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

In this women’s health and fitness episode, orthopedic surgeon Dr. Jocelyn Wittstein breaks down how women can protect, strengthen, and maintain joint health through every stage of life. We explore the powerful connection between estrogen, inflammation, bone density, muscle mass, and recovery, especially during perimenopause and menopause. Dr. Wittstein shares expert strategies for training smart for joint longevity, including how to modify workouts for joint pain, improve mobility and flexibility, and build strong bones and resilient muscles with strength and impact training.

We also uncover what the latest science says about collagen supplements, arthritis prevention, and how hormonal changes influence joint stability and injury risk. Whether you’re navigating midlife, recovering from joint pain, or simply want to stay strong, mobile, and active, this episode will help you optimize your training and longevity through smarter, evidence-based strategies.

Episode Transcript

Speaker 1 (00:00):
Hi everyone. My name is Haley and this is Laura
and welcome to the Body Pod. Doctor Joscelyn with Stein.
Welcome to the Body Pod. It is an honor to
have you here. I've been counting down for this episode.

Speaker 2 (00:21):
Oh well, thanks for having me. And you got my
last name right without even asking.

Speaker 1 (00:26):
I figured it was fifty to fifty. I was like,
I'm going with Stein and that's how I it.

Speaker 2 (00:31):
But you got it.

Speaker 1 (00:32):
Yeah, obvio starting off on a great note.

Speaker 3 (00:36):
Yeah, okay, Jocelyn, can you share a little bit about
your journey from collegiate athlete to orthopedic surgeon?

Speaker 2 (00:48):
Uh? Sure, I mean I think most orthopedic surgeons will
tell you sports are like the gateway drug to orthopedics.
It's just kind of it's a little bit of a joke, like,
you know, most orthopedic surgeons or some sort of athlete
at some point. But I do think that people who
have a history of participating in sports have some like

(01:09):
ongoing appreciation of muscle skilledal health and preserving muscle skilledal function,
and like, personally, I'm a subspecialist in the field of
sports medicine, but even my partners, who are people who
are you know, replacing joints and not preserving those joints,
but replacing them are preserving people's function. And I think
anyone who's been an athlete in the past just has

(01:31):
that desire to keep people physically functional, or they're just
aware of how important that is, you know, to the.

Speaker 4 (01:39):
Mind and body, so to speak. You know, so, yeah, absolutely, yeah.
So did you know you wanted to be a doctor
from early on? Were you file?

Speaker 2 (01:50):
And you know, I actually graduated from high school and
remember saying, oh, I'm so happy, I'll never take another
science class again, which is hilarious because I now do
a lot of clinical and basic science research, and I
you know, I'm an orthopedic surgeon. But you know, when
you're younger, my dad was a doctor is still he's

(02:11):
an ophthalmologist. And I just kind of decided I didn't
want to be a doctor. Maybe I don't know, maybe
because he was I'm not sure, but I just kind
of wasn't the thing I was going to do. And
then in college, I study nutritional science and I just
I love that, but I still liked anatomy and things
like that, and so I kind of gravitated to science anyway,
and Ultimately, I went to medical school thinking I wanted

(02:37):
to be a pediatrician. I love kids, but then I
realized I didn't like that field. It was either kind
of sometimes boring or just kind of you know, well,
child visits or really sad. And I really loved procedures
and doing things and selfishly, I mean, I will say,
I think primary care is incredibly challenging, and primary care

(02:59):
doctors are so and work so hard, but I couldn't
do what they do. It's just so much. So much
of it is trying to change maybe people's lifestyles or
modify things with medications when you can, but like it's
just there's not that same, maybe somewhat selfish gratification of
making people better by fixing things that you can fix.

Speaker 1 (03:22):
Nothing wrong with that.

Speaker 2 (03:23):
Yeah, And so I think most orthpeedic surgions will tell
you they really like helping people be more functional and
that is really rewarding. And it's so important for people
to be able to continue to move and exercise as
they get older. And we can't fix everything, you know,
not everything has a surgical solution, and tons of things

(03:44):
in orthopedics are actually treated nonoperatively, like probably more things
are treated not operately than operaately actually, but we can
also help people, you know, with those things too. So
it's a pretty gratifying field and I feel lucky to
have found my way into it. And uh, just you know,
I always say sometimes being a doctor is a little

(04:07):
bit like parenting. They are frustrating moments for wondering what
you're doing, uh, and then there are like really really
rewarding moments like being a parent, Like the frustrating ones
and the really rewarding ones that just totally continue to
keep you in it.

Speaker 1 (04:25):
So Lara's experiencing that right now.

Speaker 3 (04:32):
Of children, though you have five, correct, Yeah.

Speaker 2 (04:37):
Their profiles are randomly behind me. Actually, and those what
are you called? I actually know what that's called. One
of our kids actually made that little silhouettes of our family.
But yeah, so you know, you never know what life
brings you. I I totally thought I was going to
just go do my career and graduate from college and

(05:01):
then go to med school and then be a surgeon
and be very you know, academic, academic productive, and I
just I didn't like have marriage and children kind of
at the forefront of my mind. But then I met
the perfect person who also was a widower with three
kids and who were five, eight, and eleven at the time,

(05:22):
and then I married him and them, and then we
had two more kids while I was in North during
my residency. So we have five kids. But I I
didn't have to be pregnant five times. I've just you know,
I carried two kids during my residency added so we
have three plus two, so we have five. And yeah,

(05:43):
that's our busy, busy household. Yeah, and my husband is
also an orthpeedic surgeon, so none of our children want
to be doctors. Yeah.

Speaker 1 (05:56):
Yeah, that's always interesting to see what they choose. Yeah, well, okay,
I want to talk about specifically midlife women since that's
really our area of interest here. So as we know
these from an orthopedic surgeon side, we know that as

(06:17):
estrogen starts to decline that all of these other things
kick up in this perimenopause postmenopause phase of life. I
see it from the strength training aspect with the frozen
shoulder and and just the niggles that kind of come
with the muscular skeletal syndrome of menopause. But how does that,

(06:37):
how does estrogen levels play a role in all of this?

Speaker 2 (06:42):
Yeah, So it's really multifactorial. I think, like we know
from animal and human studies that in the absence of
ester dial whether you've had your over is removed, or
you've gone through natural menopause, or you're taking medications blocking
the effect of you know, estrogen, you're in a more

(07:02):
inflammatory state. There are cytokines, you know, inflammatory markers that
are more elevated in that state. On there are estrogen
receptors of course throughout the body, on your muscles, on
the lining of your joints, on your cartilage surfaces, in
your bones, and all of these things are impacted. Then,
so you have like a more elevated and inflammatory state.

