Latest / HER / Avoiding Women’s Unique Fitness Injuries

Transcript

Avoiding Women’s Unique Fitness Injuries · HER

0:07
Pam Peeke, MD: Hi, I'm Dr.
0:08
Pam Peeke, and this is episode 562 of The Bold and the Brave Her podcast.
0:17
Now, today I'm joined by, oh, finally, an expert that I could just
0:25
absolutely get so excited about.
0:28
This is Miho Tanaka.
0:31
Dr.
0:31
Tanaka is the director of the Women's Sports Medicine program, oh, my goodness
0:38
gracious, at Mass General Hospital.
0:42
So she knows all the things we're doing wrong, and we're gonna be
0:47
talking about avoiding and trying to decrease women's unique fitness
0:54
injuries 'cause, honey, we are unique.
0:57
There's no question about it.
0:59
So she's also the chief medical officer for the New England Revolution
1:05
and team physician for the Boston Red Sox and the Boston Ballet.
1:11
That just brought back some really funky memories from my years in the
1:16
San Francisco Ballet when they kept yelling at me, "You're too tall."
1:20
Like, what can I do about that?
1:22
Just talk to me.
1:24
You know, I'm 10 years old.
1:26
"You're too tall.
1:26
You look like a little tree in the background."
1:29
Okay, I'm five, nine, you know, hurt me.
1:32
But anyway, oh, my goodness gracious, Dr.
1:35
Tanaka, welcome to the Her podcast
1:39
Miho J. Tanaka, MD, PhD:
1:39
Thank you so much for having me
1:41
Pam Peeke, MD: Oh my gosh.
1:42
I am so excited to be talking to you because you have such a breadth of
1:49
experience in basically all things women's injuries and why we're so unique.
1:56
Now, in our HER Podcast audience is a mix of women who've just been kinda rocking
2:03
it for a long time with physical activity, and others saying, "Oh, I don't know.
2:08
I'm gonna, you know, like, take the first step."
2:11
or they're fearful.
2:13
"I did take a first step, and the whole thing went to hell.
2:17
I got hurt and, you know, blah, blah, blah."
2:20
And so what I'd love to do is take 10 steps backwards and really have you
2:28
look at why women have such unique injuries, especially around the knee
2:35
and all the rest of it, with all the torquing in tennis and Serena
2:40
Williams and all the rest of it.
2:42
So I would love for you to be able to guide women a little bit now, with some
2:50
expertise about what to try to avoid doing when you're really getting into it
2:56
Miho J. Tanaka, MD, PhD:
2:56
it's kind of a loaded question, because there's a lot of
2:58
factors that play into this.
3:00
But I would say that when it comes to injuries in women, we typically think
3:04
of this in terms of the non-modifiable risk factors, so essentially how you
3:09
are built versus the modifiable risk factors, which is more along the lines
3:14
of how your muscles work essentially.
3:17
so in terms of, you know, the non-modifiable risk factors, this
3:20
is what we always think about.
3:21
Women are just built different than men.
3:24
and there's a lot of different ways that this happens, but essentially
3:27
when we're talking about knees specifically, you know, the angles
3:31
at the knees from the hips going down to the ankles is different.
3:35
You know, this is often, evolutionarily speaking from, you know, for
3:39
childbearing purposes, but there's just more pressure at the knee, and
3:43
that can influence that as well.
3:45
We have wider hips, a lower center of gravity.
3:48
Our joints are proportionally smaller.
3:50
Our limbs are, not as long.
3:53
And so if you take that back to physics essentially, and you think
3:57
about how long your limbs are, that's kind of how you generate, you
4:01
know, what we call the moment arm, so that's how you generate force.
4:04
And so that's the reason that if you're comparing men and women in terms of
4:08
strength or speed, that women just are not gonna be as strong or as fast.
4:13
It's purely a biomechanical issue.
4:16
but when we talk about, you know, why they're more likely to get injured
4:19
and what we can do to prevent that, one of the things that we know is that
4:23
if you compare men and women, women are much more likely to have deficits
4:28
and muscular imbalances, particularly during activities like landing from
4:32
a jump or cutting and pivoting.
4:34
So specifically, you know, women tend to have weaker hamstrings, and the
4:38
hamstrings are actually the muscles that really support the knee ligaments,
4:41
especially things like the ACL.
4:43
They tend to have less core strength, and so the core is a huge stabilizer.
4:48
And you know, some people might say, "Well, how does that relate to the knee?"
4:51
But if your core isn't strong, you can actually have these imbalances that then
4:55
put more pressure onto the knee as well the thing that we call dynamic valgus,
5:01
so that's essentially w- the position that your knee falls into, the sort of
5:06
knock-kneed position that gets accentuated when you have muscular imbalances.
5:11
So that tends to be more common in women as well, and each one of those factors
5:16
has actually been shown in studies to increase your risk of knee injury.
5:20
those are kind of the thing, the ways that we typically look at this.
5:23
Now, the thing about those modifiable risk factors, meaning the muscle
5:26
imbalances, is that there are plenty of studies that have shown that you can
5:30
actually change your risk for injury.
5:34
So you can strengthen your hamstrings, and you can work on your core strength,
5:38
and you can work on the position of your knee when you're landing.
5:41
And this is especially critical in the younger population, so women under 20.
5:46
But even as you get past the age of 20, even though it might not reduce your risk
5:51
of specific types of ligament injuries, it will definitely help your performance, it
5:55
will help your body awareness, as you're playing sports, and very likely lead to
5:59
downstream effects, just not specifically related to ACL injuries, which is where
6:04
the majority of this literature is
6:06
Pam Peeke, MD: Why is it in your 20s that it's so important?
6:09
You know, I was half expecting you to say, "Well, once you become old, you
6:13
know, when you're 50 and over, that's when everything kind of goes downhill anyway."
6:19
I was half expecting you to say, "Well, it's most important in that
6:24
demographic," but you're telling me it, it's the younger demographic
6:28
Miho J. Tanaka, MD, PhD:
6:28
this is a really good point.
