Speaker 1: Oh, Hi, hey, Hi, it's the lady at the COVID
Speaker 1: swapping clinic who always has the best scrubs with like
Speaker 1: holiday lamas on them, Alley Ward. And actually I'm not her,
Speaker 1: because that lady actually does exist at the Bourbon COVID
Speaker 1: clinic drive through, and I love her every time I
Speaker 1: see her. Okay, let's talk about your shitty niece. Let's
Speaker 1: talk about Jarrett, your pod mom's shitty knies. So in
Speaker 1: late August, he was vaccinated. He was in a small
Speaker 1: pod of jiu jitsu folks starting to train again. He
Speaker 1: has a brown belt, two stripes so close to his
Speaker 1: black belt, was so excited to get back into the
Speaker 1: sport he loves. He was grappling, took a wonky fall,
Speaker 1: heard a pop, and here we are, folks. Terrible pain swelling.
Speaker 1: MRIs busted ACL surgery, physical therapy, and now he's two
Speaker 1: months out. He's still healing. Luckily, a friend of his
Speaker 1: family happens to be this world celebrated surgeon who has
Speaker 1: pioneered knee reconstructions and gotten a bunch of patents and
Speaker 1: fixes everyone from pro athletes to actors to actual ballerinas.
Speaker 1: This surgeon is also in Bay area and very out
Speaker 1: of network, but he understands how to get athletes back
Speaker 1: on their feet. So we packed our bags. We stayed
Speaker 1: with Jared's wonderful mob Christine, for a two week blur
Speaker 1: of general anesthesia and thailanol and ice and pain and
Speaker 1: crutches and rehab. But amid all that fun, why not
Speaker 1: record an episode? I feel like most people I know
Speaker 1: have kind of an on off relationship with their joints.
Speaker 1: And I found myself looking at these knee diagrams wondering
Speaker 1: what was going on in there. And luckily, Jared's surgeon,
Speaker 1: who is this athletic, soft spoken and deeply knowledgeable knee
Speaker 1: celebrity if you will, was down to sit on a
Speaker 1: porch this October afternoon in his neighborhood in the Redwoods,
Speaker 1: just north of San Francisco. So he studied internal medicine
Speaker 1: and orthopedic surgery at Harvard University and then went to
Speaker 1: this place called Stanford University to study general surgery. And
Speaker 1: he's written books and done ted talks and educated people
Speaker 1: all the world on this stuff. People who call him
Speaker 1: Doc include the Marin Ballet, the US ski team, dance companies,
Speaker 1: rugby teams, pentathletes, and of course my husband. So I
Speaker 1: was like, hey, Hi, can you explain knees? And I'm
Speaker 1: pretty sure he was like, okay, yeah, you make a podcast. Sure, okay,
Speaker 1: that's fun. But little did he know that I would
Speaker 1: lob one million all of our knee questions right at
Speaker 1: his face, but before I ask him your questions. Patrons,
Speaker 1: thank you for supporting the show like a beloved crutch
Speaker 1: since before the beginning. Anyone can join that club for
Speaker 1: a dollar a month. You can also send this episode
Speaker 1: to a friend, or rate, or subscribe, or even review,
Speaker 1: because yes I do read them and weep happily. And
Speaker 1: this week's fresh reviews from Mary Mama Sunshine, who wrote,
Speaker 1: I started listening when pregnant with my fourth little guy,
Speaker 1: especially on my trips to and from doctor's appointments, and
Speaker 1: your podcast helped mellow me out to get me through
Speaker 1: a post miscarriage pregnancy. Now fast forward and come to
Speaker 1: find out that apparently ology is the magic that mellows
Speaker 1: out my pandemic baby who hates car rights. So Mary
Speaker 1: or Mama, I'm super sorry your first child sentence is
Speaker 1: going to be about butts or have the aff word.
Speaker 1: But you're welcome. Also Smology's episodes. They're released every two weeks,
Speaker 1: their classroom and kid Safe.
Speaker 2: Okay.
Speaker 1: Genicular traumatology, so genicular means of the knee, and the
Speaker 1: root in Latin means having knots or bent, and traumatology
Speaker 1: comes from the Greek for to twist or to rub,
Speaker 1: and Surett was like, I mean pretty spot on the
Speaker 1: study of twisting and rubbing knee injuries. Boom.
Speaker 2: So we talk about.
Speaker 1: Joints, tendons versus ligaments, robot doctors, cartilage donuts, physical therapy,
Speaker 1: self surgery, joint juices, sporty injections, donor tissues, pig legs,
Speaker 1: if weight has any effect on knee health, types of arthritis,
Speaker 1: how to make exercise like play, and then how to
Speaker 1: play Forever, which is the title of his new book,
Speaker 1: Bionic Body Part Biologic Ones. The Best Exercises for healthy
Speaker 1: knees creaking, popping, locking, bending, biking, walking, and if knees
Speaker 1: are the worst. Also, some of these asides go off
Speaker 1: on some stories that maybe you'll remember forever, but I
Speaker 1: couldn't help it include them. This episode is It's a
Speaker 1: wild ride. You never knew your knees, but you will
Speaker 1: right now. So pull up a seat or go for
Speaker 1: a walk and get ready for an episode that we
Speaker 1: all need so much with orthopedic surgeon and researcher doctor
Speaker 1: Kevin Stone. Doctor Stone, can I get you a water
Speaker 1: or a tea or anything? Yeah, okay, we got that.
Speaker 3: We got that in spades. It's fine if.
Speaker 1: You hear us and you want to chime in on anything.
Speaker 1: As a patient, the people who.
Speaker 2: Are excited to figure out their knees work.
Speaker 1: And how mostly their knees don't work.
Speaker 4: So it's Kevin Stone, it's he and him cool.
Speaker 1: And doctor Kevin Stone. Do people call you doc a lot?
Speaker 4: They do?
Speaker 1: Yeah? Hey, Doc? Do you think that that's like an
Speaker 1: informal thing because they see you a lot? They know
Speaker 1: you're not just like a surgeon who works on them
Speaker 1: while they're in twilight sleep, but you're you see them,
Speaker 1: you know, follow up and stuff.
Speaker 4: Yes. And the structure of our clinic is that our
Speaker 4: rehab team is rate next all on one floor, So
Speaker 4: I'm floating around seeing them when they're rehabbing, when they're
Speaker 4: on the bike, when they're working with the therapists, and
Speaker 4: so it's a very familiar environment. Yeah.
Speaker 1: I know when Jared had surgery, you called him to
Speaker 1: check on him, like every day for after surgery. He
Speaker 1: was like, oh, thanks for I'm doing well. You called
Speaker 1: me just to let me know how he was doing.
Speaker 1: So do you feel like that's important to have that
Speaker 1: kind of relationship, like to just check on people, make
Speaker 1: sure that you're not just kind of them open and
Speaker 1: sam ba by, Yeah.
Speaker 4: The fun of what we do is to try to
Speaker 4: convince people to become athletes for life. And so if
Speaker 4: I can convince them to use their injury as an
Speaker 4: excuse to become fitter, faster, stronger, which is the phrase
Speaker 4: we like to use, than they've ever been, then it's
Speaker 4: a fun relationship for a lifetime because number one, yes,
Speaker 4: I get to know them immediately after surgery and check
Speaker 4: in on them and make sure that they're doing okay.
Speaker 4: But then number two, I get to see them as
Speaker 4: they come back for their what we call stone fit tests,
Speaker 4: which occur at one month, three months, six months, one year,
Speaker 4: and then every year or thereafter, because we want to
Speaker 4: figure out how do we help somebody become better than
Speaker 4: they've been before.
Speaker 1: So better than when they first.
Speaker 4: Yeah, and so using that injury as an excuse to
Speaker 4: become better we've got a whole rehab team. We're going
Speaker 4: to take a moment of your life where you're going
Speaker 4: to be really focused on your knee or shoulder or ankle,
Speaker 4: whatever we fixed. And so we can use that moment
Speaker 4: to engage you fully in your fitness program and your
Speaker 4: diet and your mental attitude. And so in order to
Speaker 4: do that, you need to have trust that I'm on
Speaker 4: board with you, not just during surgery, but immediately afterward
Speaker 4: and then forever. And the fun of what we get
Speaker 4: to do is that when we fix things and then
Speaker 4: watch people go back and do, whether it's an Olympic
Speaker 4: sport and win a gold medal or whether it's just
Speaker 4: be able to go to the grocery store. Yeah, but
Speaker 4: we get the feedback when they come back for their
Speaker 4: sport fit tests and show how they're doing and see
Speaker 4: where they are in life. And so, yes, to answer
Speaker 4: your question with a long winded answer, that immediate phone call,
Speaker 4: post up the next few days and bonding with them
Speaker 4: during that little window of time when it's kind of
Speaker 4: scary is a really important time.
Speaker 1: Yeah, it definitely works. Now, obviously, you were not born
Speaker 1: an orthopedic surgeon. You became one. How did you decide
Speaker 1: that cutting open and fixing knees being a knee and
Speaker 1: a joint mechanic, How did that even come about?
Speaker 4: So probably two big events. One as I went to
Speaker 4: college as a government major oh okay, and was playing
Speaker 4: soccer and tore my knee while playing soccer as a
Speaker 4: freshman at Harvard, Oh God. And in the training room
Speaker 4: after the brutal surgery at that time, I watched the
Speaker 4: orthopedic surgeon rome amongst the different athletes and check on
Speaker 4: them the way I get to do now, And I
Speaker 4: so admired that environment and that ability to be around
Speaker 4: athletes who are trying to come back, the ability to
Speaker 4: help somebody who's broken something where you can fix it
Speaker 4: and they can get better was just clearly I knew
Speaker 4: that that looked mighty attractive. So that was a first
Speaker 4: major thing. The second major thing was, unfortunately, that surgeon
Speaker 4: took out a key structure in my knee called the
Speaker 4: meniscus cartilage. And I'm sure we'll get a chance to
Speaker 4: talk about that some more later, but that structure is
Speaker 4: critical to how the knee functions. And so years later
Speaker 4: I was out for run with my mentor at the
Speaker 4: time and he looked at my bow legs and said,
Speaker 4: you know, Kevin, if you could ever figure out how
Speaker 4: to replace the meniscus, you'd make a big contribution to orthopedics.
Speaker 4: And in my typical Harvard arrogant way at the time,
Speaker 4: I said, great, I'll do it. You pay for it.
Speaker 4: And that started off my entire research career around replacing
Speaker 4: tissues in people's bodies.
Speaker 1: Oh cut Banks, Texture Crush, ask someone for millions of
Speaker 1: dollars to learn how to replace parts of bodies. That's
Speaker 1: apparently how the world works. But how do knees work.
Speaker 1: Let's get into it. Let's talk about what a meniscus is.
Speaker 1: I tried to study this before you got here so
Speaker 1: that I would not be a total adult, but I
Speaker 1: understand that there are three bones involved in the knee.
Speaker 1: I'm going to let you. I'm going to let you start.
Speaker 1: What are we even looking at it?
Speaker 4: Okay, Well, first of all, you've had some other folks
Speaker 4: on your show who talked about the heart or the
Speaker 4: kidneys or other things, and let me just prioritize the
Speaker 4: only purpose of the heart is to provide blood flow
Speaker 4: to the knee. So you need to understand our sense
Speaker 4: of priorities. Let's just get that straight up.
Speaker 1: Front, spoken like a true knee search exactly.
Speaker 4: That's number one. Number two. In normal walking, you take
Speaker 4: one to three million steps per year, add up to
Speaker 4: five times your body weight depending on the height of
Speaker 4: the step, because you're coming down on one leg, and
Speaker 4: if you're coming down from a height, it can be
Speaker 4: five times your body weight. And so for your knee
Speaker 4: joint to be able to take that many cycles and
Speaker 4: that many repetitions and not wear out, it needs to
Speaker 4: have some pretty unique structures inside it. And so the
Speaker 4: key structures that will probably get a chance to talk about,
Speaker 4: and I'm sure your listeners like to know about, are
Speaker 4: number one. The two types of cartilage. First, there's the
Speaker 4: articular cartilage, the shiny white surface on the end of bones.
Speaker 4: When you crack open your chicken wing, that white, chiny
Speaker 4: surface that's articular cartilage. And when you get arthritis, it's
Speaker 4: wearing away of that white, shiny surface down to the bone.
