I welcome Dr. Howard Luks to the show for an inspiring and interesting conversation about the importance of preserving muscle mass for health, disease prevention and longevity, and why not to get an MRI.
An orthopedic surgeon and sports medicine specialist, Dr. Luks is also an expert in shoulder, knee, and other sports injuries, and is widely known as one of the country’s best orthopedic surgeons. But this guy is off the beaten path! He wants to embrace a broader, more holistic perspective about health, fitness, and healing, so you actually stay OUT of his office, instead of continuing to come back in.
Dr. Luks is also an endurance and strength enthusiast in the 55+ division esteemed and wrote a beautiful article that you can read here about the benefits of preserving muscle mass and the dangers of sarcopenia.
In this episode, you’ll learn: that the loss of muscle mass is actually predictive of a shorter lifespan, how and why the calves are most vulnerable, that 50% of the body is muscle, and that only one minute a week is enough to preserve muscle mass. You’ll hear the reason why visceral fat is the enemy and learn about the ways that it screws up mitochondrial function and why it represents the root cause of all disease. We also discuss the importance of treating the patient, not the image, and you’ll learn about the dangers that come from not optimizing your muscle strength and muscle mass when you’re younger, and how the risks of muscle loss will multiply and be harder to overcome as we age. Finally, Dr. Luks reveals the reason why you maybe should not even get an MRI!
Dr. Luks is an orthopedic surgeon whose goal is to have us embrace a more holistic approach to preventing injury. [01:25]
Many experts now describe visceral fat as an organ. [05:27]
Sarcopenia is age-related muscle loss. [07:05]
We tend to normalize things like losing abilities to do things as we age. That shouldn’t be. [09:49]
How can we stave off the decline in muscle mass? [11:44]
How do you strike a balance between running in endurance races while keeping in your muscle mass competency? [16:49]
Many people advocate to work toward muscle failure on a single set. [22:54]
People that get themselves to the gym are doing themselves a huge favor. Just don’t overdo it! [25:02]
Many recovery problems are age related. [30:06]
Most overuse injuries are training errors. The calf muscles are particularly vulnerable. [31:26]
Minimalist shoes should be gradually introduced. [35:32]
You don’t need to know the specifics of your joint pain. [40:52]
Often the pain we experience can be solved with exercise rather than surgery. [44:35]
Maintaining muscle mass is not happening if you have your visceral fat in the midsection. [56:54]
When you think about your endurance goals, you need to exercise in your healthy aerobic zone. The zone two workout varies from person to person. [59:51]
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Hey listeners, get ready for a very interesting and inspiring show from Dr. Howard Luks. He is an orthopedic surgeon in sports medicine specialist, an expert in shoulder, knee, and other sports injuries, widely known as one of the country’s best orthopedic surgeons. But guess what? This guy is off the beaten orthopedic surgery path, and he wants us to embrace a broader, more holistic perspective when it comes to preventing, healing injuries, pursuing health, fitness, and longevity. And Dr. Luks wrote a wonderful article on his website, Howard Luks, md.com about the importance of preserving muscle mass for health, disease prevention, and longevity. And that’s what brought him to my attention. I’m so glad to connect with him and have this great conversation and you are gonna love his message, cuz he wants you to stay out of his office and handle things yourself with an ambitious exercise program and a second guessing of our traditional path toward reliance upon surgical intervention and prescription medication.
In fact, he says there’s a good, compelling reason to not go and get an MRI when you’re experiencing, uh, some sort of pain because it could mess with your head. How about that? That’s right. If you do find out that you have a degenerative disc or something wrong with your knee, it could give you something negative to fixate on, maybe develop a discouraging mindset and a desire to go and get surgical intervention when you could easily make great progress by doing what I did. And I mentioned my story with my knee injury that lasted for six months and I rested and I couldn’t sprint or jump. And it was very frustrating and I thought I was facing surgical intervention. Then I went to great physical therapy where they had me work around the pain. Obviously you don’t wanna introduce additional pain to a joint, but I started to get stronger and stronger and with their treatments and manipulations with chiropractic as well the pain went away.
There was nothing wrong with my joint. It was just all the dysfunction did. And I think a lot of people could be in that category. Dr. Luks asserts this. He sees these people every day. He has a great quote where he says, I treat the patient, not the image. And he talks about how there’s different people lined up in 12 different exam rooms, theoretically. Some of ’em feel like they’re crippled and they can can’t walk. And the other ones are complaining because it hurts after their 10 mile run and they both have a very similar image of whatever it is. A meniscus irregularity in the knee. Most of us do over the age of 50 there’s huge percentages that have some disc abnormality in the back. I think he said 20 or 30% of older folks have some sort of meniscus irregularity.
And he wants you to just forge ahead with a healthy fit athletic lifestyle with the emphasis on building and maintaining muscle mass with a very simple protocol of strength training exercises in the gym. Doesn’t take long. He details this in his article. He doesn’t like to push himself too hard because he wants to be consistent and he wants to welcome everyone as many people as possible to an athletic lifestyle, including regular resistance exercise. So there’s no need to go and get sore and get exhausted and get into that overdoing it category. And he’s an endurance athlete that participates in challenging trail races. So he makes a good point of saying that there’s great cardiovascular benefits if you train correctly and keep those heart rates down in the predominantly aerobic zone rather than into this exhaustive exercise pattern that we talk about so much on the show where you can invite cardiac disease, risk factors, over training, burnout, all that bad stuff.
And we end the show talking about that evil sinister enemy that we must all battle against. And that is the accumulation of visceral fat. That’s the fat that collects around the abdomen surrounds the vital organs and causes all kinds of health and metabolic dysfunction. The experts now describe visceral fat as an actual separate organ in the body because it secretes these inflammatory cytokines into the bloodstream. So because it has the ability to, uh, alter blood chemistry, it’s actually classified as an organ. And, um, a lot of bad stuff happens when you allow that, that a slight and steady accumulation of visceral fat over the years and the decades. So if you wanna look at a goal and really simple terms, it’s to maintain that muscle mass throughout life and stave off the accumulation of visceral fat. Here we go with much more fun, exciting insights from Dr. Howard Luks.
