Afleveringen
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You're waiting for the right day, the right program, or the right pair of shoes to start. You donât need to⌠letâs get into this.
Because⌠Here's what the research shows: the biggest leap in longevity gains doesn't come from training like an athlete; it comes from going from nothing to something.
In this episode, I explain why stillness isn't a neutral state but active harm, measurable at the cellular level years before it ever shows up on a standard lab test, and why ten minutes today will do more for you than the perfect program you keep putting off.
No gym required. Just a pair of shoes and ten minutes.
If you have knee osteoarthritis, this guide will tell you what most physicians do not have time to explain in a fifteen-minute office visit:
Written by Howard Luks, MD, an orthopedic surgeon with thirty years of practice, the guide covers what knee osteoarthritis actually is, why your X-ray does not determine your future, why metabolic health drives a large share of the pain and progression, the supplements with real evidence (and the ones without), what GLP-1 medications are doing for OA pain, when injections help and when they do not, why strength training is one of the most effective interventions available, and how to think honestly about surgery. The framing throughout is that you have more agency than the standard conversation gives you. No fluff. No fear. The levers you actually have, in a guide you can read in an hour.
This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit howardluksmd.substack.com/subscribe -
The wellness industry thrives on making us feel like weâre always falling behind. More tracking. More supplements. More gadgets. More optimization.
In this episode, I make the case for a different word: enough.
If youâre walking regularly, lifting a few times a week, sleeping reasonably well, eating real food, and staying connected to people who matter, youâre not doing the lesser version of health. Youâre doing the things that actually matter.
We explore the difference between fundamentals and fitness theater, why consistency beats complexity, and how learning to say âenoughâ to both the pressure and the noise can be one of the healthiest decisions you make.
Sometimes the most powerful health strategy isnât adding something new. Itâs realizing youâre already doing enough.
GLP-1 medications are advertised as weight loss drugs. Yet they are so much more than that, and there are important factors you should consider before you decide if theyâre right for you.
What do you need to know before you start? What lab tests or studies should you check before and during the treatment? What is the concept of the minimal effective dose, and why does that help to minimize side effects? This guide answers a lot of the questions and concerns you might have about this new class of powerful medications.
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Zijn er afleveringen die ontbreken?
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Everywhere you look, someone is selling you âlongevityâ. Live longer, add years, hack your biological age. Most of them are aiming at the wrong target. Living longer means very little if those extra years are spent unable to move well, think clearly, or take care of yourself.
We have gotten good at extending lifespan, the length of the movie, while healthspan, whether the movie is any good, has barely moved.
In this episode, I make the case for the goal that actually matters: the strong, sharp, independent years. I'll show you the simple signals that predict how you're aging better than any expensive lab, why you can't really turn back your biological clock, and why the people who age best have a certain rhythm.
Ready to join my community?
Paid subscribers get a LOT of goodness. Starting with direct access to me, Dr Luks, inside our exclusive Chat Forum, where I engage directly with my readers: answering specific questions, sharing bonus resources, and offering member-only perks along the way.In addition, if you upgrade, youâll gain access to paywalled articles that offer much deeper guidance on topics like injury recovery, strength training, bone health, metabolic health, and healthy aging â with practical frameworks, not hype.
Lastly, when you start your trial, youâll get access to important series, such as The Tendon Guide, which explains why our tendons hurt, describes various ways to ease that pain, and discusses why rest is one of the worst approaches.
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Episode 3 â You Are Not Falling Apart
We have spent so long warning people about the dangers of moving that we have forgotten to warn them about the dangers of staying still. And stillness is the far more reliable source of harm. When you do less, your body loses more, and it loses it quietly: muscle, bone, balance, cardiovascular fitness, insulin sensitivity. After 50, if youâre not training, you lose one to two percent of your muscle every year, and your power fades faster still. Falls, frailty, and dependence donât simply happen to people. They build in silence, in the absence of motion, until one day they arenât silent anymore. In this episode, an orthopedic surgeon of thirty years on why most of what we call aging isnât aging, and why the body youâre afraid of breaking is far more capable than youâve been told.