Speaker 1: Okay, quick visual, So there's cartilage coating the foremoral condolites
Speaker 1: aka the nards of your femur, as well as the
Speaker 1: top of the tibia and fibula shin bones, and between
Speaker 1: them lie two c shaped cartilage wafers, kind of like
Speaker 1: airplane neck pillows.
Speaker 4: The second type of cartilage in the knee is a
Speaker 4: fibrous tissue called the meniscus cartilage, and there's a medial
Speaker 4: one and a lateral one, and those things distribute the
Speaker 4: force inside the knee. So when you walk that one
Speaker 4: to three million steps per year at up to five
Speaker 4: times body weight, that force gets distributed by the menesky.
Speaker 4: So there's not one area that wears out. So unfortunately,
Speaker 4: when you tear one or somebody takes one out, it
Speaker 4: becomes dysfunct, and you concentrate the force and start the
Speaker 4: wear process. And then the other last key structures that
Speaker 4: everybody wants to know about, of course, are the ligaments
Speaker 4: inside the knee. And you often hear about the ACL
Speaker 4: or the PCL, and you hear about the medial clouteral
Speaker 4: ligament in the lateral clauteralligment. So these ligaments you can
Speaker 4: think of as guide wires. So you think about the
Speaker 4: marionette and the guidewires that make the marionette work well.
Speaker 4: If one of those strings is broken, they are and
Speaker 4: the marionette doesn't floppy right and doesn't work so well.
Speaker 4: And that's true inside your knee. And so if you
Speaker 4: tear that ligament, any of those ligaments, the knee doesn't
Speaker 4: flex and rotate in the normal pattern. And just like
Speaker 4: a car tire that's out of line, the tire wears
Speaker 4: down quickly down to the steel rim. So your knee
Speaker 4: wears down quickly to the steel rim when either the
Speaker 4: ligaments are torn or dysfunctional, or the meniscus has been
Speaker 4: removed or is torn. And that wear and tear is
Speaker 4: what we call post traumatic arthritis. It's the most common
Speaker 4: kind of arthritis that people get, and it's what really
Speaker 4: wears out the knees and so much of my career
Speaker 4: and many things we'll talk about today, or how do
Speaker 4: you prevent that from happening.
Speaker 1: So the two most common kinds of knee arthritis. You
Speaker 1: got your osteoarthritis, which is a breakdown of that slippery
Speaker 1: cartilage from wear and tear or injury or infection. And
Speaker 1: then there's rheumatoid arthritis, where the lining of the capsule
Speaker 1: that holds all your knee parts gets broken down by
Speaker 1: your own sneaky, jerky immune system. So thanks, Dick, I
Speaker 1: was using that. You want to scream at your immune
Speaker 1: system and I understand. So, yes, you have your femur,
Speaker 1: your tibia, and your fibulous shin bones. There's that patella kneecap.
Speaker 1: You got your LCL on the outside of your knee
Speaker 1: that connects the shin bone to the femur bone, and
Speaker 1: it hurts like a goblin when you foam roller that,
Speaker 1: but it's also kind of so good. And you have
Speaker 1: a medial collateral ligament MC on the inside of your knee,
Speaker 1: and then your PCL ligament is on the backside, and
Speaker 1: then your ACL, the anterior cruciate ligament running inside diagonally,
Speaker 1: which is why we are up here recording this. It
Speaker 1: is a ligament that is not fun when it snaps.
Speaker 1: Is it a ligament? I guess yes, ACL, yes, And
Speaker 1: what about a ligament in attendon. What's the difference there.
Speaker 4: Yeah, So the ligaments connect the bones and the tendons
Speaker 4: connect the muscles to the bone. So you have a
Speaker 4: pateeller tenon in the front of your knee, and you
Speaker 4: have an ACL in the middle of the knee, which
Speaker 4: is the ligament connecting the bones.
Speaker 1: And you have to work on all of them.
Speaker 4: Right.
Speaker 1: When someone injures her knee and they hear a pop
Speaker 1: and they know that they're screwed. That happened to Jarrett.
Speaker 1: What are they hearing? Are they hearing popping? Tearing? Like
Speaker 1: when there's an injury like that when you tore yours
Speaker 1: in soccer? What was that experience?
Speaker 4: Like? Awful? Yeah, there's an intrinsic knuck useating feeling when
Speaker 4: it happens. And so when a patient sits down and says, hey, Doc,
Speaker 4: I twisted my knee. I heard a pop. My knee swelled,
Speaker 4: they have a ninety percent chance of having torn one
Speaker 4: of the key structures in the knee, either ligaments of
Speaker 4: the meniscus or damage the articular cartilage. And that tearing,
Speaker 4: it leads to swelling, leads to that gnos feeling, leads
Speaker 4: to that instability, leads this swelling leads to all the
Speaker 4: problems that occur.
Speaker 1: What about your meniscus? Did you ever get one back?
Speaker 1: Did you ever say, hey, I figured it out, let's
Speaker 1: put a little meniski back in there.
Speaker 4: So, yes, I figured it out, but no, I wasn't
Speaker 4: able to do it to myself. So at the end
Speaker 4: of the day, my knee wore out and I had
Speaker 4: to have a partial knee replacement, which is what we
Speaker 4: do for people when they're down to bone on bone.
Speaker 4: So it turns out that if you wear out your
Speaker 4: knee so that the bone on the femur and the
Speaker 4: bone on the tibia are now rubbing against each other,
Speaker 4: that's what we call severe arthritis. And about eighty percent
Speaker 4: of people who are told they have severe arthritis and
Speaker 4: need to have a total knee replacement actually don't. Oh no,
Speaker 4: they've worn down, usually one part of the knee, not
Speaker 4: the entire knee. And depending on how much they wear
Speaker 4: it determines whether we can do a biologic knee replacement
Speaker 4: that we can talk about some more, we replace all
Speaker 4: these tissues, or whether or not we can do a
Speaker 4: partial replacement or resurfacing.
Speaker 1: So in a partial they'll go in and say, okay,
Speaker 1: this part of the femoral condolit the femur nerds needs
Speaker 1: a new surface, So doctor Stone will do a bunch
Speaker 1: of imaging, make a computerized three D model, and then
Speaker 1: perform the surgery outpatient using a frickin' robot. And then
Speaker 1: on the new surface, they smack some metal or plastic
Speaker 1: over the worn down area, but they keep the healthy
Speaker 1: stuff as it is. It's kind of like having a
Speaker 1: tooth capped with crowns. But if things are not looking good,
Speaker 1: if things are more like ooh, then it might be
Speaker 1: a denture situation. Up in there.
Speaker 4: We just put a cap over the worn out part
Speaker 4: and a tray on the tibia, just on the worn
Speaker 4: out part, not touch any of the rest of the knee.
Speaker 4: It's an outpatient procedure under a robotic control, and it's
Speaker 4: much easier for patients than a totally replacement. If they
Speaker 4: have totally worn out their knee down to bone on
Speaker 4: bone or in multiple spots, then we do a total
Speaker 4: new replacement. But even that's completely changed from what your
Speaker 4: parent's totally replacement was. So now when we do that,
Speaker 4: it's an outpatient procedure. We use a robot in order
Speaker 4: to do it extremely precisely. We don't need to use
Speaker 4: cement anymore. So the body can grow into the implant,
Speaker 4: and the implant can become part of the patient, and
Speaker 4: therefore we let our patients go back to running and
Speaker 4: climbing and skiing and doing all the sports that they
Speaker 4: want to do that previously they were told not to do.
Speaker 4: After they have a partial or total new replacement.
Speaker 1: And is that like terminator metal? Is that titanium or
Speaker 1: what kind of materials are you seeing put into knees
Speaker 1: to get them back in shape?
Speaker 4: Sure? So two big groups, the biologic replacement or the
Speaker 4: bionic replacements. Okay. If they're in the bionic replacement, that
Speaker 4: is metal and plastic, it's usually cobalt chrome on the
Speaker 4: thermeral side and titanium on the tibial side, with a
Speaker 4: high molecular rate polyethylene tray in between, which acts as
Speaker 4: the new meniscus. If it's a biologic knee replacement, what's
Speaker 4: something we called a bio knee, then I'm putting back
Speaker 4: in a new meniscus, regrowing their articular kerdil It's using
Speaker 4: a combination of growth factors and stem cell recruitment and
Speaker 4: all the cool things we're doing these days, rebuilding their
Speaker 4: ligaments and creating a new biologic knee joint. The big
Speaker 4: discussion of animal tissue versus human tissue. So right now
Speaker 4: we're only using human tissue, okay, and so it will
Speaker 4: come back. The use of animal tissue to replace ligaments
Speaker 4: in meniscus was work that we spell fifteen years doing
Speaker 4: and develop the new, first, new successful pig ligament for people,
Speaker 4: and I have people still skiing on those ligaments today.
Speaker 1: Pig legs is they're called big legs.
Speaker 4: Yep. We ran a successful clinical trial in Europe, but
Speaker 4: for right now, it's all human tissue.
Speaker 1: Okay, So to recap there are knee replacements that resurface
Speaker 1: using metal or a high molecular weight polyethylene. And then
Speaker 1: there's biologic, which doctor Stone says can include stem cells
Speaker 1: injected into animal tissue or human cadamor tissue which is
Speaker 1: beautiful and spooky and relies on really generous donations from
Speaker 1: folks who are no longer with us. So why do
Speaker 1: they use only that if it's harder to come by. Well,
Speaker 1: it turns out that it's one thing to be a
Speaker 1: brilliant surgeon and compassionate doctor and author and innovative biotechnician,
Speaker 1: but when running animal trials there's a whole other bag
Speaker 1: of worms about needing to raise funding for research, whole
Speaker 1: business thing that's all a real pain in the meniscus. Now,
Speaker 1: you have some patents in this field, is that true?
Speaker 4: Yeah?
Speaker 1: What can you tell me? Can you give me a
Speaker 1: quick rundout of some of the patents you have, and
Speaker 1: what was that like applying for a patent and being like, dang,
Speaker 1: I really did do a lot of innovation in this field.
Speaker 4: Well, the first ones that I wrote were around a
Speaker 4: collagen scaffold for regrowing the meniscus. Remember at that time,
Speaker 4: back in the late eighties, when we tear them, they
Speaker 4: were taken out, and my feeling at the time the
Speaker 4: challenge from my mentor was to figure out how to
Speaker 4: replace it. And so at that time I thought, well,
Speaker 4: if I don't have the right materials to replace it with,
Speaker 4: maybe I can stimulate the body to regrow it. And
Speaker 4: so I designed a collagen scaffold which could be sewn
Speaker 4: into the meniscus and other tissues. Then you could tweak
Speaker 4: the tissues with growth factors and other things and stimulate
Speaker 4: the meniscus to regrow. Oh wow, And that that actually
Speaker 4: was a successful approach came on the market. Eventually, it's
Speaker 4: not currently on the market, as we're going to build
Speaker 4: a new, better one now of a stronger, better collagen.
Speaker 1: Now, when you have knee surgery, do you this is
Speaker 1: a question for my dad, Larry Ward, wants to know
Speaker 1: if you're like, can you just numb me up locally
Speaker 1: and I or put me in some kind of twilight
Speaker 1: where you have one eye open, because as one of
Speaker 1: the best orthopedic surgeons on the planet, do you want
Speaker 1: to be able to work on your own knee or
Speaker 1: you just like, put me out let me know how
Speaker 1: it goes.
Speaker 4: Yeah, So we did that for quite a while where
Speaker 4: patients would stay awake and comment on their surgery while
Speaker 4: we were doing their surgery, and it turned out to
Speaker 4: be more of a distraction and not a big benefit.
Speaker 4: What's happened in anesesia's The drugs have gotten so good
Speaker 4: and so short acting now, and the procedures are pretty quick,
Speaker 4: and so most people go off and take a nap
Speaker 4: for twenty minutes or a half an hour an hour
Speaker 4: and then and don't have the old hangover effects that
Speaker 4: we all used to have from anesesia in the past.
Speaker 1: And talk to me a little bit about the evolution
Speaker 1: of human needs. Obviously we started off as crawling critters
Speaker 1: and evolutionary wise, are we still pretty new to walking upright?
Speaker 1: Are our knees still evolving to be a little bit
Speaker 1: more robust or do you think this is like evolution
Speaker 1: has found the final perfect mechanism.