Dr. Howard Luks is with me. We’re gonna talk about some important matters of muscle mass, longevity and into your world as an orthopedic surgeon and sports medicine specialist. But your article captivated me because it was going way beyond what we, we usually get from, from a doc talking about your knee surgeries and whatever else is going on. I’m wondering if you’ve been inspired to pursue this track from getting tired of cutting people up who, you know, didn’t have sufficient muscle mass to begin with and suffered orthopedic injuries.
Yeah. Great question. So honestly, I came to this approach of lifespan improvement, health span, longevity, selfishly, right. I wanna live longer. I’m a trail runner. I’m an endurance runner. I used to be a triathlete when I had a good shoulder, and I just want to be able to do this forever. So I just started diving in deeper and deeper and writing about it. I tend to just write to improve my understanding. And luckily with my training, I’m able to come at this through an evidence based manner. I’ve always prided myself in being able to drill down on things and present them, hopefully in a way that’s easy to digest. Now to the contrary, or I also have found in the last five years, years or so, it helps a lot of my patients in terms of how I approach their issues.
I don’t treat images. I treat people. So I’m not treating your MRI finding I’m treating you, cuz I may have a marathon or in front of me, I may have a couch potato. I may have someone who has no muscle mouth is not gonna recover well from an operation. I may have someone who’s had three operations and they’re looking at me to do their fourth and they haven’t given it time to recover. I’m looking at people who don’t understand how long it takes to recover from injuries and how important our metabolic health is to our overall health, not just our heart, our brain, but our knees. So as tendons and muscles too. So I came at this for my own selfish reasons and I do stutter on occasion. So forgive me. Um, but, uh, I’m now I’m here to share it, uh, for as many years as I have left.
Thank you. So, we’re talking about this disturbing condition of sarcopenia, the age related loss of muscle mass, how common it is, how normal it seems when I look around, we all seem to be in this idea of accepting that we’re just gonna decline and stoop over and you know, change our height on our driver’s license as we age and that it’s virtually inevitable and anyone over whatever, pick an age, 50, 60 is relegated to watching the NFL on TV and, and REM missing about the days when you could go out for a pass, too. But it seems like there’s a lot of, um, support for even people in the advanced age groups, being able to build muscle and make incredible strength gains
Listen, an 85 year old will gain new muscle protein mass with one work out. So you’re never too old to work out. It tires me when I call trainers and therapists who even working with my parents and they say, oh, they can’t do this. I’m like, yes, they can. I know 80 year olds who can squat 150 pounds. You know, there’s no reason to stop them from doing this. You know, it’s amazing that the human capacity to normalize tragedy or new behaviors or new issues is unprecedented, right? I mean, we’ve normalized the loss of 1800, 2000, 2500 people a day to a virus. So we can normalize anything. We don’t realize that we’re tripping on things. We don’t realize it’s hard to go up and downstairs. We don’t realize that we can’t lift certain things that we used to. We want to go put a few bags of mulch in a yard.
We have to ask our children to carry it for us. That shouldn’t be. We should be able to do these things, but you’re right. Sarcopenia is an awful process. It’s an age related, pre-programmed genetically based loss of muscle power and muscle mass. And starting at the age of 38 to 40, we lose about 1% of our muscle mass per year. And that accelerates as we get into our mid to late fifties. And the loss of mass has extraordinary consequences in regards to our health and longevity and our ability to propel ourselves along this earth for as long as we want to. So it’s a very important topic. And the earlier that we pay attention to it, the better that we’re gonna be.
So losing 1% per year is a pretty disturbing accelerated rate. Now, if we decide to take a stand on the matter and do something about it starting at 38, which is kind of scary, you know, I don’t think a lot of 38 year olds are thinking about how their muscle mass is gonna decline, but let’s say we, we try to stave that off. How can those statistics change?
Yeah. So luckily we can treat sarcopenia. We can minimize its effects. We can minimize its prevalence. And we can minimize the effects all the way into our seventies and eighties. It’s never too late to start exercising. If we participate in a resistance exercise program, beginning in our thirties, forties, or, or fifties, we will mitigate the, the sarcopenia changes that have taken place already and prevent further changes. So this is a preventable process.
Yeah. I think you could argue that if you’re doing something much better than you did a decade ago or two decades ago, you could can be, by all accounts, as stronger and arguably younger on many levels, despite your chronological age.
No doubt. I’m clear I’m in the best shape of my life from both a resistance and strength perspective and an endurance per perspective. That’s from train better. Training smarter, focusing on the right strengthening exercises, not overdoing one. It’s all about load management for me. And you know, I can compete, not compete, finish races and events easier than I did 10 years ago. I don’t compete cuz I don’t care if you finish be before me. I just care that I finish
Well, if you’re doing long stuff, I think that’s the main goal for most people. You better not be out there competing at mile 12 of a 50 K ultra marathon.
Absolutely. But I gotta to admit that when I’m, when I’m coming up at the end of a long race, a lot of vertical, is really great to see some young people dying in front of me running right by them. It no better feeling. So
So. I’m curious about your endurance passion. The listeners know, and you may know, I, I was a professional triathlete way in the day when I was a young person and I contend that the level that I trained and performed at had a lot of adverse consequences to my desire to delay aging. I, I believe it accelerated my aging process from the age of 20 to 30. My muscle mass and my muscle strength was not very impressive. I was highly adapted to swim in a straight line, pretty fast bicycle on a straight line, pretty fast and then get off and run pretty fast. But when the smoke cleared and I actually retired at the tender age of 30 from the pro circuit, and then I’m looking at this, this highway representing the rest of my life. And I realized that I was, you know, pathetic on so many scoreboard check marks for comprehensive functional fitness and longevity factors. And that’s when I embarked on becoming competent in a bunch of other stuff. But if you’re pursuing these endurance goals at your age and you’re gonna tell us your age, cuz you’re in the best shape of your life, that’s super inspiring. How do those go? How do they compliment each other, knowing that the endurance training or the, the goals you’re doing for long distance endurance are in many ways potentially compromising your, your muscle development and maintenance.