6:29
So I do, I do think that there needs to be more studies in the maturing
6:35
population of female athletes.
6:38
But a lot of the data has been done on, ACL injuries, which is one
6:41
of the most common injuries that we treat as orthopedic surgeons.
6:45
And what we know is that during puberty and then as people are
6:50
growing, that is the highest risk for most types of orthopedic injuries.
6:56
and muscle imbalances tend to become much more accentuated during that time.
7:00
And so this is why we think that these exercises, these preventative
7:03
exercises, are really important.
7:05
Now, people haven't looked as much, into ACL prevention as we get, you know, past
7:10
the age of 40 because the majority of the people who have this type of problem
7:14
and these injuries are playing cutting and pivoting sports, and so they end
7:18
up being under the ages of 20 or 30.
7:21
But to your point, you know, about the maturing athlete, there is a little bit of
7:24
a different model that we think about as we kind of get into our 30s, 40s, and 50s.
7:30
And this is the concept of, I don't wanna call it aging, but I
7:33
think, you know, this maturing is a, is a good way to think about it.
7:37
And essentially, you know, the way I describe it is that as we age, the same
7:42
collagen that's in your skin and that's in your hair as you start to see changes
7:48
in your friends around you as they reach their 30s and 40s, is also in our muscles
7:53
and in our ligaments and in our tendons.
7:55
And so with that, we're gonna find that our ligaments and, and tendons are much
8:00
more brittle, they are less likely to handle load, and they retain less water.
8:07
And so all of these things can increase your risk of injury and
8:11
make you more susceptible to things like inflammation, muscle tears,
8:16
tendonitis, and all of those things.
8:17
And I think that is, you know, for both men and women, a really challenging aspect
8:23
of being an athlete as you go through life because most people have a certain way
8:27
of training and doing their exercises, or they've kind of learned a certain way
8:32
to approach it, but now their body is responding differently, and that can be
8:37
a really difficult thing to get used to as you're, as you're going through life
8:42
Pam Peeke, MD: So it kind of begs the question.
8:44
you know, a little sidebar here.
8:46
You mentioned collagen, and it's like one of the hottest supplements out there.
8:51
So people are just like throwing it into shakes and doing whatever.
8:55
You know, as an expert, do you think that's even worth it, you know, as
8:59
we're dropping collagen as we mature?
9:03
Miho J. Tanaka, MD, PhD:
9:03
I would defer to my nutrition colleagues in terms of the real
9:06
science and the efficacy of, you know, the absorption of collagen.
9:11
the real, approach I think that we know is most effective to this sort
9:15
of aging or degenerating collagen is changing the way you approach exercise,
9:20
and kind of understanding that these changes are happening, and recognizing
9:24
that you need to warm up more.
9:27
You need to stretch more because your muscles are a lot
9:30
stiffer than they used to be.
9:32
they have less, you know, flexibility than they used to, and so, you know, warming
9:36
up, doing all these things that a lot of people, you know, who come into my
9:39
office complain to me and say, "Well, I never had to stretch, you know, before.
9:42
I've never had to warm up.
9:44
I can just go out
9:44
and, you know…"
9:45
Pam Peeke, MD: me?
9:48
I remember I, I-- when I ran Boston, you know, I got an F minus in stretching.
9:54
You know, my running coaches would just throw things at me.
9:58
you know, you're in a rush, you just got through running 12 miles, and you're
10:02
like, "Can I get out of here already?"
10:04
And then I realized we can't do that anymore because I started feeling
10:09
terrible, and recovery became my new, you know, best friend.
10:16
everything about recovery, let alone warming up to start with.
10:22
And I began to be incredibly respectful of that, only because I
10:28
came through the school of hard knocks.
10:31
I actually got a PhD in hard knocks.
10:35
And, you know, it's like, why can't I just listen to experts and do the right thing?
10:39
Well, because I'm a human being, and like so many of the people
10:43
in the Her Podcast audience, we just screw this up right and left.
10:46
So-- but, but you just emphasized something that's so terribly important.
10:52
I noticed that in my 40s, you know, I, I spent a lifetime of being quite flexible.
10:59
And then in my 40s, you know, as I course through perimenopause,
11:03
oh, what a joy, I, noticed I was stiffer, and I was, I was shocked.
11:09
It's like, whoa, you know, w-what happened there?
11:12
I, guess maybe that's when it begins to manifest itself a little bit.
11:16
Yes, no?
11:17
Miho J. Tanaka, MD, PhD:
11:17
Yeah, absolutely.
11:18
I think that, definitely kind of kicks that process into full speed.
11:22
You know, the changes definitely start to happen around your 30s
11:25
or 40s, but definitely around perimenopause and menopause, most
11:29
women really notice a huge shift, where these changes are accentuated.
11:34
But, you know, the thing that I would say about this is that just because, you
11:37
know, we're aging or maturing doesn't mean that we can't work out anymore.
11:42
It just means that we have to be that much more deliberate, about maintenance,
11:47
as you said, kind of learning how to warm up and how to stretch and realizing
11:51
that we have to actually put in that effort in order to be able to maintain
11:55
the same level of exercise that used to come easily for us, you know, in our 20s.
11:59
Pam Peeke, MD: I'm much more strategic.
12:01
I actually sit down and put thought into it.
12:04
Normally, I just ran into it and I was getting away with murder and, you know,
12:09
do a triathlon, like knock that sucker out and, you know, just go somewhere
12:13
and, chill out and like, "Oh, we forgot our recovery and our stretching."
12:18
So, you know, it's amazing how many of us do that.
12:21
But as I get older, maturing, I find myself being so much more cautious because
12:29
quite frankly, who wants to be injured?
12:31
I mean, seriously, who wants to be injured?
12:33
And I'm thinking now, about injury prevention all the time,
12:40
you know, like in a big way.
12:42
So, you know, it's interesting, in your bio, which is absolutely extraordinary,
12:49
everyone out there should know that Dr.