(07:25):
You don't have the sort of muscle repairing and maintenance
effects of estrogen, so it's harder to maybe build or
maintain muscle, and you lose some muscle mass. That of
course affects your metabolic health some You have osteoclasts, which
are the cells and bone that generally break down bone.
Being like living longer, they're they're not being inhibited by

(07:48):
the estrogen, and so there's more breaking down a bone
than there is buildings. So you have some accelerated bone
loss in menopause, you know, more like two percent bone
loss per or as compared to one percent prior to that.
And then in your joints you get the greater level
of inflammation, which ultimately you know, plays out and women
over fifty having a much greater chance of having arthritis

(08:09):
than men over fifty, especially in the knees because you know,
the cartilage gets thinner faster, the lining of the joint
is more likely to be more inflamed. And then in shoulders,
which is a long time area of interest and research
for me, of course, frozen shoulder is almost not exclusively,
but very much disease of women between the age of

(08:30):
forty and sixty. And we know that the lining of
the shoulder joint has estrogen receptors. We know that estrogen
inhibits cells called fibroblasts that thicken and stiffen the capsule
of the joint, you know, so we know that at
this point, I think it's pretty well accepted that frozen
shoulder is also adhesive catslitis is a condition of perimenopause

(08:52):
and menopause. So that's a very long answer to your question.
But all those things are kind of you know, going on.

Speaker 1 (09:00):
Okay, so I'm going to tell you something that I
used to believe before I knew what the muscular skeletal
syndrome of menopause was. And I thought as a strength
training coach that you know, a lot of these what
I would call weak links, the rotator cuff, you know,
the foot stabilizers, things like that that women just kind

(09:21):
of neglected, and in most programs they get neglected. So
I just assumed at the time that this was more
weakness from not strengthening some of these muscles that was
kind of kicking up this rotator cuff stuff, which may
be not helping and adding to it. But the role

(09:41):
that that when I learned about this, I was like, oh, okay,
there's more to the story.

Speaker 2 (09:47):
Yeah, I think now also to complicate things, as people
men and women, you know, get to be over the
age of fifty, you could also start to see you know,
rotator cuff tend and partial tears becoming full thickness tears.
But I will tell you I have studied hundreds and
hundreds and hundreds of women with frozen thousands probably a

(10:10):
woman frozen shoulder, and usually when someone presents with a
frozen shoulder, they it's really uncommon to also have a
rotator cuff tear. But they they present very differently, they
act very differently, and I always like, I kind of
think of it this way. It's kind of like, when
you're under fifty and someone has chest pain, you're like, oh,
it's probably not a heart attack, it's screwed whatever. When
you're under fifty and you have shoulder pain, it's probably

(10:33):
not a heart it's probably not a rotator cuff tair.
You might just have some personitis or impingement, or if
you're stiff, a frozen shoulder. But when you get to
be over fifty, you're kind of like, h that could
be a rotator cuff tare, or if you're stiff, you're
likely to be a frozen shoulder. But you know, age
actually has quite a lot to do with our differential
diagnosis of shoulder pain. But so men and women both,

(10:53):
we do start to see, like that's kind of the
first decade where you start to see rotator cuff tears.
But again, the frozen shoulder really starts to crop up
in the a lot more, you know, beginning in the
in the forties, earlier than rotator cuff tears. Wow.

Speaker 1 (11:06):
Okay, so if we're looking at sex differences. You mentioned
some of them that for the knees that men present
these symptoms later on, which is just so par for
the course with everything else. Are there other sex differences
that you see as far as when women present something

(11:27):
and and when men present the same thing.

Speaker 2 (11:30):
Yeah, well, kind of arthritis in general, there are some
studies that I'll kind of like generalize, but like between
the ages of fifteen eighty women kind of have like
in general, like a thirty five percent greater chance of
experiencing arthritis. That risk is most. That difference is really
I would say most pronounced in knees, maybe followed by hands.

(11:52):
It's not as big and hips that difference. But the
knee joint is like I think one of the most
disparately you know, ack to joints for some reason. I mean,
I see so many women in their fifties with it's
like clockwork sometimes. I mean I think I was in
clinic last week and I had like five fifty two

(12:13):
year old women with this knee swelling and you know,
their actually don't look that bad, but they're starting to
get knee spelling. That's activity related, which is in general,
if you're getting knee swelling without an injury. It's just
like activity related. You know, you're kind of maybe doing
the same amount of activity you would normally do, not more,
but you start to see some swelling after the fact
that it is almost always your cartilage talking back to you,

(12:35):
unless you had like a pop like you tore a
meniscus or attorny sale. But in general activity dependent spelling
your knee is really your cartilage being overloaded. It's it's
just not tolerating in whatever you're doing to it. And
so you know, you start to see this creep up
on people and they're like, I didn't hurt myself, Like
you know, what is this? Why can't I do what

(12:57):
I normally do without gett knee swelling? And it's very frustrating,
and we see it all the time. They get an
amri and in generally you may see like a little
cartilage thinning, but it's not like there's like bone spurs
or arthritis on the next ray, and it's probably like
kind of the earliest wear or degrading or softening of
the cartilage, and and like the very earliest form of

(13:20):
earth rates it's not even like the cartilage is any thinner.
It's just that it actually doesn't tolerate stress as well,
and it kind of compresses maybe faster from activity, and
then it doesn't rebound to its normal thickness like it takes.
It needs more time off, right, So you know, I
see that a lot in women in their in the
early fifties for sure.

Speaker 3 (13:39):
So what's your recommendation for them?

Speaker 2 (13:44):
Yes, well, that's that is a good question. You know,
if you back up and look at some of the
early studies of the Women's Health in the Initiative, which
people like to complain about, but they actually collect an
incredible amount of information on tons of women very diligently.

(14:04):
And one of the things you can learn from like
some of the data is that you you know, there
were a lot of women who presented with joint pain
as one of their symptoms of menopause. You know, once
these like seventy seven percent, like almost eighty percent. And
then women you know, treated with hormone therapy that included
esther dial some studies as with progesterone, but nonetheless hormone

(14:26):
therapy had reduction of their you know, number of painful
joints and severity of the joint pain. And then when
they were had that hormone therapy removed, there was like
a rebound effect. Now there isn't any study that shows
yet or ever that being on hormone therapy helps you
be less likely to need a knee replacement someday. But
I don't think we've like studied things at that level

(14:46):
or studied when you should start hormone therapy or like
what dose. We have a lot of information about hormone
therapy and how much it can improve your bone density
and how much it can prevent fractures and reduce all
cause mortality. We have less granular data I would say
about like when you initiate and what type and what dose,
and like how that might impact your cartilage health. And

(15:06):
that is an active area of interest for me. I
collaborate with some of our PhDs on this topic. But
so I think it's not like an FDA indication. It
hasn't been proven, but there's I would say, circumstantial evidence right,
Like there are estrogenmer seppors on cartilage in the lining
of the joint. We have basic science days that show

(15:28):
cinemitis or inflammation of the joint can be ameliorated with
estrogen therapy. We know that women have this divergent like risk,
you know, over fifty of more rapid cartilage than ing
and arthritis. There's probably something about hormone therapy and the
right timing and dose that will ultimately like bend that curve.

(15:51):
That's not a solution for everybody, because not everyone can
use hormone therapy, and of course I have many patients
on aromatase inhibitors who are experiencing increased joint pain, you know,
associated with their necessary treatment. So, but that's one thing.
There are very few things that slow progression of arthritis.