Yeah. So, first of all, I, I don’t do super long events. You know, I’m never gonna complete a hundred mile race. I’m probably never gonna do a 50 mile. But for me, these endurance races are, you know, 20 miles, but have 8,000 vertical feet, 5,000 vertical feet. So you’re going up and down these Northeast mountain. And it’s, it’s quite an accomplishment to do that. But you’re absolutely right training for an endurance a true endurance race, 50 a hundred miles. It’s not something you do if you wanna live longer, it’s something that you wanna do because you wanna prove something to yourself. You can do it once. You can do it twice. If you do it way too often. You are compromising, you know, your cardiac health and your longevity. I’ve seen a lot of endurance athletes suffered because of this in their forties and fifties with atrial fibrillation, heart failure, Cardiomyopathy on and on and on. You’re absolutely correct. And also, you know, you’re at very high risk when you’re performing at that level of over training and over training can be such a horrible problem to overcome.
So it’s, if 20 miles is still a long way, you still have to prepare up optimally. I’m thinking that there is some, crossover benefit where if you’re competent at weighting up a heavy bar and doing squats and doing deadlifts, that’s gonna transfer over nicely to your running goals, provided you’re keeping everything in proper balance. And how do you strike that balance where you can still get out there and do the preparatory runs of several hours, but you’re also keeping this, this muscle mass and this competency in the gym. .
Yeah. Great, great question. So in my, in the off season, in the winter, I’m concentrating on base training. So I’m running so on two heart rates. So 120. 125, et cetera. Um, so that’s 9 30, 9 45 pace, you know, easy, simple miles. And they, that’s, that’s a load that I can handle for, for a good distance. I do two days of resistance training during this time of the year. Most of it legs, some arms, but I don’t care what my arms look like. I just do it to maintain overall strength. But from a metabolic perspective, with everything that larger muscles that are well functioning for all the benefits that they provide to us, you wanna concentrate on the largest muscle groups, not two legs. And for me as a trail runner, I wanna concentrate on my legs cause I want to go up and down those hills strong and in a protective manner. And so I do focus on squats. I focus on deadlifts. I do a lot of single leg work. In the winter I do a lot of plyometric work, especially in January, February. And then starting in the spring when I start to run more events and I’m outside more, I’ll cut this down to one day of resistance training a week.
I still struggle with this balance of two disparate fitness objectives where I’m going out and, and doing my dead lifts and having a great workout in the gym. And then I’m sore for three days and it’s affecting my I’m not doing endurance running, but I’m doing sprinting and jumping and things that require freshness. And, I don’t know if you have any insights about that, where, um, you, you gotta go out there and have a nice trail run and climb the hills strong. And if you’re recovering from your previous squat session, that’s gonna be tough.
Sure. So, uh, Stuart Phillips, Brad Shewnfeld and many others have demonstrated that in order to build strength and even muscle mass special girth, if you’re interested, doesn’t have to be overly taxing, right? We can be working out at 50 to 60% of our one rep max, eight to 12 reps. So that last one is difficult, but not exhausting. And you’re done. And you’re, that is working that is allowing me to accomplish my goals, not, exceed my load capacity. So it’s not gonna set me back the next day. My longest run of the week is Sunday. So my second resist training day is Thursday. So, I’m doing, I’m doing a run on Thursday morning. I’m doing that workout on Thursday night. Fridays, a very short run. Saturdays, a shorter run five-ish miles. And so Sunday will be that long run and then Mondays a day of rest.
And you site research. There’s a lot of emerging research now that this, uh, this critical objective of building and maintaining muscle mass throughout life doesn’t really require that much time. It’s when within reach of everyone. I think your article, you said an hour a week is plenty total toward your goal of, getting strong and, and doing the workouts. I know people are even touting protocols that require much less than that. Dr. Doug McGuff book, Body by Science, my recent podcast guest. The subtitle is 12 minutes a week of your strength training, and you’ll have this incredible benefit to gaining muscle strength. And in fact, if you try to tiptoe beyond the optimal minimal frequency, that’s when you can invite some problems such as the soreness and the fatigue that I’m referencing.
Yeah, Absolutely. Look, you know, we have seven minute workouts, three minute workouts, 30 minute workouts. I get it. You know, we’re gonna have people that are pushing the extremes here on both sides. You don’t need that much to maintain your muscle mass, and to delay the issues associated with sarcopenia and to provide yourself the benefits, if you are training for a certain event, cycling, running trails hills, et cetera. I’ve gotten to the point where I’ve balanced my loads, you know, training peaks, whatever that you’re gonna use to monitor your load management. That dialed in. So I’m not sore after a workout, unless I’m stupid. And I throw in some, something new. Then I’m sore for three or four days, and it’s awful. Um, and I won’t do that again, but, yeah, it boils down to load management. It boils down some knowing what you’re, what you’re capable of doing, what you should be doing and what you need to do. And I don’t exceed what I need to do, cuz my goal is not to get bigger. My goal is not to necessarily get, you know, stronger. I, don’t not gonna be a beast at 58. And so I want to be able to run. That’s what I’m optimizing for. So I optimize for longevity and my running.
So someone optimizing for longevity and heading into the gym and deciding the specific nature of their workout, do we need to push it toward complete failure of the muscle on a single set like many people are advocating? I’m thinking of McGuff’s big five workout. I’m thinking of John Jaquish’s X three bar where you’re directed to continue to stretch the resistance band until you’re completely out of energy. My mom’s joined the OsteosStrong facility, uh, that Jaquish started and partnered with Tony Robbins and they do a single set to failure are four major compound movements. And, you know, it’s very, very short and duration, but you are asked to exhaust the muscle.
Yeah. So, I think, you know, it’s hard to define absolute failure, right? For me it’s when your, when your technique is changing, not when I’m falling on the floor. Right. You know, if I have to push my right leg harder to get my left leg, going to get that last squat up, I’m past failure. And you’re gonna hurt yourself that last one needs to be challenging. Do I need to be pushing and grunting and screaming? No, that’s not what I’m in this for. And you know, there’s a lot of research to support that. I mean, as you know, we can look at research and interpret it and find a study to qualify any of our objectives.