If you have knee osteoarthritis, this guide will tell you what most physicians do not have time to explain in a fifteen-minute office visit:
Written by Howard Luks, MD, an orthopedic surgeon with thirty years of practice, the guide covers what knee osteoarthritis actually is, why your X-ray does not determine your future, why metabolic health drives a large share of the pain and progression, the supplements with real evidence (and the ones without), what GLP-1 medications are doing for OA pain, when injections help and when they do not, why strength training is one of the most effective interventions available, and how to think honestly about surgery. The framing throughout is that you have more agency than the standard conversation gives you. No fluff. No fear. The levers you actually have, in a guide you can read in 30 minutes.
This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit howardluksmd.substack.com/subscribe -
Episode Title
Labral Tears After 40: Why Your MRI Is Lying to You
Podcast
The Three BoneheadsHoward Luks, MD ¡ Jeffrey Berg, MD ¡ Jonathan Hirsch, MD
Episode Summary
If youâre over 40 and have shoulder pain, thereâs a very good chance your MRI report mentions a labral tear. And thereâs an even better chance that tear has nothing to do with your pain.
In this episode, three experienced orthopedic surgeons unpack one of the most commonâand most misunderstoodâMRI findings in adult shoulders: superior labral (SLAP) tears. Drawing on decades of surgical experience, they explain why these findings are often age-appropriate, why MRIs frequently create unnecessary fear, and why surgery is almost never the right answer for adults with non-traumatic labral tears.
This is a candid discussion about judgment, restraint, and knowing when not to operate.
Key Topics Covered
1. What the Labrum Actually Is
* A 360-degree ring of tissue around the shoulder socket
* The superior labrum is where the biceps tendon attaches
* Age-related changes are extremely common and often mislabeled as âtearsâ
2. Why MRIs Overcall Labral Tears
* Most adults over 40 will have a âSLAP tearâ reported on MRI
* Radiologists often describe normal age-related changes as pathology
* The word tear creates anxiety and drives overtreatment
* MRI findings frequently donât correlate with symptoms
3. MRI Quality Matters More Than You Think
* 3-Tesla MRIs are far more accurate than 1.5-Tesla scans for labral pathology
* Contrast (arthrograms) improves detection but is invasive and often unnecessary
* Fellowship-trained musculoskeletal radiologists provide more reliable reads
* Not all MRIsâor interpretationsâare created equal
4. When a Labral Tear Actually Matters
* Rare in adults without trauma
* More relevant after:
* Shoulder dislocation or instability
* Clear traumatic events
* Clicking, catching, or mechanical symptoms alone are not enough to justify surgery
5. Why Labral Repairs in Adults Often Fail
* High risk of post-operative stiffness and prolonged pain
* Long recoveries with questionable benefit
* Literature consistently discourages SLAP repairs in patients over age 40
6. What Surgeons Actually Do If They See a Tear
* Most labral findings are ignored during surgery
* Minor fraying may be gently debrided (âa haircutâ)
* If the biceps is truly involved and symptomatic, biceps tenodesis is preferred
* True labral repair is exceedingly rare in adults
7. The Real Sources of Shoulder Pain
* Subacromial bursitis
* Rotator cuff tendinopathy (without a tear)
* Age-related tissue changes
* Many people improve without ever identifying a single structural cause
8. Why Time and Re-Examination Matter
* Shoulder diagnoses often evolve
* Multiple visits help clarify what actually provokes pain
* Healing, physical therapy, and patience often outperform early surgery
* Sometimes the pain resolvesâand the âdiagnosisâ never matters
Key Takeaways
* A labral tear on MRI in adults over 40 is usually a normal finding
* The likelihood that itâs causing your pain is close to zero
* The likelihood that you need surgery for it is even closer to zero
* MRIs should informânot replaceâclinical judgment
* Treat the patient, not the picture
Who This Episode Is For
* Adults over 40 with shoulder pain
* Anyone confused or alarmed by an MRI report
* Clinicians navigating imaging-driven anxiety
* Patients told they âneed surgeryâ for a labral tear
Final Word
Sometimes the hardest part of being a surgeon isnât operatingâitâs knowing when restraint, patience, and experience are the better tools. This episode is a reminder that wisdom often means doing less, not more.
This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit howardluksmd.substack.com/subscribe -
Rotator cuff tears. MRIs. Fear. Surgery.