Speaker 4: So it's an interesting comment because what's beating us first,
Speaker 4: evolution or our own advances in sports and activities. So
Speaker 4: everyone wants to play sports more harder and faster and
Speaker 4: live longer and do them, and so could evolution ever
Speaker 4: catch up to the rate in which we're advancing our
Speaker 4: sports and our desires. I have a book coming out
Speaker 4: this December called Play Forever Nice, and it addresses some
Speaker 4: of these issues about how do we adjust our sports
Speaker 4: and our desires to our bodies and adapt our bodies
Speaker 4: to be able to hopefully drop dead at one hundred
Speaker 4: playing the sport you love. Since evolution won't go so
Speaker 4: fast enough to help all of us who are here now,
Speaker 4: it's our job on the science side to number one,
Speaker 4: improve the techniques, number two to improve the materials, and
Speaker 4: number three to accelerate the healing. So for instances you
Speaker 4: know personally, now you know, why does it take a
Speaker 4: year for an ACL injury to be operated on the
Speaker 4: tissue replaced in the patient to come back. Why does
Speaker 4: it take so long for the body to recover, Why
Speaker 4: is there so much stiffness, Why does the tissue take
Speaker 4: so long to remodel? And what can we do to
Speaker 4: accelerate that process? So while It won't be evolution that
Speaker 4: does it. It will be our addition of growth factors,
Speaker 4: stem cell recruitment factors, because your body has billions of
Speaker 4: stem cells, and there's no reason why we can't figure out,
Speaker 4: which is what we're doing in our research lab now,
Speaker 4: why we can't figure out how to add just the
Speaker 4: right factors to migrate all of your body stem cells
Speaker 4: to that side of injury and accelerate the healing.
Speaker 1: Ah, so say hey, we need you over here rebuild
Speaker 1: this once. It's kind of like calling the landlord when
Speaker 1: you're like, we got to drip here, get a contractor
Speaker 1: over What about what is a growth factor exactly?
Speaker 4: So when you have an injury your body, you have
Speaker 4: bleeding in the blood usually contains a host of proteins,
Speaker 4: and those proteins are commonly both growth factors. That are
Speaker 4: factors that stimulate the cells to turn over and lay
Speaker 4: down new collagen. And there are factors that are anti
Speaker 4: fibroduct to stop scarring. There are factors that are antimicrobial
Speaker 4: to prevent an infection. And so what we want to
Speaker 4: do is use these factors, which we call growth factors,
Speaker 4: to stimulate the healing, to turn on the cells to
Speaker 4: have them lay down new collagen to have you heal
Speaker 4: without scar as fast as possible.
Speaker 2: If you're like, what.
Speaker 1: Is a stem cell? Well, they're really whatever you need
Speaker 1: them to be kind of. Stem cells can turn into
Speaker 1: more stem cells, very meta, or they can differentiate into
Speaker 1: blood cells and brain cells, bone muscle. It's kind of
Speaker 1: like if you were in a game of Uno. A
Speaker 1: stem cell is like a wild card. Whow just what
Speaker 1: a treasure common in clutch.
Speaker 4: There are other factors called cytokinds, which are again proteins
Speaker 4: usually that help recruit your body's own stem cell derived
Speaker 4: self repair cells, which is what we're calling them with
Speaker 4: a very complicated name. I guess we've learned that the
Speaker 4: stem cells aren't really the cells that come and do
Speaker 4: the work. It's their progeny, and so we can stimulate
Speaker 4: stem cells to create more progeny, to migrate those cells
Speaker 4: to the side of injury and accelerate healing. So now
Speaker 4: with almost every injury that I see in my office now,
Speaker 4: and almost every surgery that we do, we add stimulating
Speaker 4: factors to the injury, to the side of injury, or
Speaker 4: to the tissue that we're transplanting in order to accelerate
Speaker 4: that healing process.
Speaker 1: So does that cause more targeted inflammation to sort of
Speaker 1: recruit better healing? Like does that kind of blow up
Speaker 1: in mee a little bit more?
Speaker 4: It's actually interesting question, you know, I wouldn't growth factors
Speaker 4: turn on more swelling, right? Yeah, So it turns out
Speaker 4: that some of them are more anti inflammatory or what
Speaker 4: we call immunomodulatory. They shut down inflammation, and others stimulate
Speaker 4: cells to produce more of the hyaluronic acid, the natural
Speaker 4: lubric can pivot the joint, and so the body knows
Speaker 4: how to titrate that. If you have just the right combination,
Speaker 4: as I call the right chicken soup, all the components
Speaker 4: are in there together and the chicken soup tastes great,
Speaker 4: but if you're missing salt, didn't taste so good. So
Speaker 4: you need to have that right combination to not produce inflammation,
Speaker 4: but to stimulate healing.
Speaker 1: I always think of joint issues like arthritis as a
Speaker 1: rheumatological issue and an inflammation issue. How much of the
Speaker 1: knee injuries and pain that we're having, how much of
Speaker 1: that is inflammation versus traumatic injury from soccer or jiu
Speaker 1: jitsu for example?
Speaker 4: So when we hear the word arthritis. Ninety seven percent
Speaker 4: of arthritis is either osteoarthritis genetic from your family, possibly
Speaker 4: thanks Grandma, or post traumatic arthritis you had an injury,
Speaker 4: you damage the cartilage and it started to wear out.
Speaker 4: Three percent of all of arthritis is what we think
Speaker 4: of as inflammatory arthritis or rheumatoid arthritis, all of those
Speaker 4: inflammation diseases that are fortunately these days being treated. They're
Speaker 4: very potent drugs, but it's not the section that I
Speaker 4: deal with. Ideal that ninety seven percent of post injury arthritis.
Speaker 1: And you have a lot of athletes on your roster too.
Speaker 1: What happens when there's an athlete who was paid to
Speaker 1: run and jump and go laterally and use their knees
Speaker 1: and they blow something out? How I mean, there's so
Speaker 1: much at stake their whole career. How do you even
Speaker 1: go about treating that? Like I imagine mentally, it's got
Speaker 1: to be really difficult.
Speaker 4: So I'll tell you a fun story about that one.
Speaker 4: And because the person is deceased, I can use his
Speaker 4: name now, Otherwise I wouldn't. So one day I get
Speaker 4: a phone call from a very famous movie director and
Speaker 4: he said, Kevin Robin Williams has just twisted and injured
Speaker 4: his knee. It's costing me four hundred and fifty thousand
Speaker 4: dollars a day for every day that he's off the set.
Speaker 4: How fast can you fix it? How long is he
Speaker 4: going to be out?
Speaker 1: The director Francis Ford Coppola also on the way to
Speaker 1: and from taking Jarrett to physical therapy for weeks after
Speaker 1: the surgery in the city, we would pass through a
Speaker 1: bridge in Marine County. Its upper arch has this faded rainbow,
Speaker 1: and there's a freeway sign next to it, noting that
Speaker 1: it is the Robin Williams Tunnel, which honestly kind of
Speaker 1: hurt every time. But back to it, knees should not
Speaker 1: hurt too much. Her millions of years of evolution.
Speaker 4: Right, so, knees are designed beautifully. I'll give you a
Speaker 4: fun example from what we know from the animal Kingdom.
Speaker 4: Elephant fifteen pounds or more, can run up to thirty
Speaker 4: forty sometimes fifty miles an hour, lives for sixty years,
Speaker 4: almost never develops arthritis. Their cartilage is unique. It's a
Speaker 4: little bit thicker than ours, but it's still wonderful material
Speaker 4: and similar to ourrow and cartilage. Your ankle joint almost
Speaker 4: never develops arthritis, even though it's a tiny little joint
Speaker 4: that your entire body is on, unless you fracture your
Speaker 4: ankle or tear your ligaments and it's unstable. So the joints,
Speaker 4: the cartilage in the joint is a brilliantly designed material.
Speaker 4: It's five times as slick as ice on ice. If
Speaker 4: it is not injured. On the running side, run forever,
Speaker 4: as long as you use good mechanics, short stride, great sneakers,
Speaker 4: prefer soft surfaces. All the good thoughts about good running
Speaker 4: mechanics are very important to know. Optimizing your weight is
Speaker 4: pretty critical and the reason, as I mention before, you're
Speaker 4: going to take one to three million steps per year
Speaker 4: at up to five times your body weight, and so
Speaker 4: a ten pound weight loss can be up to fifty
Speaker 4: pounds one to three million steps per year. That's a
Speaker 4: lot of force. So optimizing your weight is one of
Speaker 4: the critical ways you can keep exercising and not damaging.
Speaker 4: Picking multiple sports so that you don't become a one
Speaker 4: sport athlete. So if you're going to be a runner,
Speaker 4: for sure, mix in biking and pool and weightlifting. Try
Speaker 4: to mix up your sports as much as possible. We
Speaker 4: know that resistance sports are the only way, especially for women,
Speaker 4: to counteract the osteoporosis that occurs with aging. And so
Speaker 4: you've got to hike the stairs, don't take the elevator.
Speaker 4: You need to do resistance exercise. Weightlifting is particularly the
Speaker 4: best way. Hill climbing, hiking, do whatever you can to
Speaker 4: really load the muscles and the bones. And that's true
Speaker 4: even if you've had a joint replacement.
Speaker 1: And just a quick circle back that, yes, there is
Speaker 1: so much research on biomechanics and physics and the effects
Speaker 1: of body composition and muscle mass on the development and
Speaker 1: the prognosis for osteoarthritis. I was literally up until four
Speaker 1: in the morning last night reading meta analyzes on it
Speaker 1: and summation. There's just so much research to support that.
Speaker 1: But I also wanted to acknowledge that weight optimization can
Speaker 1: be a challenge if you're in pain to begin with,
Speaker 1: or you've experienced factors like trauma or lack of access
Speaker 1: or care which exacerbated or pardon the punt here, kicked
Speaker 1: off a weight struggle to begin with. And it's also
Speaker 1: worth noting that not everyone who would call themselves fat,
Speaker 1: which is an acceptable term in the body positivity community
Speaker 1: struggles with their weight. Many are just fine the shape
Speaker 1: and size they are, and their knees are fine, and
Speaker 1: they struggle with maybe a knee jerk diagnosis and the
Speaker 1: stigmas sometimes faced in healthcare. Also, metrics used to assess
Speaker 1: health are not one size fits all either. BMI is
Speaker 1: a really loose gauge for determining body composition. It was
Speaker 1: actually invented by an Austrian scientist who wasn't actually a
Speaker 1: medical doctor, but even a legit modern MD can tell
Speaker 1: you that. Of course, BMI does not tell the whole story.
Speaker 1: Ask any bodybuilder or me the day after I eat
Speaker 1: soy sauce, I'm a talking sponge with hair. But knowing
Speaker 1: that some blanket medical guidelines might be less breezy to
Speaker 1: take in stride and I asked on Twitter the middle
Speaker 1: of the night last night. I was like, any folks
Speaker 1: have thoughts about size and knees? I heard all kinds
Speaker 1: of responses from Lord of Goats said six foot one,
Speaker 1: been over three hundred pounds with a better part of
Speaker 1: my adult life. Yes, weight is killing my knees and
Speaker 1: is getting worse with age. It's more tolerable with good
Speaker 1: low impact exercise like road biking and anti inflammatories and
Speaker 1: water helps to and Nancy, who's a scientist, said personal anecdote,
Speaker 1: my knees hurt more when I'm heavier. Currently at a
Speaker 1: moderate weight for me b. Twenty seven, and they're mostly happy,
Speaker 1: but occasionally grite me, they say. And Jay has be
Speaker 1: chimed into say overweight and forty two year desk career.
Speaker 1: Losing weight and moderate activity both helped. I played a
Speaker 1: lot of basketball younger. Best exercise for me now was
Speaker 1: a bike, and someone named Mixed Meridian said, from my
Speaker 1: personal experience, the right exercise is also important. This begins
Speaker 1: with learning to stand and move safely, and there's taischi
Speaker 1: and yoga if you have an instructor who understands anatomy
Speaker 1: and challenges and can teach you modifications. Ditto for strength
Speaker 1: and balance, and Graham shared, I've had knee problems most
Speaker 1: of my adult life, and it's been fascinating to watch
Speaker 1: how I was treated as an athletic eighteen.
Speaker 2: Year old versus a fat thirty two year old.
