Latest / The Body Pod / Best of The Body Pod: Women’s Joint Health, Hormones, and Strength Training for Longevity with Dr. Jocelyn Wittstein

Transcript

Best of The Body Pod: Women’s Joint Health, Hormones, and Strength Training for Longevity with Dr. Jocelyn Wittstein · The Body Pod

• 0:00
  Speaker 1: Hey, Body Pod family, we are back with another best
• 0:03
  Speaker 1: of the Body Pod and this is one I have
• 0:06
  Speaker 1: been wanting to bring back since the day it dropped.
• 0:09
  Speaker 1: We sat down with doctor Joscelyn Wittstein, orthopedic surgeon and
• 0:13
  Speaker 1: sports medicine specialists at Duke University, and honestly, she is everything.
• 0:18
  Speaker 1: She is brilliant, warm, she leaves nobody out of the party,
• 0:22
  Speaker 1: and she gave us one of the most practical, honest
• 0:25
  Speaker 1: conversations we have ever had on this show about what
• 0:28
  Speaker 1: is actually happening to our joints, our bones, and our
• 0:32
  Speaker 1: muscles as we move through midlife. Here's why this one
• 0:36
  Speaker 1: needed to come back. Number one, if you have ever
• 0:38
  Speaker 1: had a frozen shoulder, knee swelling that came out of nowhere,
• 0:42
  Speaker 1: or joint pain that your doctor just shrugged at, this
• 0:45
  Speaker 1: episode will finally make sense of it all. And second,
• 0:49
  Speaker 1: bone density. We are hearing this everywhere as this is
• 0:52
  Speaker 1: so important for midlife women. We cover jumping, weighted, best
• 0:56
  Speaker 1: loading the wrists, heavy lifting, and what to do when
• 0:59
  Speaker 1: your knees are shus mean you cannot do the hardest
• 1:02
  Speaker 1: version of everything. Her message is so empowering that something
• 1:07
  Speaker 1: is always better than nothing and it is never too
• 1:10
  Speaker 1: late to start. So without further ado, let's jump in
• 1:14
  Speaker 1: to the show. Hi everyone, my name is Haley and
• 1:17
  Speaker 1: this is Laura and welcome to the Body Pod. Doctor
• 1:28
  Speaker 1: Jocelyn with Stein. Welcome to the Body Pod. It is
• 1:31
  Speaker 1: an honor to have you here. I've been counting down
• 1:34
  Speaker 1: for this episode.
• 1:36
  Speaker 2: Oh well, thanks for having me. And you got my
• 1:38
  Speaker 2: last name right without even asking.
• 1:41
  Speaker 1: I figured it was fifty to fifty. I was like,
• 1:43
  Speaker 1: I'm going with Stein and that's how I e it.
• 1:46
  Speaker 3: But you got it.
• 1:47
  Speaker 1: Yeah, loving starting off on a great note.
• 1:52
  Speaker 4: Yeah, Hey, Jocelyn, can you share a little bit about
• 1:57
  Speaker 4: your journey from collegiate athlete to orthopedic surgeon?
• 2:03
  Speaker 2: Uh? Sure, I mean I think most orthopedic surgeons will
• 2:06
  Speaker 2: tell you sports are like the gateway drug to orthopedics.
• 2:10
  Speaker 3: It's just kind of it's a little bit of a joke.
• 2:13
  Speaker 2: Like, you know, most orthopedic surgeons were some sort of
• 2:16
  Speaker 2: athlete at some point. But I do think that people
• 2:20
  Speaker 2: who have a history of participating in sports have some
• 2:24
  Speaker 2: like ongoing appreciation of muscle sklledal health and preserving muscle
• 2:29
  Speaker 2: scillal function, and like, personally, I'm a subspecialist in the
• 2:33
  Speaker 2: field of sports medicine.
• 2:34
  Speaker 3: But even my.
• 2:35
  Speaker 2: Partners, who are people who are, you know, replacing joints
• 2:40
  Speaker 2: and not preserving those joints, but replacing them are preserving
• 2:42
  Speaker 2: people's function. And I think anyone who's been an athlete
• 2:45
  Speaker 2: in the past just has that desire to keep people
• 2:49
  Speaker 2: physically functional, or they're just aware of how important that is,
• 2:52
  Speaker 2: you know, to the mind and body so to speak.
• 2:56
  Speaker 3: You know, so, yeah, absolutely, yeah.
• 3:00
  Speaker 1: So did you know you wanted to be a doctor
• 3:03
  Speaker 1: from early on? Were you file?
• 3:05
  Speaker 2: And you know, I actually graduated from high school and
• 3:10
  Speaker 2: remember saying, oh, I'm so happy, I'll never take another
• 3:13
  Speaker 2: science class again, which is hilarious because I now do
• 3:17
  Speaker 2: a lot of clinical and basic science research, and I,
• 3:20
  Speaker 2: you know, I'm an orthopic surgeon.
• 3:21
  Speaker 3: But you know, when you're younger.
• 3:23
  Speaker 2: My dad was a doctor is still he's an ophthalmologist.
• 3:27
  Speaker 2: And I just kind of decided I didn't want to
• 3:30
  Speaker 2: be a doctor. Maybe I don't know, maybe because he
• 3:33
  Speaker 2: was I'm not sure, but I just kind of wasn't
• 3:35
  Speaker 2: the thing I was going to do. And then in college,
• 3:38
  Speaker 2: I studied nutritional science and I just I love that,
• 3:41
  Speaker 2: but I still liked anatomy and things like that, and
• 3:43
  Speaker 2: so I kind of gravitated to science anyway, and ultimately
• 3:49
  Speaker 2: I went to medical school thinking I wanted to be
• 3:52
  Speaker 2: a pediatrician. I love kids, but then I realized I
• 3:57
  Speaker 2: didn't like that field. It was either kind of of
• 4:01
  Speaker 2: sometimes boring or just kind of you know, well, child
• 4:03
  Speaker 2: visits or really sad. And I really loved procedures and
• 4:07
  Speaker 2: doing things. And selfishly, I mean, I will say, I
• 4:11
  Speaker 2: think primary care is incredibly challenging, and primary care doctors
• 4:14
  Speaker 2: are so smart and work so hard, but I couldn't
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  Speaker 2: do what they do.
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  Speaker 3: It's just so much.
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  Speaker 2: So much of it is trying to change maybe people's
• 4:23
  Speaker 2: lifestyles or modify things with medications when you can, but
• 4:27
  Speaker 2: like it's just there's not that same, maybe somewhat selfish
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  Speaker 2: gratification of making people better by fixing things that you
• 4:35
  Speaker 2: can fix.
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  Speaker 1: Nothing wrong with that.
• 4:38
  Speaker 2: Yeah, And so I think most orthmeetic surgions will tell
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  Speaker 2: you they really like helping people be more functional and.
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  Speaker 3: That is really rewarding.
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  Speaker 2: And it's so important for people to be able to
• 4:50
  Speaker 2: continue to move and exercise as they get older. And
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  Speaker 2: we can't fix everything, you know, not everything has a
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  Speaker 2: surgical solution, and tons of things orthopedics are actually treated nonoperatively,
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  Speaker 2: like probably more things are treated not operately than operably. Actually,
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  Speaker 2: but we can also help people, you know, with those
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  Speaker 2: things too. So it's a pretty gratifying field and I
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  Speaker 2: feel lucky to have found my way into it. And uh,
• 5:18
  Speaker 2: just you know, I always say sometimes being a doctor
• 5:21
  Speaker 2: is a little bit like parenting. They are frustrating moments
• 5:24
  Speaker 2: for I bet, wondering what you're doing. Uh, and then
• 5:30
  Speaker 2: there are like really really rewarding moments, like being a parent,
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  Speaker 2: Like the frustrating ones and the really rewarding ones that
• 5:36
  Speaker 2: just totally.
• 5:38
  Speaker 3: Continue to keep you in it.
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  Speaker 1: So Laura's experiencing that right now.
• 5:47
  Speaker 4: Of children, though you have five, correct, Yeah, their profiles
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  Speaker 4: are randomly behind me.
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  Speaker 2: Actually, and those what do you call I should know
• 5:59
  Speaker 2: what that's called. One of our kids actually made that
• 6:02
  Speaker 2: little silhouettes of our family.
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  Speaker 3: But yeah, so you know, you never know what life
• 6:09
  Speaker 3: brings you.
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  Speaker 2: I totally thought I was going to just go do
• 6:13
  Speaker 2: my career and graduate from college and then go to
• 6:17
  Speaker 2: med school and then be a surgeon and be very
• 6:20
  Speaker 2: you know, academic, academically productive, and I just I didn't
• 6:24
  Speaker 2: like have marriage and children.
• 6:26
  Speaker 3: Kind of at the forefront of my mind.
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  Speaker 2: But then I met the perfect person who also was
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  Speaker 2: a widower with three kids and who were five, eight,
• 6:36
  Speaker 2: and eleven at the time, and then I married him
• 6:39
  Speaker 2: and them, and then we had two more kids while
• 6:41
  Speaker 2: I was in North during my residency, so we have
• 6:44
  Speaker 2: five kids. But I I didn't have to be pregnant
• 6:50
  Speaker 2: five times. I just you know, I carried two kids
• 6:53
  Speaker 2: during my residency added so we have three plus two,
• 6:55
  Speaker 2: so we have five.
• 6:57
  Speaker 3: And yeah, that's our busy, busy household. Yeah.
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  Speaker 2: And my husband is also an northpeedic surgeon, so none
• 7:05
  Speaker 2: of our children want to be doctors.
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  Speaker 3: Yeah.
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  Speaker 1: Yeah, that's always interesting to see what they choose.
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  Speaker 3: Yeah.
• 7:16
  Speaker 1: Well, okay, I want to talk about specifically midlife women
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  Speaker 1: since that's really our area of interest here. So as
• 7:26
  Speaker 1: we know these from an orthopedic surgeon side, we know
• 7:31
  Speaker 1: that as estrogen starts to decline that all of these
• 7:35
  Speaker 1: other things kick up in this perimenopause postmenopause phase of life.
• 7:41
  Speaker 1: I see it from the strength training aspect with the
• 7:44
  Speaker 1: frozen shoulder and and just the niggles that kind of
• 7:47
  Speaker 1: come with the muscular skeletal syndrome of menopause. But how
• 7:52
  Speaker 1: does that How does estrogen levels play a role in
• 7:55
  Speaker 1: all of this.
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  Speaker 2: Yeah, so it's really multifactorial. I think, like we know
• 8:03
  Speaker 2: from animal and human studies that in the absence of estradoal,
• 8:09
  Speaker 2: whether you've had your over is removed or you've gone
• 8:12
  Speaker 2: through natural menopause, or you're taking medications blocking the effects
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  Speaker 2: of you know, estrogen, you're in a more inflammatory state.
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  Speaker 3: There are.
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  Speaker 2: Cytokines, you know, inflammatory markers that are more elevated in
• 8:24
  Speaker 2: that state. On there are estrogen receptors of course throughout
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  Speaker 2: the body, on your muscles, on the lining of your joints,
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  Speaker 2: on your cartilage surfaces, in your bones, and all of
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  Speaker 2: these things are impacted. Then, so you have like a
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  Speaker 2: more elevated and inflammatory state. You don't have the sort
• 8:41
  Speaker 2: of muscle repairing and maintenance effects of estrogen, so it's
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  Speaker 2: harder to maybe build or maintain muscle, and you lose
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  Speaker 2: a muscle mass. That of course affects your metabolic health.
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  Speaker 3: Some you have.
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  Speaker 2: Osteoclasts, which are the cells and bone that generally break
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  Speaker 2: down bone. Being like living longer, they're not being inhibited
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  Speaker 2: by the estrogen, and so there's more breaking down a
• 9:05
  Speaker 2: bone than there is building, so you have some accelerated
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  Speaker 2: bone loss in menopause, you know, more like two percent
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  Speaker 2: bone loss per or as compared to one percent prior
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  Speaker 2: to that.