Three words that often get tangled togetherâand usually in the wrong order.
In this episode of The Three Boneheads, we unpack why MRI findings often matter far less than people think, how age-related âabnormalitiesâ are frequently normal, and why pain, function, and real-life goals should drive decisionsânot radiology reports.
Please leave a comment. We need to know your thoughts about these podcasts. We would also like to know which topics interest you.
We talk about:⢠Why many people with massive tears have little painâand others with tiny ones canât sleep⢠How MRIs can sometimes do more harm than good⢠When surgery truly changes outcomesâand when it doesnât⢠Why rotator cuff care should be a conversation, not a knee-jerk reaction⢠How rehab, load management, and time often outperform the scalpel
If youâve ever been told, âYou have a tearâyou need surgery,â this episode is for you.
Howard, Jeff, and Jon
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After more than 30 years in practice, one truth has become impossible to ignore: a technically successful surgery does not always lead to a successful outcome.
In this episode, we unpack why âfailed surgeryâ is often the wrong questionâand why outcomes are shaped by far more than what happens in the operating room. From biology and inflammation to expectations, secondary gain, recovery, and communication, we explore why surgery should be viewed as an opportunity, not a guarantee.
This is a candid, nuanced conversation about what really determines success after surgeryâand how both patients and surgeons can do better.
What We Cover in This Episode
* When technical success â patient success
* How decades of surgical experience change how you view outcomes
* Why many âfailed surgeriesâ begin before the first incision
* The role of:
* inflammation
* metabolic health
* diabetes and insulin resistance
* smoking, sleep, and stress
* Why expectations matter as much as anatomy
* How pain perception and the nervous system influence recovery
* The difference between fixing structure and restoring function
* Why recoveryânot surgeryâis where outcomes are decided
* The uncomfortable truth about post-op instructions:
* When patients donât follow them
* and when the instructions themselves are the problem
* How prolonged inflammation can derail an otherwise good repair
* Why timing mattersâtoo early vs too late
* Why surgery rarely addresses just one problem
* Reframing âfailureâ as insight, not blame
Key Takeaways
* Surgery is one moment in a long biological process
* Outcomes are multifactorial, not binary
* Biology, expectations, preparation, and recovery all matter
* Surgery creates an opportunity, not a guarantee
* Better outcomes start with better conversationsâbefore surgery
This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit howardluksmd.substack.com/subscribe -
Meniscus tears are among the most common reasons people walk into an orthopedic office, and also among the most misunderstood. The word tear carries a psychological weight that often sends people straight to panic modeâand straight to a surgeonâbefore anyone has examined them, before we know if the tear even matters, and before they understand that many tears have nothing to do with their pain. In this episode, the three of us walk through what meniscus tears really mean, what they donât mean, and why the overwhelming majority of these findings do not require surgery.
We also get into the nuance that rarely shows up in MRI reports or quick clinic visits: degenerative tears that coexist with arthritis, meniscus findings in people with no symptoms at all, and the small subset of tears that actually compromise knee functionâlike bucket-handle or true radial tears. We talk about why so many people are told they âneed surgeryâ based on imaging alone, why that approach fails patients, and how good clinical evaluation changes everything. And toward the end, we cover biologics like PRP, where they fit, and where they absolutely do not.
If you or someone you know has been given an MRI report with the word "meniscus tear" highlighted, this conversation will help you understand what matters, what doesnât, and how to make decisions that align with your symptoms. Not with fear, quick assumptions, or rushed recommendations.
Key Topics Covered
* Why âmeniscus tearâ is one of the most misleading diagnoses in orthopedicsMost tears seen on MRIâespecially in people over 40âare age-related changes, not injuries and not sources of pain.
* Degenerative vs. traumatic tearsHow to tell them apart clinically, why degenerative tears rarely require surgery, and why symptomsânot MRI findingsâshould guide decisions.
* MRI pitfallsWhy imaging often overcalls pathology, why radiology language can scare patients unnecessarily, and how to interpret findings in the right clinical context.
* When a meniscus tear actually mattersThe small subset that truly cause mechanical dysfunction, including:
* Bucket-handle tears with loss of extension
* True radial/root tears that destabilize the meniscus
* Acute traumatic tears in younger athletesEverything else is typically non-operative.