Speaker 1: Most recently, I tore my meniscus and the first doctor
Speaker 1: I saw didn't even do an exam, just told me
Speaker 1: to lose weight and quit soccer. So someone on Twitter,
Speaker 1: Marina suggested that doctors take a more compassion approach, something
Speaker 1: along the lines of studies do show that weight plays
Speaker 1: a role in this, but don't focus on that as
Speaker 1: the cause. Causation does not always mean correlation. It's important
Speaker 1: to treat potentially weight correlated issues as medical conditions first,
Speaker 1: bringing up weight as one of many possibilities. And ultimately
Speaker 1: I was pointed in the direction of a biomedical researcher
Speaker 1: and engineer, doctor Dina aka It's broken Me on Twitter,
Speaker 1: who wrote, Hi, did my PhD evaluating osteoarthritis related knee pain,
Speaker 1: bone body mass and distribution, and bone mechanics. Simply put,
Speaker 1: it's complicated. It's a lot going on in that joint
Speaker 1: related to osteoarthritis, and you can't just attribute pain to
Speaker 1: mass and activity. She went on to say that pain
Speaker 1: is biopsychosocial, meaning there's a lot to factor in. Take
Speaker 1: home regarding mass and knee health. Be as active as
Speaker 1: you can for as long as you can and as
Speaker 1: much as you are able to pain wise, but don't
Speaker 1: over do it. And after I saw that tweet, I
Speaker 1: tag doctor Rachel's oftness from the Dolerology episode in this thread,
Speaker 1: as you can imagine, a Twitter friendship was born. And
Speaker 1: also worth noting that a lot of conditions can cause
Speaker 1: acute or chronic me pain and the right diagnosis is important.
Speaker 1: As these good footwear. A few people said that getting
Speaker 1: the right shoes or seeing a podiatrist too helped them
Speaker 1: a lot and got them on the road if you will,
Speaker 1: to a more active and happier lifestyle. And myself, I
Speaker 1: used to love to run four or five times a
Speaker 1: week because you can turn up music and you can
Speaker 1: pound the pavement like boxing with your feet, and I
Speaker 1: loved it. But true story, when I launched ologies in
Speaker 1: twenty seventeen, I stopped running like I used to. I
Speaker 1: just couldn't fit it in my day. And I also
Speaker 1: have gained an appreciation for homemade sour dough during the pandemic.
Speaker 1: And sure my pants are a little tight, but whatever.
Speaker 1: When we think about body composition, a lot of the
Speaker 1: times it's really sexualized. How big is my butt? Can
Speaker 1: you see my apps? Does this look ot? And that's
Speaker 1: all appearance and that shit does not matter and it's
Speaker 1: nobody's business. But I have to say that this conversation
Speaker 1: and working on this episode. Looking at my body as
Speaker 1: kind of a biomechanical marvel and move as play and
Speaker 1: maintenance for it, as opposed to a sentence that I
Speaker 1: was served for neglecting my sneakers has gotten me really
Speaker 1: jazz to take better care of it in a way
Speaker 1: that feels good to me both mind and body, better
Speaker 1: than anything else I've read or heard for years. So
Speaker 1: I hope, no matter what you're feeling, less pain, more happiness,
Speaker 1: and whether from an injury or wear and tear, that
Speaker 1: you do not need a knee replacement, but back to exercise,
Speaker 1: even after having a little work done in there.
Speaker 4: So in the old days, doctors told patients after a
Speaker 4: joint replacement, go home and rest your knee. Huh, I
Speaker 4: did two terrible things. Number one, their muscles got weak,
Speaker 4: and number two, of their bones became osteoproduct. And so we,
Speaker 4: after we do a partial or total knee replacement these days,
Speaker 4: explain to our patients that the more they exercise, the
Speaker 4: better they are going to do, the stronger their bones
Speaker 4: will be either better the muscles, the more they'll protect
Speaker 4: their joints. And we've never seen a joint worn out
Speaker 4: from exercise. And so all those years of doctor's telling
Speaker 4: patients to you know, rest a knee and protect it,
Speaker 4: we don't think is the right advice today.
Speaker 1: Yeah, I was going to say, Jarrett went into your
Speaker 1: clinic like the next day to start physical therapy, during
Speaker 1: which he cried that it was the hardest exercise he's
Speaker 1: ever done, just lifting his leg straight. And this is
Speaker 1: a guy who is powerlifted and you know, grappled until
Speaker 1: he's choked to death. So why is it so important
Speaker 1: to do PT And when do you know if it's
Speaker 1: just something that you have to do physical therapy on
Speaker 1: versus get in there with a knife and noodle around.
Speaker 4: So let me give you an example. So from my
Speaker 4: ballet dancers, if they suffer a knee injury, a an
Speaker 4: ACL injury, or a meniscus injury, immediately in their recovery room,
Speaker 4: I have them extend their leg and see their line.
Speaker 4: Just want to be perfect. It's so important for their
Speaker 4: brain to see their line, to know that they're going
Speaker 4: to be able to come back to that beautiful extension
Speaker 4: that they're so good at doing, both men and women.
Speaker 4: And so the reason that patients are in our clinic
Speaker 4: the next day after surgery. Is that they know immediately
Speaker 4: that they shouldn't treat themselves as an injured wounded animal
Speaker 4: and hide in bed, get moving right away mentally knowing
Speaker 4: that they can do it. Having the therapist do manual
Speaker 4: therapy to push the fluids out of the swollen joint,
Speaker 4: to get them contracting their muscles right away, to get
Speaker 4: them moving through a range of motion. All of that
Speaker 4: can start right away, and we don't let them get
Speaker 4: stiff and sore, which is natural after any injury or surgery,
Speaker 4: which will occur, but we want to have it occur
Speaker 4: in the least amount possible.
Speaker 1: Right So it's not like when I got my tonsils
Speaker 1: out and I went home after surgery and ate gallons
Speaker 1: of ice cream every day.
Speaker 4: I wish I had ice cream for the knee. And
Speaker 4: that's what we have for these cold machines now, these
Speaker 4: cold depression machines PS.
Speaker 1: Now there are these electronic contraptions that involve a hose
Speaker 1: and a cooler full of ice and water. Are they
Speaker 1: magic a little bit?
Speaker 4: They're like ice cream for the need? Now?
Speaker 1: Are those pretty new on the scene.
Speaker 4: They've actually been around for the last ten years. They
Speaker 4: weren't as good as they are now, so immediately after
Speaker 4: surgery used the ice compression machines that intermittently provide compression
Speaker 4: pumping the fluid out icing, which we do for twenty
Speaker 4: minutes each hour while they're awake.
Speaker 1: Yeah, Jarret was like, I don't think I need one
Speaker 1: of those, and literally, like the next day he was like, yeah,
Speaker 1: I going, so he's got one rented. I think it's
Speaker 1: a cuff. It's like a blood pressure cuff that has
Speaker 1: cold water going through it so you don't have to
Speaker 1: keep holding soggy ice packs. I realized that the bags
Speaker 1: of frozen peas I got him were not necessary after
Speaker 1: all that he'd need them. Can I ask you listener questions? Sure, Oh,
Speaker 1: we have so many good ones. Also, we donate to
Speaker 1: a charity every episode in your name. Is there a
Speaker 1: related charity or foundation or your own that you would
Speaker 1: want the genation going to.
Speaker 4: Yeah. So the Stone Research Foundation is a public nonprofit
Speaker 4: five to one c three dedicated to the science of accelerating,
Speaker 4: healing and reducing, treating, preventing arthritis. And so we're driven
Speaker 4: on the research side and it's all for that public
Speaker 4: research foundation and you can find it at Stoneresearch dot org.
Speaker 1: Great, We're going to do a donation to them. So yes,
Speaker 1: a donation is going to Stoneresearch dot org and their
Speaker 1: mission is to pioneer new orthopedic treatments that accelerate healing
Speaker 1: and enable people to stay active through research, development, innovation,
Speaker 1: and education. And they are an independent five oh one
Speaker 1: c three nonprofit. So a donation went to Stoneresearch dot org.
Speaker 1: Thanks to sponsors on the show, who you will hear
Speaker 1: about now? Okay? This first patron submitted question was asked
Speaker 1: by Alex opp as well as a few others okay questions.
Speaker 1: Mike Monokowski, Denise and Abraham Livingston all wanted to know.
Speaker 1: Mike said, do supplements like glucosamine or boron actually do anything?
Speaker 1: Are they expensive placebos? Denise wants to know does drinking
Speaker 1: college and effect that joints or do you just pee
Speaker 1: it out? And Abraham same question. Anything you can eat
Speaker 1: like you mentioned chicken soup. Does eating a lot of
Speaker 1: collagen and bone broth? Does that actually affect our joints
Speaker 1: at all?
Speaker 4: So let me answer that two ways. Of all the supplements,
Speaker 4: we think that the best science is around glucosamine. It's
Speaker 4: been around a long time. There are plenty of good
Speaker 4: studies that show that it does get into the joints
Speaker 4: and into the tissues. It's a precursor for building cartilage.
Speaker 4: The most common thing we hear from patients over the
Speaker 4: last twenty years of giving them glucosamine is that patients
Speaker 4: say they feel less stiff after they take glucosamine. So
Speaker 4: it's objective proof that the glucosamine is getting into the
Speaker 4: bloodstream and doing something. Collagen, on the other hand, when
Speaker 4: you eat it is a steak, it's digested quite completely
Speaker 4: in by the stomach acid, and so taking additional oral
Speaker 4: collagen does not produce a benefit. Eating protein, which is
Speaker 4: collagen in proteins amino acids is important part of your diet,
Speaker 4: and so we generally advise patients to be on a
Speaker 4: high protein, low carb, low fat diet, so lean protein.
Speaker 4: That's probably the healthiest way to optimize your weight when
Speaker 4: you add least eight classes of water to it each day.
Speaker 4: So the water part of is you think of supplements,
Speaker 4: We think water is the primary beverage that most people
Speaker 4: should drink. If you can lift the glass of water
Speaker 4: before you lift the fork, most people will find they
Speaker 4: feel little full, and it's good portion control. If you're
Speaker 4: an athlete, if you can use both water and protein
Speaker 4: as your primary food sources, you generally build muscle and
Speaker 4: stay healthy.
Speaker 1: And doctor Stone has written on this most recently in
Speaker 1: his book Play Forever that was released literally yesterday, and
Speaker 1: he writes, here's what you need to know. Complete our
Speaker 1: quality protein is protein that has all the essential amino
Speaker 1: acids required for health. Lean protein sources such as skinless
Speaker 1: chicken or turkey ninety percent or leaner ground beef, low
Speaker 1: fat or non fat dairy, seafood, soy products, porkloin, and
Speaker 1: eggs are ideal and incomplete. Proteins such as beans, oatmeal, barley, corn, nuts,
Speaker 1: and seeds are missing some of the essential amino acids
Speaker 1: and must be combined with other foods and for good
Speaker 1: health maintenance. He recommends point eight to one point five
Speaker 1: grams per kilogram of body weight. So do some beepop beepop,
Speaker 1: and you figure out how many grams are protein a day.
Speaker 1: And he also says that for sick or injured people
Speaker 1: trying to build muscle, the recommendation increases to two grams
Speaker 1: per kilogram a day, but he warns other health issues
Speaker 1: must be taken into account before introducing any dramatic increases
Speaker 1: in protein intake. Always consult your own physician before making
Speaker 1: any changes. And he's also written via some blog posts
Speaker 1: on a website which is just like a treasure trove
Speaker 1: of orthopedic articles he's written, and he writes fats and
Speaker 1: carbohydrates and sugars are also essential parts of diets, yet
Speaker 1: most everyone gets an excess of both, and it takes
Speaker 1: effort to get protein, but if it's consumed in the morning,
Speaker 1: protein carries most people through the days activities longer than
Speaker 1: other choices. And it's protein that builds muscle and provides
Speaker 1: the longest lasting energy supply. It helps the immune system
Speaker 1: resist infection. Good to know during these times, and it
Speaker 1: also allows bones to build mass and it helps your
Speaker 1: tissues repair. So he tends to recommend using carbohydrates and
Speaker 1: fattier foods as kind of a garnish to compliment protein
Speaker 1: dishes and vegetables. So washing down a chicken breast with
Speaker 1: a two liter of mountain dew is not good. Now,
Speaker 1: it's not good, And gird your bladders because one of
Speaker 1: doctor Stone's posts is about to get you so horny
Speaker 1: for water. He writes, water is the ideal beverage, no calories,
Speaker 1: no sugar, pure taste, and an optimal source of hydration.
Speaker 1: There are millions of people who, if they drank water
Speaker 1: more often, would save untold dollars while improving their performance. Damn,
Speaker 1: this guy just managed to single handedly be a water influencer,
Speaker 1: and working on this episode is the most hydrated I've
Speaker 1: ever been in years. I'm not getting I peede so much.