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  Speaker 3: And then in your joints you get.
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  Speaker 2: This greater level of inflammation, which ultimately you know, plays
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  Speaker 2: out and women over fifty having a much greater chance
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  Speaker 2: of having arthritis than men over fifty, especially in the knees,
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  Speaker 2: because you know, the cartilage gets thinner faster, the lining
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  Speaker 2: of the joint is more likely to be more inflamed.
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  Speaker 2: And then in shoulders, which is a long time area
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  Speaker 2: of interest and research for me, of course, frozen shoulder
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  Speaker 2: is almost not exclusively, but very much disease of women
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  Speaker 2: between the age of forty and sixty. And we know
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  Speaker 2: that the lining of the shoulder joint has estrogen receptors.
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  Speaker 2: We know that estrogen inhibits cells called fiber blasts that
• 9:54
  Speaker 2: thicken and stiffen the capsule of the joint, you know,
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  Speaker 2: so we know that at this point, I think it's
• 10:02
  Speaker 2: pretty well accepted that frozen shoulder is also a adhesa.
• 10:05
  Speaker 2: Catslitis is a condition of perimenopause and menopause. So that's
• 10:10
  Speaker 2: a very long answer to your question. But all those
• 10:12
  Speaker 2: things are kind of you know, going on.
• 10:16
  Speaker 1: Okay, So I'm going to tell you something that I
• 10:19
  Speaker 1: used to believe before I knew what the muscular skeletal
• 10:22
  Speaker 1: syndrome of menopause was. And I thought as a strength
• 10:26
  Speaker 1: training coach that you know, a lot of these what
• 10:30
  Speaker 1: I would call weak links, the rotator cuff, you know,
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  Speaker 1: the foot stabilizers, things like that that women just kind
• 10:36
  Speaker 1: of neglected, and in most programs they get neglected. So
• 10:40
  Speaker 1: I just assumed at the time that this was more
• 10:44
  Speaker 1: weakness from not strengthening some of these muscles that was
• 10:48
  Speaker 1: kind of kicking up this rotator cuff stuff, which may
• 10:53
  Speaker 1: be not helping and adding to it. But the role
• 10:57
  Speaker 1: that that when I learned about this, I was like, oh, oh,
• 11:00
  Speaker 1: there's more to the story.
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  Speaker 2: Yeah, I think now also to complicate things, as people
• 11:07
  Speaker 2: men and women, you know, get to be over the
• 11:09
  Speaker 2: age of fifty, you could also start to see you know,
• 11:13
  Speaker 2: rotator cuff ten and partial tears becoming full thicknesschairs. But
• 11:18
  Speaker 2: I will tell you I have studied hundreds and hundreds
• 11:21
  Speaker 2: and hundreds of women with frozen thousands probably a woman
• 11:26
  Speaker 2: frozen shoulder, and usually when someone presents with a frozen shoulder.
• 11:30
  Speaker 2: They it's really uncommon to also have a rotator cuff tear,
• 11:35
  Speaker 2: but they present very differently, they act very differently, and
• 11:38
  Speaker 2: I always like, I kind of think of it this way.
• 11:40
  Speaker 2: It's kind of like, when you're under fifty and someone
• 11:42
  Speaker 2: has chest pain, you're like, oh, it's probably not a
• 11:43
  Speaker 2: heart attack.
• 11:44
  Speaker 3: It's screwed whatever.
• 11:45
  Speaker 2: When you're under fifty and you have shoulder pain, it's
• 11:47
  Speaker 2: probably not a heart it's probably not.
• 11:49
  Speaker 3: A rotator cuff tair.
• 11:50
  Speaker 2: You might just ask some versiitis or impingement, or if
• 11:53
  Speaker 2: you're stiff, a frozen shoulder. But when you to be
• 11:55
  Speaker 2: over fifty, you're kind of like that could be a
• 11:58
  Speaker 2: rotator cuff tare or if you're more likely to be
• 12:01
  Speaker 2: a frozen shoulder. But you know, age actually has criite
• 12:04
  Speaker 2: a lot to do with our differential diagnosis of shoulder pain.
• 12:06
  Speaker 2: But so men and women both we do start to
• 12:09
  Speaker 2: see like that's kind of the first decade where you
• 12:10
  Speaker 2: start to see rotator cuff tears.
• 12:12
  Speaker 3: But again, the frozen shoulder really starts to crop up.
• 12:15
  Speaker 2: In a lot more, you know, beginning in the in
• 12:17
  Speaker 2: the forties, earlier than rotator cuff tears.
• 12:21
  Speaker 3: Wow.
• 12:21
  Speaker 1: Okay, So if we're looking at sex differences, you mentioned
• 12:25
  Speaker 1: some of them that for the knees, that men present
• 12:29
  Speaker 1: these symptoms later on, which is just so par for
• 12:33
  Speaker 1: the course with everything else. Are there other sex differences
• 12:38
  Speaker 1: that you see as far as when women present something
• 12:42
  Speaker 1: and and when men present the same thing.
• 12:45
  Speaker 2: Yeah, well, kind of arthritis in general, there are some
• 12:49
  Speaker 2: studies that I'll kind of like generalize, but like between
• 12:53
  Speaker 2: the ages of fifteen eighty women kind of have like
• 12:55
  Speaker 2: in general, like a thirty five percent greater chance of
• 12:59
  Speaker 2: experiencing arthritis. That risk is most That difference is really
• 13:03
  Speaker 2: I would say most pronounced in knees, maybe followed by hands.
• 13:08
  Speaker 2: It's not as big in hips, that difference, But the
• 13:11
  Speaker 2: knee joint is like, I think, one of the most
• 13:14
  Speaker 2: disparately you know, affected joints for some reason. I mean,
• 13:18
  Speaker 2: I see so many women in their fifties with it's
• 13:22
  Speaker 2: like clockwork sometimes. I mean I think I was in
• 13:25
  Speaker 2: clinic last week and I had like five fifty to
• 13:28
  Speaker 2: year old women with this knee swelling and and you
• 13:31
  Speaker 2: know the actualis don't look that bad, but they're starting
• 13:33
  Speaker 2: to get knee swelling that's activity related which is in general,
• 13:37
  Speaker 2: if you're getting knee swelling without an injury, it's just
• 13:39
  Speaker 2: like activity related. You know, you're kind of maybe doing
• 13:42
  Speaker 2: the same amount of activity you would normally do, not more,
• 13:44
  Speaker 2: but you start to see.
• 13:45
  Speaker 3: Some swelling after the fact.
• 13:46
  Speaker 2: That is almost always your cartilage talking back to you,
• 13:50
  Speaker 2: unless you had like a pop like you tore meniscus
• 13:54
  Speaker 2: or autority sale. But in general, activity dependent swelling your
• 13:56
  Speaker 2: knee is really your cartilage being overloaded. It's it's just
• 14:01
  Speaker 2: not tolerating in whatever you're doing to it.
• 14:04
  Speaker 3: And so you know, you start to see this creep.
• 14:07
  Speaker 2: Up on people and they're like, I didn't hurt myself,
• 14:10
  Speaker 2: Like you know, what is this? Why can't I do
• 14:12
  Speaker 2: what I normally do without getting these swelling And it's
• 14:15
  Speaker 2: very frustrating, and we see it all the time they
• 14:19
  Speaker 2: get an MRI, and in generally you may see like
• 14:21
  Speaker 2: a little cartilage thinning, but it's not like there's like
• 14:24
  Speaker 2: bone spurs or arthritis on the next ray, and it's
• 14:27
  Speaker 2: probably like kind of the earliest wear or degrading or
• 14:31
  Speaker 2: softening of the cartilage, and and like the very earliest
• 14:35
  Speaker 2: form of earth rate is it's not even like the
• 14:37
  Speaker 2: cartilage is any thinner. It's just that it actually doesn't
• 14:40
  Speaker 2: tolerate stress as well, and it kind of compresses maybe
• 14:42
  Speaker 2: faster from activity and then it doesn't rebound to its
• 14:46
  Speaker 2: normal thickness like it takes. It needs more time off, right,
• 14:49
  Speaker 2: So you know, I see that a lot in women
• 14:53
  Speaker 2: in their in the early fifties for sure.
• 14:55
  Speaker 4: So what's your recommendation for them?
• 14:59
  Speaker 3: Yes, well, well that's that is a good question.
• 15:02
  Speaker 2: You know, if you back up and look at some
• 15:08
  Speaker 2: of the early studies of the women's Health in the initiative,
• 15:12
  Speaker 2: which people like to complain about, but they actually collected
• 15:15
  Speaker 2: an incredible amount of information on tons of women very diligently.
• 15:20
  Speaker 2: And one of the things you can learn from like
• 15:22
  Speaker 2: some of that data is that you you know, there
• 15:24
  Speaker 2: were a lot of women who presented with joint pain
• 15:27
  Speaker 2: as one of their symptoms of menopause. You know, once
• 15:30
  Speaker 2: these like seventy seven percent, like almost eighty percent. And
• 15:33
  Speaker 2: then women you know, treated with hormone therapy then included
• 15:37
  Speaker 2: esther dial some studies astra with progesterone, but nonetheless hormone
• 15:41
  Speaker 2: therapy had reduction of their you know, number of painful
• 15:45
  Speaker 2: joints and severity of the joint pain, and then when
• 15:47
  Speaker 2: they were had that hormone therapy removed, there was like
• 15:50
  Speaker 2: a rebound effect. Now, there isn't any study that shows
• 15:53
  Speaker 2: yet or ever that being on hormone therapy helps you
• 15:57
  Speaker 2: be less likely to need a kne replacement someday. But
• 15:59
  Speaker 2: I don't think we've like studied things at that level,
• 16:01
  Speaker 2: or studied when you should start hormone therapy or like
• 16:05
  Speaker 2: what dose. We have a lot of information about hormone
• 16:08
  Speaker 2: therapy and how much it can improve your bone density
• 16:10
  Speaker 2: and how much it can prevent fractures and reduce all
• 16:13
  Speaker 2: cause mortality.
• 16:15
  Speaker 3: We have less.
• 16:16
  Speaker 2: Granular data I would say about like when you initiate
• 16:18
  Speaker 2: and what type and what dose, and like how that
• 16:20
  Speaker 2: might impact your cartilage health. And that is an active
• 16:22
  Speaker 2: area of interest for me. I collaborate with some of
• 16:26
  Speaker 2: our PhDs on this topic. But so I think it's
• 16:31
  Speaker 2: not like an FDA indication. It hasn't been proven, but
• 16:34
  Speaker 2: there's I would say circumstantial evidence right, Like there are
• 16:37
  Speaker 2: estrogener seppors on cartilage in the lining of the joint.
• 16:41
  Speaker 2: We have basic science studies that show cinemitis or inflammation
• 16:44
  Speaker 2: of the joint can be ameliorated with estrogen therapy. We
• 16:50
  Speaker 2: know that women have this divergent like risk, you know,
• 16:53
  Speaker 2: over fifty of more rapid cartilage than ing and arthritis.
• 16:58
  Speaker 2: There's probably something about hormone therapy and the right timing
• 17:03
  Speaker 2: and dose that will ultimately like.
• 17:05
  Speaker 3: Bend that curve.
• 17:06
  Speaker 2: That's not a solution for everybody, because not everyone can
• 17:10
  Speaker 2: use hormone therapy, and of course I have many patients
• 17:13
  Speaker 2: on aromatase inhibitors who are experiencing increased joint pain, you know,
• 17:17
  Speaker 2: associated with their necessary treatment.
• 17:20
  Speaker 3: But that's one thing.
• 17:23
  Speaker 2: There are very few things that slow progression of arthritis.