12:51
Tanaka is not only an MD, she's a PhD.
12:56
she's got a full alphabet soup, actually, after her name.
13:01
she's an expert in something I was diagnosed with.
13:06
Hmm.
13:07
Let me see.
13:08
I remember it was during COVID, and it was probably around 2022 when I
13:15
suddenly had a, like a little funky feeling around my kneecaps, and I
13:20
thought, "Okay, what's that about?"
13:22
Now, mind you, my gyms had been closed.
13:25
I couldn't do a lot of my normal physical activity.
13:29
And here's what my orthopedic surgeon said, " You have incredibly strong legs."
13:34
I have, you know, big muscles, and I'm a fairly muscular person.
13:38
He said, "Because you couldn't do your normal training," 'cause I had no
13:42
access to my equipment and all the rest of it, there's only so much you can
13:46
do with body weight, what I had been doing was actually shielding myself
13:51
from what was my actual diagnosis, which was, patellofemoral syndrome.
14:00
had to look it up.
14:01
Okay?
14:02
I've heard it.
14:03
I kind of had a fairly good feeling.
14:05
Here's the good news.
14:07
My knees were fine.
14:09
the space was beautiful.
14:10
He said it-- I've always protected my knees.
14:13
That was the good news.
14:14
This was one of those things, you hate it when doctors do this.
14:17
"First, I'm gonna give you the good news.
14:19
Your knees are cool.
14:20
You know?
14:21
You've never had a problem with ACL or, you know, whatever."
14:24
He says, "Here's the bad news.
14:26
You have end-stage- I love it when they start that, now all
14:31
of a sudden I'm a physician.
14:32
I'm like, "Well, e- excuse me, what?"
14:34
You have end-stage osteoarthritic patellofemoral syndrome.
14:40
So I said, "Okay, I need a drink.
14:43
what the hell is that?
14:47
And, and what do I do?"
14:49
And he said, "Well, you've been working on it for a while, right?
14:52
And now it's just, you know, because your legs are so strong they protected
14:56
your kneecaps and all the rest of it."
14:58
But I did notice I could no longer do deep knee squats.
15:03
Those were out.
15:05
And, he said, "Bingo."
15:08
No more of those, you know, past 90 degrees.
15:11
So then I looked it up and I said, "Oh my God, it's one of the most,
15:15
it's the most common injury whatever."
15:17
It's called runner's knee.
15:19
Now, could you please explain what the heck this is and how
15:23
I got myself in this mess?
15:25
Miho J. Tanaka, MD, PhD:
15:25
Well, I mean, I'll do my best.
15:27
You know, when it comes to patellofemoral pain, we've actually started
15:31
moving away from the term syndrome.
15:33
but you know, that is what it had been called for so many years.
15:37
And honestly, even within the orthopedic community, in one textbook about 30 years
15:42
ago, patellofemoral pain was called the black hole of orthopedics because people
15:47
just didn't understand what it was.
15:49
But essentially, you know, as you said, it is like runner's knee, and it refers
15:53
to inflammation under the kneecap.
15:55
And I think the thing that makes it so hard to understand is that there are
15:58
so many different causes of things that cause inflammation under the kneecap.
16:03
when you have inflammation under the kneecap, it will
16:06
hurt in the front of the knee.
16:08
it will hurt with things like running or jumping, or a deep squat
16:13
going up and down stairs obviously, and obviously with running.
16:16
And then some people will say if they're sitting with their knees
16:19
bent for a prolonged period of time, it really starts to become painful.
16:23
and this inflammation is kind of a, funny thing because it
16:27
can happen due to pure overload.
16:30
So some people can have totally normal knees, no problems with
16:34
cartilage or their arthritis, and just overload their kneecaps, and
16:38
this can cause patellofemoral pain
16:40
Pam Peeke, MD: that blew my mind.
16:42
I never knew I was, as it were, overloading my kneecap.
16:46
Now, how in the heck do you overload a kneecap?
16:49
I mean, I, you know, we all know the knee thing,
16:52
Miho J. Tanaka, MD, PhD:
16:52
Yeah, yeah.
16:53
Pam Peeke, MD: the kneecap?
16:54
Miho J. Tanaka, MD, PhD:
16:54
Yeah.
16:54
Well, that's a good question.
16:56
So, I would say though, the majority of people who have this problem
17:00
don't have normal knees, and they have subtle differences, that may
17:04
contribute to overloading the knee.
17:07
so some of the patients might have, some sort of, alignment issues that
17:14
are very subtle, but you might be a little bit knock-kneed, or you might
17:17
be a little bit flat-footed, or you might be a little bit pigeon-toed.
17:22
All of these things that just kind of exist within, you know, people
17:25
who are normal and athletic and don't really show any sort of signs
17:29
of severe disease over time, over the course of their lifetime can
17:33
Pam Peeke, MD: I know
17:34
what happened with me.
17:36
I know what happened.
17:37
When I first began to run, you know, years ago when dinosaurs ruled the Earth,
17:44
one, one of the coaches said, "Have you ever seen yourself run?"
17:47
I'm, you know, I'm just saying.
17:49
And I said, "Well, actually, how the hell do I do that?"
17:52
He says, "Let me just tell you what you look like, a duck."
17:55
he said, "So, you know, how many years did you do ballet?"
18:00
And I, "How did you know I did ballet?"
18:02
He says, "You're running in first position."
18:06
Miho J. Tanaka, MD, PhD:
18:06
Yeah
18:06
Pam Peeke, MD: had no idea that the turnout that had been beaten into
18:10
me after years just kept sneaking in there, and I literally had to have
18:17
a third eye, and I kept reminding myself, "Straight, straight.
18:22
Keep my feet straight."
18:24
So to your point, I think that's what set me up
18:28
Miho J. Tanaka, MD, PhD:
18:28
Yeah, I would say that's very likely.
18:30
And also if you were a dancer, the other category of people who have this
18:33
problem are people who are hyperlax.