Speaker 1: I'm not mad about it. And if you're wanting to
Speaker 1: up your glucosamine, but like doctor Stone's patience, you don't
Speaker 1: want to kick back six big pills a day. That
Speaker 1: joint juice, which he no longer owns, can still do
Speaker 1: the trick. It has fifteen hundred milligrams of glucosamine and
Speaker 1: two hundred milligrams of chondroyten per serving. And I wasn't
Speaker 1: going to mention all that because it sounds like we
Speaker 1: must have just gotten free knee surgery out of it,
Speaker 1: and trust me, oh boy, if we did not, this
Speaker 1: was very out of network and lots of money, but
Speaker 1: worth it. But I dug around into studies and there
Speaker 1: was this one twenty eighteen paper in the Clinical Rheumatology,
Speaker 1: a journal entitled Effects of Glucosamine in Patients with Osteoarthritis
Speaker 1: of the knee a systematic review and meta analysis and
Speaker 1: found that sixty seven percent of published studies showed that
Speaker 1: glucosamine was effective in reducing pain and osteoarthritic symptoms compared
Speaker 1: with a placebo also joint juice not to be confused
Speaker 1: with a juice joint, which is prohibition era language for
Speaker 1: the clerb Okay. Speaking of laud, so many of you patrons,
Speaker 1: including Larinda, Desiree Minetti, Hulton, Tony Vessels, Aubrey Nelson, Lena
Speaker 1: Zika's Ruby, Eric Azolk, Careless Kitty, Meghan Stingle and agusman
Speaker 1: Adele Masa nouve Ed Nogg, Danielle Rosa, Sylvia t Christy
Speaker 1: Kazakhov all had questions about our crunchy, creaky, poppy squeaky parts, or,
Speaker 1: as Michelle Chick called them, my favorite joint to hate
Speaker 1: the Niece, Let's get to noises Aubrey Nelson, Otter Apocalypse,
Speaker 1: Jennifer wy Sakowski all wanted to know Truther flin Flamm
Speaker 1: that popping or cracking your knees can cause problems later,
Speaker 1: and Otto Apocalypse said why do my knees crackle like
Speaker 1: popcorn on the way upstairs? But there's not a sound.
Speaker 1: One descending Jennifer said, I get a soft, crunchy sound
Speaker 1: on my knees when I go downstairs, So what is that?
Speaker 1: When I do squats they crunch and it's terrifying what
Speaker 1: is going on in there?
Speaker 4: So two major groups of noises in the knee snap,
Speaker 4: crackling pop for the knee. Yeah, so occasional pops and
Speaker 4: cracks of your joints are pretty normal and almost everybody
Speaker 4: has them, and as long as they're harmonious and not cacophonus,
Speaker 4: we generally don't pay too much attention.
Speaker 1: By the way, this noise has a name. It's called crepitis,
Speaker 1: and it comes from the Latin word for rattle, and
Speaker 1: it happens when you get air bubbles in your tissues
Speaker 1: or when ligaments those straps that secure bones to bones,
Speaker 1: or tendons which attach muscles to bone snap over your
Speaker 1: knee bones. It's usually pretty harmless and painless.
Speaker 4: Usually the grinding in the front of your knee, though
Speaker 4: going up or downstairs is usually your knee cap loading
Speaker 4: on the femur, and that sometimes can be a sign
Speaker 4: of rough cartilage there or tissue getting caught. Generally we
Speaker 4: ignore it as long as it's not producing pain or swelling.
Speaker 4: If you come into the office say hey, i've got
Speaker 4: some noise there and we feel your knee, there's a
Speaker 4: little bit of grinding, but no pain or swelling with it,
Speaker 4: will generally ignore it or provide a lubrication injection if
Speaker 4: it's bolished them in any way. If there's grinding associated
Speaker 4: with pain or swelling, then that's damaging the cartilage, and
Speaker 4: there we want to address it, and we can address
Speaker 4: it either with injections or surgery to smooth it down
Speaker 4: or regrow the cartilage, depending on how bad it is.
Speaker 1: Okay, So that lubrication injection is called Visco supplementation, and
Speaker 1: it's usually a gel form of hyaluronic acid, which if
Speaker 1: you listen to the Glycobiology episode from twenty eighteen you'll know.
Speaker 1: Is it carbohydrate that your body already makes and it
Speaker 1: binds to water up to one thousand times its volume,
Speaker 1: and they inject about two milliliters of it right into
Speaker 1: the joint capsule around your knee. If they have any leftover,
Speaker 1: maybe they can jam it in your face because if
Speaker 1: hyaluronic acid injections sound familiar, think Jupiter and restalin and
Speaker 1: other dermal fillers.
Speaker 2: PS.
Speaker 1: They won't actually do that, but trend wise medically, cortisone
Speaker 1: injections are passe, and what surgeons like doctor Stone recommend
Speaker 1: is getting things all juicy with anib therapy or stimulating
Speaker 1: the tissues. And he says that instead of injecting stem
Speaker 1: cells directly, since we already have billions of them, but
Speaker 1: injected ones can die off quickly, docs like him use cidokines,
Speaker 1: which is what cells used to direct as he calls
Speaker 1: it a symphony of healing and patron Ryan Martin wrote
Speaker 1: in said longtime listener first time question asker wanted to
Speaker 1: know what role are plasma rich platelet injections or PRPs
Speaker 1: playing in today's procedures. He wanted to know if the
Speaker 1: good doctor and his patients had any thoughts on that.
Speaker 1: Ryan has had three of them, so I looked this up.
Speaker 1: So PRP platelet rich plasma injections, that's when they take
Speaker 1: your blood. They concentrate the platelets, which are tiny cell
Speaker 1: fragments that help clotting. They look for damage tissue to repair,
Speaker 1: and you can also call platelets thrombocytes for short, and
Speaker 1: these things are just choc a block with growth factors
Speaker 1: and cidokines. So they do kind of one of those
Speaker 1: wolf whistles at stem cells and they say.
Speaker 2: Hey, get trasses. O here, we got some tissue to fix.
Speaker 1: But what about cartilage makeovers? So patron Shannon Patterson asked,
Speaker 1: when can we grow new cartilage in humans? Asking for
Speaker 1: a me, and Samantha Ray's shades niece asked straight up,
Speaker 1: why are they so injury prone? Mara Rosenbloom said that
Speaker 1: they tore their meniscus and didn't need surgery. But Beverly
Speaker 1: Soberman wants to know, in their words, about snipping off
Speaker 1: all the jaggedy bits of cartilage like a shredded meniscus,
Speaker 1: their's having been thrice torn. Ouch ouch ouch, how does
Speaker 1: that cartilage get shreddy like that?
Speaker 4: Yeah? So remember that smooth surface that's five times as
Speaker 4: slick as ice on ice and can go one to
Speaker 4: three million steps per year. Well, that only works when
Speaker 4: it's white and shiny like the chicken wing. The crack
Speaker 4: open as soon as you damage it, either by hitting
Speaker 4: it directly or by losing the meniscus, and therefore there's
Speaker 4: more force concentration or by tearing the ligaments and now
Speaker 4: there's abnormal rotations and pivoting in the joint. Any of
Speaker 4: those mechanisms will cau that smooth surface to now become
Speaker 4: rough if you damage it. We want to repair that
Speaker 4: surface right away. And we've got very good techniques for
Speaker 4: stimulating the cartilage to regrow. Now. One of them that
Speaker 4: we invented back in nineteen ninety one was called articular
Speaker 4: cartilage paste grafting. It's like grouding a hole in the wall.
Speaker 4: And so if you have a hole in your cartilage,
Speaker 4: we want to fill that before it becomes too big
Speaker 4: a hole in the cartilage. So back to your grinding question.
Speaker 4: If there are no symptoms, would generally ignore it. If
Speaker 4: they're causing pain or swelling, we want to pay attention.
Speaker 1: Is it kind of like dentistry, like if you've got
Speaker 1: a knee injury, is it better to get it looked
Speaker 1: at earlier so that it doesn't cause you, like the
Speaker 1: equivalent of a root canal later.
Speaker 4: Yes? Okay, So the best example of that is if
Speaker 4: you have a meniscus tear, you want the surgeon to
Speaker 4: repair it. If they have to take it out. You
Speaker 4: want them to replace it right away before you develop
Speaker 4: the arthritis that will certainly occur from losing the.
Speaker 1: Meniscus, Like what happened to you a little bit?
Speaker 4: Yeah?
Speaker 1: Yeah, And now your wife is also a patient.
Speaker 4: Oh, she's been a patient a number of times, unfortunately,
Speaker 4: from ski injuries and other things. It's always challenging you.
Speaker 1: Do you operate on her?
Speaker 4: I do?
Speaker 1: Is she like all right? A lot on the line here, yes.
Speaker 4: But fortunately there's no one else she trusts more, I imagine,
Speaker 4: and she knows that I would do anything possible to
Speaker 4: make it come out right. But it is stressful. And
Speaker 4: there are lots of folks who think that you shouldn't
Speaker 4: take on the liability and responsibility of repairing a family member,
Speaker 4: and I think that that has validity as well. So
Speaker 4: there has to be only certain circumstances. When you, you
Speaker 4: or somebody feels like you're the best in the world
Speaker 4: of doing that particular procedure, then it seems like it
Speaker 4: may be the right thing to do.
Speaker 1: Yeah, I would trust you, But would you trust you?
Speaker 1: You know? My dad Elward asked earlier off doctor Stone,
Speaker 1: as ever attempted to operate on himself, and obvious as
Speaker 1: your grandpad. He's being cheeky. But this did not stop
Speaker 1: me from spending way too long reading old medical documentation
Speaker 1: of autosurgery. So please grab my creepy, bony hand and
Speaker 1: to send for a quick diversion on surgeons who read
Speaker 1: their own YELLP reviews and were like, yeah, this is
Speaker 1: the doctor for me. Okay, so really quickly. In the
Speaker 1: nineteen twenties, there was a German medical student who was like, yo,
Speaker 1: what if instead of cracking open a chest, we just
Speaker 1: jammed a tube through some veins to reach the heart.
Speaker 1: And other doctors were like the fuck, dude no. And
Speaker 1: he told a nurse about it, who was like, I'm
Speaker 1: down to clown. She's like, that's a great idea, dude,
Speaker 1: try it on me. So he sedated her, numbed her up,
Speaker 1: and then he was like, psych too dangerous. I'm shoving
Speaker 1: this thing up my own elbow vein. And another doctor
Speaker 1: saw what was happening was like your trip and dude no,
Speaker 1: and then a dramatic tussle ensued. But this doctor, Werner
Speaker 1: Theodore auto Forceman made it, jammed the two foot long
Speaker 1: catheter all the way to his heart, and then calmly
Speaker 1: walked himself to the X ray department to get a
Speaker 1: gander at this handiwork. What kind of penalty did he
Speaker 1: get for this recklessness? Well, the Nobel Prize, happy ending,
Speaker 1: not really he was also a Nazi. But you know
Speaker 1: who wasn't Inez Ramirez Perez, who was a woman living
Speaker 1: in a remote region of Wojaca, Mexico. She was in
Speaker 1: labor this is in the year two thousand with her
Speaker 1: ninth child, and realized this kid isn't taking the open
Speaker 1: door option. She's gonna have to make him a window.
Speaker 1: She sat herself on a stool, she took three shots
Speaker 1: of hard liquor, got to work using kitchen knife and
Speaker 1: some skills she learned butchering animals. And that is enough detail.
Speaker 1: But she and the baby survived. And later she was like, yeah,
Speaker 1: don't recommend that. But every March fifth, I think we
Speaker 1: should all celebrate her son, Orlando Ramirez's birthday. I hope
Speaker 1: he gives her at least a cart every year. Also,
Speaker 1: there was a nineteen sixty autosurgery by a Russian doctor
Speaker 1: on an Antarctic expedition who realized he had no choice
Speaker 1: but to break up with his bitch of an appendix,
Speaker 1: and he was the only person available on this icy
Speaker 1: continent to remove it. And he described the pain that
Speaker 1: led him to operate on himself. He wrote, it hurts
Speaker 1: like the devil, a snowstorm whipping through my soul, wailing
Speaker 1: like a hundred jackals. God, I wish this guy had
Speaker 1: a blog. But the autosurgery, honestly, that sticks with me,
Speaker 1: the most last one, I promise. Pennsylvania surgeon doctor Evan
Speaker 1: O'Neil kane, who was not only the owner of Caine Hospital,
Speaker 1: but he was also a client. He too had an
Speaker 1: appendix needing ousting, and he really just put the patient
Speaker 1: in impatient because in peak passive aggression or like the
Speaker 1: worst episode of Under the Cover's Boss, he decided, you
Speaker 1: know what, we're gonna do it live.