(16:11):
One of them is weight loss. If you have weight
to lose, so losing five or ten pounds will actually
take quite a lot off of your knees and make
them feel a lot better. You know, for people who
are obese, even your non weight bearing joints are more
prone to arthritis, probably because of an inflammatory state. And

(16:32):
that's I think one of the beauties of use of
medications like DLP one medications. At this point, you're not
only helping people lose weight, but you're reducing systemic inflammation
and probably reducing risk of arthritis. And then, you know,
but for people of healthy body weight, if you don't
have like weight to lose, you know, what else can
you do? I think there's reasonable evidence behind collagen supplements.

(16:56):
I think that certainly you can always utilize anti implanmatary medication,
but there's pretty reason levidence for using tumeric as an
alternative if you don't want to be on those all
the time. I think choosing your activities wisely if you're
someone where your activities of choice are causing swelling, like
maintaining strength training exercises, I think that's good to do.

(17:19):
If you are someone if you love to play pickleball,
but every time you play pickleball your nie swells, you're
probably advancing your earthwritis a little bit with every episode
that creates swelling. So you need to either back down
on the dose or duration or something, or find alternative.
So sometimes there's some modulating of like how much of
something you do, how often you do it. You don't
want to like exacerbate things, but you kind of get

(17:41):
into the land of, you know, symptom management, which might
include also different types of injections, PRP things like that.
So we could I could go on and on, but
I don't want to. You guys have questions.

Speaker 1 (17:52):
Well, I was I'm curious, and I'm glad you brought
up Collegeen because we've had lots of experts on the
show that it's ones that are pro and ones that
are against and say it's totally worthless, and other ones
that have done their own research on it and are
on these studies that say, yeah, it's actually been shown
to help with X y Z. So, so you're a

(18:13):
fan of that, you think that it's it's potentially helpful.

Speaker 2 (18:17):
Yeah, I will say I changed my mind about it
probably a couple of years ago, just from I'm constantly
reading studies, and when I was working on in my book,
I just revisited all the literature and went down so
many rabbit holes abound and read so many studies, and
I think that, like the basic science mind that is reasonable.

(18:42):
There isn't a study that shows it like necessarily slow.
It certainly doesn't reverse arthritis, and actually, like to be clear,
nothing actually like reverses arthritis. That's one of the annoying
things about earthritis. Sometimes I tell my patients it's like
gum receession. If you go to the dentist and you
have a little gum recession, it's you're never gonna have
less gummer session. But you'll be happy if someone tells
you it's not any worse the last. If you want it's,

(19:08):
it's going to be there. And it's also not something
you can scrape out. Like there are so many people
that get unnecessary nee scopes for arthritis because they're well.
And I don't want to say that someone is doing
unnecessary surgery, but they they want the surgery or they
end up having the surgery because they have the sense

(19:28):
or belief that arthritis can be scraped out of their knee.
And it's kind of like a double negative. Arthritis is
generalized thinning of cartilage, and you can't remove something that's
missing or thinner, right, we don't have that way of
magically adding back thickness to cartilage everywhere. So collagen studies show,
you know, is basically a lot of them show decreased

(19:51):
downstream breakdown products of cartilage, and meaning like that should
suggest you're kind of maintaining the health of your of
your cartilage more, right, And so I don't think. I
think if someone tells you take this collagen supplement, you're
going to you know, gain more joint space and thick

(20:11):
in your cartilage, Like that's not true, but I think
it does help with maintenance of cartilage health, you know,
maintenance of what you have. And of course, as you
probably know, there's like hydrolyzed and under natured collagen, and
there's also studies on the different types. You know, the
hydrolyzed ones are digestible and absorbable, whereas the you know

(20:32):
U see two, the under natured collagen of type two H,
which is the kind of the primary kind of collagen
that's in our smooth gliding cartilage, it seems to have
like a different effect, like something that is more of
an oral tolerance effect exposure to your GI tract, but
same thing. You know. The measures are like looking at

(20:53):
kind of breakdown products of your cartilage, right, not whether
or not you develop arthritis or not. So no, I
can't say that taking collagen definitely slows the progression of
your arthritis or definitely makes you less likely to even
the replacement later on life. Those studies don't exist, but
some again pieces of scientiic scientific evidence to kind of

(21:15):
suggest to me that that I do think it's beneficial,
and I like to use a collagen supplement that combines
type one and two collagen because I do think there's
also a strong evidence for hydrolyzed type one collagen supporting
bone health. And you know, I kind of just lump
them in together in my coffee.

Speaker 1 (21:32):
And there's never like just a straightforward answer. Most of
the time. It's you know, I love how you explain that,
because it is there's a lot that goes into it
other than just saying yes it helps or no it doesn't.

Speaker 2 (21:44):
Yeah, and I definitely don't think it hurts. So yeah,
so I if you ask, I think it's reasonable enough
that I use it. And then people always ask, like
what collagen do you use? I want and I don't.
I'm never trying to like promote a product, but people
always ask that, so that I tell them what one

(22:06):
I use, but I don't want them to like think
they have to get like that specific one. But I
do like it because it has it does have type
one and type two collagen in it.

Speaker 1 (22:15):
Well, now you have to say what it is because
then we're going to.

Speaker 2 (22:17):
Is healthy bones one, healthy bones, total body one, the
healthy bones, toubtle body. Uh and yeah, and it's it's
really dissolvable and you just put it dissolves. It's sort
of fun to watch. Actually, this is such a strange
thing to say, but just for fun, make a cup
of coffee and then you I heat up my milk
and I like a ton of milk with really strong

(22:40):
coffee because so coffee, I feel like it's like I'm
getting some protein and some calcinum, and coffee has other
good factors. But you just like dump this scoop and
it's like this little white mountain and it literally disintegrates
into it. You barely have to mix it, and it
is weirdly satisfacing to watch. You should try it.

Speaker 1 (22:56):
Okay, I have collagen and it's literally it's sitting in
a cupboard and I never get it out, and every
day I'm like, I should get out. The college bill.

Speaker 2 (23:06):
I think is a good option because people, you know,
like that's something that most people do every day. And
I also think got it done well. Yeah, like it's
there's other great things about coffee too, but I just
it's so easy to add in.

Speaker 3 (23:21):
So I'm with you on that. That's what sold me.
I'm like, now I'm going to be very consistent.

Speaker 2 (23:25):
With my college so slightly smooth. It's kind of weird.

Speaker 1 (23:33):
Well, now you've intrigued me. Now I've got to go
buy I've got to go like, do this whole procedure
and see if it If it's a mesmerizing.

Speaker 2 (23:40):
Is worst thing in the morning, I kind.

Speaker 1 (23:43):
Of I love it, so okay, if we I want
to really dive into These are the questions that come
up all the time jump training. Now, this is how
I found you, and I actually got served up on Instagram.
Laura was just asking me, how did you find Jocelyn?

