te nuinga o te iwi ki te mahi me te kaha o ō rātou pakihiwi i roto i te 4 ki te 6 marama i muri i te pokanga, ā, ka taea e rātou te mahi i ngā mahi o ia rā.
• Heoi, e 9, 12, 18 marama rānei te roa hei whakaora katoa, hei hoki anō ki ngā mahi pēnei i ngā hākinakina. Kei te rahi o te pakaru, te momo pokanga, tō tau, me te pai o tō mahi whakaora tinana.

He aha ngā mea ka tupu i muri i te whakaoranga? (Matapae/Tirohanga)

Ka taea e te nuinga o te iwi te ora pai i muri i te pakaru o te rotator cuff.

• He tokomaha te hunga e pāngia ana e te whakaiti i te mamae me te whakapai ake i te āhua mahi mā roto i ngā maimoatanga kore-pokanga .
• Mā te pokanga, inā koa mā ngā tikanga hou pēnei i te arthroscopy, ka taea e te tini o te tangata te whakaora anō i te mahi pai o ō rātou pakihiwi.
• Heoi, he iti noa te tūponotanga ka pakaru anō te uaua kotahi. He nui rawa tēnei mōrearea mēnā he nui rawa te pakaru tuatahi, mēnā he kaumātua koe, he kaipaipa rānei. Mēnā ka pakaru anō, ā, ka mamae nui, ka ngaro rānei te mahi, me whakaaro anō koe ki te pokanga.

Ka taea te ārai i tēnei mea kei puta anō? (Ārai)

Ahakoa kāore e taea te ārai katoa, kei reira ētahi mea ka taea e koe te mahi hei whakaiti i tō tupono ki te whakawhanake i te pakaru o te rotator cuff:

• Kia kaha, kia ngāwari hoki ngā uaua o tō pakihiwi. Me mahi tonu ngā mahi totoro me te whakapakari i tō pakihiwi. Pātai atu ki tō tākuta, ki tō kaiwhakaora tinana rānei mō ngā tohutohu mō tēnei.
• Kia tika te tū a te tinana i te wā e mahi ana, e tākaro hākinakina ana rānei.
• Ki te mea kei te mahi tonu koe i ngā nekehanga ōrite, me whai wā okioki i waenganui. Kaua e whakakaha rawa i ō pakihiwi.
• Ina hiki koe i tētahi kawenga, me hiki tika. Kaua e tōia katoatia i te wā kotahi, engari me hiki noa mā ō pakihiwi.
• Ki te kai hikareti koe, kati.

Āhea me waea atu ki tō kaiwhakarato hauora?

Mena kei a koe tētahi o ēnei tohu, me toro atu koe ki te tākuta mō ētahi tohutohu:

• Te mamae o te pakihiwi me te ringa rānei kua roa e pāngia ana.
• Mena ka kino haere te mamae i te pō, ā, ka whakararuraru i te moe.
• Mena he whero, he pupuhi, he mamae nui rānei ina pāngia te hononga pakihiwi.
• Mena ka pāngia koe e te ngoikore ohorere i tō pakihiwi, i tō ringa rānei , inā koa i muri i tētahi aituā.
• Mena kei te pāngia ō mahi o ia rā e te mamae me te kore whakamarie o tō pakihiwi, ā, kāore e taea e koe te mahi i ō mahi o ia rā .

He aha ngā pātai me pātai atu koe ki te tākuta?

Ina haere koe ki te tākuta, kaua e mangere ki te pātai i ēnei pātai:

• Nā te aha i pakaru ai te poroporo o te ringa? He aha te tino take o tēnei mate?
• He aha te momo roimata o taku roimata (wāhanga, katoa)? He aha te rahi?
• He aha te rongoā pai rawa atu mōku? Me pokanga ahau?
• E hia te nui o te whakapainga ka taea e au te tumanako mai i ngā maimoatanga kore-pokanga?
• Mena ka pokangahia ahau, he aha ngā mōrearea? Kia pēhea te roa o te wā e ora ai ahau?
• Me aha ahau hei ārai i tēnei momo haehae kei puta anō?
• He aha ngā mahi me karo e au? He aha ngā mea ka taea e au te mahi?
• Me mōhio ahau ki ngā raruraru? He aha ngā tohu o aua raruraru?

Mena he nui tō mahi, he kaitākaro rānei koe, ka taea e te haehae o te rotator cuff te tango i a koe i tō mahi, i ō hākinakina rānei mō tētahi wā. Heoi, kāore e tika kia waiho hei mutunga mō tō umanga, mō tō umanga hākinakina rānei. Kōrero ki tō tākuta mō te kōwhiringa maimoatanga pai rawa atu māu – ahakoa ehara i te pokanga, he pokanga rānei. Ahakoa he mamae, he ngoikore hoki tō pakihiwi mō tētahi wā, ka taea e ia te ora i roto i te wā, te maimoatanga tika, me ō ake mahi. Ko te manawanui me te whai i ngā tohutohu a tō tākuta te mea nui.

Karere Tangohia ki te Kāinga

He mate noa te haehae o te rotator cuff, engari he mate kino pea, ka pā te mamae o te pakihiwi me te ngoikore.

• Ngā Take: Ngā aituā, te pakaru me te haehae i te kaumātuatanga, te whakamahinga nui o te pakihiwi, me te whanaketanga o ngā whēkau wheua.
• Ngā Tohu: Mamae te pakihiwi (ina koa i te pō me te wā e hiki ai te ringa), uaua ki te hiki i te ringa, ngoikore, haruru 'pāwhiri' e puta mai ana i te pakihiwi.
• Ngā whakamātautau: Whakamātautau tinana, X-ray, MRI, ultrasound rānei.
• Maimoatanga: Okioki, rongoā whakamamae mamae (NSAID), whakaora tinana, werohanga steroids, me te pokanga (pēnei i te pokanga arthroscopic) mēnā e tika ana.
• Ko te mea nui: Ki te mamae tonu tō pakihiwi, ki te kore rānei e pai te āhua , me toro atu ki te tākuta. Mā te wawe o tō kitenga me te tīmata i te maimoatanga, ka nui ake te tūponotanga ka ora koe. Kaua e ngana ki te rongoā i a koe anō! He pai te utu mō tō pakihiwi.

Mamae pakihiwi, poroporo poroporo, pakaru uaua, whara pakihiwi, whakaora tinana, pokanga pakihiwi, pakaru poroporo poroporo