Right. Yeah. So my way is right. Look here. Notice this research. Yeah.
Hundred percent correct. Yeah. So I’m not throwing it out. That I’m the only correct one. No. I’m giving people a way to maintain an active lifestyle to excel at aging and longevity and running and weight training without putting yourself at risk of an overuse injury or tendon tear or anything else. I, I don’t need to push it that far.
I love it. Especially, being deeply immersed in this diet and fitness scene for so many years, decades. And then you kind of take a breath once in a while and notice real life and real people wandering around in your orbit. And to me, like anyone who’s parked their car and walking into the front door of the health club and getting their little tag scanned at the front desk and hitting off to a workout, wherever they go, whatever hall they choose, whatever machine they’re working on, they have just done themselves, an incredible solid that’s, you know, far beyond the people that haven’t shown up in the parking lot. And it’s almost not even worth splitting the hairs to say, Hey, what are you doing? You’re doing that wrong. This, this exercise is better because if they’re going in there and sweating and, and, you know, getting some, getting some calories burned in the big picture, that’s a huge benefit. But a lot of our listeners, a lot of people out there who are wanting to optimize, I think, you know, number one, we have to avoid that overtaxing of the body. And so if you’re coming out of the door, you go in, that’s great. If you’re coming out with a thumbs up and a mile, that’s also, allowed you to rise up, you know, in the, uh, in, in the category of, of doing something great. instead of, you know, frying yourself from going there too frequently and pushing too hard,
Absolutely showing up is the hardest thing. You know, we get lost in the weeds. We get stuck in our bubbles on Twitter, on Instagram, wherever it is, and we lose the big picture. You know, if we’re exercising, working out and running, we’re part of a very small minority of people. Most people are not doing this. So showing up is half the issue. I don’t sweat the details. It’s funny, you know, you look at, you look in the gym, uh, the parking lot and people are circling around to get the closest spot to the front door. I mean, what’s up with that, right? You’re there to work out, go park in the farthest spot along, you know, and get some extra steps in it. So you’re a hundred percent correct, just showing up. You’re in the top five, eight, 9% of people. Don’t kill yourself because you wanna be able to come back in a day or two, you, you don’t wanna have to sit home, call me, come to my office.
Get an exam,
Love it. Okay, man. I’m, I’m working on that myself, cuz I get so excited when I’m out there at the high jump facility, practicing, practicing, and you, you feel great at the time the inflammation processes have have kicked in so that your muscles are warm and, and loose. And then you notice 24, 36 hours later. Oh gosh. Maybe I did too much there and, and set, I set myself back a bit. So, I like that message of just going in there and getting some work, done, putting your muscles under the resistance load. One thing you mentioned, you
You’re gonna try something. I’m sorry to interrupt. If you’re gonna try something new, right. If you’re doing squats and deadlifts, your buddy says do some side stuff, some side lunges. Do three with a five pound, with a five pound Kettlebell and go home. Don’t do 20. Don’t go to exhaustion cuz you’re not gonna move for five days. You know, build that up slowly, you know?
Oh gosh. Yeah. Especially, um, the, any bands which are some very good trainers. I know at the elite level, working with Olympic athletes, they call that the single most beneficial. And you know what I’m talking about, listeners, the mini bands is the thing. It can fit in your pocket or in your backpack for traveling and you strap it around your ankles and do the work that isolates the glutes. But I was so afraid of those for, for years because anytime I’d bust them out, of course I’d have to do a heroic workout. And then the next day, uh, my glutes were so tight. I, it was, you know, I couldn’t walk right for four days. And so finally I said, you know what? These are important and I’m gonna baby them into my morning routine to where I’m not gonna get ridiculously sore the next day. And now I can do an impressive set every single day because they’re, they’ve made the cut they’re in the mix. And so yeah, getting over that threshold where the workout is sensible to whatever level you’re at and then you can build, build, build from there, I think is, is the way to go.
Exactly anything that’s new to your routine, a new direction, a new exercise, just start slow and be smart. And two, three weeks you can do as many as you want. But we have to avoid downtime. I don’t know how old, how old you are, but at my age, you know, two weeks off will take, take me six, eight weeks to get back.
Right? You know, if, if you’re, if you’re running you take a few weeks off, you watch your heart rate. When you go back out to run, it’s elevated. It’s going to take you time.
To get back to your time and distance. You, I guess that’s three weeks off from weight training and you’re gonna be sore the first time you start doing it. That’s an at least in my age.
Yeah. Yeah. An age related concession. I’ll accept that. I’m in the same, we’re in the same club, I’m in the 56 category and uh, looking forward to, you know, racing in the 55 59 division. There’s always good news. You can compete with your peers. It’s great. You do it. Yeah. Same with making a mistake. I feel like at my age, I’m mentioning those, you know, overdoing it with a certain workout and I’m sore for four days in comparison to the young folks where they can, you know, go and blast themselves and do something crazy. And they’re super sore for one or two days. And then, you know, they’re off and running. I remember my son in middle school, um, he, he pulled a hamstring. It was a severe injury collapsed on the soccer field and had to, you know, had to get helped off and missed the rest of the game.
And we went home and iced it and we made an appointment to the, to see the chiropractor and, you know, this whole thing. I was so distraught cause he was gonna miss his important soccer season. And then like three days later, he is in a track meet. He says, yeah, I can run. I feel fine. And I’m like, well, are you sure how’s your leg? And, and he forgot which hamstring that he pulled. And I’m like, okay, I guess you’re okay. Then if you, if you, if they both feel the same and it was just such a stark contrast too, you know, stuff that happens to me and I’m for four months later, I’m still testing that hamstring out.
Absolutely. Especially as a runner, right? Most overuse injuries are training errors. We hear it ourselves. You know, and if you get proximal hamstring tendonopathy, Achilles tendonopathy, patella tendons. These scans can be 8, 10, 12 month issues. So you don’t want that. You wanna train smart.
One thing you said in, in the article was that the calf muscles are particularly vulnerable or sensitive to this sarcopenia and that we really wanna pay close attention to those when we’re, we’re attempting to build up muscle mass. Why, why are they calf muscles isolated there?