• 17:27
  Speaker 2: One of them is weight loss if you have weight
• 17:29
  Speaker 2: to lose, so losing five or ten pounds will actually
• 17:32
  Speaker 2: take quite a lot off of your knees and make
• 17:34
  Speaker 2: them feel a lot better. You know, for people who
• 17:38
  Speaker 2: are obese, even your non weight buring joints are more
• 17:43
  Speaker 2: prone to arthritis, probably because of an inflammatory state. And
• 17:47
  Speaker 2: that's I think one of the beauties of use of
• 17:50
  Speaker 2: medications like DLP one medications. At this point, you're not
• 17:53
  Speaker 2: only helping people lose weight, but you're reducing systemic inflammation
• 17:56
  Speaker 2: and probably reducing risk of arthritis. And then you know,
• 18:00
  Speaker 2: but for people of healthy body weight, if you don't
• 18:02
  Speaker 2: have like weight to lose, you know, what else can
• 18:05
  Speaker 2: you do. I think there's reasonable evidence behind collagen supplements.
• 18:11
  Speaker 2: I think that certainly you can always utilize antim planet
• 18:14
  Speaker 2: farme medications, but there's pretty reasonable evidence for using tumeric
• 18:17
  Speaker 2: as an alternative if you don't want to be on
• 18:19
  Speaker 2: those all the time. I think choosing your activities wisely
• 18:25
  Speaker 2: if you're someone where your activities of choice are causing swelling,
• 18:30
  Speaker 2: like maintaining strength training exercises, I think that's good to do.
• 18:34
  Speaker 2: If you are someone if you love to play pickleball,
• 18:37
  Speaker 2: but every time you play pickleball your nie swells, you're
• 18:39
  Speaker 2: probably advancing your earthritis a little bit with every episode
• 18:43
  Speaker 2: that creates swelling. So you need to either back down
• 18:45
  Speaker 2: on the dose or duration or something, or find alternative.
• 18:48
  Speaker 2: So sometimes there's some modulating of like how much of
• 18:51
  Speaker 2: something you do, how often you do it. You don't
• 18:53
  Speaker 2: want to like exacerbate things, but you kind of get
• 18:56
  Speaker 2: into the land of, you know, symptom management, which might
• 18:59
  Speaker 2: include also different types of injections, PRP things like that.
• 19:03
  Speaker 2: So we could I could go on and on, but
• 19:04
  Speaker 2: I don't want to you guys have questions.
• 19:07
  Speaker 1: Well, I was, I'm curious, and I'm glad you brought
• 19:09
  Speaker 1: up collegeen because we've had lots of experts on the
• 19:12
  Speaker 1: show that it's ones that are pro and ones that
• 19:16
  Speaker 1: are against and say it's totally worthless, and other ones
• 19:19
  Speaker 1: that have done their own research on it and are
• 19:22
  Speaker 1: on these studies that say, yeah, it's actually been shown
• 19:25
  Speaker 1: to help with X y Z. So, so you're a
• 19:28
  Speaker 1: fan of that, you think that it's it's potentially helpful.
• 19:32
  Speaker 2: Yeah, I will say I changed my mind about it
• 19:36
  Speaker 2: probably a couple of years ago, just from I'm constantly
• 19:39
  Speaker 2: reading studies, and when I was working on in my book,
• 19:44
  Speaker 2: I just revisited all the literature and went down so
• 19:48
  Speaker 2: many rabbit holes and read so many studies, and I
• 19:51
  Speaker 2: think that, like the basic science mind, it is reasonable.
• 19:58
  Speaker 2: There isn't a study that shows it like necessarily slow.
• 20:01
  Speaker 2: It certainly doesn't reverse arthritis, and actually, like to be clear,
• 20:04
  Speaker 2: nothing actually like reverses arthritis. That's one of the annoying
• 20:07
  Speaker 2: things about earthritis. Sometimes I tell my patients it's like
• 20:10
  Speaker 2: gummer session. If you go the dentist and you have
• 20:12
  Speaker 2: a little gummer session. It's you're never gonna have less
• 20:15
  Speaker 2: gummer session, but you'll be happy if someone tells you
• 20:17
  Speaker 2: it's not any worse the last you want, it's going to.
• 20:23
  Speaker 3: Be there.
• 20:25
  Speaker 2: And it's also not something you can scrape out, Like
• 20:27
  Speaker 2: there are so many people that get unnecessary knee scopes
• 20:30
  Speaker 2: for arthritis because they're well. I don't want to say
• 20:35
  Speaker 2: that someone is doing unnecessary surgery, but they they want
• 20:38
  Speaker 2: the surgery or they end up having the surgery because
• 20:40
  Speaker 2: they have the sense or belief that arthritis can be
• 20:45
  Speaker 2: scraped out of their knee. And it's kind of like
• 20:46
  Speaker 2: a double negative. Arthritis is generalized thinning of cartilage, and
• 20:50
  Speaker 2: you can't remove something that's missing or thinner, right, we
• 20:53
  Speaker 2: don't have that way of magically adding back thickness.
• 20:56
  Speaker 3: To cartilage everywhere. So collagen studies show.
• 21:01
  Speaker 2: You know, is basically a lot of them show decreased
• 21:06
  Speaker 2: downstream breakdown products of cartilage, and meaning like that should
• 21:13
  Speaker 2: suggest you're kind of maintaining the health of your of
• 21:15
  Speaker 2: your cartilage more, right, And so I don't think I
• 21:20
  Speaker 2: think if someone tells you take this collagen supplement, you're
• 21:23
  Speaker 2: going to you know, gain more joint space and thick
• 21:26
  Speaker 2: in your cartilage, Like, that's not true, but I think
• 21:28
  Speaker 2: it does help with maintenance of cartilage health, you know,
• 21:30
  Speaker 2: maintenance of what you have. And of course, as you
• 21:33
  Speaker 2: probably know, there's like hydrolyzed and under natured collagen, and
• 21:37
  Speaker 2: there's also studies on the different types. You know, the
• 21:40
  Speaker 2: hydrolyzed ones are digestible and absortable, whereas the you know
• 21:48
  Speaker 2: U see two, the under natured collagen of type two UH,
• 21:53
  Speaker 2: which is the kind of the primary kind of collagen
• 21:55
  Speaker 2: that's in our smooth gliding cartilage, seems to have like
• 22:00
  Speaker 2: a different effect, like something that is more of an
• 22:03
  Speaker 2: oral tolerance effect exposure to your gi track, but same thing.
• 22:06
  Speaker 3: You know.
• 22:07
  Speaker 2: The measures are like looking at kind of breakdown products
• 22:10
  Speaker 2: of your cartilage, right, not whether or not you develop
• 22:14
  Speaker 2: arthritis or not. So no, I can't say that taking
• 22:17
  Speaker 2: collagen definitely slows the progression of your arthritis or definitely
• 22:20
  Speaker 2: makes you less likely to even the replacement later on life.
• 22:22
  Speaker 3: Those studies don't exist, but some again.
• 22:28
  Speaker 2: Pieces of scienti scientific evidence to kind of suggests to
• 22:31
  Speaker 2: me that that I do think it's beneficial, and I
• 22:33
  Speaker 2: like to use a collagen supplement that combines type one
• 22:36
  Speaker 2: and two collagen, because I do think there's also strong
• 22:38
  Speaker 2: evidence for hydrolyzed type one collagen supporting bone health.
• 22:42
  Speaker 3: And you know, I kind of just lump them in
• 22:45
  Speaker 3: together in my coffee.
• 22:46
  Speaker 1: So and there's never like just a straightforward answer. Most
• 22:51
  Speaker 1: of the time. It's you know, I love how you
• 22:53
  Speaker 1: explain that, because it is there's a lot that goes
• 22:56
  Speaker 1: into it other than just saying yes it helps or
• 22:58
  Speaker 1: no it doesn't.
• 23:00
  Speaker 3: Yeah, and I definitely don't think it hurts.
• 23:04
  Speaker 2: So yeah, so I if you ask, I think it's
• 23:07
  Speaker 2: reasonable enough that I use it. And then people always ask, we, like,
• 23:13
  Speaker 2: what collagen do you use? I want to, and I don't.
• 23:15
  Speaker 2: I'm never trying to like promote a product, but people
• 23:19
  Speaker 2: always ask that, so that I tell them what one
• 23:21
  Speaker 2: I use, but I don't want them to like think
• 23:23
  Speaker 2: they have to get like that specific one. But I
• 23:25
  Speaker 2: do like it because it has it does have type
• 23:28
  Speaker 2: one and type two collagen in it.
• 23:30
  Speaker 1: Well, now you have to say what it is because
• 23:32
  Speaker 1: then we're going.
• 23:32
  Speaker 2: To healthy bones one, healthy bones, okay, total body one,
• 23:36
  Speaker 2: the healthy bones, toubtle body. Uh and yeah, and it's
• 23:41
  Speaker 2: it's really dissolvable and you just put it dissolves.
• 23:45
  Speaker 3: It's sort of fun to watch.
• 23:46
  Speaker 2: Actually, this is such a strange thing to say, but
• 23:48
  Speaker 2: just for fun, make a cup of coffee and then
• 23:50
  Speaker 2: you I heat up my milk and I like a
• 23:53
  Speaker 2: ton of milk with really strong coffee.
• 23:55
  Speaker 3: Because coffee, I feel like.
• 23:57
  Speaker 2: It's like I'm getting some protein and some flacy, and
• 24:01
  Speaker 2: coffee has other good factors. But you just like dump
• 24:04
  Speaker 2: this scoop and it's like this little white mountain and
• 24:06
  Speaker 2: it literally disintegrates into it. You barely have to mix it,
• 24:08
  Speaker 2: and it is weirdly satisfied to watch.
• 24:10
  Speaker 3: You should try it.
• 24:11
  Speaker 1: Okay, I have collagen and it's literally it's sitting in
• 24:15
  Speaker 1: a cupboard and I never get it out, and every
• 24:17
  Speaker 1: day I'm like, I should get out the collagen bill.
• 24:21
  Speaker 2: I think is a good option because people, you know,
• 24:25
  Speaker 2: like that's something that most people do every day.
• 24:28
  Speaker 3: And I also think got it done well.
• 24:31
  Speaker 2: Yeah, Like it's there's other great things about coffee too,
• 24:33
  Speaker 2: but I just it's so easy to add in.
• 24:37
  Speaker 1: So I'm with you on that. That's what sold me.
• 24:39
  Speaker 1: I'm like, now I'm going to be very consistent with
• 24:41
  Speaker 1: my college.
• 24:43
  Speaker 3: So slightly smooth. It's kind of weird.
• 24:48
  Speaker 1: Well, now you've intrigued me. Now I've got to go
• 24:50
  Speaker 1: buy I've got to go like, do this whole procedure
• 24:53
  Speaker 1: and see if it if it's mesmerizing.
• 24:56
  Speaker 2: Is first thing in the morning, I kind of I love.
• 25:02
  Speaker 1: It, so okay, if we I want to really dive
• 25:05
  Speaker 1: into These are the questions that come up all the
• 25:08
  Speaker 1: time jump training. Now, this is how I found you. Yeah,
• 25:13
  Speaker 1: and I actually got served up on Instagram. Laura was
• 25:17
  Speaker 1: just asking me, how did you find Jocelyn? I said,
• 25:19
  Speaker 1: she got served up. And then I saw that doctor
• 25:22
  Speaker 1: Vonda Wright followed you and all of these other leaders
• 25:25
  Speaker 1: in the space, and you were doing a jump of
• 25:28
  Speaker 1: how much impact from you know, you had your tape
• 25:31
  Speaker 1: measure and you were jumping off of that.
• 25:33
  Speaker 2: Well funny, I didn't realize how much that would grab
• 25:36
  Speaker 2: people's attention.
• 25:37
  Speaker 1: I just, yeah, I did.
• 25:39
  Speaker 3: It was a little aiden's drop jump. And I didn't
• 25:42
  Speaker 3: make this up. There's a researcher.
