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

Transcript

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

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