* Pain generators that mimic meniscus tearsIncluding early arthritis, synovitis, patellofemoral overload, and deconditioning.
* Non-operative managementActivity modification, loading strategies, strengthening, neuromuscular work, and timeâplus why most patients improve without surgery.
* PRP and other biologicsWhere they fit, where they donât, and what current evidence actually supports.
* When surgery is reasonableClear criteria: loss of extension, true locking, mechanical block, or failure of adequate conservative care in clearly defined traumatic tearsânot degenerative fraying.
Takeaways
* The presence of a tear on MRI does not mean itâs causing pain.
* Most degenerative tears behave like wrinklesâcommon, expected, and not surgically correctable.
* Good clinical evaluation matters far more than imaging.
* Surgery is for mechanical problems, not MRI findings.
* The right rehab plan resolves symptoms for most people.
-Howard, Jeff, and Jon
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The Three Boneheads sit down to answer one question: What would you tell your 25-year-old self about building a career that lasts?
The answer isnât what youâd expect. Itâs not about technical skill or case volume. Itâs about protecting your humanity while doing hard work for decades.
Itâs about the sleepless nights that never stop, the weight of worrying about every patient, and learning that you canât pour out compassion endlessly without refilling yourself. Itâs about holding onto your values when the healthcare system shifts around you, learning to listen in a way that makes people feel safe, and understanding that vulnerability isnât weakness - itâs what keeps you human.
Itâs about the loneliness of practice and why you need a resource group from day one. Itâs about how psychology matters more than you thought - because anxiety and depression magnify pain, and most patients need reassurance theyâll be okay.
The complicated cases fade. The titles fade. What sticks are the small moments: a patient dancing because their knee works, someone serving at tennis because you fixed their shoulder, a family who felt heard.
A sustainable career isnât about being invincible. Itâs far more than that.
Show Notes:
This is a podcast episode from âThree Boneheadsâ - three orthopedic surgeons (Howard Luks, Jeffrey Berg, and Jonathan Hirsch) with 75+ years combined experience discussing what theyâd tell their younger selves about building a sustainable career in surgery.
Central Theme: Success in orthopedic surgery isnât about volume, speed, or accolades - itâs about sustainability, maintaining humanity, and protecting what matters while doing hard work for decades.
Key Insights from Jeff Berg:
Loneliness of Practice
* Training is collaborative, but practice is isolating - everything falls on you alone
* Early advice: Build a resource group of trusted colleagues immediately
* This group becomes essential for support throughout your career
Psychology Matters More Than Expected
* Initially, I thought orthopedics was âanti-psychology.â
* Reality: interpersonal relationships are crucial - doctor-patient, doctor-family dynamics
* Anxiety and depression are pain magnifiers - understanding psychology is essential for treating orthopedic patients
* Many patients just need reassurance that theyâll be okay
Sleepless Nights Never End
* Expected during training, but persists throughout the career
* Constant worry about patients, questioning decisions, self-blame when outcomes arenât perfect
* Patients donât realize how much surgeons worry about them
The Job is Hard - Donât Be Hard on Yourself
* Bad outcomes happen despite your best efforts
* Self-compassion is essential for longevity in the field
Key Message from Howard Luks:
You Canât Pour Endlessly Without Refilling
* Protect patients, but protect yourself too
* Canât absorb everyoneâs fear and expectations without boundaries
* Serve patients best when youâre steady, rested, and supported - not carrying the world alone
Values Are Your Compass
* Hospitals, administrators, chiefs change - your values must stay constant
* Hold onto them when efficiency crowds out empathy, when paperwork overwhelms purpose
* The healthcare landscape is complex and evolving, but values keep you from losing your way
Listen in a Way That Makes People Feel Safe
* At 25, you think being a good doctor is about knowing things
* What patients remember decades later: whether they felt heard, seen, understood
* Listening is the most powerful (and cheapest) intervention - but most straightforward to forget when busy
Vulnerability Isnât Weakness
* Youâre allowed to be human, say âI donât know, but Iâll find out,â and ask for help.
* Trying to be invulnerable makes you brittle; staying human keeps you flexible and connecte.d
Identity Beyond the Job
* When you die, no one cares about titles, papers published, or patient volume.
