Interview with Dr. Howard Luks

Jarlo Ilano: [00:00:00] Hey, this is Jarlo Ilano. This is the GMB Fitness podcast. So I'm Jarlo, I'm one of the co-founders of GMB Fitness.

Jarlo Ilano: I'm also a physical therapist, martial artist, but mostly I think of myself as a teacher, an instructor and educator. So I'm really happy to have, as our guest today, Dr. Howard Luks, he's an experienced orthopedic surgeon, but more than that, I feel like he's also a great educator. I've been, reviewing his work for several years.

Jarlo Ilano: I think one, the first ones that I read from you was just you know, a good article on zone two work, but I really liked your take on the, it's the building, the mitochondrial capacity to mitochondria health. That, that one really kind of set you apart from a lot of the other stuff I was reading, like, you know, out there.

Jarlo Ilano: So I'm, I really enjoy your content and I would like to listeners to kinda have a brief introduction to you and you know, where you're coming from. 

Dr. Howard Luks: Yeah, sure. I'm an orthopedic surgeon [00:01:00] grew up in New York, always very athletic and decided to pursue sports medicine as my specialty. I learned how to do a lot of different sports medicine surgeries in my training, but didn't really get a lot of exposure into why people are injured.

Dr. Howard Luks: Mechanism to avoid injury. And since a lot of injuries, especially in in adults, can take a year to heal, obviously prevention is our best medicine. And then you start to realize along the way, you know, people cancel a surgery. They have to wait a few months, but they get better and they call you back and they see you in the office and they didn't need the operation.

Jarlo Ilano: Right? 

Dr. Howard Luks: And then people don't follow your path for recovery or rehab and you realize, okay, maybe they don't need crutches for six weeks. And you just, you know, you have to sit back and think at these moments. You know, this is a [00:02:00] lifelong learning process. And I started to dive into a lot of, a lot of orthopedic issues initially on my website.

Dr. Howard Luks: And then I took a course. Towards longevity and the influence of movement, strength, balance, power, mobility, et cetera. I wrote a book about this and in my own office, I dive into the entire person in front of me. I, you know, I wanna know about your metabolic health, your movement patterns, your daily activity, because it all shapes how I'm gonna treat you.

Dr. Howard Luks: Joint pain is not an isolated entity. A lot of joint pain is just a Ilano Ilanother manifestation of metabolic disease. You know, what do I mean? Someone with diabetes fatty liver, insulin resistance, have a lot of inflammatory mediators in their body. Our joints and tendons are exposed to that. You expose [00:03:00] cartilage and tendons to inflammatory mediators for years.

Dr. Howard Luks: They weaken a lot of the cells involved die. You get accelerated osteoarthritis, you get more pain with osteoarthritis, you have an increased cause of tendon tears. You have a lot more, a lot more tendon pain. You poor, poor healing ca poor healing capabilities. And more so over the last, especially five to seven years, that's predominantly what I've written about on my substack or I've moved to Substack recently away from my website.

Dr. Howard Luks: And it's just been great. It really, you know, I think that my career has, has come ju just full circle. Because we don't need as much surgery as we think we are operating on far too many people. We recover a lot more than we think we treat normal age related changes. On, on [00:04:00] MRI too often.

Dr. Howard Luks: And so I have a lot to say before I go away. 

Jarlo Ilano: So, yeah, I, I like how you said you come back full circle and you're with training and know you, you run, you know, you're very active. And when, like most people, when you do that, you, you wonder, you know, I have patients that are like, okay, I've been running for 20 years, 25 years, or I've been, you know, I like to play basketball, or I like to do this.

Jarlo Ilano: And then I, you know, now my, my hips hurt and my knee hurts. My, my shoulder hurts. And you know, it's obviously because I've been doing this for so long, right. I, I get a lot of that. Like, they, they come in, they're like, yeah, this wear and tear, I just knew it was gonna happen. People tell me it was gonna happen.

Jarlo Ilano: Right? And, and now you're in this conversation with like, they're kind of blaming themselves. They're sort of like, well, I love it so much, but yeah, I don't wanna just be in pain my whole life. Right. And so I. [00:05:00] That's why I like the flavor of a lot of your writings is really just kind of dispelling that myth that arthritis is an wear and tear issue, or it's because you were just, you ran it into the ground.

Jarlo Ilano: Right. You know, you ran all that cartilage away, you know, that kind of stuff. And, and I'm kind of imitating these, these patients, the clients that come see me. But that's obvious. That's obviously it. I mean, and it kind of makes sense. You're like, you, they, when people kind of think of, of body as machines and you, of course you're gonna wear and tear your car only last, you know, 150,000 miles.