Speaker 2: I got this.
Speaker 1: He did what anyone would do. He spent half an
Speaker 1: hour injecting himself with adrenaline and cocaine, did a little cutcut, snippy,
Speaker 1: snippy appendectomy. Maybe some of his guts fell out and
Speaker 1: he had to stop them back in to the horror
Speaker 1: of all of the other medical personnel, but he gave
Speaker 1: him self five stars. In fact, becomes a repeat patient
Speaker 1: of himself he operates on his own hernia a few
Speaker 1: years later. But that's not all he's known for. I
Speaker 1: found out he also helped invent music therapy and operating rooms,
Speaker 1: bringing in a record player with some chill jams to
Speaker 1: help his patients relax. He also invented asbestos band ads
Speaker 1: and clear peekaboo windows for your skull.
Speaker 2: You know what, not.
Speaker 1: Every idea is a good idea, and that's okay, let's
Speaker 1: get back to nice. You're screaming at your windshield while
Speaker 1: I google fruitlessly for the nineteen seventeen paper sheet mica
Speaker 1: plate for brain covering, which I never found anyway. People
Speaker 1: want to know about the pain factor, So patron Ashley
Speaker 1: Oki cut surgically right to the chase, asking very important,
Speaker 1: why do my knees hurt all the time? And this
Speaker 1: was echoed in various degrees by patrons Lana Schuster, Jesse Hurlbert,
Speaker 1: Pam Lynn Hodnett, Elise, Alana, Rickman Olga and Ali Barg
Speaker 1: who asked again, why do they hurt so much? Seems
Speaker 1: like a design flaw? How painful is that? Surgery?
Speaker 4: Is a knee surgery, so pain is very individual? Okay,
Speaker 4: Number one, we don't think there's any benefit to having pain,
Speaker 4: So we want to do all the little tricks we
Speaker 4: can to help your husband and others, you know, not
Speaker 4: suffer from pain, because pain causes you to freeze up
Speaker 4: and stop moving and to be depressed and all the
Speaker 4: things that we don't like. We want you to feel
Speaker 4: great about it and be moving and be active. We
Speaker 4: like to avoid narcotics whenever we can, because of all
Speaker 4: their downsides and their inhibition of muscle function. But we
Speaker 4: have better long acting injections, we have better patches, We
Speaker 4: have exercise right away and soft tissue and ice and
Speaker 4: all those things we have boosting up your attitude about
Speaker 4: your healing, which definitely decreases pain. So we find that
Speaker 4: people very widely in their pain response to a procedure,
Speaker 4: and we respect their responses in our jobs to figure
Speaker 4: out what's going to work for that individual patient.
Speaker 1: That's good to know. I think a lot of people
Speaker 1: figure like, oh, you get knee surgery, you're going to
Speaker 1: be on vic it in for six months, which is like,
Speaker 1: really not everyone wants that. For more on what is pain,
Speaker 1: why do things hurt? What's acute immediate pain versus longer
Speaker 1: chronic pain, and how can outside factors reduce how we
Speaker 1: feel pain aka the biopsychosocial pain model. Check out that
Speaker 1: Dolerology episode with doctor Rachel's Softness.
Speaker 2: Herself a sufferer of.
Speaker 1: Chronic pain from an injury, and she also has a
Speaker 1: workbook to help you understand your own pain and how
Speaker 1: social and psychological factors come into play when it comes
Speaker 1: to disability. And the TLDR is it's not all in
Speaker 1: your head or imaginary or made up or your fault,
Speaker 1: and not all doctors get that. And I was actually
Speaker 1: really impressed after Jareded's pre surgery appointment when he left
Speaker 1: doctor Stone's office with a pamphlet written by Kevin himself
Speaker 1: which explained that the surgery happens, all goes well, you
Speaker 1: begin your rehab, but a couple of weeks later you
Speaker 1: hit the skits. You've had it. You're sick of the soreness,
Speaker 1: the dressings, the ice machines, the knee braces, the PT appointments.
Speaker 1: You just want your life back, he writes. For this malaise,
Speaker 1: he continues, you have officially acquired ACL depression syndrome. And
Speaker 1: a recent study documented that forty percent of people who
Speaker 1: undergo ACL surgery experience clinically diagnosable depression. So yes, of course,
Speaker 1: our bodies affect our minds. Our minds affect our bodies,
Speaker 1: and a good doctor knows that pain is real and
Speaker 1: that the bigger picture will get you feeling better faster,
Speaker 1: and that psychology of a physical condition is not just
Speaker 1: for the birds.
Speaker 2: Which was the worst.
Speaker 1: Segue I've ever done to read one patron question from
Speaker 1: Sarah Meaden who said, do you know why some animals
Speaker 1: have knees in reverse? And Jacob Elsbury who asked, why
Speaker 1: do chickens and birds have backward bending knees? And we
Speaker 1: don't which is better from an evolutionary standpoint. I'm still
Speaker 1: not convinced people are better than chickens, Jacob brights, which
Speaker 1: might be true. And another patron, Maria, responded to Jacob
Speaker 1: and said, they don't. What we see as a backwards
Speaker 1: knee is actually their ankles and their knees are further up,
Speaker 1: hidden under the feather. So thank you Maria for answering
Speaker 1: that question. But you know what my favorite animal part
Speaker 1: ever is. It's the apn femoro tibial joints. Those are
Speaker 1: the bees nies. Now this is my show. I do
Speaker 1: what I want, I'm leaving it in. Okay, what else
Speaker 1: is weird? Your babies? Let's talk babies and how weird
Speaker 1: they are. A lot of people, including Jesse Hurlbert, wanted
Speaker 1: to know why are babies born without a kneecap? Are they?
Speaker 1: Someone told me this once? Is this true? Do babies
Speaker 1: do not have knee caps?
Speaker 4: Not that I know of. I think they all have kneecaps.
Speaker 4: They're just small.
Speaker 1: Okay, so they're not born without them, not that I
Speaker 1: know of. Okay, that is a big that's some big
Speaker 1: flim flam that we've just debunked, because for a second
Speaker 1: I was like, where do they get them? Later?
Speaker 4: So let me explain. The kneecap is what we call
Speaker 4: a sesamoid bone. So it's a very small ossification within
Speaker 4: the tendon. So you have them underneath your great toe,
Speaker 4: you have one at the front of the knee, and
Speaker 4: so at birth they're very very small that ossification center.
Speaker 4: And what happens is they grow that center ossifies and
Speaker 4: becomes a real kneecap. So yes is not truly what
Speaker 4: you think of as your normal kneecap, but it is
Speaker 4: an ossification center and it becomes that sesamoid bone.
Speaker 1: But it's teeny tiny. Katy Noble had a good question,
Speaker 1: why do we have kneecaps and why don't our elbows
Speaker 1: have elbow caps?
Speaker 4: Super good question, Katie. So if you look at the
Speaker 4: long lever arm of your leg, in order for your
Speaker 4: quadriceps muscle to lift your shin, it would have to
Speaker 4: be much larger if it didn't have the lever arm
Speaker 4: of the patella the kneecap rate in between. So by
Speaker 4: firing the muscle of your quad loading that kneecap on
Speaker 4: the center, you can lift through the pedellar ten and
Speaker 4: you can lift your shin. That's why in your arm
Speaker 4: you don't have such a long leave arm. It's doesn't
Speaker 4: need as powerful a muscle to extend your elbow, and
Speaker 4: you also can use gravity.
Speaker 1: Is the patella kind of like a fulk crumb in
Speaker 1: that great example? Ah physical indeed Archimedes right away. Good
Speaker 1: to know. Physical and physics both come from a root
Speaker 1: word meaning nature. In case you have like a zoom
Speaker 1: trivia night you need to win. Now, tall folks, let's
Speaker 1: talk ready. Violent badger wants to know is there an
Speaker 1: actual correlation between being tall and having bad knees? How
Speaker 1: can I stop my knees from killing me in the future?
Speaker 1: They write, and Grace Robis Show and Leanna Schuster's thirteen
Speaker 1: year old daughter Sammy both want to know about growing pains,
Speaker 1: leg length and knees. So yes, physical physics, I ale
Speaker 1: Vanmuherbeek says, does the ratio of lower length leg length
Speaker 1: to upper leg length affect your likelihood to having knee
Speaker 1: pain and certain activities? And also, if you have more
Speaker 1: muscle on your upper leg versus your lower leg, does
Speaker 1: that affect your knee health at all?
Speaker 4: Not really, except just say that muscle balance is always helpful. Okay,
Speaker 4: So folks who are doing one type of exercise exclusively,
Speaker 4: you know, we really try to focus them on more
Speaker 4: than one exercise and becoming a fit all around and
Speaker 4: having a balanced musculature.
Speaker 1: I like the idea that if you are exercising and
Speaker 1: you are more fit, you'll save money on knee surgeries
Speaker 1: later because they're not cheap.
Speaker 4: True.
Speaker 1: I guess I guess I'll go for a walk because
Speaker 1: I'd rather buy a boat than knee surgery. Okay, great
Speaker 1: question here. Mark Ship wants to know do allographs bone
Speaker 1: tendon bone graphs particularly remain the standard of treatment for
Speaker 1: torn acls are their new technologies on the forefront. Also,
Speaker 1: so many people have fml acls or loved ones who
Speaker 1: have snapped theirs, including question askers Mofo, Margaret Shephard, Jennifer Green,
Speaker 1: Malia Holland, Dream Tree, Calli Girl, Nolan Childerhose, Pam Carry, Constantino,
Speaker 1: and Keenan Day. So they all wanted to know about
Speaker 1: ACL surgery. Many folks asked about donor tissue aka allographs
Speaker 1: versus autographs, like Patron Kelly Olsen who has a donor tendon,
Speaker 1: and Aaron Sandfold. So yes, grafting human tissue was a
Speaker 1: big question. And Anna Rubino wants to note does the
Speaker 1: body reject cadaver tendons and if no, why not? And
Speaker 1: if yes, are there anti rejection meds needed? Because if
Speaker 1: you get a transplant of anything else, you'd have to
Speaker 1: worry about your body saying get out of here, right.
Speaker 4: So that's a great series of questions. Okay, So let's
Speaker 4: start with the first principle Number one, donor tissue. The
Speaker 4: person's asking about allographs and bone put teller tendon bone allographs.
Speaker 4: So when you tear your ACL, we have a choice
Speaker 4: of which tissues to replace it with. We can use
Speaker 4: your own tissues, your own petiller tendon which is called
Speaker 4: a bone, putillar tendon, bone, your quadriceps tendon, or your
Speaker 4: hamstring tendons. Each of those tendons that requires a second surgery.
Speaker 4: So we're robbing Peter to pay Paul. We're producing a
Speaker 4: second injury to repair the first injury. And intuitively, I
Speaker 4: think that's a terrible idea. I did it for the
Speaker 4: first half of my career because that's all we had.
Speaker 4: But then what happened about fifteen years ago is that
Speaker 4: tissue banks got very very good at providing donor tissues.
Speaker 4: So unfortunate's usually a donor cycle. Somebody has fallen off
Speaker 4: their motorcycle at a young age and has donated their tissues.
Speaker 4: So then once we have tissues that have been tested
Speaker 4: so we know they're not contaminated and that they've not
Speaker 4: been irradiated, so have just fresh frozen tissues, and we
Speaker 4: can then use them instead of taking the tissues from
Speaker 4: the patient's own body. And these days we can add
Speaker 4: growth factors and sided kinds to stimulate stem cell derived
Speaker 4: cells to migrate into them and accelerate the healing. So now,
Speaker 4: when we rebuild knees, our preference is to use donor tissue. However,
Speaker 4: there is some data to say that their rerupture rate
Speaker 4: of donor tissue is higher than the rerupture rate of
Speaker 4: normal tissue of the patient's own tissue, and the reason
Speaker 4: for that probably is the wide variety of donor tissues
Speaker 4: that are there. There is no rejection and the reason
Speaker 4: for that is that since the tissue is dead, there
Speaker 4: are no live cells to stimulate, another part of the
Speaker 4: rejection phenomenon. When you get a heart transplant or a
Speaker 4: kidney transplant, we have to keep that tissue alive. Therefore
Speaker 4: you have all those live cells and therefore you need
Speaker 4: anti rejection drugs. In orthopedics, we have the luxury of
Speaker 4: having dead tissue which we then want to recreate to
Speaker 4: be live. But we want it to be live with
Speaker 4: your own cells, so we don't have a rejection phenomenon.