• 25:45
  Speaker 2: First of all, we know that impact creates a stimulus
• 25:49
  Speaker 2: to our bone that increases bone density, especially at our hips.
• 25:53
  Speaker 2: So like in general, strength training does a little bit
• 25:56
  Speaker 2: more for our lumbar spy and than it does for
• 25:58
  Speaker 2: our hips, although it does something for hips to but
• 26:00
  Speaker 2: is primarily affects our hips. And so the specific study
• 26:08
  Speaker 2: of the amount of impact you get with an eight
• 26:10
  Speaker 2: inch drop jump and a rebound came from a study
• 26:12
  Speaker 2: done by a researcher named Tracy Klissel and her group
• 26:16
  Speaker 2: of the group of researchers she was working with, and
• 26:19
  Speaker 2: I just wanted to show people like, you don't need
• 26:21
  Speaker 2: a ton of fancy equipment. Like I was like, look,
• 26:24
  Speaker 2: here's my ruler. It's eight inches. Most steps are eight inches.
• 26:28
  Speaker 2: And I was just in my backyard, which is frequently
• 26:31
  Speaker 2: where I make little educational videos, and I just was like,
• 26:34
  Speaker 2: this is all you have to do is like jump
• 26:36
  Speaker 2: off this jump and do a jump landing. And I
• 26:38
  Speaker 2: mean it's kind of like I think sometimes people don't
• 26:41
  Speaker 2: realize that you have you don't need a lot of stuff.
• 26:45
  Speaker 2: Sometimes sometimes you do, like if you want to go
• 26:47
  Speaker 2: do like heavy lifting, which I also like to do
• 26:48
  Speaker 2: a couple of days a week, but jump training you
• 26:51
  Speaker 2: can do like anywhere, play a metrics you can do
• 26:53
  Speaker 2: pretty much anywhere.
• 26:55
  Speaker 1: Yeah, okay, so we have the jumping and from the
• 27:00
  Speaker 1: clistles from her research, she recommends landing with like a
• 27:06
  Speaker 1: straight lake like not really absorbing the bounce. Is that
• 27:10
  Speaker 1: more what you were doing or.
• 27:11
  Speaker 2: Kind of like the softer the knees or the more
• 27:14
  Speaker 2: like kind of toe to heal, you would be absorbing
• 27:16
  Speaker 2: some of the load, but you're trying to give drop
• 27:20
  Speaker 2: and then do a rebound, which actually if you haven't
• 27:22
  Speaker 2: done that in a while, like so many people just
• 27:24
  Speaker 2: drop and hit the ground and like don't actually know
• 27:27
  Speaker 2: how to rebound, like a kind of a pliometric they are.
• 27:30
  Speaker 2: And so I had a lot of people to write
• 27:32
  Speaker 2: to me, Oh I forgot how to do that, And
• 27:35
  Speaker 2: I just think that we actually people like forget how
• 27:39
  Speaker 2: to skip and yeah stop, or people forget how to
• 27:43
  Speaker 2: jump rope. And I'm I don't know how to say
• 27:46
  Speaker 2: I'm immature, but I love doing like I was a gymnast.
• 27:50
  Speaker 3: I'm always like, this is a gymnast and.
• 27:53
  Speaker 1: You coming out.
• 27:54
  Speaker 3: I like doing things.
• 27:55
  Speaker 2: If I'm at the playground, I do some pullovers, I
• 27:58
  Speaker 2: do the monkey bars, or I like jumping around. But
• 28:01
  Speaker 2: I even I noticed that, like I shared a few
• 28:05
  Speaker 2: months ago, I almost forgot how to do the monkey
• 28:07
  Speaker 2: bars with like I almost forgot I hadn't done it
• 28:10
  Speaker 2: in a long time. It just felt really weird. But
• 28:12
  Speaker 2: I think jumping is like that. If you haven't done
• 28:15
  Speaker 2: like a jump landing in a while, it feels weird
• 28:17
  Speaker 2: and you forget how to drop into a rebound and
• 28:19
  Speaker 2: so you could start less than eight inches and try
• 28:21
  Speaker 2: it or you know. Actually, that same group did just
• 28:23
  Speaker 2: like a big squat jump with the rebound, and you
• 28:26
  Speaker 2: still gotta get that effect on the second on that
• 28:29
  Speaker 2: rebound jump. But I thought it was more visual for
• 28:32
  Speaker 2: people to kind of do it off of a step.
• 28:35
  Speaker 1: So yeah, no, it was great and I love it.
• 28:37
  Speaker 1: Like I remember this was years ago when my daughter
• 28:41
  Speaker 1: who's now twenty one, when she was I think in
• 28:44
  Speaker 1: kindergarten probably kindergarten, and there were monkey bars and at
• 28:49
  Speaker 1: the time I wasn't doing any lifting. I was doing
• 28:51
  Speaker 1: triathlon and I just didn't do any lifting with it.
• 28:55
  Speaker 1: And I tried to do the monkey bars. I thought
• 28:57
  Speaker 1: my arms were gonna fall, like fall out of this socket.
• 29:02
  Speaker 2: This sucks, It's well, says your people don't use their
• 29:06
  Speaker 2: lats very.
• 29:08
  Speaker 1: Yeah, clearly I wasn't. It was terrible. So okay, so
• 29:13
  Speaker 1: we have the jump and then other options, so we
• 29:17
  Speaker 1: we know that you know, we're looking at and not
• 29:20
  Speaker 1: that osteoporosis doesn't have anywhere else. But we get tested
• 29:23
  Speaker 1: at the risk that the e femeral neck and then
• 29:27
  Speaker 1: the umbark. So so if we're looking at like the wrist,
• 29:32
  Speaker 1: so if we were doing overhead you know, a barbell
• 29:35
  Speaker 1: overhead press, we're loading the wrist. That's one way where
• 29:40
  Speaker 1: we could load the risk. But what are other ways
• 29:43
  Speaker 1: that you could add more dynamic to it.
• 29:46
  Speaker 2: So I think that people should, yeah, try to load
• 29:49
  Speaker 2: your wrist. Now, the funny thing about your wrists, you know,
• 29:51
  Speaker 2: so like first of all, when you talk about the risk,
• 29:54
  Speaker 2: we're usually talking about the distal radius the wider bone here.
• 29:57
  Speaker 2: Of course there's smaller bones in the actual risk here
• 29:59
  Speaker 2: in your own small but the thing that people break
• 30:02
  Speaker 2: is the is the distal radius of note, you know,
• 30:06
  Speaker 2: like the first peak that we see in distal radius
• 30:09
  Speaker 2: fractures in women is like actually in the fifties, and
• 30:12
  Speaker 2: it's kind of like a canary in the coal mine situation.
• 30:16
  Speaker 2: Because if you fall like same level fall and break
• 30:18
  Speaker 2: your wrist, it's a good time to get your bone
• 30:21
  Speaker 2: density checked because that may mean you have like lesser
• 30:23
  Speaker 2: bone density in some other places as well. And for instance,
• 30:27
  Speaker 2: like there are some says that show if you break
• 30:29
  Speaker 2: your wrists, you have a forty fifty percent greater chance
• 30:33
  Speaker 2: of having a hip fracture later on than someone who
• 30:35
  Speaker 2: has never broken the risk because it's it's an indicator
• 30:38
  Speaker 2: maybe of your bone health or maybe your likelihood of fall,
• 30:41
  Speaker 2: who knows, But so risk fracture can be I always
• 30:44
  Speaker 2: tell people the silver lining of a risk fracture is
• 30:46
  Speaker 2: this can be a bit of a wake up call,
• 30:48
  Speaker 2: like maybe you just have some osteopenia.
• 30:50
  Speaker 1: Yeah.
• 30:50
  Speaker 2: Also, it's so often happening to people who are like
• 30:52
  Speaker 2: in their early fifties, when maybe they're making decisions about
• 30:55
  Speaker 2: like hormone therapy or not, which is prophylactic against othtyproosis.
• 31:00
  Speaker 2: Not that I want people to go around breaking the wrist,
• 31:02
  Speaker 2: but like, if that happens to you, like take advantage
• 31:05
  Speaker 2: of that situation, Go get your bone density de tecked,
• 31:07
  Speaker 2: you know, paytenship. But anyway, it's an interesting thing about
• 31:10
  Speaker 2: the wrist. It doesn't have like a ton of large
• 31:14
  Speaker 2: muscles attached like right here. So like, in addition to
• 31:18
  Speaker 2: like impact strength training, carrying things, putting load.
• 31:22
  Speaker 3: Across your bone strengthens your bones.
• 31:24
  Speaker 2: But also just like the tugging and pulling of large
• 31:26
  Speaker 2: muscle groups will strengthen their remodel bones, like your deltoid,
• 31:30
  Speaker 2: your biceps, your triceps. But this is kind of an
• 31:32
  Speaker 2: area where like a lot of tendons and nerves and
• 31:34
  Speaker 2: vessels cross over.
• 31:36
  Speaker 3: There are some smaller muscles that attach here.
• 31:39
  Speaker 2: That you know, like pronate your wrist and move some
• 31:42
  Speaker 2: of your fingers, but like they're not like huge muscle groups.
• 31:45
  Speaker 2: So I actually think if you you know, wanted to
• 31:48
  Speaker 2: like maybe try to impact your wrists bone density, that
• 31:52
  Speaker 2: doing some load bearing on it is good. It could
• 31:54
  Speaker 2: be as you said, an overhead press, which of course
• 31:56
  Speaker 2: is part of the liftmore protocol and also is going
• 31:58
  Speaker 2: to load your skeleton because it's it's you're pressing it overhead.
• 32:03
  Speaker 2: But I like to encourage people to do planking walk out.
• 32:07
  Speaker 2: I shared a video the other day of like kind
• 32:09
  Speaker 2: of a drop onto your arms.
• 32:11
  Speaker 1: Yes, I saw that. It great to do.
• 32:13
  Speaker 2: Like you know, like when you're a gymnast. We used
• 32:15
  Speaker 2: to like handstand pops. But people aren't going to run
• 32:17
  Speaker 2: around doing like little jumps and handstands like a gymnast.
• 32:21
  Speaker 3: But I love to do handstands. I do them at
• 32:24
  Speaker 3: the gym against the wall.
• 32:25
  Speaker 2: With my seventeen year old, but you know you could
• 32:30
  Speaker 2: do so push ups are load bearing, honestly pushing a lawnmower.
• 32:35
  Speaker 2: Someone suggested the other day, like, that's some load bearing
• 32:37
  Speaker 2: on your wrist. If you can't do like, you could
• 32:40
  Speaker 2: do put clap push ups, but that's a you have
• 32:43
  Speaker 2: to be pretty strong do that. So you could do
• 32:44
  Speaker 2: that on your knees, or you just push and then
• 32:46
  Speaker 2: land like a knee push up, where with a push off.
• 32:51
  Speaker 3: I kind of showed you can.
• 32:52
  Speaker 2: Do like a little drop onto your hands from a
• 32:56
  Speaker 2: yoga block, or someone suggested pt for women on Instagram
• 33:02
  Speaker 2: suggested doing like a bear walk to drop into a
• 33:05
  Speaker 2: push up position like a plyo push up. I love
• 33:08
  Speaker 2: bear walks because that's a core exercise. Beer also weight brain.
• 33:11
  Speaker 2: And I love single leg walkouts because it's like a
• 33:13
  Speaker 2: balanced and core thing. You know, you walk out, you
• 33:16
  Speaker 2: walk back in, or ball walk outs with a plo ball.
• 33:20
  Speaker 3: You know you're basically hard. Yeah.
• 33:25
  Speaker 2: Yeah, I think a lot of the things I like
• 33:27
  Speaker 2: to do are remnants from old gymnastics things, but you
• 33:30
  Speaker 2: can apply them to non gymnastics people too. It's just
• 33:34
  Speaker 2: simpler versions and so to put some weight on your arms.