(24:04):
I said, she got served up? And then I saw
that doctor Vonda Wright followed you and all of these
other leaders in the space and you were doing a
jump of how much impact from you know, you had
your tape measure and you were jumping off of that.

Speaker 2 (24:18):
Well funny, I didn't realize how much that would grab
people's attention. I just yeah, it did. It was a
little Aidens drop jump. And I didn't make this up.
There's a researcher. First of all, we know that impact
creates a stimulus to our bone that increases bone density,
especially at our hips. So like in general, strength training

(24:40):
does a little bit more for our lumbar spine than
it does for our hips, although it does something for
hips too, But the impact training is primarily affects our hips,
and so the specific study of the amount of impact
you get with an aidence drop jump and a rebound
came from a study done by a researcher named Tracy
Klissel her group of the group of researchers she was

(25:03):
working with, and I just wanted to show people like
you don't need a ton of fancy equipment. Like I
was like, look, here's my ruler. It's eight inches. Most
steps are eight inches. And I was just in my backyard,
which is frequently where I make little educational videos, and
I just was like, this is all you have to
do is like jump off this jump and do a
jump landing. And I mean it's kind of like I

(25:25):
think sometimes people don't realize that you have you don't
need a lot of stuff. Sometimes sometimes you do, like
if you want to go do like heavy lifting, which
I also like to do a couple days a week,
but jump training you can do like anywhere, play a
metrics you can do pretty much anywhere.

Speaker 1 (25:40):
Yeah, okay, so we have the jumping and from the
Tracy clistles from her research, she recommends landing with like
a straight lake like not really absorbing the bounce. Is
that more what you were doing or kind of like.

Speaker 2 (25:56):
The softer the knees or the more like kind of
toe to heal, you would be absorbing some of the load,
but you're trying to give drop and then do a rebound,
which actually if you haven't done that in a while,
like so many people just drop and hit the ground
and like don't actually know how to rebound, like a
kind of a pliometric thing. And so I had a
lot of people to write to me, Oh, I forgot

(26:19):
how to do that. And I just think that we
actually people like forget how to skip and yeah pop,
or people forget how to jump rope. And I'm I
don't know. I say I'm immature, but I love doing
like I was a gymnast. I'm always like, this is
a gymnast, and't you coming out? I like doing things.

(26:40):
If I'm at the playground, I do some pullovers, I
do the monkey bars, or I like jumping around. And
but I even I noticed that, like I shared a
few months ago, I almost forgot how to do the
monkey bars with like I almost forgot I hadn't done
it in a long time. It just felt really weird.
But I think jumping is like that. If you haven't
done like a jump luning in, it feels weird and

(27:02):
you forget how to drop into a rebound and so
you could start less than eight inches and try it
or you know, actually that same group did just like
a big squat jump with the rebound and you still
gotta get that effect on the second on that rebound jump.
But I thought it was more visual for people to
kind of do it off of a step.

Speaker 1 (27:19):
So yeah, no, it was great and I love it.
Like I remember this was years ago when my daughter
who's now twenty one, when she was I think in
kindergarten probably kindergarten, and there were monkey bars and at
the time I wasn't doing any lifting. I was doing
triathlon and I just didn't do any lifting with it.

(27:40):
And I tried to do the monkey bars. I thought
my arms were gonna fall, like fall out of the socket.
Like this sucks.

Speaker 2 (27:48):
Its well, says your people don't use their lats very Yeah,
clearly I wasn't.

Speaker 1 (27:56):
It was terrible. So okay, so we have to jump
and then other options so we know that you know
we're looking at and not that osteoporosis doesn't have anywhere else.
But we get tested at the risk that the femoral
neck and then the bark. So so if we're looking
at like the wrist, so if we were doing overhead

(28:19):
you know, a barbell overhead press, we're loading the wrist.
That's one way where we could load the risk. But
what are other ways that you could add more dynamic
to it.

Speaker 2 (28:31):
So I think that people should, yeah, try to load
your wrist.

Speaker 5 (28:34):
Now.

Speaker 2 (28:34):
The funny thing about your wrists, you know, so like
first of all, when you talk about the risk, we're
usually talking about the distal radius the wider bone here.
Of course, there's smaller bones in the actual risk here
in your owl, no small but the thing that people
break is the is the distal radius of note, you know,
like the first peak that we see in distal radius
fractures in women is like actually in the fifties, and

(28:56):
it's kind of like a canary in the coal situation.
Because if you fall like same level fall and break
your wrist, it's a good time to get your bone
density checked because that may mean you have like lesser
bone density in some other places as well. And for instance,
like there are some says that show if you break
your wrists. You have a forty fifty percent greater chance

(29:18):
of having a hip fracture later on than someone who
has never broken the wrist, because it's it's an indicator
maybe of your bone health or maybe your likelihood of fall,
who knows, But so risk fracture can be I always
tell people the silver lining of a risk fracture is
this can be a bit of a wake up call,
like maybe you just have some mastiopenia.

Speaker 1 (29:35):
Yeah.

Speaker 2 (29:35):
Also, it's so often happening to people who are like
in their early fifties, when maybe they're making decisions about
like hormone therapy or not, which is prophylactic against othtproosis.
So not that I want people go around breaking the wrisk,
but like if that happens to you, like take advantage
of that situation, Go get your bone density checked, you know,
pay atenship. But anyway, it's the interesting thing about the wrist.

(29:57):
It doesn't have like a ton of large muscles attacked
like right here. So like, in addition to like impact
strength training, carrying things, putting load across your bone strengthens
your bones. But also just like the tugging and pulling
of large muscle groups will strengthen their remodel bones, like
your deltoid, your biceps, your triceps. But this is kind
of an area where like a lot of tendons and

(30:18):
nerves and vessels cross over. There are some smaller muscles
that attach here that you know, like pronate your wrist
and move some of your fingers, but like they're not
like huge muscle groups. So I actually think if you
you know, wanted to like maybe try to impact your
wrists bone density, that doing some load bearing on it
is good. It could be, as you said, an overhead press,

(30:41):
which of course is part of the liftmore protocol and
also is going to load the rest of your skeleton
because it's you're pressing it overhead. But I like to
encourage people to do planking walk out. I shared a
video the other day of like kind of a drop
onto your arms.

Speaker 1 (30:55):
Yes, I saw that. I loved it.

Speaker 2 (30:57):
Great to do, like you know, like when you're a
gymnasts to like handstand pops. But people aren't gonna run
around doing like little jumps and handstands like a gymnast.
But I love to do handstands. I do them at
the gym against the wall with my seventeen year old son,
but you know you could do so push ups are
load bearing, honestly pushing a lawnmower. Someone suggested the other day, like,

(31:21):
that's some load bearing on your wrist. If you can't
do like, you could do put clap push ups, but
that's a you have to be pretty strong do that.
So you could do that on your knees, or you
just push and then land like a knee push up
where with a push off I kind of showed you
can do like a little drop onto your hands from
a yoga block or someone suggested pt for women on

(31:46):
Instagram suggested doing like a bear walk to drop into
a push up position like a ply a push up.
I love bear walks because that's a core exercise. Beer
also weight bearing. And I love single leg walkouts because
it's like a balance and core thing. You know, you
walk out, you walk back in, or a ball walk
outs with the plio ball. You know you're basically well
that's hard. Yeah. Yeah. I think a lot of the

(32:11):
things I like to do are remnants from old gymnastics things,
but you can apply them to non gymnastics people too.
It's just simpler versions. And I to put some weight
on your arms yeah, for sure.