* They care about how you made them feel.
* Build life outside hospital walls: relationships, interests, physical health, purpose, play.
* Youâre a person who practices medicine, not just a clinician
Burnout is System Failure, Not Personal Weakness
* You can love medicine and feel drained by how itâs delivered
* Burnout isnât about resilience - itâs about unreasonable load
* Recognize early signs, donât ignore them out of pride
Small Moments Matter Most
* Complicated cases fade; even successes fade quickly
* What sticks: patients dancing because their knee works, seeing someone serve at tennis, a smile from reassurance
* Donât always need the answer, but always need to be there
Purpose Over Prestige
* Titles and accolades fade; purpose doesnât
* Never regret doing the right thing, making a patient feel safe, defending a colleague.
* Will absolutely regret bending values to fit someone elseâs priorities
You Get to Write the Story
* At 25, the path looks fixed - itâs not
* Can pivot, slow down, speed up, redefine success, walk away from what doesnât align
* Meaningful career isnât found - itâs actively, passionately crafted
Final Message: A promising career is built with intention. Patients donât need a perfect doctor - they need an honest one. The people you help and the values you hold matter far more than accolades. If you take care of yourself along the way, youâll still love this work decades later.
Bottom Line: This is about sustainable humanity in a profession that can hollow you out if you let it. Technical skill matters, but protecting your humanity, building community, setting boundaries, and staying anchored in purpose are what allow you to thrive for 25+ years.
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A month or so ago, I wrote a post about why our tendons hurt. The most common reason is a process known as tendinopathy. It can be caused by excessive or insufficient use. Believe it or not, insufficient use is more common. Your metabolic health plays a significant role in whether you experience tendon pain, how severe it is, and how long it lasts. Read the post below for some background information.
In todayâs podcast, we touch on this topic. Itâs not a small topic, and thereâs a lot of nuance.
Weâll have a lot more to say on this topic when we dive into particular diagnoses in the future.
Howard, Jeff, and Jon
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Pain is not a linear equation. This is an incredibly complex topic. I think youâll like it. At least youâll learn something about a subject that all three of us think about a lot.
We can see the same pathology in various people, yet their expression of pain will be vastly different. Why is that?
Is pain more prevalent today?
Is pain more severe today?
When is pain adaptive?
When is pain maladaptive?
Furthermore⌠is pain always dangerous? Do we always need to rest?
Why do the three of us, all of us with fairly spicy back pain, exercise when our backs hurt?
These are just some topics of the asynchronous conversation weâre having today.
We often say the same thing during our previous episodes. That was not the case today. This is probably one of our best episodes to date.
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The emergence of a high-tech, low-touch healthcare environment is not beneficial to the human condition.
The second quote from my portion resonates deeply⌠but itâs at the end of the pod ;-).
â⌠Visits have become transactions and volume is the currency⌠but volume without value is noiseâŚâ
â⌠We (3) still believe in traditional medicine⌠where visits go back to where it belongs⌠in a space between two people, one who is suffering and one who is listeningâŚThatâs where the art still lives. And if we don't protect that⌠all the AI, robotics, and precision medicine wonât make up for what we lost⌠⌠because medicine isnât just about fixing whatâs broken⌠Itâs about understanding whatâs humanâŚâ 26 min.
This was a deeply personal episode. Iâm not sure many people see whatâs emerging and recognize what it means.
Medicine has never had more technology.We can see deeper, measure more, and diagnose faster than ever before.And yet⌠patients arenât necessarily doing better.
Weâre drowning in data, but starving for meaning.We image too much, diagnose too much, treat too much â and often, we listen too little.
Somewhere along the way, the practice of medicine shifted from conversation to transaction. Twelve-minute visits. Click boxes. Pre-filled templates. The pressure to move faster, see more, bill more.
But the heart of medicine was never in the imaging suite or the EMR. It was in the exam room â in the pause before the next question, in the hand on a shoulder, in the act of truly listening.
This episode is about what happens when high-tech replaces high-touch â when algorithms replace intuition â and how we can take medicine back to where it belongs: between two people, one trying to help the other.