• 33:39
  Speaker 1: Yeah, for sure. Yeah, I'm super impressed with that because
• 33:43
  Speaker 1: I always get asked, well, what do I do if
• 33:46
  Speaker 1: I have osteoarthritis in the knee and I can't jump,
• 33:51
  Speaker 1: and they you know, there's all these other options that Okay,
• 33:54
  Speaker 1: sure you're not going to if you can't jump, but
• 33:57
  Speaker 1: you can load the wrist, how you say, but you
• 34:00
  Speaker 1: know you can still load the spine. But what else
• 34:05
  Speaker 1: do you have for women that have osteo arthritis and
• 34:09
  Speaker 1: they can't jump and they feel left out of the party.
• 34:12
  Speaker 1: And I never want anyone to feel left out of
• 34:14
  Speaker 1: the party.
• 34:14
  Speaker 3: Yeah, So this is where.
• 34:18
  Speaker 2: Like what you can tolerate comes into play and something
• 34:22
  Speaker 2: is better than nothing, and like the concept of I
• 34:26
  Speaker 2: don't know if you know the term weaper is tolerated
• 34:28
  Speaker 2: that we use orthopedics, like I have a nerdy hat
• 34:30
  Speaker 2: that says it w bat, which I'm going to make
• 34:34
  Speaker 2: some T shirts of. But some of my lady residents
• 34:39
  Speaker 2: we have a little we bat club we call it.
• 34:41
  Speaker 3: But anyway, so we're obsessed with the way beer.
• 34:43
  Speaker 2: Ascelerted, it's a fun acronym for something we tell people
• 34:47
  Speaker 2: to do after surgery, like if it's safe to put
• 34:49
  Speaker 2: weight on your leg.
• 34:49
  Speaker 3: We say, you know waite bear as tolerated, but it's
• 34:52
  Speaker 3: a term.
• 34:53
  Speaker 2: That I think people can apply to so many things,
• 34:57
  Speaker 2: like at what can you tolerate? Like, yeah, you've got
• 35:00
  Speaker 2: some earthritis in your knee and you can't jump for impact.
• 35:03
  Speaker 2: You can do heel drops probably right, like that does
• 35:07
  Speaker 2: have some create some of that impact. You can do
• 35:13
  Speaker 2: using like a rebounder or mini tramp jumping on there.
• 35:17
  Speaker 2: It's not as effective for stimulating bone density at the
• 35:20
  Speaker 2: hips as jumping on the ground is, but it does
• 35:22
  Speaker 2: something and it's better than not doing anything. And likewise,
• 35:26
  Speaker 2: you could you can jump in a pool like kind
• 35:28
  Speaker 2: of like where some of your body is underwater and
• 35:31
  Speaker 2: so there's some resistance to get out of the water.
• 35:33
  Speaker 2: There's some impact, although diminished on entry. Again, and that's
• 35:37
  Speaker 2: better than being sedentary. It's not as much as jumping
• 35:41
  Speaker 2: on the land. So like, find what you can do
• 35:44
  Speaker 2: and do it and keep doing it. And it's not
• 35:47
  Speaker 2: going to help you if you have really been the
• 35:50
  Speaker 2: earthritis and you're like, I'm gonna jump because someone told
• 35:53
  Speaker 2: me I need to jump, but then you have swollen
• 35:55
  Speaker 2: knees for three days, like that's not a good outcome
• 35:57
  Speaker 2: for you.
• 35:58
  Speaker 3: So I just think everyone needs like listen to their bodies.
• 36:02
  Speaker 2: Not everything is for everyone, and that's okay, and there
• 36:04
  Speaker 2: are modifications, and just the hard thing for women, especially
• 36:11
  Speaker 2: in your like say fifties, is you're trying to navigate
• 36:14
  Speaker 2: doing exercise to maintain your bone density, but the same
• 36:16
  Speaker 2: time you're at risk for arthritis, and so you have
• 36:21
  Speaker 2: to listen to I think your joint pain or knee
• 36:23
  Speaker 2: swelling and modify. So like squatting, if you have bad knees,
• 36:28
  Speaker 2: I mean, I don't think anyone. I don't think you
• 36:30
  Speaker 2: have to go past ninety of neflextions. So maybe you
• 36:32
  Speaker 2: can do that, or maybe you do your squatting with
• 36:35
  Speaker 2: moderate intensity not high intensity. Maybe you can do higher
• 36:38
  Speaker 2: with dead lift, and if you don't have shoulder issues,
• 36:42
  Speaker 2: maybe you can lift heavy with overhead press, Like you
• 36:44
  Speaker 2: don't have to go high, and you have to listen
• 36:46
  Speaker 2: to whatever issues you have going on. And I always
• 36:49
  Speaker 2: give the example I actually am never going to be
• 36:52
  Speaker 2: a high intensity overhead pressor because it always gives me
• 36:57
  Speaker 2: a recurring injury or tennonitis or whatever. And so for me,
• 37:01
  Speaker 2: like overhead press forever for my whole life is always
• 37:04
  Speaker 2: going to be like no more than modern intensity because
• 37:06
  Speaker 2: I know that about me, and that's fine. I'm still
• 37:09
  Speaker 2: contributing to my maintenance of muscle mass and it's and
• 37:13
  Speaker 2: moderate intensity lifting still helps with bone density. It's not
• 37:16
  Speaker 2: as helpful as high intensity, but high intensity isn't helpful
• 37:20
  Speaker 2: for you if it takes you out for three weeks
• 37:23
  Speaker 2: and then you can't do something because you sendonitis. So
• 37:27
  Speaker 2: I just think people need to listen to themselves and
• 37:30
  Speaker 2: not feel excluded if they can't do like the hardest
• 37:33
  Speaker 2: version of everything. And you know, I mostly try to
• 37:38
  Speaker 2: share with people data and options, and for I think
• 37:44
  Speaker 2: exercise can be fun and I can't stand to not exercise,
• 37:49
  Speaker 2: and I hate it when one of my patients who
• 37:51
  Speaker 2: likes to exercise feels like they can't exercise because their
• 37:55
  Speaker 2: limits work. I hate it for them, and so I
• 37:58
  Speaker 2: just constantly try to think of work around and like,
• 38:01
  Speaker 2: for so many of my patients, okay, if you have
• 38:04
  Speaker 2: you can't They're like, I can't run anymore, I can't jump,
• 38:11
  Speaker 2: you know, like what can I do? A lot of
• 38:12
  Speaker 2: them I refer to like if they can if they
• 38:14
  Speaker 2: have a good hip mobility, like rowing.
• 38:16
  Speaker 3: Is a great option.
• 38:17
  Speaker 2: It's actually quite tolerable to arthritic knees, and because of
• 38:23
  Speaker 2: the forces you're applying to all of your muscles, actually
• 38:26
  Speaker 2: has some you know books It's a low impact, you know,
• 38:31
  Speaker 2: on your knees type thing, but still actually has some
• 38:33
  Speaker 2: benefits for bone density. So I just think we constantly
• 38:36
  Speaker 2: have to find ways for people to keep threading the
• 38:39
  Speaker 2: needle between joint pain and maintaining their muscle mass and
• 38:43
  Speaker 2: maintain their bone density.
• 38:45
  Speaker 1: If you're a woman in midlife who's ready to take
• 38:48
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• 38:53
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• 40:00
  Speaker 1: or tack the link in the show notes. Now back
• 40:03
  Speaker 1: to the conversation. Okay, so this is the last question
• 40:07
  Speaker 1: on this, but well, first of all, I have to
• 40:09
  Speaker 1: say I had knee surgery eight years ago where I
• 40:15
  Speaker 1: had a full meniscus root tear, so I couldn't I
• 40:18
  Speaker 1: was non weight bearing for six weeks. We bring six
• 40:21
  Speaker 1: weeks the worst, the worst. But I would go and
• 40:24
  Speaker 1: sit up my physical therapists office and they had the
• 40:26
  Speaker 1: arm bike and I would sit on there for forty
• 40:30
  Speaker 1: five minutes. The crazy ladies in here again doing sprints
• 40:33
  Speaker 1: on the arm bike. It was all I could do.
• 40:36
  Speaker 2: I was like I should somehow It's too bad that
• 40:38
  Speaker 2: we didn't know each other then, because I could have
• 40:40
  Speaker 2: told you about three limb biking, which is we get
• 40:43
  Speaker 2: on an air bike and you put your injured leg
• 40:46
  Speaker 2: on a leg rest and then you bike with two
• 40:50
  Speaker 2: arms and one leg.
• 40:51
  Speaker 1: Oh I'm so mad.
• 40:54
  Speaker 2: Well, if everyone else to work around and that's the
• 40:59
  Speaker 2: I think that's the best way to get your heart
• 41:01
  Speaker 2: rate up.
• 41:01
  Speaker 3: When you have like one leg that you can't like.
• 41:05
  Speaker 2: Do cardio with, oh yeah, I just don't get enough,
• 41:10
  Speaker 2: or you can do a ski or if you have
• 41:12
  Speaker 2: the ability to balance on the one leg.
• 41:14
  Speaker 1: Yeah, I mean I eventually got on the pool and
• 41:16
  Speaker 1: just put a booie in between my legs so I
• 41:18
  Speaker 1: could just.
• 41:19
  Speaker 3: Maddening root tears. I really Also, by.
• 41:24
  Speaker 2: The way, I think people need to choose carefully because
• 41:29
  Speaker 2: if you already you I don't think you had an
• 41:31
  Speaker 2: earth RTIs. But if you already have some earthritis and
• 41:34
  Speaker 2: you tore your meniscus route by like simply getting up
• 41:36
  Speaker 2: out of a chair or something like that, that means
• 41:38
  Speaker 2: the tissue quality isn't good, and then you get into
• 41:41
  Speaker 2: the disease of treatment because sometimes people are having a
• 41:44
  Speaker 2: root repair touchdown weight brain for six weeks, their muscles
• 41:48
  Speaker 2: atrophies so much on that leg. Actually you will get
• 41:50
  Speaker 2: focal loss of bone density on that leg that will
• 41:53
  Speaker 2: take a couple of years to return to normal sometimes
• 41:56
  Speaker 2: and it's not it's not benign. So it's like it's
• 42:02
  Speaker 2: it's you have to choose wisely if you're going to
• 42:04
  Speaker 2: have a root repair because it's six sneaks on crutches
• 42:08
  Speaker 2: can and you're then you're already in a situation like
• 42:10
  Speaker 2: let's say you're a woman in your fifties where you
• 42:12
  Speaker 2: have a hard time building muscle, so you get atrophy
• 42:16
  Speaker 2: and disuse, and then you have to you know, disuse
• 42:18
  Speaker 2: is hard to get.
• 42:20
  Speaker 3: It's true.
• 42:20
  Speaker 2: I hate to put weight buring restrictions on people, but
• 42:23
  Speaker 2: that's one surgery where I tell them you can't put
• 42:25
  Speaker 2: wait in your leg for six weeks, and so it's
• 42:26
  Speaker 2: a big deal.
• 42:27
  Speaker 1: Yeah. No, I my doctor I had hospital for special surgery,
• 42:32
  Speaker 1: did my my surgery. And I mean he was like,
• 42:36
  Speaker 1: I don't really, I'll take you. I just finished an
• 42:40
  Speaker 1: iron Man, so I had like a bunch of things
• 42:42
  Speaker 1: that way. But I mean he was even hesitant because
• 42:44
  Speaker 1: he's like the success rate and all of these other
• 42:47
  Speaker 1: things that come with it, but I was desperate. But
• 42:50
  Speaker 1: if we move on to this, this lifting heavy. Okay,
• 42:56
  Speaker 1: so I partner with two women that really, you know,
• 43:00
  Speaker 1: really want women to lift heavy. I lift heavy, although
• 43:04
  Speaker 1: it looks different now because my back doesn't love back
• 43:07
  Speaker 1: squatting really heavy, so I just don't do it. I
• 43:10
  Speaker 1: do it in other ways. But let's go over when
• 43:14
  Speaker 1: you said the high intensity, you're meaning eighty percent or
• 43:18
  Speaker 1: more of your one report.