18:36
So they have some sort of-- They're on the spectrum of instability.
18:40
You know, what I treat as a surgeon is when people's kneecaps kind of
18:43
pop all the way out, and that can be
18:45
a huge problem.
18:46
Yeah.
18:47
But most people don't actually have that.
18:51
Yeah, that's pretty
18:51
extreme.
18:52
So I guess that's
18:53
the good news, you don't have that.
18:55
But, that, is, you know, kind of the extreme version of this, and
18:59
there are a lot of people who have some instability, especially people
19:02
like dancers who use that sort of hyperflexibility to their advantage.
19:07
You know, that's what makes them good at it.
19:08
But it means that they rely so much more on muscles to keep their joints stable.
19:13
And
19:13
Pam Peeke, MD: You're so right.
19:16
Oh my gosh, that blows my mind.
19:18
Now, when we come back, I'm gonna be talking to you about what
19:26
another element that's gonna complicate this whole picture.
19:30
And it's a surprise
20:31
And we're back.
20:33
Okay, what's that little Cracker Jack surprise Dr.
20:35
P is talking about?
20:39
Well, if we look around at women today, they're heavier
20:47
They're carrying more weight.
20:50
And correct me if I'm wrong, but I think the number one reason for
20:55
knee replacements in this country is overweight and obesity, right?
21:01
It's not
21:02
Miho J. Tanaka, MD, PhD:
21:02
Yeah.
21:03
Well, it's definitely the
21:04
number one thing that's associated with prevention of knee
21:07
replacement,
21:08
Pam Peeke, MD: yes.
21:09
Absolutely correct.
21:10
So what happens when you're, you're heavier?
21:13
I remember when I first started running, they said, "Okay, for every
21:17
time you hit the pavement, you know, with your leg, you're taking like
21:21
at least twice your body weight in terms of what your poor little knee
21:27
is, is trying to cushion there."
21:29
I can only imagine if you're, if you're walking around with an extra,
21:33
say, 50 pounds, what's, going on then?
21:37
And does that set you up for what kind of problems?
21:40
Miho J. Tanaka, MD, PhD:
21:40
Absolutely.
21:41
Absolutely.
21:42
So that in and of itself can lead to a whole cascade of problems.
21:47
But since we're talking about the kneecap, what we know from biomechanical studies
21:51
is that for every pound that you gain, it's five to six pounds with every
21:57
step on your kneecap when you're doing things like going up and down stairs.
22:01
And if you're jumping or running, it can even be seven to eight times.
22:05
So think about if you gain five pounds, we're talking about a 30
22:10
pound load on your knees-- kneecaps with every step that you're taking.
22:15
And this can really, lead into this sort of, problem and this sort of
22:20
vicious cycle because some people then, you know, start trying to run
22:24
to lose that weight, their knees hurt more, so then they're doing even less
22:28
activity, and then they gain more weight, and their knees hurt more, and
22:31
it becomes this sort of horrible cycle.
22:33
But that is directly related to that amount of inflammation that you can get
22:38
in your knee, mostly because of that load.
22:40
So it is an important consideration and a modifiable one for people to know
22:44
about
22:45
Pam Peeke, MD: when I see a lot of these celebrities who are, who are
22:49
definitely obese, and they're wearing high heels and they're dancing
22:53
on stage in them, I'm in tears.
22:56
I'm, I'm like, I'm in tears for their knees.
22:59
Tell us what's going on when you're wearing high heels on top of that.
23:04
You know, they wear the, super glittery shoes and whatever, and they're dancing
23:09
around and singing and everything in it.
23:11
I'm like, I don't think this is good."
23:14
Miho J. Tanaka, MD, PhD:
23:14
Yeah.
23:15
Yeah.
23:15
No, you're exactly right.
23:16
I mean, when you're wearing heels, you're essentially putting even more
23:20
weight and more pressure on your knees.
23:23
And, you know, the tough part about understanding this is it's usually not one
23:27
thing that's gonna tip the scale for you.
23:30
It's usually gonna be a combination of weight and heels and activity.
23:35
And honestly, the support that your muscles have is one of the biggest factors
23:40
because you could be maybe not doing too much or weighing too much, but you could
23:45
have what we consider to be under support.
23:47
If your muscles are weak or they're imbalanced, say like during COVID,
23:51
if you stop working out and you stop doing as many things, then the normal
23:55
amount of activity can suddenly feel like overload because your knees
24:00
aren't able to-- they're not used to
24:01
seeing that stress
24:03
Pam Peeke, MD: That's a fantastic point.
24:05
Yep, you're absolutely correct.
24:07
You know what I found?
24:09
as soon as, the gyms opened up, and I learned my own lesson,
24:14
and that is, you know, my hubby and I, put together our own gym.
24:19
We said, "This is never happening again."
24:21
So we, we spent way too much money, but we now have our own
24:24
gym, so I can control all this.
24:27
But as soon as I was able to, and I accessed the equipment, I
24:33
really built my, quads, and my gastrocs are ridiculously strong.
24:41
I have almost 17-inch gastrocs.
24:45
Those are my calves.
24:46
I'm like, "W- where did these come from?"
24:48
They're like Jurassic calves.
24:53
and I even gave them names, Selma and Louise.
24:56
but they power me up hills when I'm cycling and, and get out of my way, right?
25:01
And when I was doing my tour jeté, you know, in the ballet, it was like,
25:05
"Okay, girlfriends, you know, you're still down there, I'm up here."
25:09
But you know, what I found was as soon as I was able to get back to
25:14
strengthening again, I had no pain.
25:18
I, because I'd never had pain before until I was…
25:21
You know, the COVID thing happened, and I couldn't access.
25:24
Never had pain again unless I let my knees go beyond 90 degrees
25:30
accidentally, and guess what?
25:33
I can't kneel without, cushion, just the two things.
25:39
So no more barbell squats, right?
25:43
So you know what I did instead?
25:45
It's called a workaround.
25:47
I don't whine.
25:48
I find ways to work around things, so here we go.