Yeah. So it’s the more, it’s the more distal muscles. So it’ll be your forearms in hand. You know, you see people with a lot of atrophy in their hand. You could see the metacarpals and the bone structure. You can’t open bottles as easily as you used to, you should be able to, you know, do a farmer’s carry every now and then, you know, work those grip muscles out. And so your calf is also a distal muscle. It’s lower in the extremity. So it’s most sensitive to the sarcopenia process. And as we lose calf strength, we also start to lose more balance. We start to trip more, stumble more and thus we’re at higher risk of an injury. So I do prioritize calfs alot. A lot of seated calf raises because it’s not the gastroc. That’s the stronger calf muscle. It’s the soleus. And the soleus is much more powerful. So seated calf raises are critical if you’re a runner, if you’re a cyclist and as you’re getting older,
The gastroc, people, that’s the one that’s shaped like a rock up high. At least if you have good muscle definition, that’s how I always remember. And the soleus is the one that extends on either side of the leg and attaching into the Achilles tendon. So when you’re seated, doing rising up onto your tippy toes underway eight, or, or even not underweight, that’s, uh, a good exercise for the soleus. So, um, I’ve been trying to integrate those further because I’m curious about, you know, the foot pain is one of the major complaints of the population along with back pain. And I’m wondering if the foot pain and the, the plantar fasciitis that I’ve suffered for so many years on and off, um, is that associated with poor calf function?
You know, it’s possible, I think it’s poor intrinsic muscle strength in the foot, right? Our foot is anatomically very similar to our hand. And do so, you know, do something simple, take your hand, you know, you can make, you can close it and make a fist. Now, just put some pressure across your fingers here to hold ’em together. Now, try and make a fist. Squeeze that. Squeeze that those fingers together and try and make a fist you can’t. Right.? Yet we are slamming our feet into shoes that are far too narrow. Sneakers that are too narrow. And, we’re throwing off the normal mechanics of our feet. And we’re forcing them to accommodate through our shoe wear as opposed to just allowing them to accommodate to, to our environment. So I tell people, get outta the shoes as often as possible. You know, I, I do one or two runs a week in a minimalist shoe, not the fingers, not the steel, not the five fingers I use Xeros. They’re fantastic. I just love them, but I can’t go too far in them cause I still get some pain, but very important to work your foot intrinsics. Try picking things up on the carpet, just try squeezing those toes into a ball. They need to be exercised as well.
Yeah. Nice plug for Xero shoes. I had Steven Sashon on my show. He’s the founder. And, uh, he was an interesting guest with a lot of promotions of, you know, getting the bare feet back involved and the way his shoe design is with that wider tow box allows your toes, the freedom to actually perform. And I love those shoes. They’re fantastic. I’ve also been a big fan of Libra for a long time, but I think that’s an important point that you make that this is a gradual and sensible integration of more time in barefoot or minimalist shoes. And your feet are very sensitive cuz we’ve had ’em in casts our entire life versus some hunter gatherer who’s got really strong feed and uh, you know, the Vibram represents to step up from a lifetime of barefoot. And so we have to be very, very careful as we integrate these, uh, these times where we’re minimizing our shoe function.
And I, I tell people, first thing is just walk around the home barefoot and just get some time on your bare feet and get the arches going and absorbing load again. But I’m, you know, I’m constantly teetering on that edge where I’m inviting more calf soreness and foot pain because I insist on doing my sprint workouts and Vibrams or bare feet and it’s taken, it’s taken about 14 years of progression and integration. When I first put on my first pair of Vibrams in 2006. And so, you know, now I can go on a long, high hike or a five mile run or whatever, a sprint workout wearing the, um, the minimalist shoes. But, um, it’s, it’s a, um, it’s a gentle road that you want to go and, and air on the side of conservatism
Agreed. But you know, for you and I we’ve been doing this for 30 years to our feet. So, you know, we came about, we came upon this a little too late and, and you know, some of the damage is already done. So, you know, luckily my feet are sore when I work. You know, when I first wake up, it’s funny. I mean, if you saw me wake, wake up in the morning, you can’t imagine that I would be running in 10 minutes. You, I can’t move, you know, everything hurts
Even you. Huh? Okay. I feel better doctor.
Cause I used to for many years, especially when I was doing the crazy training as a triathlete, my first act in the morning was to get outta bed and hop on one foot out the door and into my spa in the backyard and stick my left foot in there and start doing range of motion and, and getting the jets on it because I could, I could not put weight on my foot until I had this water therapy. And it was, it was sort of pathetic when you look back and think, and then of course I would go lace up and run 12 miles in the canyon and, and go about my, you know, training day as an elite athlete. But, um, when you’re talking about pursuing general health goals and a guy who can’t walk in the morning, <laugh> something is off there with the whole training pattern. And um, yeah, so join the club, everybody. But if you, if you work on those mobility drills and, uh, fascial conditioning and, um, things that you we’ve heard about on the show a little bit, you can make incremental progress to the point where you’re waking up in the morning and it’s not so bad. It’s not ridiculous. You can actually walk with a stride down the hall.
Absolutely. You know, it, it takes a minute, but things will get going and it’s actually, you know, a chemical reason for it. There’s a biological reason for it. When, you know, if we image our joints, if I get a three T MRI of your knees or feet and look at the cartilage and find detail, we’re, we’re gonna find changes there. The radiologist might call them arthritic or degenerative. I hate those words. They’re age appropriate. Our cartilage doesn’t look the same as it did when we were 16 or 18. Right. And what’s what we find in, uh, degenerative or age appropriate knees or joints is higher levels of inflammatory mediators like interleukin six, et cetera. So joints don’t like not moving. Hmm. Um, as much as they don’t like moving too much. So we wake up and they’ve been somewhat still all night. So our interlink in six levels, our comp levels, which is a sign of pro of cartilage degradation. Those levels are higher. Once we start, aren’t moving in interleukin 10, which are anti-inflammatory start rising. That’s why our joints start to feel better. Comp levels start to decrease. That’s why our joints start to feel better. So there’s a biological reason why a lot of us feel this way and it’s not, it doesn’t mean you’re gonna fall apart. It doesn’t mean that you’re gonna be crippled as you get older.