• 43:20
  Speaker 2: The high is that eighty percent single rep max, which,
• 43:25
  Speaker 2: since most people don't know their single retmax, I try
• 43:27
  Speaker 2: to translate what that means. It would be like the
• 43:30
  Speaker 2: weight that you could do a set of four or
• 43:34
  Speaker 2: five or six, where like the fourth, fifth or six
• 43:36
  Speaker 2: is really hard for you. It's the last one you
• 43:39
  Speaker 2: could do with good form. So that would be like
• 43:41
  Speaker 2: your and then you have to rest before you do
• 43:43
  Speaker 2: another set. That would be like you're that version of
• 43:46
  Speaker 2: your eighty percent single ret max. And I do that
• 43:50
  Speaker 2: for certain things and not for others. And I and
• 43:54
  Speaker 2: I think that if you look at studies of less
• 43:57
  Speaker 2: intense lifting and more intense lifting as intervention for women,
• 44:00
  Speaker 2: specifically menopausal women, even with osteopenia, that there is more
• 44:07
  Speaker 2: return on investment, meaning you do gain more bone density,
• 44:11
  Speaker 2: especially in the lumbar spine with the higher intensity lifting
• 44:15
  Speaker 2: the lift heavy. But even within those studies, you know,
• 44:21
  Speaker 2: of course they show safety, which is great, like these
• 44:25
  Speaker 2: we have the lift more trials showed safety and these
• 44:27
  Speaker 2: women who were average aged sixty five ostupoenic, there weren't
• 44:30
  Speaker 2: any injuries. But those are studies and they're not real
• 44:33
  Speaker 2: world and people are screened out because they had that
• 44:36
  Speaker 2: root repair or can't do something because of some pre
• 44:40
  Speaker 2: existing injury or whatever. So in real life, we're not
• 44:43
  Speaker 2: subjects and studies that met exclusion and inclusion criteria, and
• 44:47
  Speaker 2: we have things. And I think the messages are very
• 44:54
  Speaker 2: good that heavy lifting is the most effective for building
• 44:57
  Speaker 2: and maintaining bone density and muscle mass, or at least
• 45:01
  Speaker 2: for bone density, but there are also benefits of the
• 45:05
  Speaker 2: less intense lifting. You have to obviously do more repetitions,
• 45:08
  Speaker 2: not less, and the return on like the gains in
• 45:12
  Speaker 2: bone density isn't as much, but it's it's still a positive.
• 45:16
  Speaker 2: And so I I mean, I see people all the
• 45:18
  Speaker 2: time in clinic, but if I told them to go
• 45:20
  Speaker 2: do that, they would be like that would hurt my
• 45:22
  Speaker 2: knee because I had a root repair, or I had
• 45:26
  Speaker 2: my roddator cuff repaired last year. I can't do heavy
• 45:28
  Speaker 2: overhead presses, and so we can find workarounds and things
• 45:33
  Speaker 2: like that. You know, maybe you can do more farmers
• 45:37
  Speaker 2: carries with something heavy, or or maybe you can do
• 45:40
  Speaker 2: like I prefer hexpar squatting over back squats more or
• 45:43
  Speaker 2: less kind of. But yeah, so I think real life
• 45:50
  Speaker 2: doesn't always, like I said, match these inclusion exclusion criteria,
• 45:54
  Speaker 2: and people have actual issues they have to work around,
• 45:58
  Speaker 2: and so I just don't want people to feel excluded
• 46:02
  Speaker 2: from the strength training process or the benefits of it,
• 46:05
  Speaker 2: or think that if you like that, if you aren't
• 46:08
  Speaker 2: doing the highest intensity, that it's not worth doing, because
• 46:11
  Speaker 2: that's also not true in a perfect world.
• 46:13
  Speaker 3: If you can do it, I think it does have
• 46:15
  Speaker 3: more benefits.
• 46:16
  Speaker 2: Yeah, and I do it a couple of days a week,
• 46:19
  Speaker 2: like I said, but not for overhead.
• 46:21
  Speaker 1: Press No, that's good, and it gives women permission to say, hey,
• 46:27
  Speaker 1: you know what, you know, it's great if you can
• 46:30
  Speaker 1: lift heavy at this eighty percent one rep max or
• 46:33
  Speaker 1: four sets of four or five sets of five or
• 46:35
  Speaker 1: whatever you're doing. But if you can't, then there's an option,
• 46:40
  Speaker 1: and thank goodness, there's these other options that still can
• 46:43
  Speaker 1: give us almost as much of that benefit. But can
• 46:46
  Speaker 1: we can we do the unilateral? Can we do unilateral
• 46:52
  Speaker 1: where you're not loading as much, but you're still doing
• 46:54
  Speaker 1: four reps where you're really taxed and it's just as heavy,
• 46:58
  Speaker 1: but you're just working one one leg instead of bilateral?
• 47:03
  Speaker 2: Uh yeah, I think that actually is sometimes better at
• 47:07
  Speaker 2: identifying asymmetry. Sometimes we're compensating, you know, you know, we
• 47:15
  Speaker 2: all have a dominant leg, you know, for instance. So yeah,
• 47:18
  Speaker 2: I think that there's definitely benefits to unilateral strengthening and
• 47:22
  Speaker 2: also certainly helps with balance and things like that.
• 47:27
  Speaker 3: So yeah, you're still.
• 47:32
  Speaker 2: Either doing a high intensity on that one leg or moderate.
• 47:36
  Speaker 3: It's just you're doing it one at a time. It
• 47:38
  Speaker 3: takes twice as long. I think that's that's not an issue.
• 47:41
  Speaker 1: Yeah, Okay, well, lots of options, ladies. I hope you're
• 47:44
  Speaker 1: taking notes. Something is better than nothing. Yeah, I always.
• 47:49
  Speaker 2: Think something is better than nothing. I mean, the classic
• 47:53
  Speaker 2: example is, uh, well, I don't want to call walking
• 47:57
  Speaker 2: nothing because walking has real benefits, Like certainly studies showing
• 48:01
  Speaker 2: that walking, you know, regularly reduces your fracture risk, even
• 48:06
  Speaker 2: if it doesn't necessarily improve your bone density dramatically. But
• 48:12
  Speaker 2: I just think people also need to think of use
• 48:15
  Speaker 2: as the opposite of disuse. I mean, I don't want
• 48:19
  Speaker 2: to say like like walking is nothing, but it's not
• 48:21
  Speaker 2: that something is better than nothing. It's just that you're
• 48:23
  Speaker 2: using and weight bearing on your lower extremities. You're maintaining
• 48:26
  Speaker 2: your balance, your movement patterns. The opposite of not walking
• 48:31
  Speaker 2: and not standing is being on crutches. Like you had
• 48:34
  Speaker 2: your root repair and you were on crutches for six weeks,
• 48:36
  Speaker 2: if you had even just an ACL reconstruction, and so like,
• 48:40
  Speaker 2: let's say you're on crutches for a period of time
• 48:42
  Speaker 2: and then you know you have you get some atrophy
• 48:43
  Speaker 2: and you have to build your muscle back up. One
• 48:46
  Speaker 2: of my good friends who's chief of Orthopedics and sports
• 48:48
  Speaker 2: Medicine at University of Wisconsin, Tammy Scrapello, has done some
• 48:51
  Speaker 2: more in this. Like even a person who in an
• 48:53
  Speaker 2: ACL reconstruction two years after their ACL surgery, that's how
• 48:57
  Speaker 2: long it takes them for their bone density in the
• 48:59
  Speaker 2: surgical limb to like fully recover all the way across.
• 49:01
  Speaker 3: The length of their femur. And that's from a short
• 49:04
  Speaker 3: period of disuse.
• 49:05
  Speaker 2: So or if you were an astronaut, you're not putting
• 49:08
  Speaker 2: any weight on your legs, have you develop off to
• 49:10
  Speaker 2: yourporosis at a ridiculous rate? So you know, weight buring
• 49:14
  Speaker 2: on your limbs, whether you're walking with or without a
• 49:17
  Speaker 2: vest or jumping, or if you're on your arms, if
• 49:21
  Speaker 2: you're load bearing, Like, these are things that are the
• 49:23
  Speaker 2: opposite of disuse, which would be in an extreme version
• 49:27
  Speaker 2: being an astronaut or being on crutches or something like
• 49:29
  Speaker 2: that to yeah.
• 49:31
  Speaker 1: Bless the astronauts.
• 49:33
  Speaker 2: Yeah, that's why they have a special thing. They have
• 49:37
  Speaker 2: a special resistance training thing on the ship. That is
• 49:41
  Speaker 2: it's not weights, it's like basically super resistance bands. So
• 49:45
  Speaker 2: they're like squatting and they still do resistance training like
• 49:50
  Speaker 2: multiple hours a day when they're on missions in order
• 49:53
  Speaker 2: to try to stave off bone loss. Actually, so even
• 49:57
  Speaker 2: the astronauts are doing strength training to maintain their bon.
• 50:01
  Speaker 1: You have to.
• 50:04
  Speaker 4: Going back to the ACL, what factors can contribute to
• 50:11
  Speaker 4: ongoing atrophy and imbalance and after after a full ACL
• 50:19
  Speaker 4: and Menesca's tear and reconstructive surgery, what are the most
• 50:24
  Speaker 4: effective ways to restore full strength.
• 50:29
  Speaker 2: Uh, well, I think the key one of the key
• 50:33
  Speaker 2: elements is when you tear your ACL the knee spells,
• 50:37
  Speaker 2: you get fluid in it, and then after surgery there's
• 50:40
  Speaker 2: usually spelling in it too. Whenever you have swelling in
• 50:42
  Speaker 2: your knee, your brain will like automatically shut down your
• 50:46
  Speaker 2: quad and you get what's called quad steps inhibition. And
• 50:49
  Speaker 2: so someone will come in and they're like, won't even
• 50:51
  Speaker 2: be able to lift their leg off the table, or
• 50:53
  Speaker 2: they can't walk because their knee would buckle. And so
• 50:57
  Speaker 2: the longer that goes on, the more at you get
• 51:00
  Speaker 2: or of a hole you have to dig out of.
• 51:01
  Speaker 2: And so I actually like to in the really early
• 51:05
  Speaker 2: postop course after my patients, like the first visit, if
• 51:08
  Speaker 2: they have swelling in any I actually stick a needle
• 51:11
  Speaker 2: in it and drain it out and they can immediately
• 51:13
  Speaker 2: activate their QUAD Like it's an immediate difference. Like someone
• 51:17
  Speaker 2: who couldn't lift their leg up can lift their leg up.
• 51:19
  Speaker 2: Someone who couldn't show me active hyper extension can do it.
• 51:21
  Speaker 2: It just immediately helps them restore their function.
• 51:24
  Speaker 3: So that's one thing.
• 51:25
  Speaker 2: Getting the swelling out of the as soon as you
• 51:27
  Speaker 2: can so that you can get your QUAD activation back,
• 51:30
  Speaker 2: and the sooner you start to activate your quad, the
• 51:32
  Speaker 2: less accurately you're going to have and then you know,
• 51:35
  Speaker 2: like restoring normal gait as soon as you can so
• 51:37
  Speaker 2: starting to walk normally, and then it's just a matter
• 51:41
  Speaker 2: of like being really regular about like with whatever you
• 51:45
  Speaker 2: can do. I mean, we obviously give parameters. Usually in
• 51:48
  Speaker 2: the first few months, we don't want you doing certain things.