25:51
Instead of that, I'm a kettlebell queen.
25:54
So what I do is I hip hinge, a deadlift for the kettlebell with a heavy kettlebell
26:00
for, so I can get my high-intensity interval training, and I'll double hand
26:05
it, and up it comes, and it's hip hinge.
26:07
And my knees are fine except for one thing, and I need to ask you.
26:12
They make all kinds of noise.
26:14
Okay, so you could hear it across the damn gym.
26:18
It's like snap, crackle, and pop.
26:21
All right?
26:22
what is going on?
26:23
And I have no pain whatsoever.
26:25
It's just I can hear the noise.
26:29
unless I do more of a sumo stance.
26:32
Instead of straight, I'm sumo.
26:34
So that means that I'm turning my legs out a little bit at a diagonal,
26:39
maybe like at about a 45 degree, and then most of the noise stops.
26:45
All right, what's going on?
26:47
Miho J. Tanaka, MD, PhD:
26:47
Yeah.
26:48
So that sound that you're hearing is related to the arthritis
26:52
that you were diagnosed with.
26:54
And arthritis has to do with a wear and tear of the cartilage that's in your knee.
26:59
So specifically when we're talking about the kneecap, the under surface
27:02
of the kneecap is lined with cartilage, and that cartilage has two functions.
27:06
One is to be smooth so that it can glide up and down when you're
27:11
bending and straightening your knee.
27:12
And the other one is to be a shock absorber.
27:15
So when you're doing things like kneeling or s- squatting,
27:19
that it can absorb that shock.
27:21
And so if it starts to break down, then you're gonna start
27:24
to feel like these potholes.
27:26
You know, as you're doing those squats, you might hear some crunching sensations.
27:30
and then as your cushion starts to wear down, you'll notice it, as you were
27:34
saying, with kneeling, or you might even feel like if you do too much on
27:38
it, it's more likely to be reactive.
27:41
Your knee might be painful.
27:42
It might become swollen.
27:44
And the reason for that is when there's not enough cushion to absorb the stress in
27:48
your knee from the activities that you're doing, it transfers all the stress to
27:52
the bone, and then this is when your knee becomes painful and it becomes swollen.
27:56
But you bring up a really good point about now not having pain, and I
28:00
think this is really important to know because a lot of people think,
28:03
"Oh my God, I have arthritis.
28:05
Now I need a replacement, knee replacement.
28:07
You know, my life is over, and I'm gonna have pain unless I do that."
28:10
But, you know, there's, actually this really interesting study that, you know,
28:14
I don't know how they ended up doing this.
28:16
This was like, 30 years ago, and there's a famous orthopedic surgeon out of UCSF who
28:21
let his, brother, put an arthroscope in his knee, so surgery while he was awake.
28:27
And they did this study where they kind of poked and prodded different structures
28:30
in the knee to see which ones were sensate and which ones were insensate.
28:34
And the reason why this pertains to our conversation now is that
28:38
the cartilage under the kneecap, which has long been blamed for
28:42
this patellofemoral pain, you know, chondromalacia, "Oh, it's the cartilage
28:46
issue," it was completely insensate.
28:50
even though we had historically blamed these cartilage problems,
28:55
for people's anterior knee pain and patellofemoral pain, we now know that
28:59
it's not so much the cartilage, but the inflammation and what we call the
29:02
synovium, so the lining of the joint around it, which is so sensitive.
29:06
And so if you can get rid of that inflammation, as you have, you can
29:10
still have this sort of degeneration but not have pain, which is, not
29:15
the ideal situation if you're trying to avoid, avoid surgery
29:19
Pam Peeke, MD: Yeah, someone once said-- you know, when I was talking to my
29:23
orthopod, several years ago, I said, "Well, what do people do eventually?"
29:28
He goes, "You know, you can get, like, replaced kneecaps."
29:31
I said, "What?"
29:33
And, and so I looked at him, I said, "Oh, that looks special."
29:37
I said, "Tell you what, I'm just gonna hit the gym and, build
29:41
up my muscles, and y'all just have a good day and everything."
29:46
I don't want any damn surgery.
29:48
you know, with all due respect, to all of our wonderful
29:51
surgeons, I just didn't want any.
29:53
But, you know, let's get back just for a moment, please, because I've
29:57
had a lot of, you know, my listening audience say, you know, "What do
30:02
you do when you're not perfect?"
30:04
You know?
30:05
And so maybe you're 30 pounds over and whatever.
30:08
I mean, if you look at the statistics, we have about 43% of, adult women
30:16
right now are approaching, you know, basically obese, and that means 50
30:20
and over, 50 extra pounds and over.
30:24
actually, the majority of American adults have been overweight
30:29
since the end of the 1990s.
30:32
but nobody really brought it up 'cause what happened was things got normalized.
30:36
Like, ah, 20 pounds, who died?
30:38
and so we ended up with this little mess here.
30:42
So given the fact that, you know, we have a lot of people who have
30:47
their heart in their hand and they say, "I want to get more fit.
30:52
I wanna take better care of myself," et cetera.
30:54
And then they go see a bunch of runners run by, and they go, "I wanna do that."
30:59
And then I have to, like, grab a leash and drag them back and say, "No."
31:04
And then I explain to them what happens.
31:07
You know, double your weight.
31:08
Let's see now.
31:08
You're 220.
31:10
Yeah, That's 400 pounds on your poor little knee.
31:14
Do you hear that screaming?
31:15
Yeah, that's your knee.
31:17
and so, and, and so what I have everyone do, you know, is walk.
31:23
when they're walking and you're heavy, you're burning more calories.
31:29
It makes more sense.
31:30
It's like if I gave you or me a coat that had 50 pounds on it, then I told
31:35
you to go take a walk for three miles, you're gonna burn a lot more calories
31:40
because you're basically, for all intent and purposes, power lifting.
31:44
You're lifting, you know?
31:46
And, and you have to do that, right?
31:48
Make sense?
31:49
Miho J. Tanaka, MD, PhD:
31:49
Yes, absolutely.