Speaker 1 (32:25):
Yeah, I'm super impressed with that because I always get asked, well,
what do I do if I have osteoarthritis and the
knee and I can't jump, and they you know, there's
all these other options that Okay, sure you're not going
to if you can't jump, but you can load the wrist,
how you said, you know, you can still load the spine.

(32:48):
But what else do you have for women that have
osteoarthritis and they can't jump and they feel left out
of the party. And I never want anyone to feel
left out of the party.

Speaker 2 (32:59):
Yeah, So this is where like what you can tolerate
comes into play and something is better than nothing, and
like the concept of I don't know if you know
the term weaper is tolerated that we use orthopedics, like
I have a nerdy hat that says it wbat, which
I'm gonna make some T shirts of. But some of

(33:22):
my lady residents we have a little wa bat club
we call it. But anyway, so we're obsessed with wapper ascelrated.
It's a fun acronym for something we tell people to
do after surgery, like if it's safe to put weight
on your leg. We say, you know wape bearers tolerated,
But it's a term that I think people can apply
to so many things, Like at what can you tolerate?

(33:43):
Like if you've got some arthritis in your knee and
you can't jump for impact, you can do heel drops
probably right, like that does have some create some of
that impact. You can do using like a rebounder or
mini ramp jumping on there. It's not as effective for
stimulating bone density at the hips as jumping on the

(34:06):
ground is, but it does something and it's better than
not doing anything. And likewise, you could you can jump
in a pool like kind of like where some of
your body is underwater and so there's some resistance to
get out of the water. There's some impact, although diminished
on entry again, and that's better than being sedentary. It's
not as much as jumping on the land. So like,

(34:27):
find what you can do and do it and keep
doing it. And it's not going to help you if
you have really beat the arthritis and you're like, I'm
gonna jump because someone told me I need to jump,
but then you have swollen knees for three days, Like
that's not a good outcome for you. So I just
think everyone needs like listen to their bodies. Not everything
is for everyone, and that's okay, and there are modifications,

(34:50):
and just the hard thing for women, especially in your
like say fifties, is you're trying to navigate doing exercise
and maintain your bone density, but at the same time
you're at risk for arthritis, and so you have to
listen to I think your joint pain or knee swelling
and modify. So like squatting, if you have bad knees,

(35:13):
I mean, I don't think anyone. I don't think you
have to go past ninety of neeflextion. So maybe you
can do that, or maybe you do your squatting with
moderate intensity not high intensity. Maybe you can do higher
with dead lift, And if you don't have shoulder issues,
maybe you can lift heavy with overhead press, like you
don't have to go high, and you have to listen
to whatever issues you have going on. And I always

(35:34):
give the example I actually am never going to be
a high intensity overhead pressor because it always gives me
a recurring injury or tendonitis or whatever. And so for me,
like overhead press forever, for my whole life is always
going to mean like no more than moderate intensity, because
I know that about me, and that's fine. I'm still
contributing to my maintenance of muscle mass and it's and

(35:58):
moderate intensity lifting still help with bone density. It's not
as helpful as high intensity, but high intensity isn't helpful
for you if it takes you out for three weeks
and then you can't do something because of tendonitis. So
I just think people need to listen to themselves and
not feel excluded if they can't do like the hardest
version of everything. And you know, I mostly try to

(36:23):
share with people data and options, and for I think
exercise can be fun and I can't stand to not exercise,
and I hate it when one of my patients who
likes to exercise feels like they can't exercise because their
limits worse. I hate it for them, and so I

(36:43):
just constantly try to think of workarounds and like, for
so many of my patients, okay, if you have you
can't They're like, I can't run anymore, I can't jump,
you know, like what can I do? A lot of
them I refer to like if they can, if they
have a good mobility, like rowing is a great option.
It's actually quite tolerable to arthritic knees, and because of

(37:08):
the forces you're applying to all of your muscles, actually
has some you know, it's a low impact you know,
on your knees type thing, but still actually has some
benefits for bone density. So I just think we constantly
have to find ways for people to keep threading the
needle between joint pain and maintaining their muscle mass and
maintain their bone density.

Speaker 1 (37:30):
Okay, so this is the last question on this, but well,
first of all, I have to say I had knee
surgery eight years ago where I had a full meniscus
root tear, so I couldn't I was non weight bearing
for six weeks. Weight brings six weeks the worst, the worst.
But I would go and sit at my physical therapist's

(37:50):
office and they had the arm bike and I would
sit on there for forty five minutes. The crazy ladies
in here again doing sprints on the arm bike. It
was all I could do. I was like I should somehow.

Speaker 2 (38:02):
It's too bad that we didn't know each other then,
because I could have told you about three limb biking,
which is you get on an air bike and you
put your injured leg on a leg rest and then
you bike with two arms and one leg, so well,
everyone work around and that's the I think that's the

(38:24):
best way to get your heart rate up. When you
have like one leg that you can't like do cardio with,
oh yeah, I just don't get enough. Or you can
do a ski er if you have the ability to
balance on the one leg.

Speaker 1 (38:39):
Yeah, I mean I eventually got on the pool and
just put a booie in between my legs so I
could just maddening.

Speaker 2 (38:45):
It's it's just root tears.

Speaker 1 (38:48):
I really.

Speaker 2 (38:49):
Also, by the way, I think people need to choose
carefully because if you already you I don't think you
had earth RTIs, But if you already have some earthritis
and you tore your menisco by like simply getting up
out of a chair or something like that, that means
the tissue quality isn't good, and then you get into
the disease of treatment. Because sometimes people are having a

(39:09):
root repair touchdown weight burin for six weeks, their muscles
atrophies so much on that leg. Actually you will get
focal loss of bone density on that leg that will
take a couple of years to return to normal. Sometimes
and it's not it's not benign. So it's like it's
it's you have to choose wisely if you're going to

(39:29):
have a root repair, because it's that six weeks on
crutches can and you're then you're already in a situation
like let's say you're a woman in your fifties where
you have a hard time building muscle, so you get
atrophy and disuse and then you have to you know,
disuse is hard. It's true. I hate to put weight
bearing restrictions on people, but that's one surgery where I
tell them you can't put weight on your leg for

(39:50):
six weeks, and so it's a big deal.

Speaker 1 (39:52):
Yeah. No, I my doctor I had hospital for special surgery,
did my my surgery. And I mean he was like,
I don't really, I'll take you. I just finished an
iron Man, so I had like a bunch of things
that way. But I mean he was even hesitant because
he's like the success rate and all of these other
things that come with it. But I was desperate. But

(40:15):
if we move on to this, this lifting heavy. Okay,
so I partner with two women that really, you know,
really want women to lift heavy. I lift heavy. Although
it looks different now because my back doesn't love back
squatting really heavy, so I just don't do it. I

(40:35):
do it in other ways. But let's go over when
you said the high intensity, you're meaning eighty percent or
more of your one rep.