All right. Good to know. So you’re just working with your in inflammatory agents and movement being the best formula, the best medicine, uh, better than popping an ibuprofen, just get up and walk around.
Love it. Is that the same for something like back pain that that’s kicking in or other joint pain, knee pain where you’re, you’re getting up from a seated position and you experience that the discomfort that’s worsened from a, a different time on the clock of the day
Could be absolutely. You know, I have one of the world’s worst looking had back x-rays on x-ray um, I played, you know, elite level tennis when I was young. It was every day, you know, two hours training and turns out that’s not so good for a maturing spine. Even my friends who are spine surgeons, like don’t lift, don’t work out. You’re gonna kill yourself. If I don’t do my dead lifts, I feel pain. If do do them, I feel better. You know, as I said earlier, don’t treat an x-ray, treat a person. Don’t yeah. I have a great post on my website. It says you don’t need to know the specifics of your joint pain. It’s okay. Not to know. Cuz a lot of times these aches pains and little niggles are just gonna go away. You start to MRI things that imprints, that MRI finding on the back of your brain. No one our age has a normal MRI of anything.
So you’re gonna blame every pain on something that you saw in an MRI report. You’re gonna think that every step is making it worse. You’re gonna change your exercise habits. You’re gonna change your workout habits. You’re gonna think that you’re protecting your knees by not working out anymore. But humans die of predictable causes. Right? We die of heart disease. We die of stroke, dementia, diabetes on and on. All of those are prevented or mitigated by exercise. So my point being, you start diving too deep. You start going to doctors and asking for MRIs, demanding MRIs. You’re gonna find things that are going to affect your psyche. So don’t ask for it unless it’s absolutely necessary.
Oh my gosh. That’s heavy doctor. I love it. I, I just spoke with Dr. Bruce Lipton, author of Biology of Belief, the bestselling book about how your thoughts manifest your cellular function at all times. And you know, it’s a lot of people think it is the woo woo category and the spirituality mixing in with science, but he makes an excellent point. And, and we have this, you know, backed by research in quantum physics and medicine that, um, the cells can only be in a, a state of growth or protection and protection represents the stress and the worry and the things that we manufacture, the chemicals we manufacture with our thoughts and sending stress hormones into the bloodstream. And that totally lines up with what you’re saying, where if you go looking hard enough for an excuse or something to complain about or blame, you are going to manifest that as a bad knee.
And then in contrast the physical therapy people that I, that I really love there’s there’s Rod Shorey in Los Angeles and there’s PT Revolution in Lake Tahoe. And I had this horrible knee injury that I couldn’t run or jump for six months. And I was, I thought I was facing surgery and I finally went in to get the proper care. And, they were working around the pain. So I was all kinds of stuff that did not aggravate the injury that did not invite additional pain, but now I’m getting my glutes and my quads and things that had atrophied stronger and stronger. And then getting the hands on manipulation, you know, a different treatment than a knife and a scalpel. And sure enough, the pain subsided really quickly because as I was now attacking, you know, the actual root cause to, to take care of the symptom rather than just fixate on, Hey, my body’s not perfect and I’m in big trouble.
Right. You know, there are times when I tell people in my office, stop going to doctors. You know, they’re there for
Dr. Luks says, stop going to doctors.. Oh, mercy. This guy is not gonna be welcome at the next conference.
I’m already, I’m already disinvited. But you know, they’ve been to three experts, four experts if had three different MRIs, you know, they’re unsure exactly what’s hurting them, but it’s clear. There’s no obvious structural defect. You know, there are age appropriate changes. There may be a small meniscus there. It doesn’t need an operation, just start exercising, gain back their confidence, start slowly and go. And you know what? A lot of these people come back three or four years later, when something else hurts and says, you know what? You told me to stop seeing doctors. To just go at the slowly to take the time that it’s going to need and look, you know, I was fine and I got back. It’s such a critical message. You know, we have things so wrong in medicine and sometimes, I mean, how many times have you gone to a doctor with pain and you’re told, come back in two weeks, if it still hurts, then we’ll do this. Right? What feels better at our age in two weeks? Nothing.
We’re counting, we’re counting down the wrong direction. It ain’t, ain’t gonna be any better. This is as good as it gets that Jack Nicholson in the movie. Yeah.
So yeah, you know we have to go slow, um, whatever.
It’ll be good if left to our own desires. If we allow our biology to work, we gain the confidence. Uh, and we don’t have any obvious structural abnormalities.
Okay. Then what’s your practice? Like, are you doing a lot of chit-chatting on the couch and, and getting people psyched up to go to go work out or are some people eventually ending up with, you know, invasive medical treatment?
Yeah. So that’s a great question. Listen, I’m an orthopedic surgeon. I operate there are people who do need surgery. There are people who slip off a roof or whatever, fall on a rock and tear things. There are runners our age who, you know, can’t run because of arthritis. You know, that’s localized to one side or the other. There are procedures, short of a knee placement that we can do. And we can restore that runner’s longevity by allowing them to return to running with an osteotomy or another complex procedure. And I really thrive in that complex environment. That’s what I enjoy doing. So my favorite patients are 40, 50, 60s. They used to be a triathlete. They used to be a runner they’ve been told they can never do it again. That’s a challenge that I’ll accept any day.
Right. And then you’re gonna work hand in hand with that person to say, look, we’re gonna go in and fix this. And then your job is to go and do your PT exercises as prescribed for the next six months. So we can come out and serve for the match again, someday in the future.
Absolutely. Listen, I, you know, I’ll see 10, 12 tris or runners a week with meniscus terrors for second and third opinions. I’m like, just stop, just do your therapy, commit to it, and you’re gonna be fine. 95% of the time, you’re not gonna need an operation. A lot of times an operation can make things worse. You know, our joints don’t like to be invaded. Yeah. Especially if that meniscus is not going to be fixed. So.
Once they understand that it’s gonna take a few months, do the physical therapy and you’re gonna do fine. A lot of them are good. Some of them may choose to have the surgery. They don’t get better immediate and they get better a few months later. Why did they get better? Because they didn’t do the therapy well before the surgery they’d had the surgery. So now they commit to the therapy.