• 51:51
  Speaker 2: We start to add in, like lunging and squatting and
• 51:53
  Speaker 2: leg press And I think the number one mistake people
• 51:56
  Speaker 2: make in rehab is they think that you do physical
• 51:58
  Speaker 2: therapy only when you're at physical therapy.
• 52:00
  Speaker 3: But it's so important to just.
• 52:03
  Speaker 2: Like if you were going to, like if you don't
• 52:05
  Speaker 2: work out one day a week, your physical therapy like
• 52:08
  Speaker 2: kind of becomes your workout. And I tell people, you
• 52:10
  Speaker 2: need to be really diligent about this. You need to
• 52:13
  Speaker 2: do this like three or four days a week for
• 52:14
  Speaker 2: the strength training part, and just treat it like it's
• 52:18
  Speaker 2: your exercise routine. And I think that is kind of
• 52:23
  Speaker 2: one of the major reasons why people can kind of
• 52:25
  Speaker 2: get prolonged atrophies, are just not being diligent enough about it,
• 52:29
  Speaker 2: or maybe a lot of people don't even understand like
• 52:31
  Speaker 2: if they don't think about it in that way, but
• 52:33
  Speaker 2: it's kind of your your workout. And I had this
• 52:38
  Speaker 2: hip surgery last July, and I was completely obsessed with rehab.
• 52:44
  Speaker 2: I took seven weeks off of work, and I think
• 52:47
  Speaker 2: the early phase can be kind of some of the
• 52:50
  Speaker 2: most important phase to sort of try to like not
• 52:52
  Speaker 2: get so much atrophy. That's what I was doing, the
• 52:53
  Speaker 2: three limb biking. I would do it like two hours
• 52:55
  Speaker 2: a week.
• 52:58
  Speaker 1: It's not gave me a year of working back until
• 53:03
  Speaker 1: I got I mean, I think it was more like
• 53:05
  Speaker 1: eighteen months before I got full strength back in that leg. Man,
• 53:10
  Speaker 1: that would have been helpful.
• 53:12
  Speaker 4: Well, what if it's been a couple of years and
• 53:14
  Speaker 4: you're doing pretty good, but you're not a hundred what
• 53:17
  Speaker 4: are the things that you can do to like feel
• 53:20
  Speaker 4: like you're running again and you are regaining like.
• 53:25
  Speaker 1: You're back to one hundred percent.
• 53:27
  Speaker 2: Yeah, So most people do end up losing. It's common
• 53:30
  Speaker 2: to lose about ten percent of your strength in the
• 53:32
  Speaker 2: leg that had the surgery. That's a good we like
• 53:35
  Speaker 2: people to get to ninety percent limb symmetry.
• 53:39
  Speaker 3: You can try to.
• 53:40
  Speaker 2: Use blood flow restriction therapy later on if you're just
• 53:43
  Speaker 2: kind of like struggling to like get stronger, that can
• 53:47
  Speaker 2: be an option to kind of help with muscle hypertrophy.
• 53:51
  Speaker 3: Return to running is well. One thing that can make.
• 53:55
  Speaker 2: The hard is if you do have any residual swelling.
• 53:58
  Speaker 2: Hopefully someone doesn't, but I actually have people work with
• 54:02
  Speaker 2: like a running physical therapist and have them do like
• 54:05
  Speaker 2: a gate analysis and sort of just make sure that
• 54:07
  Speaker 2: they're striking evenly and their stridle link is even because
• 54:12
  Speaker 2: people really sometimes up until a year, we'll have this
• 54:16
  Speaker 2: altered gait where they spend less time on the surgical
• 54:20
  Speaker 2: leg and more time on the other leg, and it's
• 54:22
  Speaker 2: just they're compensating, and so I think sometimes we need
• 54:25
  Speaker 2: to work on that.
• 54:26
  Speaker 1: Do hormones play a part in recovery for women?
• 54:32
  Speaker 3: And so interesting there's some mixed data on estrogen.
• 54:38
  Speaker 2: This is a whole massive topic about estrogen and hormones
• 54:41
  Speaker 2: and why the girls toar their acls eight times.
• 54:43
  Speaker 3: More than boys.
• 54:44
  Speaker 2: And this is an area of active research for me
• 54:49
  Speaker 2: and a couple of our PhDs that I work with,
• 54:52
  Speaker 2: and we have a study upcoming where we're like actually
• 54:55
  Speaker 2: currently looking at this. But yeah, there's theory that estrogen
• 55:01
  Speaker 2: makes the ACL like more lax and more likely to tear.
• 55:06
  Speaker 2: On the other hand, there's some theory that it also
• 55:09
  Speaker 2: kind of helps to organize the fibers.
• 55:11
  Speaker 3: Of the ACL.
• 55:13
  Speaker 2: Also, the low estrogen state may be of the cycle
• 55:16
  Speaker 2: maybe associated with more like muscle fatigue. So, you know,
• 55:19
  Speaker 2: is it be more likely to tarr ACL when you're
• 55:22
  Speaker 2: in a low estrogen state or a higher estrogen state.
• 55:25
  Speaker 2: That's something that we're trying to get to the to
• 55:27
  Speaker 2: the bottom of with these kind of three D MRI
• 55:31
  Speaker 2: models we make of knees and have people do this
• 55:35
  Speaker 2: jump task and then we measure how much their ACL
• 55:38
  Speaker 2: stretches and compared to hormone levels and things like that.
• 55:41
  Speaker 3: So we're actually actively studying that. But it's more of it.
• 55:44
  Speaker 2: It doesn't seem to be so much of a factor
• 55:46
  Speaker 2: in recovery. It seems to be more of a factor
• 55:48
  Speaker 2: in or something that we need to understand better in
• 55:51
  Speaker 2: terms of a risk for injury, because unfortunately, you know,
• 55:56
  Speaker 2: someone asked me, like, why are you so interested in
• 55:59
  Speaker 2: midlife women's joint health, and it's like, well, I'm interested
• 56:02
  Speaker 2: in the full span of women's joint health because girls
• 56:06
  Speaker 2: are eight times more likely than boys to tear their ACL.
• 56:09
  Speaker 2: If you tear ACL, you're also more likely to get
• 56:11
  Speaker 2: post traumatic arthritis. And that's another area that we that
• 56:14
  Speaker 2: we study. But then you know, women are more likely
• 56:18
  Speaker 2: to get arthritis regardless of the age. So for a
• 56:21
  Speaker 2: teenage athlete who tears their ACL when they're sixteen, you know,
• 56:25
  Speaker 2: when they're maybe coming up on thirty, they may start
• 56:28
  Speaker 2: to have some arthritis in their need from post traumatic arthritis.
• 56:31
  Speaker 2: And then you may arrive at adulthood, you know, and
• 56:35
  Speaker 2: be even more at risk. So for people who are
• 56:38
  Speaker 2: teenage athletes who toward the ACL, they're really high risk
• 56:41
  Speaker 2: for earthritis as they is they age.
• 56:44
  Speaker 1: Wow. Okay, so if we move on, and I'm glad
• 56:48
  Speaker 1: that you mentioned Wait, Bess, so there there's a lot.
• 56:52
  Speaker 1: I've now been online for four years and so last
• 56:57
  Speaker 1: year the space has gotten really wow. Wow. All I
• 57:03
  Speaker 1: can say is there's really not any any like, there's
• 57:06
  Speaker 1: pros and CODs to everything. What do you like to do?
• 57:10
  Speaker 1: What works for you? But people get so hooked up
• 57:13
  Speaker 1: on no absolutely no weight vest or yeah, yes, do
• 57:17
  Speaker 1: the weight vest, And I'm like, why is it that
• 57:18
  Speaker 1: it shouldn't be that big deal. I'm curious on.
• 57:20
  Speaker 2: Your own as you can tell them a big kind
• 57:25
  Speaker 2: of it's not the road. There's yeah, there's nuance.
• 57:29
  Speaker 3: Nuance. I'm a nuanced person. There's a lot of me too.
• 57:33
  Speaker 2: So I think I don't ever want someone to think
• 57:38
  Speaker 2: that wearing a weight to vest is the thing that's
• 57:40
  Speaker 2: gonna you know, improve or restore maintain their bone density.
• 57:45
  Speaker 2: And the studies that looked at that are limited, and
• 57:50
  Speaker 2: there's a study that's a subset of a study, so
• 57:52
  Speaker 2: it's like even a smaller part of a study that
• 57:54
  Speaker 2: included women that were doing other things including some strength
• 57:57
  Speaker 2: spanning and jumping and stuff. And so there this one
• 58:00
  Speaker 2: study that showed some improvement and bone density, but it
• 58:02
  Speaker 2: was like a component of a program and a subset
• 58:05
  Speaker 2: of a group of women. So it's not something to
• 58:08
  Speaker 2: necessarily hang your hat on. But I have I have
• 58:12
  Speaker 2: a weighted vest, and I have a rock sack. Actually
• 58:14
  Speaker 2: like a rock sack better because I feel like it
• 58:16
  Speaker 2: makes me. I feel like it's more of a core
• 58:18
  Speaker 2: activity because you're kind of like stabilizing it. But I
• 58:23
  Speaker 2: don't necessarily use it for maintaining or building bone density.
• 58:28
  Speaker 2: It adds to my cardiovascular exercise. I put it on
• 58:32
  Speaker 2: I walk my dog or which is early in the
• 58:35
  Speaker 2: morning and late at night, and it's then it's a
• 58:38
  Speaker 2: nice add on, And I think things do add up.
• 58:44
  Speaker 2: So I don't think there's any definitive study that shows
• 58:48
  Speaker 2: that walking with the weighted vest is definitely like increasing
• 58:52
  Speaker 2: your bone density, but it is taking your.
• 58:55
  Speaker 3: Walk up a notch. It is a little bit more load.
• 58:58
  Speaker 2: There's again I think these things you're cue relative, and
• 59:00
  Speaker 2: it's it's more use than less use. Now, the conundrum
• 59:06
  Speaker 2: I kind of struggle with for some people is if
• 59:09
  Speaker 2: you have some new arthritis and we're telling you, if
• 59:11
  Speaker 2: you lose five or ten pounds, your knees will notice
• 59:14
  Speaker 2: the difference and they'll feel better. Do I want to
• 59:17
  Speaker 2: tell someone who has who's dealing with neuroythritis and trying
• 59:20
  Speaker 2: to find ways to maintain their cardiovascuaractivity and not get
• 59:23
  Speaker 2: knee smelling? Do I want to tell them to put
• 59:25
  Speaker 2: on a ten pound or a five pound thirteen whatever
• 59:29
  Speaker 2: most of them are.
• 59:30
  Speaker 3: You know you can get five ten percent of you.
• 59:31
  Speaker 2: Do I want to tell that person I just told
• 59:33
  Speaker 2: you your knees would fee much better if you lost
• 59:35
  Speaker 2: five or ten pounds.
• 59:39
  Speaker 3: So I kind of don't.
• 59:42
  Speaker 2: If I'm at the same time, if someone is like
• 59:45
  Speaker 2: kind of at the cusp of like, you know what,
• 59:46
  Speaker 2: if they've said to me, my knees feel so much
• 59:48
  Speaker 2: better when I'm five or ten pounds later and they're
• 59:51
  Speaker 2: trying to walk for cardiovasc activity, that's probably not the
• 59:53
  Speaker 2: person I'm going to tell to put on a weighted best.
• 59:56
  Speaker 3: So as for someone who's knees are feeling good and
• 59:59
  Speaker 3: they want.
• 59:59
  Speaker 2: The added card a vest exercise, great, and some of
• 1:00:02
  Speaker 2: the studies show like it did help with strength or
• 1:00:06
  Speaker 2: maybe like parameters that would be associated with fall risk,
• 1:00:10
  Speaker 2: like balance and things like that. So it's in the category.