Speaker 2 (40:47):
Is that eighty percent single rep max, which, since most
people don't know their single retmax, I try to translate
what that means. It would be like the weight that
you could do a set of four or five or
six were like the fourth, fifth, or six is really
hard for you, and it's the last one you could
do with good form. So that would be like you're
and then you have to rest before you do another set.

(41:08):
That would be like you're that version of your eighty
percent single rep max. And I do that for certain
things and not for others. And I and I think
that if you look at studies of less intense lifting
and more intense lifting as interventions for women, specifically menopausal women,
even with osteopenia, that there is more return on investment,

(41:33):
meaning you do gain more bone density, especially in the
lumbar spine with the higher intensity lifting the lift heavy.
But even within those studies, you know, of course they
show safety, which is great, Like these we have the
lift more trials showed safety and these women who were
average age sixty five ostupoenic, that weren't any injuries. But

(41:56):
those are studies and they're not real world, and people
are screened out because they had that root repair or
can't do something because of some pre existing injury or whatever.
So in real life, we're not subjects and studies that
met exclusion and inclusion criteria, and we have things. And
I think the messages are very good that heavy lifting

(42:20):
is the most effective for building and maintaining bone density
and muscle mass, or at least for bone density, but
there are also benefits of the less intense lifting. You
have to obviously do more repetitions, not less, and the
return on like the gains in bone density isn't as much,
but it's it's still a positive. And so I mean,

(42:42):
I see people all the time in clinic, but if
I told them to go do that, they would be like,
that would hurt my knee because I had a root
repair or I had my rottator cuff repair last year.
I can't do heavy overhead presses, and so we can
find workarounds and things like that. You know, maybe you
can do more. Farmers carries with something heavy or or

(43:04):
maybe you can do like I prefer xpar squatting over
back squats more or less kind of. But yeah, so
I think real life doesn't always, like I said, match
these inclusion exclusion criteria, and people have actual issues they
have to work around, and so I just don't want

(43:25):
people to feel excluded from the strength training process or
the benefits of it, or think that if you like that,
if you aren't doing the highest intensity, that it's not
worth doing, because that's also not true in a perfect world.
If you can do it, I think it does have
more benefits. Yeah, and I do it a couple of
days a week, like I said, but not for overhead press.

Speaker 1 (43:47):
So no, that's good, and it gives women permission to say, hey,
you know what, you know, it's great if you can
lift heavy this eighty percent one rep max or four
sets of four or five sets five or whatever you're doing.
But if you can't, then there's an option, and thank goodness,
there's these other options that still can give us almost

(44:09):
as much of that benefit. But can we can we
do the unilateral? Can we do unilateral where you're not
loading as much but you're still doing four reps where
you're really taxed and it's just as heavy, but you're
just working on one leg instead of bilateral.

Speaker 2 (44:29):
Yeah, I think that actually is sometimes better at identifying
asymmetry and sometimes we're compensating, you know, you know, we
all have a dominant leg for instance. So yeah, I
think that there's definitely benefits to unilateral strengthening and also
certainly helps with balance and things like that. So yeah,

(44:55):
you're still either doing a high intensity on that one
leg or moderate. It's just you're doing it one at
a time. It takes twice as long. I think that's
that's not an issue.

Speaker 1 (45:06):
Yeah, Okay, well lots of options, ladies. I hope you're
taking notes.

Speaker 3 (45:11):
Something is better than nothing.

Speaker 1 (45:13):
Yeah, oh, I always.

Speaker 2 (45:14):
Think something is better than nothing. I mean the classic
example is, well, I don't want to call walking nothing,
because walking has real benefits, like certainly studies showing that walking,
you know, regularly reduces your fracture risk, even if it
doesn't necessarily improve your bone density dramatically. But I just

(45:38):
think people also need to think of use as the
opposite of disuse. I mean, I don't want to say
like every like walking is nothing, but it's not that
something is better than nothing. It's just that you're using
and weight bearing on your lower extremities. You're maintaining your balance,
your movement patterns. The opposite of not walking and not
standing is being on crutches. Like you had your root

(45:59):
repair and were on crutches for six weeks, if you
had even just an ACL reconstruction, and so like, let's
say you're on crutches for a period of time and
then you know you have you get some atrophe and
you have to build your muscle back up. One of
my good friends who's chief of Orthopedics and sports Medicine
at University of Wisconsin, Tammy Scrapello, has done some more
in this. Like even a person who an ACL reconstruction

(46:19):
two years after their ACL surgery, that's how long it
takes them for their bone density in the surgical limb
to like fully recover all the way across the length
of their femur. And that's from a short period of disuse.
So or if you were an astronaut, you're not putting
any weight on your legs, you have you develop asthioporosis
at a ridiculous rate, So you know, weight buring on
your limbs whether you're walking with or without a vest,

(46:43):
or jumping, or if you're on your arms, if you're
load bearing, Like, these are things that are the opposite
of disuse, which would be in an extreme version being
an astronaut or being on crutches or something like that
to yeah, yeah.

Speaker 1 (46:56):
Bless the astronauts.

Speaker 2 (46:58):
Yeah, that's why they have this special thing. They have
a special resistance training thing on the ship. That is,
it's not weights, it's like basically super resistance spans, so
they're like squatting and they still do resistance training like
multiple hours a day when they're on missions in order
to try to stave off bone loss. Actually, so even

(47:21):
the astronauts are doing strength training to maintain your.

Speaker 1 (47:26):
You have to.

Speaker 3 (47:29):
Going back to the ACL, what factors can contribute to
ongoing atrophy and imbalance?

Speaker 2 (47:40):
And after.

Speaker 3 (47:42):
After a full ACL and Menesca's tear and reconstructive surgery,
what are the most effective ways to restore full strength?