Oh my gosh. <laugh> That’s Hey, whatever works, but let, let’s think of a different option. Huh? <laugh> oh my gosh. That’s funny. But it, it does make sense. Like once you’re, once you’re going in for the big deal, it kind puts a different category in your brain. Listeners, I should share when I was of 39, I had a spontaneous tear of the meniscus walking down the street with my old dog and all of a sudden, my knee swelled up and I, I was, I had to limp back home and I couldn’t believe it, cuz I had done nothing to invite this. And I was Googling and I found in this article that said males around age 40 often experience a spontaneous tear than meniscus with no known attribution. And I’m like, wait, I’m only 39. This is crap. But I, it was so minor that I refused to consider the prospect of surgery.
I could walk and bicycle without pain, but I couldn’t run a step for what turned out to be nine months. But I rehab that thing like crazy. I got my muscle so strong and eventually everything vanished with no intervention, but it took, it took much longer than the people you hear about where they’re, they’re back running five miles, two weeks after their meniscus surgery. But I contend that, you know, in the long term, when you’re going in and, and cutting things out, you probably, we gonna have repercussions that, uh, you know, pick up a decade or, or more later
They absolutely will. And you know, you are making the assumption that, that meniscus tore at that moment, uh, that may not even be, be the case, right? How, what percent of active 50 olds have a meniscus tear in their knee and don’t know it. So we take 100 50 year olds. We give ’em a hundred dollars to volunteer in a study, lay down in the machine, uh, upper to 20% of them are gonna have a meniscus abnormality.
No way. <laugh> crazy.
Yeah. So you know, and a lot are gonna have the same in their rotator cuff. 80% are gonna have a disc abnormality in their back. These are people who have no pain. So you go to a doctor’s office. That’s why I was saying sometimes you don’t want to know exactly why your knee is hurting. You sometimes it’s okay, that doctor examines you. They find out, look, you’re not complaining of this, that, and this, your exam is normal. You’re gonna feel better in a few months. Let’s do some therapy. Don’t necessarily push for that MRI. Cause you’re gonna see things. You know, if you see a meniscus tear, you don’t know that that started the other day when your pain started. It could have been there for years or months. Um, and that may not be the source of your pain. MRIs don’t show as pain. MRIs show as structures.
And those structures much like our hair, our eyes and everything else change as we get older. So a lot of them are age appropriate changes. So the lesser imaged, some times the better off we are. And I had the same incident that, that you did. I came off a trail. I don’t remember an injury. I got into my car at the trail head. I got home an hour later. My knee was swollen. I had no idea why. Waited a month. Swelling was still there. I was able to run, but it was hard. I was able to work out, but I couldn’t go deep, etc. And I kept working out and I kept running, but I didn’t push it. Two months later, geez. I talked to a friend he’s like, come on, we’ll get an MRI. Okay, fine. Get an MRI. This meniscus tear a cartilage. I’m like, I shouldn’t have done this. And sure enough, three months all gone. Back on the trail, no swelling never came back. Go figure.
What did you do to rehab nine months?
I rehabbed it. I you know, I spoke to friends, great therapists in my area. They helped me. I did my own workouts and runs and it just went away. That’s why I was saying, nothing’s gonna get better in two weeks at our age. Just wait.
You know, I’m reading these stats about the increasing prevalence of joint replacements in the hip and the knee particularly. And I’m wondering if some of these concepts would apply to those. Everyone I’ve talked to that had a hip replacement or was considering it, you know, reports that there’s no use, it’s bone on bone. It’s beyond, you know, beyond repair. And um, so I’m going in for the titanium. And, it seems, seems kind of scary that, uh, the, the 400% increase that we’re seeing in recent years. I wonder what you think about, about those joint replacements.
I did a great podcast with David Hunter, who’s an arthritis researcher, one of the tops in the world, out of Australia. And that was the entire focus of the podcast. We, as I, as we talked about earlier, you don’t treat x-rays. You treat people because you can, I can see the same x-ray on 10 different people in the same day, and I’m gonna get 10 different issues and 10 different complaints. So you can have bone on bone and room one, and they have some ache and discomfort and some swelling when they finish a 10 mile run. The woman, the person in room two, can’t walk. The person in room three. Yeah. They develop a little swelling in the morning. It’s gone by noon. So who needs the knee replacement? You know, you don’t, don’t do it because you have bone on bone.
There’s no surgery without risk. The only surgery without risk is a surgery on somebody else. Especially when you’re talking about a joint replacement, right? You’re taking very substantial risks. One, it may not meet your expectations, right? You may be expecting a joint that you had when you were 18. You’re gonna run. You’re gonna play tennis. You see the ads on TV. People are, you know, snowboarding, skiing. They, you may not be able to. You might, who knows? But you’re taking a risk. You get an infected joint, joint replacement. You need to have that joint removed. You need six weeks of antibiotics, and then you need another one put back in. And that reimplantation the third time has a 20% at risk of reinfection. Blood clots, on and on and on. So joint replacements have been wonderful, just wonderful at restoring movement and the ability to walk and participate in life in those who need it. If you’re getting it because you can’t run four miles anymore, you can only do two. You can’t play three sets. You have to stop at one. It’s probably not the right indication. Right. But if done for the right reason in the right person, they’re a wonderful procedure,
Right. I guess you would wanna exhaust all possibilities with this aggressive rehabilitation regimen and, and strengthening regimen. And then, you know, there’s probably a point where, uh, especially an athletic mind person, which most of the people I know were going in for the surgery. So they could, you know, hit some extreme goals coming out of there that they used to do. And so that’s a, that seems like a good candidate, an athletic person. That’s gonna take it and run with it afterward.
Yeah. Really important. If you are considering a joint replacement as an athletic person out there, you better make sure you have a long and hard discussion with your surgeon about what your goals are and allow the surgeon to discuss with you what the realistic goals of a procedure are. <laugh> you better make <laugh>. Yeah. If they’re not, you’re gonna be solely disappointed. But you’re right. Physical therapy is a high value treatment option for osteoarthritis. There’s no doubt, because again, we’re not treating an image, we’re treating a person and there are plenty of people out there with bone on bone, hip arthritis, bone and bone, knee arthritis, and they’re doing fine. And there are others who are crippled. So the crippled ones that are the ones who need the surgery. Hmm.