Speaker 1: Is it vascularized at all?
Speaker 4: Not at first? We have to stimulate the blood supply
Speaker 4: to grow into it, which is part of those growth
Speaker 4: factors inside of kinds.
Speaker 1: And how old usually is that tissue? Is it usually
Speaker 1: a recent donation or are you able to flash freeze
Speaker 1: it and keep it until it's appropriate for a certain patient.
Speaker 4: Yes, the tissues are fresh frozen. We only use tissues
Speaker 4: from people under forty years of age and healthy. But
Speaker 4: there's always a shortage of good tissues for orthopedic donation,
Speaker 4: and so everybody, if they can, should check off that
Speaker 4: little box and their driver's license saying they're willing to
Speaker 4: be a donor if they unfortunately have an accident. But
Speaker 4: for orthopedic tissues, we only use them from people under forty.
Speaker 1: And it seems like there's it's really appreciated by the
Speaker 1: donor's family to hear from someone who has gotten a
Speaker 1: tissue and to say thank you for this donation, thanks
Speaker 1: for facilitating it. This allows me to do to get
Speaker 1: back to my activities and things like that.
Speaker 4: It's a real gift. And I wish in our country
Speaker 4: we had what's called an opt in or opt out,
Speaker 4: where right now you have to opt in to become
Speaker 4: a donor, and it would be so much better if
Speaker 4: you had to opt out. And the reason is people
Speaker 4: would not do it and they would forget to do it,
Speaker 4: and then everybody would basically be a donor unless they
Speaker 4: chose not to be, and that would solve the tissue
Speaker 4: supply problem in the United States.
Speaker 1: Also, how cool would it be if you're dead but
Speaker 1: then you're also winning Olympic medals. There you go, You're like,
Speaker 1: might need and did that? So Doctor Stone told me
Speaker 1: that so many lives are changed and saved by tissue
Speaker 1: and organ donation, and that motorcyclists are one of the
Speaker 1: more common causes of fatalities for the donors, so much
Speaker 1: so that some people call really fast motorcycles donorcycles. And
Speaker 1: I have never heard that term, and I certainly understand
Speaker 1: why many people would have a harsh reaction to it.
Speaker 1: And I asked Jarrett, who both has a donor ligament
Speaker 1: and has ridden motorcycles for years, and he said that
Speaker 1: acknowledging the risks that come with riding and the potential
Speaker 1: anguish that can follow those risks is a reality kind
Speaker 1: of deserves to be acknowledged. Riding is scary and risky,
Speaker 1: and I went to go look into this. I was
Speaker 1: reading a comment thread on Reddit in a motorcycle group
Speaker 1: about the term donor cycles, and one writer wrote, in
Speaker 1: the UK, bikes makeup one percent of road traffic but
Speaker 1: are involved in twenty percent of incidents where someone is
Speaker 1: killed or seriously injured. No one buys a bye to
Speaker 1: be safe, they wrote, Although there are some economic benefits parking,
Speaker 1: my point is if you can opt in the rest
Speaker 1: of us to save a life.
Speaker 4: Do it.
Speaker 1: And thank you to any family who's facilitated tissue an
Speaker 1: organ donation from a family whose lives were changed by it. Seriously,
Speaker 1: and patron and philosopher Ali Rosser asked, why use cadaver
Speaker 1: ligaments when we could be making super jumpers or runners
Speaker 1: by using cheetah or kangaroo ligaments instead, And that's a
Speaker 1: good question. Sure they're working on animal transplants and Ali Rosser,
Speaker 1: you're not going to swoop in and steal a gold
Speaker 1: medal with any kangaroo upgrade just yet.
Speaker 2: So just take a seat.
Speaker 1: And if you're Michael Schwartz, take a seat too, because
Speaker 1: you deserve a break.
Speaker 4: Oh yeah.
Speaker 1: Michael Schwartz had a great question, what can workers that
Speaker 1: stanned all day do to protect their knees? Michael has
Speaker 1: inserts which seems to help, but they want to know
Speaker 1: more so if you have an occupational kind of hazard,
Speaker 1: how can you make your knees happier?
Speaker 4: Super good question. So number one shoewear. Of course, having
Speaker 4: good shock absorbing shoewear is important. If you're using orthotics,
Speaker 4: try to avoid this hard, stiff, carbon fiber orthotox because
Speaker 4: basically Nike and everybody else spent tens of millions of
Speaker 4: dollars designing these very cool shock absorbing souls, and then
Speaker 4: you go and put the street on top of it.
Speaker 1: When you put apart arthotic, I didn't think.
Speaker 4: Avoid those hard orthotics. That's number two. Number three moving
Speaker 4: and exercising, so don't stand still. Really see if you
Speaker 4: can move around all the time. Number four, we do
Speaker 4: recommend people use glucosemine because they feel less stiff. Number
Speaker 4: five Exercising in the morning before you go to work,
Speaker 4: getting the blood float going. It really does seem to
Speaker 4: help a lot of people. And trying to get on
Speaker 4: a bike, spinning, doing whatever you can to get motion going.
Speaker 4: So these are the key things optimizing your weight, of course,
Speaker 4: building your strength. These are how you protect your knees.
Speaker 1: How do you feel about treadmill desks?
Speaker 4: I think anything that induces people to move is helpful.
Speaker 4: Sitting is the cigarettes of the twenty first century. True.
Speaker 1: How do you feel aout high heels?
Speaker 4: I love high heels.
Speaker 1: Like do they make you a lot of patience?
Speaker 4: They actually don't.
Speaker 1: Okay.
Speaker 4: The foot doctors, you know, see the bunions which I
Speaker 4: don't see, but we don't really see knee injuries or
Speaker 4: ankle injuries from my heels.
Speaker 1: Okay. A few people had questions about Pateller instability. Hope
Speaker 1: wants to know why does your patella float like that.
Speaker 1: They used to be a ballerina and something that happened
Speaker 1: not infrequently with someone would grab their kneecap instead of
Speaker 1: legs and it would just like move. My niece also
Speaker 1: has pateeller instability and had to get some surgery and
Speaker 1: is still like still dislodges. Gaelic Pearl wants to know
Speaker 1: why knee caps dislodge. What's happening there?
Speaker 4: So that's a really big question because a kneecap can
Speaker 4: dislodge from reasons starting at the low back down to
Speaker 4: the feet, and the angle of your hips, the angle
Speaker 4: of your bones, the way you stand. All of those
Speaker 4: things affect the angle of the kneecap in the trochlear
Speaker 4: or the groove of the femur. Picking your parents back
Speaker 4: is one of the other ways. So if your parents
Speaker 4: have given you genes that cause either shallow grooves or
Speaker 4: hyper mobility of the collagen call airlos danlos disease. Where
Speaker 4: people are much more flexible than others, then they'll have
Speaker 4: more mobile kneecaps. Almost all of my ballet answers fit
Speaker 4: on some scale of hypermobility, and they all have quite
Speaker 4: mobile kneecaps, and unless they dislocate them, then they're not
Speaker 4: a problem. Usually, when the kneecap dislocates, though, that means
Speaker 4: you've torn the key ligament called the medial pateelephemeral ligament,
Speaker 4: because you can't get the kneecap out of the groove,
Speaker 4: usually without really badly stretching or tearing that ligament. Unfortunately,
Speaker 4: these days we've got a very good repair technique for
Speaker 4: that ligament and can put the kneecap back where it belongs.
Speaker 4: But again, if you've chosen your parents badly and you
Speaker 4: have very shallow chrochlear grooves, you may dislocate again and
Speaker 4: so got to get pick and better, Gotta pick them better.
Speaker 1: What about in ballet? Do people with hyper mobility tend
Speaker 1: to be the ones who succeed in ballet? Or does
Speaker 1: it happen over time.
Speaker 4: So I don't think that there's a correlation between hypermobility
Speaker 4: and ballet success. Ballet success is a magical interaction between
Speaker 4: artistry and physical ability. Very early on, when I started
Speaker 4: caring for ballet dancers in the late eighties, they were
Speaker 4: all smoking and terrible diets and influenced by Balanchine and
Speaker 4: not particularly cross training at all. Fortunately, the entire sport
Speaker 4: and art of ballet evolves so that we can now
Speaker 4: treat the dancers as athletes, not just artists. And so
Speaker 4: they can train as athletes, they can do cross training,
Speaker 4: they can optimize their diet, we got rid of the cigarettes,
Speaker 4: and by cross training they can jump higher, land better,
Speaker 4: diminish their injury rate, come back from injuries faster, and
Speaker 4: so I think those are more important factors than their
Speaker 4: mobility status and their sense of artistry cos their success
Speaker 4: as well.
Speaker 1: And if you're like, I'm sorry, I grew up watching
Speaker 1: a lot of Threes Company reruns and not ballet. Who
Speaker 1: is Balanchine? Well, I googled that for us, and he
Speaker 1: co founded the New York City Ballet and also married
Speaker 1: a bunch of his dancers, including one who was sixteen.
Speaker 1: So I'm guessing kind of weird culture around that scene,
Speaker 1: not a super healthy or save vibe. But hopefully times
Speaker 1: have changed. And yes, patrons hope Patricia den Lindsay Mixer
Speaker 1: who have been ballet answers, I hope that you are
Speaker 1: plas taking care of your niece. Please. Okay, this next
Speaker 1: one is a great question. It was also on the
Speaker 1: mind of Edgar Barrera and I'm sure a lot of
Speaker 1: us out there who are like I never want to
Speaker 1: have knee surgery.
Speaker 2: Thank you so much.
Speaker 1: I thought this was a great question. Jolin Bloom wants
Speaker 1: to know what is the best way for an overweight
Speaker 1: person to protect their knees while exercising to lose weight.
Speaker 4: It's a great question, and we have, you know, counts
Speaker 4: lots of patients over the years on how to get
Speaker 4: to their optimal status. I think most people, and if
Speaker 4: they have access to a pool, that it's a great
Speaker 4: way to train. You don't have to be a swimmer,
Speaker 4: just walking pool laps. If you walk side to side
Speaker 4: in a swimming pool and walk twenty laps, and every
Speaker 4: day you walk side to side and chest deep water
Speaker 4: a little bit faster than you did the day before,
Speaker 4: you'll have a great cardiovascular workout, also doing any of
Speaker 4: the other exercises, and particularly I think the best single
Speaker 4: thing to do is to get a trainer. It's just
Speaker 4: very hard to exercise hard enough to change your intrinsic habits.
Speaker 4: And yet if there's somebody watching you and pushing you,
Speaker 4: you'll go harder than you normally would. They don't have
Speaker 4: to be superb, they just have to push you and
Speaker 4: it has to be an appointment that you can't miss.
Speaker 4: And so if you do that, you'll reduce your weight,
Speaker 4: to choose water as your primary beverage, diminish the carbs,
Speaker 4: and really change your diet in life.
Speaker 1: And save money on these surgeries. I mean, you're going
Speaker 1: to stay in business no matter what. And so if
Speaker 1: paying a personal trainer feels lavish, maybe consider it a
Speaker 1: health investment that'll pay back so much, including a boost
Speaker 1: in mental health and endorphins longer life. And I just
Speaker 1: looked it up and according to lessons dot com, personal
Speaker 1: trainers start around twenty five to fifty dollars for a
Speaker 1: half hour session, maybe seventy dollars for an hour session
Speaker 1: or more depending on what city you live in. Group
Speaker 1: classes can be under ten bucks or if you're able
Speaker 1: to safely join a gym. There are group class schedules.
Speaker 1: There YouTube has so many free workouts. There are even
Speaker 1: Twitch streamers who are dedicated to free live group lessons.
Speaker 1: And need I remind you of how much knee surgery
Speaker 1: costs in America. At a pocket it costs more than
Speaker 1: like four used preuses. And Jarrett, who partly blames his
Speaker 1: torn acl from being unconditioned from not working out during COVID,
Speaker 1: says that kettlebell swings are really good for conditioning without
Speaker 1: putting a lot of strain on your knees. If you're
Speaker 1: looking to up your muscle mass and sharpen your bio
Speaker 1: mechanic bod so get those pits, sweaty all your pits.