Jarlo Ilano: Right. So how many miles does a, does a knee last over, you know, over years? Would you say that's something that a lot of patients come into you with? Who 

Dr. Howard Luks: Oh, of course. And it's tough, them otherwise. You know, I'll get a 70-year-old in who needs a knee replacement and they said, oh, I ran marathons for my entire life.

Dr. Howard Luks: That's why I need a knee replacement. And I say, no [00:06:00] you kept your knee for 70 years because you ran knee, because, because you ran marathons. You know, the body has a lot of innate repair mechanisms, as does cartilage. They're not very robust, but they're present. But these repair mechanisms aren't triggered unless we're active.

Dr. Howard Luks: And I'm not talking about walking. They need to see this repetitive loading. Our cartilage actually likes the repetitive loading of running. Now, I'm not talking about a hundred miles a week, of course, right. But very few people do that. Our muscles are an an internal pharmacy. They release an enormous number of mykines and beneficial chemicals and signals and proteins when they're triggered and very active.

Dr. Howard Luks: And those chemicals have distant effects on many tissues. So [00:07:00] our bodies were engineered to move. We were not engineered to sit, we were engineered over tens of thousands of years, such that if we're not active, if we're not moving, then we're deteriorating. So we have to break the idea that or the concept that we wore ourselves out.

Jarlo Ilano: Right. Absolutely 

Dr. Howard Luks: aging Aging is gonna bring changes, right? Arthritis is gonna settle in. Aging is a number one cause of arthritis because the cartilage, it, it's had enough. And our ability to repair diminishes as we age, like many things. But the idea that you, cause this is wrong, 

Jarlo Ilano: right? And I, I think it's very important to have that message.

Jarlo Ilano: And you mentioned the imaging with MRIs or x-rays and, [00:08:00] you know, the research, especially in the last, you know, 15, 20 years, is that, you know, there's a lot of excessive imaging. There's a lot of imaging that causes harm because these patients, they see, you know, the, what is normal, age related joint degeneration, you know, what is normal related tissue changes, you know, in a 60-year-old or a, you know, even a 50-year-old.

Jarlo Ilano: And then they equate that with damage. But a lot of that is like you, you said. It's difficult to counter because I was just reading Ilanother study where they were, you know, talking about the imaging, but it also related to patient satisfaction with your care. So if they, if they didn't get imaging right, which they shouldn't have, because that was, that's a correct plan of care, right.

Jarlo Ilano: Correct thing to, for the doctor to do, they would get upset because they're suppo, you know, they, in their head, they're like, I'm supposed to get imaging. Even though the doctor educated them, like, you know, you really don't need the imaging. This is, this is where we're at. So even with [00:09:00] that, even with trying to educate a person and with the right way, they're still gonna have this sort of, well, in that study they had sort of that dissatisfaction, like, what is this doctor doing?

Jarlo Ilano: I'm supposed to get X-rays, right. I'm supposed to get x-rays from my back. It's like, no, not really. It's, it's not good. Right. It's actually not good for you to, to have gotten, you know, to get x-rays. 

Dr. Howard Luks: No, you're right. I, I have to. Explain why I'm imaging people and why I'm not. And people don't understand that age appropriate changes in MRIs are gonna scare a lot of people.

Dr. Howard Luks: Mm-hmm. You can't unsee your MRI report. So when it says tear of this, afraid that partial tear of this people are gonna get worried. I've seen people stop running. Yeah. Because, because they're so meniscus tear. I've seen tennis players stop playing tennis because of the label tear in the shoulder.

Dr. Howard Luks: People don't realize that, [00:10:00] you know, you have a hundred percent of having a disc abnormality on, on a lumbar spine. MRI over 50, you have a 70% chance of having a label tear. Right. You have, you know, at a certain age of 50%. Chance of having a label tear in your shoulder as well as your hip. Right. Partial tears or rotator cuff.

Dr. Howard Luks: There are pitchers who are throwing a hundred miles an hour with a torn rotator cuff. It, we, we don't need to be perfectly structurally intact to be, to be, to be functioning perfectly well. So I run with a lot of runners who have meniscus tears. I myself run with meniscus tears, rock climb, right.

Dr. Howard Luks: Weight, you know, lift. I do whatever I want and it doesn't bother me. And just because you see something torn on your MRI doesn't automatically mean it's the cause of that occasional pain you're gonna get. That's [00:11:00] right. That's, I think that's an important concept to understand. I 

Jarlo Ilano: think these examples that you have, and I have lots of examples too.

Jarlo Ilano: Very important to share. You know, it is difficult to counter this information, especially because it's so prevalent, but you know, the more we can do it. And that's why I really appreciate, you know, your work in your latest substack, you talked about that, you know, the no SIBO effect, right? The, the words really matter.