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Only a handful of you received this yesterday, so I am republishing it to everyone this morning. SorryâŚ
Your comments will drive the topics and quality of this podcast. So, thank you, and keep them coming.
Many people come to the office expecting⌠or even insisting on an MRI.
It seems like a high-tech tool worth considering.
But sometimes itâs not.
Can you be harmed by seeing a result? Yes, many can.
Can it alter how you feel about playing in your evening tennis game? Yes.
Can a musculoskeletal MRI tell us what hurts? Nope⌠Not usually.
When are MRI scans useful?
When do we order them?
How do we explain the results?
Why do we talk to you before the MRI to set expectations?
Have we ever seen an MRI from a 50+ year-old, and the results say ânormal?
You know⌠You might be running on a meniscus tear now and donât even know it.
This was a solid podcast⌠This is an important topic. We hope you enjoy it.
Hereâs the post that I mentioned earlier in the introduction to this episode:
Howard, Jeff, and Jon
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In episode 3, Jeff, Jon, and I start to peel back the layers on what wisdom looks like at the tail end of our orthopedic careers.
We see things far differently than we used to. We operate far less than we used to. We discuss the reasons that have led to this realization and perhaps teach you how to think about your own orthopedic issues when confronted with the option for surgical intervention.
As we continue to evolve this format we look forward to your questions, comments and suggestions. This is for you!
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Weâve been doing this for decades. We talk to each other a lot. We are surgeons. We were taught to operate and trained accordingly.
But decades later, we operate far, far less than we used to.
Why is that?
The first reply is from Jeff Berg. Heâs a sports medicine doctor in Northern Virginia.
The second reply is from Jon Hersch. Heâs a sports medicine doctor in Boca Raton, Florida.
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Jon, Jeff, and I are three Orthopedic Surgeons with 75+ years of experience between us. We have a lot to say⌠but finding time for all three of us to sit together to record a podcast is challenging. We wanted to gauge your thoughts on this format.
In this format, I posed a question to them. They each answered asynchronously, then I answered. The podcast contains our answers, but with no back-and-forth between us.
Please⌠Please take a moment to share your thoughts on this format. We could continue like this⌠or, if necessary, try to have a podcast in a more conventional format.
Your replies will determine what we do next.
Thank you.
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This should be interesting. 3 Orthopedic Surgeons with 60 years of experience between us. We have a lot to say⌠and a lot to share.
This is the welcome message about the format and structure. Stay tuned for our first episode coming soon.
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Attention to detail before surgery has a significant impact on your ability to recover and your risk of complications.
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Exercise is the risk you take to avoid the consequences of being still.
In the past, I often had issues or injuries related to improper load management, either ramping up too quickly or adding too many activities into a day. Some folks tolerate amazing load ratesâŚ, but thatâs never been me. I learned many lessons in the past because of these injuries⌠but I still have some work to do.
My middle son got me into rock climbing a while back. Itâs a lot of fun⌠a terrific challenge⌠and a great way to maintain full-body fitness.
I monitor my load often⌠using my watch and a HR strap to record most exercises. But heart rate isnât a great way to assess the load of a workout or a climbing session.
I ended up sustaining a tear in a tendon of my elbow. And it wasnât healingâ although itâs safe to say I wasnât allowing it to heal. I ignored it for as long as I could. The red in the US picture is the tendon. The blue is the bone that the tendon should attach to. The yellow is the tear.
I had a PRP injection last week⌠those hurt ;-)! But in a few months, Iâll be back climbing. Hopefully, with lessons learned about technique, how often I should climb and what positions I should try to avoid.
Built to Move, Born to Heal: Notes on Midlife Fitness is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.
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Zone 2 training is an overused term. It is important, especially for people with poor endurance abilities. More importantly, low heart rate training is the best way to improve overall health and limit the consequences of metabolic diseases such as type 2 diabetes and insulin resistance.
Google recently released NotebookLM, a fascinating AI platform that can synthesize various sources and produce a two-host podcast. I fed NotebookLM my writings on low heart rate training, which resulted in this 20-minute podcast.
As I improve how I utilize this technology, these will be for paid subscribers only in the future. I hope you enjoy this. Please leave a comment. Your comments will determine how much I will use this in the future, which will be essential.
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