• 1:00:14
  Speaker 2: I definitely don't think it hurts you, and there are
• 1:00:16
  Speaker 2: definitely some positives. It's just I wouldn't I wouldn't portray
• 1:00:20
  Speaker 2: it as this is the way too, like this is
• 1:00:24
  Speaker 2: the path to preventing it's not the paths. It's not
• 1:00:27
  Speaker 2: enough by it self to prevent al zuperosis.
• 1:00:29
  Speaker 1: Just a deeper I mean, there's always a deeper conversation
• 1:00:31
  Speaker 1: than just wait, best yes or no, but it is.
• 1:00:35
  Speaker 1: It's it's funny. I want to say the Internet needs
• 1:00:38
  Speaker 1: to chill. Chill.
• 1:00:41
  Speaker 3: Yeah, I don't. I don't think we should villainize people who.
• 1:00:45
  Speaker 2: Who are supporting them or or Yeah, it's almost like
• 1:00:51
  Speaker 2: a become a are you a vest person or not?
• 1:00:53
  Speaker 2: And I think it's certainly getting people out and walking.
• 1:00:58
  Speaker 2: And I see a lot of women at my YMCA,
• 1:01:03
  Speaker 2: which is where I go do my heavier weights, you know,
• 1:01:07
  Speaker 2: doing like inclined treadmill walk with an on. I think
• 1:01:09
  Speaker 2: they're getting a really good workout and it's another option.
• 1:01:15
  Speaker 2: Some of those people are probably people who maybe aren't
• 1:01:16
  Speaker 2: running anymore, maybe that was botting their knees, and so
• 1:01:19
  Speaker 2: they're doing that and they want the exercise.
• 1:01:22
  Speaker 3: I do think it has benefits for sure.
• 1:01:24
  Speaker 1: Okay, so this is my last question before we wrap
• 1:01:27
  Speaker 1: it up. And this just popped into my head and
• 1:01:31
  Speaker 1: it wasn't on the list or anything, But do you
• 1:01:34
  Speaker 1: think I mean, I hear from this from women every
• 1:01:39
  Speaker 1: day and it's maybe just because I you know, I
• 1:01:42
  Speaker 1: have my app and I have a lot of women
• 1:01:43
  Speaker 1: on there and different courses and everything like that. Do
• 1:01:46
  Speaker 1: you think that we have or the internet having access
• 1:01:50
  Speaker 1: to every different specialist and strength coach and this has
• 1:01:56
  Speaker 1: made it more confusing for women, you know where I'm
• 1:02:00
  Speaker 1: like it for me, I don't think it has to
• 1:02:03
  Speaker 1: be that deep pick and choose, like, sure, you should
• 1:02:05
  Speaker 1: do a little bit of this, a little bit of that,
• 1:02:07
  Speaker 1: but the perfect prescription doesn't exist because it's not unique
• 1:02:11
  Speaker 1: to you. But what are your thoughts on that?
• 1:02:13
  Speaker 2: Do you what?
• 1:02:14
  Speaker 3: Yeah? I do think.
• 1:02:18
  Speaker 2: Online resources could certainly be lacking in the nuance and.
• 1:02:24
  Speaker 3: Uh yeah, I think a lot of people are very.
• 1:02:29
  Speaker 2: Just kind of black and white in their opinions, and
• 1:02:33
  Speaker 2: it's yeah, you could easily find one person saying one
• 1:02:36
  Speaker 2: thing once another. We hear all the time about what
• 1:02:38
  Speaker 2: to eat, when to eat it, and yeah, you should
• 1:02:42
  Speaker 2: be jumping or you shouldn't. And I struggle with that
• 1:02:44
  Speaker 2: a little bit because I do want to share good
• 1:02:46
  Speaker 2: information and I've enjoyed sharing information, and I try to
• 1:02:52
  Speaker 2: respond to anyone who asked me a question with the
• 1:02:55
  Speaker 2: nuance related to them.
• 1:02:56
  Speaker 3: But it's hard even if.
• 1:02:57
  Speaker 2: Someone is giving me information, specifically the actually seeing a
• 1:03:00
  Speaker 2: person in front of you and examining them and knowing
• 1:03:03
  Speaker 2: their medical history, you can't really give.
• 1:03:06
  Speaker 3: The best information.
• 1:03:07
  Speaker 2: So I think that, yeah, people need to like still
• 1:03:12
  Speaker 2: consider their own, you know, individual circumstance and not just
• 1:03:16
  Speaker 2: put expectations upon themselves. Like I don't think everyone needs
• 1:03:19
  Speaker 2: to look at everyone on the internet and think, what
• 1:03:23
  Speaker 2: I worry about it actually is, is people feeling like
• 1:03:25
  Speaker 2: inadequate or like I said, excluded if they maybe can't
• 1:03:29
  Speaker 2: do like what someone is saying they should be able
• 1:03:32
  Speaker 2: to do, and that's okay. So I think people need
• 1:03:36
  Speaker 2: to start somewhere, do something raper is tolerated. These are
• 1:03:42
  Speaker 2: reasonable expectations, and you can always starts. Never too late
• 1:03:48
  Speaker 2: to start, like I like to say, like so many
• 1:03:52
  Speaker 2: of the studies on even bone density are on women
• 1:03:56
  Speaker 2: who are sixty five, and some of these so these
• 1:04:00
  Speaker 2: are following people for fifteen years and you know, reporting.
• 1:04:05
  Speaker 3: Decreased fracture risks and things like that.
• 1:04:08
  Speaker 2: So I think the other thing people hear is that
• 1:04:13
  Speaker 2: it's too late speak.
• 1:04:16
  Speaker 3: And I don't ever want anyone to think it's too late.
• 1:04:18
  Speaker 2: When you hear it's too late, Oh you should have
• 1:04:21
  Speaker 2: had a deck soo when you were fifty.
• 1:04:23
  Speaker 3: You didn't get it until you were sixty five. It's
• 1:04:24
  Speaker 3: too late for you. It's like this.
• 1:04:25
  Speaker 2: I don't want anyone to like hear like fear mongering.
• 1:04:29
  Speaker 2: I just think sometimes when we're saying things like current
• 1:04:34
  Speaker 2: recommendations seem too late, it's more like wishful thinking. I
• 1:04:37
  Speaker 2: wish people could get, you know, something studied earlier, or
• 1:04:41
  Speaker 2: I think it would be better if we could that
• 1:04:43
  Speaker 2: kind of thing. So I just, yeah, I think you're right.
• 1:04:47
  Speaker 2: People hear stuff on the internet. It's confusing, it's maybe
• 1:04:50
  Speaker 2: hard to apply directly to them. And I just think,
• 1:04:56
  Speaker 2: maybe look for people who are using data. I think
• 1:04:59
  Speaker 2: that's good, using research to help kind of guide what
• 1:05:02
  Speaker 2: they're telling you. But yeah, there there's always going to
• 1:05:06
  Speaker 2: be some some mixture of opinions. There's there's data overload. Frankly, yeah, yeah.
• 1:05:11
  Speaker 1: For sure. Well I want a hat. I want one
• 1:05:14
  Speaker 1: of your hats when you make it really cute, by
• 1:05:17
  Speaker 1: the way.
• 1:05:19
  Speaker 2: My my residents made that for me. And she's really
• 1:05:25
  Speaker 2: interesting there. Actually the two of them are really interested
• 1:05:27
  Speaker 2: in this. She's actually currently studying three all application to
• 1:05:33
  Speaker 2: fracture sites, you know S three all the stuff that's
• 1:05:36
  Speaker 2: in the.
• 1:05:36
  Speaker 3: Face screen, yes, to see if that will help with
• 1:05:39
  Speaker 3: bone healing.
• 1:05:40
  Speaker 2: But one of one of those, one of the two
• 1:05:42
  Speaker 2: residents that's in the we thatt hat.
• 1:05:47
  Speaker 1: I love it. Oh, we're staying we're staying up to
• 1:05:50
  Speaker 1: date with that. I can't wait to hear that. Well, Jocelyn,
• 1:05:54
  Speaker 1: it has been a pleasure. I can tell that you
• 1:05:57
  Speaker 1: were someone that never left anyone out in elementary school
• 1:06:00
  Speaker 1: and high school. I feel the same way. This is
• 1:06:02
  Speaker 1: why I want everyone to join on the party. I'm like,
• 1:06:05
  Speaker 1: we don't want to leave anyone out.
• 1:06:07
  Speaker 2: I can.
• 1:06:08
  Speaker 1: I just love your your demeanor and just how you
• 1:06:13
  Speaker 1: can apply the information. But there aren't these hard fast absolutes.
• 1:06:17
  Speaker 1: I think it's really helpful for women to not feel
• 1:06:21
  Speaker 1: discouraged if they don't fit that mold, because a lot
• 1:06:24
  Speaker 1: of women aren't going to fit that mold, including even
• 1:06:28
  Speaker 1: my you know myself that I had back surgery at seventeen,
• 1:06:33
  Speaker 1: had you know, these different things that I just can't
• 1:06:36
  Speaker 1: do it the same way, but I can do a
• 1:06:38
  Speaker 1: lot of other things that are just as good.
• 1:06:41
  Speaker 3: None of us are immune to these things.
• 1:06:42
  Speaker 2: I mean, I had a hip surgery last summer, and
• 1:06:48
  Speaker 2: like nine months ago, I had a frozen shoulder, which
• 1:06:52
  Speaker 2: is extremely ironic because I'm a female hick surgeon. I
• 1:06:56
  Speaker 2: study frozen shoulder, and I was like, I have so yeah,
• 1:07:00
  Speaker 2: and no one is immune to these these things, and
• 1:07:03
  Speaker 2: none of us are like immune to aging.
• 1:07:05
  Speaker 3: And it's just I think we can try.
• 1:07:07
  Speaker 2: To age wisely and you know, be proactive about our health.
• 1:07:17
  Speaker 3: So yeah, but thanks for having me. It's so nice
• 1:07:20
  Speaker 3: to actually meet you.
• 1:07:22
  Speaker 2: Guys. I want to say in real life, but we're
• 1:07:24
  Speaker 2: on zooms my life.
• 1:07:27
  Speaker 1: I'm hoping. I'm hoping in real life one day.
• 1:07:30
  Speaker 3: Yeah, in real life someday yet.
• 1:07:34
  Speaker 1: So okay, while we're wrapping up and we're done, we're
• 1:07:38
  Speaker 1: we're locking up, but I want to make sure that
• 1:07:40
  Speaker 1: people know where our listeners can find you. Can you
• 1:07:44
  Speaker 1: share that information before we jump off?
• 1:07:47
  Speaker 2: Yeah, I mean maybe maybe the easiest way is my
• 1:07:51
  Speaker 2: Instagram page, which is just Joscelyn Underscore Witstein Underscore MD,
• 1:07:54
  Speaker 2: which full caveat my nineteen year old daughter showed me
• 1:07:57
  Speaker 2: how to use in January of this year.
• 1:08:01
  Speaker 3: So but she's doing it incredible, She's taught me.
• 1:08:05
  Speaker 2: Well yeah, and then I practice full time as North
• 1:08:11
  Speaker 2: Peak surgeon at Duke University. But in terms of like
• 1:08:15
  Speaker 2: the information I try to share in sort of you know,
• 1:08:18
  Speaker 2: data driven digestible.
• 1:08:21
  Speaker 3: Bites, I think is in a lot of Instagram reels.
• 1:08:25
  Speaker 1: So yeah, perfect, Well, thank you so much for sharing
• 1:08:28
  Speaker 1: your time today. We can't wait to launch this episode.
• 1:08:32
  Speaker 1: We know it's going to be a real hit for
• 1:08:34
  Speaker 1: our listeners, so thank you again.
• 1:08:36
  Speaker 3: Yeah, thanks for having me, Thanks for listening everyone.
• 1:08:39
  Speaker 4: If you enjoyed this episode, please consider giving us a
• 1:08:42
  Speaker 4: five star rating and sharing the body Pod with your friends.