31:50
Absolutely
31:50
Pam Peeke, MD: what do we say to these wonderful people?
31:53
I just tell them to walk, walk, walk.
31:57
And then at what point, let's just say the person who's, you know,
32:03
she's, five foot six, two twenty-five, she's just dropped fifty, okay?
32:11
She's not quite, you know, like a runner thing, body or whatever, but is it
32:18
okay for her to, run with an extra, you know, maybe twenty-five pounds on board?
32:24
Is that gonna kill anybody here, or should she wait, or what should she do
32:30
Miho J. Tanaka, MD, PhD:
32:30
getting into running or returning to running for some people is a really
32:34
challenging thing, and the reason for that is running is actually
32:39
a really difficult thing to do.
32:41
You know, we take it for granted because we do it as children, we run around.
32:45
But if you think about the mechanics of running, it's a series of single
32:50
leg squats, being able to stand on one leg and jump and push off
32:54
and to propel your body forward.
32:56
So you need strength, you need cardiovascular fitness, you need,
33:02
endurance, you need muscle control, and all of these things have to then
33:06
come together and be sustainable for the amount of time that you're running.
33:10
And so the most important thing that you need to do before you start
33:13
running is to build a good foundation of each of those things before you
33:18
put them all together, you know?
33:20
this means developing strength, but also developing things like endurance.
33:24
You don't really want to run to get in shape, because that's when
33:29
your form starts to fall apart.
33:31
You start to, you know, run past what your muscles can handle, and that's when all
33:35
of the load gets shifted onto your joints.
33:38
And so I think getting, you know, as you said, starting to walk, but also doing
33:42
some weight training, also cross-training, so getting on the bike or getting in
33:47
the pool and making sure that c- your cardiovascular fitness is not the
33:50
limiting factor when you're running is probably one of the most important things.
33:54
And then when you're starting to do it, I think there's two main key concepts.
33:59
One is to make sure that you're not doing too much too soon.
34:03
and so you have to, you know, do a little bit- not go as hard as you can
34:08
for as long as you can, but start with like five minutes, 10 minutes, 'cause
34:12
really something is better than nothing.
34:14
And really what we know is that our bodies are not capable of increasing
34:18
our strength or our endurance by more than about 10 to 20% each week.
34:23
And so this means if you do 10 minutes and it's hard, you're not
34:26
doing 20 minutes the next week.
34:28
You know, you're doing 12, and then 15, and then-- And it has to go that
34:32
way because if you push yourself beyond that, which many people
34:36
can when they're motivated, their muscles just can't keep up with that.
34:41
You know, just like you can't get in shape, you know, in two weeks really.
34:45
your body needs that time to adapt, and if you go too hard too fast,
34:49
that is the most common reason that people end up with injury.
34:53
The other thing has to do with the load and the impact.
34:56
So this is what you were referring to in terms of the body weight and how
35:00
much pressure is on your joints, and running is one of the things that just
35:03
really magnifies any changes in weight.
35:06
but if you can, budget how much load your knees are seeing, so making sure that, you
35:13
know, maybe you're not running every day of the week, but some days you're biking,
35:16
some days you're on the elliptical, some days you're swimming, so you're still
35:19
getting those types of workouts, then what you'll find is that your body will
35:23
start to adapt to that load, and then you can slowly increase the amount of impact.
35:28
So running is not just, you know, fitness and strength, but also your
35:31
body's ability to handle that load on your knees and on your joints.
35:36
Pam Peeke, MD: I have to tell everyone-- I have to restrain them physically.
35:41
you know, just stop.
35:43
You know?
35:43
Take this patiently as best you can, because people, you
35:50
know, they go to TikTok and, "Overnight, I became a runner."
35:55
No, you didn't.
35:56
You're lying through your teeth, but, you know, you wanna get some clicks and,
36:00
you know, and somebody's sponsoring you.
36:03
No.
36:04
It, it-- this takes quite some period of time.
36:07
You know, truth be told, the grand majority of people are not runners.
36:13
The, the absolute majority of people do not run.
36:17
They just don't.
36:18
and, that's fine.
36:20
That's fine.
36:21
Now, you, you know, when you were at Stanford, you were a member of
36:25
the varsity track and field team.
36:28
We're not talking to you, because because you were born to be a runner.
36:34
I'm actually, if you see my body, I'm a mesomorph.
36:39
I'm, I'm very muscular.
36:41
I have no business doing marathons.
36:45
You know, I only did it 'cause you get a really cool medal, and you
36:48
meet all these really nice people.
36:50
right about half-marathon, you know, when you become homicidal,
36:53
you know, you just meet all these great people, and then that was it.
36:57
So Boston was my last.
36:59
I said, "Okay, we're, done with this, and we'll just move to the triathlon where,
37:04
you know, I won't be so bored anymore."
37:06
But I'm actually a sprinter, so, you know, my body was built for the sprint.
37:12
I have no business doing endurance at all.
37:17
and so I think part of this is you have to look at yourself and tell your true truth.
37:26
You know, you really do.
37:28
And as you mature and you change, like I don't really do that
37:33
much running anymore at all.
37:35
I really don't find it pleasurable.
37:37
I don't find it necessary, and my knees are like, "Don't even think about it."
37:42
so, you know, there are so many other things to do.
37:46
I'm a cycler.
37:48
I'm a swimmer.
37:48
I'm a master swimmer.
37:52
I'm a, you know, an advanced hiker.
37:54
I've done the Grand Canyon twice, no problem.
37:58
there are so many other beautiful things to do.
38:00
And to your point, functional training and cross-training are so healthy.
38:08
Why?
38:09
Why?
38:11
Miho J. Tanaka, MD, PhD:
38:11
it has to do with, I think, several things.
38:14
One is that more and more we're starting to recognize that if you do the same thing
38:18
all the time, then that is what increases your s- your risk of injury because
38:23
you're not giving those muscles a break, and you're also not, generalizing your
38:28
strength and building a good foundation.