Before we, before we go, I wanna talk about the, the other end of the continuum that you mentioned in your discussions about maintaining muscle mass. So we have this critical objective, we’re fired up. We’re gonna go put our body under resistance load, maintain that muscle mass. And on the flip side, if we don’t, we have this insidious accumulation of visceral fat, which causes so many health problems. Um, it seems to be most frequently talked about male on the side where you’re getting that beer belly as you age, and it’s getting bigger and bigger. So let’s talk about what that represents and the stark contrast between someone who’s able to stave off that visceral fat and maintain muscle versus letting that slippery slope, you know, commence.
Yeah. So as we alluded to before we die of very predictable causes: heart disease, dementia, type two diabetes. These, these are at their core metabolic diseases, which if you drill down to the root cause of metabolic diseases is a defect in the mitochondria, right. We have poor mitochondrial flexibility. So your mitochondria have a lot of difficulty in burning fat. They instead prefer to burn glucose, which you don’t want. And we have a lower number of mitochondria. We have less muscle mass. We have less mitochondria as a whole. And so in fixing, or it eliminating the risk of developing a metabolic disease, just fatty liver, metabolic syndrome, et cetera, or mitigating the downstream effects of the longstanding metabolic diseases we need to achieve metabolic health. And resistance exercise is one of the critical ways of doing this because as you increase your muscle mass, you increase the number of mitochondria as you improve the aerobic respiration, either with zone two exercise, with my resistance training, you’re increasing and improving your metabolic flexibility or how you mitochondria work. You’re allowing them to burn fat as opposed to glucose. You’re encouraging fat mobilization. You’re improving the ability of your muscle cells to burn triglycerides. So these all contribute to improving your metabolic health. Now the answer is not just resistance training and not just muscle mass. You need some aerobic work in there too. And that’s the magic of zone two or low heart training. But all these too work in conjunction to improve your metabolic health by improving your mitochondrial function
Well said. I think that’s a beautiful finish. We gotta go out there and keep our aerobic conditioning. Keep moving around. Especially when you say zone two, if the listeners aren’t familiar with that, that’s the, a very comfortably paced predominantly aerobic, predominantly fat burning. And I think something you said earlier when I asked you about balancing your endurance goals with your strength training and your longevity goals, that seems to be the key where the negative aspects of the endurance training come when you exceed that zone two. When you exceed that aerobic heart rate and start to embark upon these workouts that are slightly too significantly, too stressful. And that’s your day after day pattern that’s when you see the, the AFib and the problems coming up.
Yeah, absolutely. Most runners, if they’re not trained, uh, they run too hard or too fast on their slow days and too slow on their hard days. So it’s okay to do an anaerobic threshold day. It’s okay to do, you know, a V02 max workout, but it should be your training should be 80/20 in most circumstances, right? 80% simple or easy or zone two or one even, uh, 20% higher, if that works for, for Kipchoge and others, it can work for us.
Right. And everything’s relative. So when Kipchoge’s running, uh, five minute 30, second miles at high altitude, and that’s a zone one, maybe a little zone, two, you know, very, very easy for the average person. That means a brisk walk. And that’s the part that a lot of endurance athletes aren’t getting where, well, I’m gonna go for an easy day today. And so I’m gonna go four miles at, uh, nine 30 pace, and that’s not a brisk walk. And it it’s, it’s harder than Kipchoge’s easy day and that’s kind of mind blowing, but it is what it is in terms of the relative, you know, you’re, you’re measuring the, um, percentage of, of maximum heart rate. And so we’re comparing apples to apples. Yeah,
You’re absolutely correct. But zone two workout of an elite athlete would, would kill me if I tried to match, you know, their, their pace and distance, right? Your zone two is unique to you. You have to find out what it is and you have to stay under it. You know, we both go out with a lot of runners and as soon as they start their heart rate is one 50. Yeah. You know, they blow away through zone zone 1, 2, 3, and they’re up at low zone four immediately. That’s because they haven’t built their aerobic base. It’s an investment that will pay off. But zone two, running is hard. It’s annoying as hell. Um, and it takes a long time to show benefits, unlike our aerobic training, where we see the benefits fast. So that’s a lot sets.
Yeah. I mean, that’s, that’s, uh, setting it straight and that’s the reason it’s so alluring. And we get that instant gratification of busting out an impressive workout and getting a sweat going and high fiving, our training partner. But we do have to look down at our, our ultimate goals. It’s like overdoing it in the gym or doing too many CrossFit sessions in a week. Um, you went from a great fitness stimulation to something that’s now put you into a high risk category.
All right, Dr. Howard Luks. That was fun. Thank you for joining us. Good stuff. Thank you, listeners. Another great show. And we can go look at your great articles and commentary on Howard Luks, md.com and anywhere else we want to, uh, send people?
Twitter, HJ Luks, L UK S
HJ Luks, L U K S on Twitter. Go, go tweet away with him when you’re, when you’re done doing your, your resistance training workout. Thanks everybody. Thank you for listening to the show. I love sharing the experience with you and greatly appreciate your support. Please. Email podcast@Brad ventures.com with feedback, suggestions, and questions for the Q and A shows. Subscribe to our email list at Bradkearns.com for a weekly blast about the published episodes and a wonderful bimonthly newsletter edition with informative articles and practical tips for all aspects of healthy living. You can also download several awesome free eBooks when you subscribe to the email list. And if you could go to the trouble to leave a five or five star review with apple podcasts or wherever else, you listen to the shows that would be super, incredibly awesome. It helps raise the profile of the B.rad Podcast and attract new listeners. And did you know that you can share a show with a friend or loved one by just hitting a few buttons in your player and firing off a text message? My awesome podcast player called Overcast allows you to actually record a sound bite excerpt from the episode you’re listening to and fire it off with a quick text message. Thank you so much for spreading the word and remember B.rad.