Speaker 2 (47:55):
Well, I think the key one of the key elements
is when you your ACL the knee spells, you get
fluid in it, and then after surgery there's usually spelling
in it too. Whenever you have swelling in your knee
your brain will like automatically shut down your quad and
you get what's called quad steps inhibition. And so someone
will come in and they'll like won't even be able

(48:16):
to lift their leg off the table or they can't
walk because their kne would buckle. And so the longer
that goes on, the more atrophy you get, the more
of a hole you have to dig out of. And
so I actually like to in the really early postop
course after my patients, like the first visit, if they
have swelling in their knee, I actually stick a needle
in it and drain it out and they can immediately

(48:38):
activate their QUAD. Like it's an immediate difference. Like someone
who couldn't lift their leg up can lift their leg up,
someone who couldn't show me active hyper extension can do it.
It just immediately helps them restore their function. So that's
one thing. Getting the swelling out of the as soon
as you can so that you can get your quad
activation back. And the sooner you start to activate your quad,
the less atrophy you're going to have. And then you know,

(49:00):
like restoring normal gait as soon as you can, so
starting to walk normally, and then it's just a matter
of like being really regular about like with whatever you
can do. I mean, we obviously give parameters. Usually in
the first few months, we don't want you doing certain things.
We start to add in, like lunging and squatting and
leg press And I think the number one mistake people

(49:21):
make in rehab is they think that you do physical
therapy only when you're at physical therapy. But it's so
important to just like if you were going to, like
if you don't work out one day a week, your
physical therapy like kind of becomes your workout. And I
tell people, you need to be really diligent about this.
You need to do this like three or four days
a week for the strength training part, and just treat

(49:43):
it like it's your exercise routine. And I think that
is kind of one of the major reasons why people
can kind of get prolonged atrophies or just not being
diligent enough about it, or maybe a lot of people
don't even understand, like if they don't think about it
in that way, but it's kind of your your workout.
And I had this hip surgery last July, and I

(50:07):
was completely obsessed with rehab. I took seven weeks off
of work and I think the early phase can be
kind of some of the most important phase to sort
of try to like not get so much attribate. That's
what I was doing the three limb biking. I would
do it like two hours.

Speaker 1 (50:24):
It would have saved me a year of working back
until I got I mean I think it was more
like eighteen months before I got full strength back in
that leg. Man, that would have been helpful.

Speaker 3 (50:37):
Well, what if it's been a couple of years and
you're doing pretty good, but you're not one hundred what
are the things that you can do to like feel
like you're running again and you are regaining like you're
back to one hundred percent.

Speaker 2 (50:52):
Yeah, So most people do end up losing It's common
to lose about ten percent of your strength in the
leg that had the surgery. That's a good we like
people to get to ninety percent limb symmetry. You can
try to use blood flow restriction therapy later on if
you're just kind of like struggling to get stronger, that
can be an option to kind of help with muscle hypertrophy.

(51:16):
Return to running is well. One thing that can make
the hard is if you do have any residual swelling.
Hopefully someone doesn't. But I actually have people work with
like a running physical therapist and have them do like
a gate analysis and sort of just make sure that
they're striking evenly and their strid length is even because

(51:37):
people really sometimes up until a year, we'll have this
altered gait where they spend less time on the surgical
leg and more time on the other leg, and it's
just they're compensating, And so I think sometimes we need
to work on that.

Speaker 3 (51:51):
Do hormones play a part in recovery for women?

Speaker 2 (51:57):
And so interesting there's some mixed data on estrogen. This
is a whole massive topic about estrogen and hormones and
why do girls tear their acls eight times more than boys?
And this is an area of active research for me
and a couple of our PhDs that I work with,

(52:17):
and we have a study upcoming where we're like actually
currently looking at this. But yeah, there's some theory that
estrogen makes the ACL like more lax and more likely
to tear. On the other hand, there's some theory that
it also kind of helps to organize the fibers of
the ACL. Also, the low estrogen state maybe of the

(52:40):
cycle maybe associated with more like muscle fatigue. So you know,
is it be more likely to tear ACL when you're
in a low estrogen state or a higher estrogen state.
That's something that we're trying to get to the to
the bottom of with these kind of three D MRI
models we make of knees and have people do this
jump task and then we measure how much their ACL

(53:03):
stretches and compared to hormone levels and things like that.
So we're actually actively studying that, but it's more of it.
It doesn't seem to be so much of a factor
in recovery. It seems to be more of a factor
in or something that we need to understand better in
terms of a risk for injury because unfortunately, you know,
someone asked me, like, why are you so interested in

(53:24):
midlife women's joint health, and it's like, well, I'm interested
in the full span of women's joint health because girls
are eight times more likely than boys to tear their ACL.
If you tear ACL, you're also more likely to get
post traumatic arthritis, and that's another area that we that
we study. But then you know, women are more likely
to get earthritis regardless as the age, So for a

(53:46):
teenage athlete who tears their ACL when they're sixteen, you know,
when they're maybe coming up on thirty, they may start
to have some arthritis in their need from post traumatic arthritis.
And then you may arrive at adulthood, you know, and
be even more at risk. So for people who are
teenage athletes who TWI the ACL, they're really high risk
for arthritis as they as the age.

Speaker 1 (54:09):
Wow. Okay, So if we move on, and I'm glad
that you mentioned weight best. So there there's a lot.
I've now been online for four years and uh, the
last year the space has gone really wow. Wow. All
I can say is there's really not any any like,

(54:31):
there's pros and cons to everything. What do you like
to do? What works for you? But people get so
hooked up on no absolutely no weight best or yes,
do the weight best? And I'm like, why is it
that it shouldn't be that big deal. I'm curious on
your phone.

Speaker 2 (54:46):
Yeah, as you can tell them to make kind of
it's not all the road. There's yeah, there's nuance, nuance,
I'm a nuanced person. There's a lot of yeah, me too.
So I think I don't ever want someone to think
that wearing a way to vest is the thing that's gonna,

(55:06):
you know, improve or restore maintain their bone density. And
the studies that looked at that are limited. And there's
a study that's a subset of a study, so it's
like even a smaller part of a study that included
women that were doing other things including some strength spanning
and jumping and stuff. And so there's this one study
that showed some improvement and bone density, but it was

(55:28):
like a component of a program and a subset of
a group of women. So it's not something to necessarily
hang your hat on. But I have a way to vest,
and I have a rock sack. Actually like a rock
sack better because I feel like it makes me. I
feel like it's more of a core activity because you're
kind of like stabilizing it. But I don't necessarily use

(55:49):
it for maintaining or building bone density. It adds to
my cardiovascular exercise. I put it on, I walk my
dog or which is early in the morning and late
at night, and it's a nice add on, and I
think things do add up. So I don't think there's

(56:11):
any definitive study that shows that walking with the weighted
vest is definitely like increasing your bone density, but it
is taking your walk up a notch. It is a
little bit more load. There's again, I think these things
you're cumulative, and it's it's more use than less use. Now,
the conundrum I kind of struggle with for some people

(56:33):
is if you have some new arthritis and we're telling you,
if you lose five or ten pounds, your knees will
notice a difference and they'll feel better. Do I want
to tell someone who has who's dealing with new arthritis
and trying to find ways to maintain their cardiovascuar activity
and not get knee smelling? Do I want to tell
them to put on a ten pound or a five
pound thirteen whatever most of them are. You know you

(56:55):
can get five ten percent of your Do I want
to tell that person I just told you your needs
would feel much better if you lost five or ten.
So I kind of don't if I'm at the same time,
if someone is like kind of at the cusp of like,
you know what, if they've said to me, my knees
feels so much better when I'm five or ten pounds
later and they're trying to walk for cardioaster activity, it's

(57:18):
probably not the person I'm gonna tell to put on
a weighted best.

Speaker 1 (57:21):
Yeah.