38:30
And more and more we're seeing this in kids as well, and the sort of single
38:33
sport specialization where people used to play three or four sports and now they're
38:37
just, you know, specializing in baseball, and they're starting when they're 10.
38:41
And, you know, all of these things lead to a greater risk of injury, but we
38:44
see this in adults as well, doing one thing all the time, definitely not good.
38:49
but I think the other thing is that the more you diversify what you're
38:53
doing, the more you're able to, as you said, find what makes sense for you.
38:59
And I would say the number one most important thing when it comes to
39:03
exercise for anybody is sustainability.
39:05
You know, it's not just running the next marathon or dropping a few pounds,
39:09
you know, this month or next month, but it's really how long can you maintain
39:13
this amount of exercise, so that you can maintain your mobility later in life.
39:19
And so it has to be something that you like, something that you have access
39:23
to, and I think for most people, keeping it diverse and being able to
39:26
be flexible with what they're doing, and also making it a social component
39:30
as well for a lot of people, is really what, drives them as opposed to just
39:35
being fixated on one specific exercise
39:39
Pam Peeke, MD: at the end of the day Women are unique.
39:44
We have all these delightful little imbalances in our body.
39:48
The grand majority of women are not told this.
39:51
what I'm asking everyone out there to do, you know, following what Dr.
39:57
Tanaka has been saying and sort of piling onto it, is I am begging you to
40:04
get appropriate guidance from a trained, right, trained fitness professional.
40:14
So as you know, I'm with the American College of Sports Medicine, we have
40:19
by far the most rigorous certification program for fitness professionals.
40:26
Run on over to the American College of Sports Medicine's website and link
40:32
up with somebody who's local, who's passed that certification so that you
40:37
know that you're gonna be protected.
40:40
It's so terribly important.
40:42
And when it comes to women, it's like you just wanna ask that question.
40:46
Be bold and just put it out there.
40:48
"Are you comfortable working with women?"
40:51
Because we have a different anatomy, We're, not a halfback for the Raiders.
40:57
You know, this is not happening.
40:59
We are who we are.
41:01
You know, do you know how to, how to work with them?
41:04
Ask that question.
41:06
Be bold.
41:07
You know, and y- you're protecting yourself.
41:11
that's actually what I've done for a long time.
41:13
You know, my running, coach when I did, my final marathons was Jeff
41:19
Galloway, who just passed away.
41:21
And, he was the one who taught me the, the walk-run and kinda like the walking part.
41:27
But, you know, once you got really into it, it was like, "No, okay," you know?
41:33
And this is one reason why I never, had any meniscal tears or ACL
41:40
issues or whatever else 'cause I took really good care of my knees.
41:43
Little did I know my kneecaps were dissolving into dust.
41:47
But but now I've learned, and now you've all learned out there in the
41:53
podcast land, these things do happen.
41:56
And of course, with the maturing process, in our lives, osteoarthritis shows up.
42:03
I mean, it's a y- you know, it's a use, issue.
42:07
I've been using my body for decades, and I'm happy about that.
42:12
I've had some pretty good times, and now it's time to pay the piper.
42:18
And, and so I just work around it and I'm actually perfectly fine.
42:23
I'm, I'm totally good with all that.
42:25
I did have to stop the advanced Tai Chi Quan that I was doing because the deep--
42:32
Kind of the dragon, and snake, poses.
42:38
Yeah.
42:39
I had to have a little conversation with my Tai Chi Quan master.
42:43
I was like, "You know, you know, let me just give you a little handout
42:47
on the patellofemoral syndrome."
42:50
Yeah, yeah, it's not working for me, one way or the other,
42:53
but there you have it, you know?
42:55
And you know what I'm thinking for women as they mature, they
42:59
also pick up other issues.
43:01
You know, you've got osteoporosis, osteopenia.
43:04
You have scoliosis that's showing up right and left, and if you wanna really
43:09
feel imbalance, try scoliosis sometime.
43:13
So adult onset scoliosis is actually incredibly common.
43:19
you and I have a mutual friend, Dr.
43:22
Michael Gardner at Stanford University, and he spends a lot
43:25
of time with scoliosis, patients.
43:29
And I was absolutely blown away by, the incidence.
43:35
It's over 60% by the time you hit, the age of 60, and most people
43:41
don't, most women have no clue unless it's found incidentally on
43:46
an X-ray for some other reason.
43:49
And, you know, they get the old, "By the way, by the way, you know, your spine
43:52
looks a little, looks a little rotated.
43:55
You might wanna look into that."
43:57
And nobody pays any attention to this.
43:59
Ugh.
44:00
So it makes women more imbalanced.
44:02
It's crazy, you know?
44:03
So as you mature, you've got all these extra little layers of complexity, right?
44:09
Miho J. Tanaka, MD, PhD:
44:09
with the things that you're mentioning, I don't think it all
44:12
has to be doom and gloom, you know?
44:15
And, probably one of the most important things for things like, you know, even
44:20
though we can't prevent scoliosis or just like you couldn't prevent arthritis, and
44:24
we certainly aren't encouraging people to stop doing activity and stop using their
44:29
joints, but the more you can kind of keep your foundational strength, and by that
44:34
I mean things like even your postural muscles, the muscles that support your
44:38
back and kind of keep, you know, support your spine, these are all the things that
44:43
kind of work against those processes that you were mentioning, and those are also
44:47
the muscles that you lose as you mature.
44:49
You're just not able to keep those muscles up without a deliberate process
44:54
of doing that, and that's why things like yoga and Pilates are not only popular,
44:59
but really, really helpful for women of our age and as we age because it
45:03
just helps us to support all of those processes that are aging, you know?
45:08
And we're it just helps us to fight, fight that process
45:11
Pam Peeke, MD: You are so right.
45:13
I love Pilates.
45:14
It's another reason why dancers, you know, use Pilates so much all the time too.
45:20
But Pilates also just extends and elongates the spine, and it
45:25
allows you to work with that.