Speaker 1: Leah and Natasha bars need to know if there's a
Speaker 1: name for the back of the knees. Natasha says, if
Speaker 1: it's knee or leg pit, I'd rather not know what
Speaker 1: is the armpit of the knees.
Speaker 4: Well, in the back of the knee is what we
Speaker 4: call the posterior capsule, okay, but most people notice it
Speaker 4: when they injure their knee and they get some swelling.
Speaker 4: There called a Baker's cyst, and that's fluid that tracks
Speaker 4: out from the injured part inside the knee has nowhere
Speaker 4: to go, so it pushes out the back and causes
Speaker 4: swelling at the back of the knee.
Speaker 1: Ooof so posterior capsule internally or pop lideal fossa. But
Speaker 1: in non doctor terms, and you can throw this out
Speaker 1: there when a holiday dinner gets awkward and you need
Speaker 1: there to be words near. The official word for a
Speaker 1: knee pit is a huff like huff hough like I
Speaker 1: want to smell sexy. I just dab a little Chanelle
Speaker 1: number five on my houffs. Okay, mar Rosenblum wants to know,
Speaker 1: And I don't know if we cover this. I know
Speaker 1: that I asked, but I'm not sure if I asked
Speaker 1: it about this in particular. They say I had a
Speaker 1: torn meniscus and didn't need surgery, but others I know
Speaker 1: with similar injury did, So why do some people have
Speaker 1: to be surgically fixed?
Speaker 4: It's a good question. If the meniscus is torn, it
Speaker 4: no longer is functioning the same way it did before
Speaker 4: it was torn, so it's not absorbing the force and
Speaker 4: distributing it the way a normal meniscus is. So people
Speaker 4: usually get it repaired when it starts catching or producing pain.
Speaker 4: But the question is should it be repaired even if
Speaker 4: it's not catching or producing pain. And fundamentally, there's no
Speaker 4: other key structure in the body that we let become
Speaker 4: dysfunctional and just ignore and hope that it won't cause
Speaker 4: a problem, because they almost always do cause problems. And
Speaker 4: so what we're learning is that the meniscus is a
Speaker 4: critical structure. It needs to be repaired or repla placed
Speaker 4: or the knee is doomed.
Speaker 1: So says someone without a meniscus who launched a knee empire.
Speaker 1: People need to recognize how important meniscus is. Correct good
Speaker 1: to know. I'll hail the meniscus, As Alina Bittencourt says,
Speaker 1: what's physically happening when knees lock up? And is there
Speaker 1: a way I can prevent it? I'm tired of tripping
Speaker 1: while walking hole.
Speaker 4: Yes, So locking is one of the key mechanical signs
Speaker 4: that we listen to, and we're talking to a patient
Speaker 4: because most of the time we can make the diagnosis
Speaker 4: of what's wrong with the patient's knee just by listening
Speaker 4: to the patient. Amazing doctor listens to patients, right, But
Speaker 4: it's invariably true. If the patient tells you that their
Speaker 4: knee is locking, it means that something is getting caught
Speaker 4: between the femur and the tibia. Most commonly that something
Speaker 4: would be a torn meniscus, but it can also be
Speaker 4: a loose body It can be a chunk of scar tissue.
Speaker 4: It means something that blocks that knee from flexing and
Speaker 4: extending normally, and generally we pay attention to that. And
Speaker 4: so if you're having locking, it's worth doing an MRI,
Speaker 4: doing a careful physical exam and figuring out exactly what's wrong.
Speaker 1: So it's time to see a doctor. I perhaps yes, haha.
Speaker 1: And patrons Asia Yeger, Jeffrey Bradshaw, and Jeff Swan all
Speaker 1: have this question. Jess asks, why shouldn't you lock your
Speaker 1: knees while standing? Number one? Not great if you've got
Speaker 1: a tissue stuck in there, like beef jerky between molars.
Speaker 1: But also I looked it up and locking your knees
Speaker 1: while standing could invite orthostatic or postural syncope. That's when
Speaker 1: you cut off circulation and you pool blood in your
Speaker 1: lower extremities and then boom, timber, we got a piper down.
Speaker 1: Not fun? Are we talking too much shit on knies.
Speaker 1: Last listener question, Yoga mel, I want you to address
Speaker 1: this question and tell me if you agree with it.
Speaker 1: They say, why do knees suck so bad? Seriously, the
Speaker 1: engineering sucks, evolution couldn't make them better. Do you agree
Speaker 1: that knees suck and the engineering is bad? Or do
Speaker 1: you think that we just are we living too long?
Speaker 1: Because I would definitely be dead right now if there
Speaker 1: weren't for technology and indoor plumbing and heating and medicine.
Speaker 4: So I think knees are brilliant inventioned. Again, as I mentioned,
Speaker 4: if you don't injure them, they can last forever. You
Speaker 4: know what else is five times as slick as ice
Speaker 4: and ice? What else can take millions of cycles per year?
Speaker 4: What else generally doesn't cause a problem unless you injure it.
Speaker 4: So is it the knees that or is it the people?
Speaker 4: So the fact is that we are all pushing harder,
Speaker 4: we're doing more extreme sports, we're playing harder, we're playing more,
Speaker 4: We're exposing our body to higher levels of risk. And
Speaker 4: so if you're going to do that, you have to
Speaker 4: train for that risk, you have to prepare for it.
Speaker 4: You have to try to prevent it if you can.
Speaker 4: The most common cause of an injury to the knee
Speaker 4: is a mental error. Oh nice, so my skiers, we're
Speaker 4: just we're not paying attention for the moment, or we're
Speaker 4: going too fast. Somebody on a soccer field was thinking
Speaker 4: about their girlfriend or boyfriend or whatever. It's the mental
Speaker 4: gap when you make the move that you know you
Speaker 4: shouldn't have made. And if we can train both our
Speaker 4: bodies and our minds to be in the moment in
Speaker 4: the sport, not on your cell phone, and really be there,
Speaker 4: then you'll dramatically diminish the number of injuries that occur.
Speaker 1: So the knees don't suck.
Speaker 4: The court finds the defendants not guilty.
Speaker 1: What about your work does suck? What's the worst aspect
Speaker 1: of being one of the top surgeons in the world,
Speaker 1: or what do you hate the most about knees or
Speaker 1: recovery or having to have your own knee surgery?
Speaker 4: The worst part is scar tissue. So we're driven to
Speaker 4: figure out how not to let people form scar because
Speaker 4: after injury, the body lays down disorganized collagen and that's scar.
Speaker 4: You look at your skin when you cut it, you
Speaker 4: form scar, and our job is to figure out how
Speaker 4: to induce the body to lay down collagen along the
Speaker 4: lines of stress so that the tissues look healthy, the
Speaker 4: ligaments look healthy, the knee has a full range of motion.
Speaker 4: So scar tissue and the loss of joint motion is
Speaker 4: our number one bugaboo. It's a thing that keeps us
Speaker 4: up at night. It's the thing I'm trying so hard
Speaker 4: to solve in our research. And so as we figure
Speaker 4: out which injections to give to people, a big part
Speaker 4: of figuring that out is which are the most potent
Speaker 4: anti fibronic injections, What will induce the least amount of scar,
Speaker 4: what will diminish the scar, How you help that patient
Speaker 4: keep their range of motion.
Speaker 1: So you want your body to not do a sloppy
Speaker 1: patch job after an injury. And if you would rather
Speaker 1: buy a very expensive stay in a bungalow over the
Speaker 1: turquoise blue sea instead of knee surgery, well treat them
Speaker 1: right when you got them, use them.
Speaker 2: Drink water. Protein is your friend.
Speaker 1: Ask yourself not what your knees can do for you,
Speaker 1: but what you can do for your knees, and if
Speaker 1: you love it, loupit.
Speaker 4: One of the things that's dramatically diminished knee surgery for
Speaker 4: my patient is that they come in now and get
Speaker 4: a joint lube. And so once a year, many of
Speaker 4: my skiers, sometimes twice a year, will come in. They'll
Speaker 4: have tremendously arthritic knees. On X ray, they look like
Speaker 4: they should have a knee replacement. And yet each year
Speaker 4: I've given them a combination of hyaluronic acid, the natural
Speaker 4: lubricant of the joint, and growth factors these days from
Speaker 4: PRP or used to be from birth tissues, but right
Speaker 4: now the FDA has put a pause on that until
Speaker 4: further studies are done. So we combine these growth factors
Speaker 4: with the lubricant, and in many patients they get six
Speaker 4: months to a year of tremendous relief and they say
Speaker 4: to me, hey, doc, I'll let you fix my knee
Speaker 4: when those injections stop working. And so that is one
Speaker 4: of the great ways in which we're diminishing the role
Speaker 4: of knee surgery and permitting just by better lubrication, better
Speaker 4: growth factors, better recruitment of the body's repair cycle, we
Speaker 4: can diminish the rate of knee surgery for so many people.
Speaker 1: That's got to be rewarding to watch too. What is
Speaker 1: your favorite thing about what you do?
Speaker 4: Oh, seeing somebody go back to the sport they love. Yeah, sure,
Speaker 4: it's such a thrill. The surgery is fun. I love
Speaker 4: doing s love repairing things that are broken, but I
Speaker 4: most love seeing the patient return better than they've ever been.
Speaker 1: Well, it seems like your patient's success rate is really high,
Speaker 1: so that must be something that continues to reward you
Speaker 1: like that, and you're great at it. I mean we
Speaker 1: when Jarrett came up to see you, it was like,
Speaker 1: of course you were the first person he was going
Speaker 1: to come see. But we came up from LA to
Speaker 1: see you. And when it came to who is going
Speaker 1: to do the surgery, it's like, well, we've just got
Speaker 1: to be up there for a couple of weeks to
Speaker 1: do pet. There was just like no question about it.
Speaker 1: So I'm happy that I could sequester you on a
Speaker 1: bench and ask you all these questions.
Speaker 4: Happy to help you anytime.
Speaker 1: Thank you so much for doing this. Thanks for being such.
Speaker 2: A great doc.
Speaker 4: Doc my pleasure.
Speaker 1: So ask smart people creaky, bendy poppy questions, because you'll
Speaker 1: never bend your knees the same. You'll say, hey, good job.
Speaker 1: If you want to know more about Kevin Stone. His
Speaker 1: website is linked in the show notes Zone clinic dot com. Also,
Speaker 1: you can find us at aliward dot com slash Ologies.
Speaker 1: There'll be a link to this episode in the show
Speaker 1: notes as well. We are on Twitter and Instagram at Ologies.
Speaker 1: I'm at both at ali Ward with one l. Thank
Speaker 1: you to Aaron Talbert who admins the Facebook Ologies podcast group.
Speaker 1: Thank you to Shannon and Bonnie who handle our merch.
Speaker 1: Transcripts are by Emily White of the Wordery. Bleeping is
Speaker 1: done by Caleb Patten and those are available for free.
Speaker 1: The transcripts and the Bleeped episodes at aliward dot com,
Speaker 1: slash Ologies dash extras linked in the show notes. Thank
Speaker 1: you to Noel Dilworth for scheduling and Susan Hale also
Speaker 1: handles so much Ologies business. Smologies episodes are out every
Speaker 1: two weeks. They're clean in classroom friendly. Thank you Stephen
Speaker 1: Ray Morris and Zeke Rodriguez Thomas for working on those.
Speaker 1: Nick Thorburn wrote and performed the theme music. Thank you
Speaker 1: to Jared Sleeper, husband pod Mom, Knee Surgery Survivor, and
Speaker 1: the whole Muse for this entire episode. I'm glad we
Speaker 1: all know about nies. If you listen to the end
Speaker 1: of the episode, I tell you a secret and number one,
Speaker 1: there's so many long asides in this I went down
Speaker 1: way too many rabbit holes, and I didn't even include
Speaker 1: the fact that your elbow pit is called a chi
Speaker 1: leiden and it's named after a swallow bird. Also, I
Speaker 1: have been adjusting my brain meds and it has not
Speaker 1: been easy. So stay tuned for an episode on ADHD
Speaker 1: wherein you might learn a little bit something about that
Speaker 1: and whether or not I have recently been grappling with
Speaker 1: a diagnosis of that. We'll learn more. But if you're like, hey,
Speaker 1: why have the last two episodes been up a day
Speaker 1: or two late? Pops is struggling, but it's gonna get
Speaker 1: better anyway, Thank you for being here. Episodes will be
Speaker 1: up on time in the future probably, Okay, bye bye.
Speaker 4: I used to be an adventurer like you. Then I
Speaker 4: took an arrow in the knee.
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