Jarlo Ilano: And it's, and it's interesting too because I've learned a lot of that, you know, in our pain education. You know, I, I've gone through that certification and coursework, but a lot of it is when you first learn it, and I'm kind of referring to myself and, and different other PTs, they sort of kind of go onto that pain education route and re you know, really try to work on it and, you know, talk to patients and kinda explain, you know, damage doesn't necessarily equal pain and all of that, but it can kind of backfire, you know, when you're [00:12:00] working with a patient.

Jarlo Ilano: Because if you don't work. Have your words correctly, you can sort of, they can, they can get the feeling that you're dismissing, that they're in pain, right. That you're dismissing, you know, the very real pain that they're in. And so I think it's even important for us as, you know, trying to educate the patient in what's correct and real, but not in a way that dismisses, you know, their actual lived experience.

Dr. Howard Luks: Oh, so true. You know, and well take, take tendon rehab, right? I just put up I think a 2,500 word article today on tendon rehab. And, you know, we both know that tendons require load for healing. They require a lot of load over a long course of time. And you are not gonna get through [00:13:00] this pain free, right?

Dr. Howard Luks: So, right. We have to acknowledge the pain, we have to acknowledge that it exists, adjust how we're gonna load that tendon accordingly. But we have to make it clear that we can't avoid discomfort during the process. And that's part of the healing, and that not all pain implies harm. And it's the same thing with other joint pains.

Dr. Howard Luks: You know, it might be the meniscus that's a annoying and bothering you, but if you're running, you navigate stairs in the environment well and it doesn't hold you back, then why would you consider an operation for it? Right? Or why would you consider not running, you know, people who I'm, I'm sure you see this.

Dr. Howard Luks: All the time too. You tell someone that they have some [00:14:00] arthritis or et cetera, they'll stop being active, right? They'll stop running or they'll stop playing pickleball. So they're not doing the number one activity that's going to lead to a healthy, long and fit life. You know, they've stopped the activities that they enjoyed thinking they're gonna save their joint and Right.

Dr. Howard Luks: I think you're not gonna save the joint. Right. It's probably causing harm and you're throwing your overall health under the bus. 

Jarlo Ilano: Absolutely. And I think and that's just a, an again, a natural response, right? Because they don't have that, that education. You know, the, the examples and I mentioned the examples that you talked about earlier and why they're so important.

Jarlo Ilano: Because to be able to counter that information you need to. Convey to the patient in, in terms that they understand, because a lot of, you know, a lot of stuff out there and it's like, you know, you have all these chemical words and, and all this [00:15:00] stuff, and it's really hard to kind of get through. But that's why it's, it's great to have these examples in your back pocket.

Jarlo Ilano: You know, for example we talked about, you know, you talked about the joint degeneration and the normal joint degeneration in the knee. I remember I had this patient and I had, I was seeing him for something else. I think I was seeing him from his hip. This was a long time ago, but I, you know, of course I'm doing the exam and his knee barely moved.

Jarlo Ilano: His knee barely moved like 50, 60 degrees, like in a total range of motion. Hard. Like you go into flexion and it's like, fuck. Right. You go in extension, not even going out. And I asked him, I was like, well, you're here for your hip, but how's your knee? He is like, oh, it's fine, it's fine. Right? And it was obviously like, I think this man was a, a, you know, a vet and, and all of these things.

Jarlo Ilano: But you would think, and I bet you if he had the x-rays that, you know, it was what people say, bone on bone. But I was like, it's fine. He's like, yeah, I don't have any pain. Right? I don't have any [00:16:00] pain. I, I'm fine with it. And they keep telling me I need surgery. I'm like, it's, I'm fine. I'm here for my hip.

Jarlo Ilano: You know, I fix my hip. But in that example, and you talk to patients and you, you say, okay, this is, this is what, this is a real thing, arthritis and, and the degeneration. But as you mentioned before, it's because of the inflammatory reactions of inflammatory response. You know, what is your overall level of inflammation?

Jarlo Ilano: So I think talking to patients in that way is like, yeah, there's lots of people that have say disc problems or, you know, degeneration in their, your shoulder or their, their knee or their hip, and they don't have issues and it's likely because they, they're not having these sort of inflammatory.

Jarlo Ilano: Processes that's, that may be happening with you. So I think giving them a kind of not a short answer, but you know, a really quick answer as to why, you know, why are they experiencing this versus, you know, some of the other [00:17:00] examples that we have of, you know, this man isn't, or this woman isn't, and it, it's not you.

Jarlo Ilano: It's sort of this, your whole environment of, of what's happening. 

Dr. Howard Luks: Yeah. You know, the way I practice now is not it's not a way that employers enjoy because it takes a long time to communicate this. Yeah, absolutely. To patients. I can't see a patient in seven minutes. And especially since I actually examined them, you know, we're in a high tech, low, low touch culture.