45:26
And you mentioned the P word, posture.
45:29
Okay, everyone out there, sit up.
45:32
Now, I saw you.
45:34
You weren't sitting up.
45:35
You were, you, you know, you were doing, like, the little hunch thing.
45:38
Hmm.
45:39
Okay, now, how long does it take before you blow it after I told you to sit up?
45:44
11 seconds.
45:46
It's gone.
45:47
You're right back to slouching again.
45:49
So to your point, my goodness, I spend so much time on my
45:55
core and my, my back muscles.
45:59
You know, just that whole kind of girdle almost, you know,
46:02
that, that kind of holds you up.
46:05
And I literally correct myself all day long.
46:09
I roll my shoulders back, so my scapula are saying yo to each other in the back.
46:15
it, just keeps…
46:17
Well, first of all, it feels really good when you roll your shoulders.
46:21
and then it just sort of helps kind of align you again.
46:26
And when you get out of a chair after you…
46:29
Well, has anyone ever taken a picture of you in a chair?
46:33
Oh, th- that's you, the one who looks like a cashew.
46:36
you know, you're, like, bent over, little nasty looking thing.
46:40
So, you know, you get up and, and you're still like a little cashew,
46:44
and you have to just deliberately…
46:46
I have, like, Post-its everywhere, you know, no cashew.
46:52
And, you know, a cashew with a big red thing through it back and
46:56
forth, and then I roll my shoulders.
46:59
And 'cause, you know, girlfriends, you know, if you wanna drop some waist
47:05
circumference, stand up straight, okay?
47:10
It works.
47:11
It, it totally works, but you've gotta work that, those core
47:16
muscles to hold your posture.
47:18
And to your point, Dr.
47:19
Tanaka, if you're not working out, like doing your stretching and your
47:25
strength training, good luck with that.
47:29
It's, gonna be very hard.
47:30
And the next thing you know, your, waistline is sticking out here.
47:33
It's residing in a different state.
47:36
And then suddenly you're all bent over, and you're going, "I
47:40
swore I'd never look like this as I matured," and there you are.
47:45
So, you know, have someone take a little picture of you kind of randomly
47:49
if you wanna scare the hell out of yourself, and then remember that.
47:54
Stick that picture somewhere like, "No.
47:56
No, no, no, no, no, no.
47:57
We're not going there."
47:59
Does that make sense?
48:00
Miho J. Tanaka, MD, PhD:
48:00
Absolutely.
48:01
I mean, I think it's not even just about, you know, your back and, how you look
48:07
and, and how you feel, but even things, where you're going up and down the stairs
48:13
or if you are looking at powerlifters, you know, form is so important.
48:18
The way you're positioning your body is not just about standing up straight
48:22
and making your spine straight, but it basically puts all of your joints,
48:26
which are starting to wear down, in the most favorable position to be able
48:31
to handle different types of loads.
48:33
And so even for people who might say like, "Ugh, I don't wanna do yoga or Pilates,
48:37
I just wanna like get out there and work out and, you know, play sports," your
48:41
performance is gonna be affected if you don't have a good postural foundation,
48:45
you know, and good strength there in order to be able to support some of the
48:49
more complex movements that you're doing.
48:51
So I think it should play in not just to when you're sitting and not just,
48:54
you know, to when you're, standing up from a chair, but for every step
48:57
that you're taking, everything that you're doing, there should be a little
49:00
bit of this deliberate process in terms of maintaining your posture
49:04
Pam Peeke, MD: I just, I could, ugh, I've learned so much.
49:07
I'm like a little sponge, as I know everyone out there
49:11
in the HerPodcast land is.
49:12
We could listen to you forever.
49:14
You are fabulous.
49:16
I am so happy you came here and set the record straight.
49:21
it's wonderful to know you're out there helping women as well, because you are the
49:27
director of the Women's Sports Medicine program at Massachusetts General Hospital.
49:33
And it's just also wonderful to see a woman orthopedic surgeon, so that
49:39
we don't have to womansplain things, you know, as, as it goes through.
49:45
You're like, "Oh, yeah, been there, done that, got the T-shirt," and
49:48
understand where you're coming from.
49:51
Just absolutely fabulous.
49:53
I cannot begin to thank you enough for coming to the HerPodcast and,
49:59
really enlightening all of us.
50:01
Dr.
50:03
Miho Tanaka can be found at her website, D-R M, as in Mary,
50:10
I-H-O, Tanaka, T-A-N-A-K-A.com.
50:15
Again, drmihotanaka.com
50:19
to learn more about her marvelous work.
50:22
And, Miho, all I can say is thank you, thank you, thank you
50:27
Miho J. Tanaka, MD, PhD:
50:27
Thank you.
50:27
This was so much fun.
50:28
I appreciate you having me here
50:30
Pam Peeke, MD: Way fun.
50:31
Way fun.
50:31
And I also wanna thank my sponsor, and that is SkinSafe.
50:36
And, you know, again, if you wanna really understand what's in the
50:41
ingredients, everything that you put on your body, SkinSafe is an app developed
50:47
by the Mayo Clinic, sorry about Mass General, by the Mayo Clinic that
50:52
takes the guesswork out of shopping for skincare and personal products.
50:57
So just download the app for free and use the link in the description in our
51:02
sponsorship to get 20% off a SkinSafe premium membership because you wanna
51:08
know what you're putting on your skin.
51:10
I'm just saying that's, is how important it is.
51:14
Now, take a moment and leave us a review because our entire team runs
51:19
up and down the stairs with no pain in their knees waiting to hear from you.
51:24
We love your feedback.
51:26
Now, this has been a production of Podcast Health.
51:30
And what I really wanna say is, your time on this wonderful Earth may be
51:37
limited, but the things you can do with that time are not, and one of those
51:43
things is taking better care of your joints and your skeleton, just as Dr.
51:48
Tanaka said.
51:50
So everyone get on out there and seize the day.
51:52
A little carpe diem.
51:54
How about that?
51:55
Thanks for listening