Speaker 2 (57:21):
So as for someone who's knees aer feeling good and
they want the added cardiovaster exercise, great, And some of
the studies show like it did help with strength or
maybe like parameters that would be associated with fall risk,
like balance and things like that. So it's in the category.
I definitely don't think it hurts you, and there are

(57:41):
definitely some positives. It's just I wouldn't I wouldn't portray
it as this is the way too, like this is
the path to preventing it's not the paths. It's not
enough by it self to prevent alzeproosis.

Speaker 1 (57:54):
Just a deeper I mean, there's always a deeper conversation
than just wait, best yes or no? But yes, it's
it's funny. I want to say the internet needs to chill. Chill.

Speaker 2 (58:06):
Yeah, I don't. I don't think we should villainize people
who who are supporting them or or yeah. It's almost
like a become a are you a vest person or not?
And I think it's certainly getting people out and walking.
And I see a lot of women at my y MCA,

(58:28):
which is where I go do my heavier weights, you know,
doing like inclined treadmill walk with an on. I think
they're getting a really good workout, and it's another option.
Some of those people are probably people who maybe aren't
running anymore, maybe that was bothering their knees, and so
they're doing that and they want the exercise. So I
do think it has benefits for sure.

Speaker 1 (58:49):
Okay, so this is my last question before we wrap
it up. And this just pop popped into my head
and it wasn't on the list or anything, But do
you the I mean, I hear from this from women
every day, and it's maybe just because I you know,
I have my app and I have a lot of
women on there and different courses and everything like that.

(59:11):
Do you think that we have or the internet having
access to every different specialist and strength coach and this
has made it more confusing for women, you know where
I'm like it for me, I don't think it has
to be that deep pick and choose, like, sure, you
should do a little bit of this, a little bit

(59:31):
of that, but the perfect prescription doesn't exist because it's
not unique to you. But what are your thoughts on that?

Speaker 2 (59:38):
Do you?

Speaker 1 (59:39):
Yeah?

Speaker 2 (59:40):
I do think online resources could certainly be lacking in
the nuance. And uh yeah, I think a lot of
people are very just kind of black and white in
their opinions, and it's yeah, you could ease find one

(01:00:00):
person saying one thing once to the other. I mean,
we hear all the time about what to eat, when
to eat it, and you should be jumping or you shouldn't.
And I struggle with that a little bit because I
do want to share good information and I've enjoyed sharing
information and I try to respond to anyone who asked
me a question with the nuance related to them. But

(01:00:21):
it's hard even if someone is giving me information specifically them.
If you're not actually seeing a person in front of
you and examining them and knowing their medical history, you
can't really give the best information. So I think that yeah,
people need to like still consider their own, you know,
individual circumstance and not just put expectations upon themselves. Like

(01:00:43):
I don't think everyone needs to look at everyone on
the internet and think. What I worry about it actually is,
is people feeling like inadequate or like I said, excluded
if they maybe can't do like what someone is saying
they should be able to do, and that's okay. So
I think people need to start somewhere, do something waper

(01:01:04):
is tolerated. These are reasonable expectations, and you can always start.
It's never too late to start, like I like to say,
like so many of the studies on even bone density
are on women who are sixty five, and some of

(01:01:24):
these studies are following people for fifteen years and you know,
reporting decreased fracture risks and things like that. So I
think the other thing people hear is that it's too
late speak. And I don't ever want anyone to think
it's too late. When you hear it's too late, Oh,

(01:01:46):
you should have had a deck, so when you were
fifty you didn't get it until you were sixty five,
it's too late for you. It's like this. I don't
want anyone to like hear like fear mongering. I just
think sometimes when we're saying things like current recommendations seem
too late, it's more like wishful thinking. I wish people
could get, you know, something studied earlier, or I think

(01:02:07):
it would be better if we could that kind of thing.
So I just, yeah, I think you're right. People hear
stuff on the internet. It's confusing, it's maybe hard to
apply directly to them. And I just think maybe look
for people who are using data. I think that's good,
using research to help kind of guide what they're telling you.

(01:02:29):
But yeah, there's always going to be some some mixture
of opinions. There's there's data overload. Frankly, yeah, yeah, for sure.

Speaker 1 (01:02:37):
Well I want a hat. I want one of your
hats when you make.

Speaker 5 (01:02:40):
It really cute, by the way, my rest residence made
that for me, and she's really interesting.

Speaker 2 (01:02:51):
Actually, the two of them are really interested in this.
She's actually currently studying three all application to fracture sites,
you know, estre all the stuff that's in the face screen, yes,
to see if that will help with bone healing. But
one of one of those, one of the two residents
that's in the we that hat.

Speaker 1 (01:03:12):
I love it. Oh, we're staying up to date with that.
I can't wait to hear that. Well, Jocelyn, it has
been a pleasure. I can tell that you were someone
that never left anyone out in elementary school and high school.
I feel the same way. This is why I want
everyone to join on the party. I'm like, we don't
want to leave anyone out. I just love your your

(01:03:35):
demeanor and just how you can apply the information. But
there aren't these hard fast absolutes. I think it's really
helpful for women to not feel discouraged if they don't
fit that mold, because a lot of women aren't going
to fit that mold, including even my you know myself
that I had back surgery at seventeen, had you know,

(01:03:59):
these different things that I just can't do it the
same way, but I can do a lot of other
things that are just good.

Speaker 2 (01:04:06):
None of us are immune to these things. I mean,
I had a hip surgery last summer, and like nine
months ago I had a frozen shoulder, which is extremely
ironic because I'm a female HIG surgeon and I study
frozen shoulder, and I was like, I have so yeah,
we're in No one is immune to these these things,

(01:04:27):
and none of us are like immune to aging, and
it's just I think we can try to age wisely
and and you know, be proactive about our health. So yeah,
but thanks for having me. It's so nice to actually
meet you guys. I want to say in real life,

(01:04:48):
but we're on zoom.

Speaker 3 (01:04:51):
Life.

Speaker 1 (01:04:52):
I'm hoping. I'm hoping in real life one day, yeah,
in real life some day.

Speaker 3 (01:04:56):
Yeah.

Speaker 1 (01:04:59):
So okay, while we're wrapping up and we're done, we're
locking off, but I want to make sure that people
know where our listeners can find you. Can you share
that information before we jump off?

Speaker 2 (01:05:12):
Yeah? I mean maybe maybe the easiest way is my
Instagram page, which is just Joscelyn Underscore Witstein Underscore MD,
which full caveat my nineteen year old daughter showed me
how to use in January of this year.

Speaker 3 (01:05:26):
So but she's doing it incredible, She's taught me.

Speaker 2 (01:05:30):
Well yeah, and then I practice full time as North
Peak surgeon at Duke University. But in terms of like
the information I try to share in sort of you know,
data driven digestible bites, I think is in a lot
of Instagram reels.

Speaker 1 (01:05:50):
So yeah, perfect. Well, thank you so much for sharing
your time today. We can't wait to launch this episode.
We know it's going to be a real hit for
our listeners. Thank you again.

Speaker 2 (01:06:01):
Yeah, thanks for having me, Thanks for listening everyone.

Speaker 3 (01:06:04):
If you enjoyed this episode, please consider giving us a
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