Dr. Howard Luks: Or environment and you don't examine, you don't listen, you're gonna miss a lot of things. Right. You know, you are an MRI is only a very small part of the information that I use to determine how we're gonna treat you. So it takes quite a while to describe these issues to people and to make sure that they understand [00:18:00] 'em.

Dr. Howard Luks: And they don't think that you're blowing them off. 

Jarlo Ilano: Right, exactly.

Dr. Howard Luks: And they understand that they're being heard. And you gotta start working through it with them. And you have to see them back. You know, a lot of surgeons don't wanna see non-surgical patients. Right. 

Jarlo Ilano: Yeah. And we talked a little bit about this, I think.

Dr. Howard Luks: Yeah. I think 97% of p. Of people in my office are treated without surgery. That's excellent. You know, if you look at it from an economic perspective, that's not that's not the best way to employ a surgeon. But, but, but, but orthopedic surgeons are all, I mean, where the, where, where the family practice doctor for the musculoskeletal system.

Dr. Howard Luks: No one understands it like we do. Or, or like we should, and its role in, in our overall health. So we [00:19:00] stand in a, in a position where we can significantly impact someone's overall health by, by being encouraging and by teaching and educating so that people don't slow down, don't stop don't hold back.

Dr. Howard Luks: But that's, no, I think it's very important. Not what transpires. 

Jarlo Ilano: Yeah. I think it's very important, especially in in people, doctors in your position where you could do a surgery, right? You could do a, an intervention where, you know, that's you, what they call invasive, you know, invasive people listening just mean, you know, you're going skin invasive with cutting scalpel, you know, doing surgeries, you know.

Jarlo Ilano: Then the next part are injections or any kind of treatment like that. And then non-invasive is, you know, exercise education, dietary and, you know, nutrition guide, you know, guidance, that type of thing. So I think it's a very powerful message that you send to a patient that comes in to see you because you [00:20:00] know, a lot of 'em expect, well, I'm gonna go to the doctor.

Jarlo Ilano: And they're gonna tell me, I need this procedure, so I'm gonna already figure out when I can do that. I gotta get off work. You know, they already have that running in their head before they even see you. And so for you to spend time with them, really explain and then go, you know, I think we don't, I think, I think you don't need this right now.

Jarlo Ilano: I think it's, it can be to be a really great light bulb moment and then hopefully, you know, they tell that to their family, to their friends. And, you know, I think that's what you know, a great educator does and why your substack, your books, you know, your, you know, your Instagram, all of that's so important because you have that ripple effect of education.

Jarlo Ilano: And it's, and it's really interesting, you know, we were talking before the call about, you know, the kind of bad reputation for a lot of orthopedic surgeons. You know, I've been doing this a long time and I've seen some of that kind of poor bedside manner with our orthopedic surgeon's like. They really just do wanna, you [00:21:00] know, do their surgery and then, you know, pass you off to the, to the PT that's, they're gonna see in a couple weeks.

Jarlo Ilano: I think what I like how you described, you came into it kind of from a different place over the years as, as a, as a orthopedic surgeon. Like, have you seen that change, like your profession change in, in, you know, how they're responding to, you know, their job and how they want to educate patients and, and all of that?

Dr. Howard Luks: Yes. I mean, the most interesting group of orthopedists that I know are a few guys that I graduated, went through residency with because we've all seen the same changes that I discussed earlier. You know, we're all operating far less often. For for problems that we used to operate on. We understand risk, we understand disease [00:22:00] processes far greater than we used to.

Dr. Howard Luks: We understand the limitations of what we're able to do. You know, we're also better at discussing it with people, right? I can't tell you how many, you know, I'll see a kid with an ACL tear and they're unstable. So I said, listen, you know, having an ACL reconstruction is an option for you, probably a wise option.

Dr. Howard Luks: And the parent says all right. You know, we serve a first opinion. And, and they said, they'll get my kid back on the field in six months. And I'm like, yeah, no. 12 months. Right, right. And, and I'll go into the reasons, but eight times outta 10, I lost that patient. Right. So there's still a lot of misinformation out there.

Dr. Howard Luks: A lot of doctors behave badly. Interestingly there's you know, there's this old plastic [00:23:00] surgeon if I'm calling someone old, they're old because I'm 60 something. 

Dr. Howard Luks: he, you know, he's a New York City plastic surgeon and he has a video out about running on TikTok and Instagram. It's gotten millions of views.

Jarlo Ilano: Okay. 

Dr. Howard Luks: And he is telling people don't run. 

Jarlo Ilano: Oh geez. Don't run, 

Dr. Howard Luks: don't run, don't run. It's the worst thing you could do. It destroys your knee, is, destroys your hips. And of course, because of him, you know, he claims it makes your face sad. But, you know, so he has millions of views on these videos and, and I've been sent the video by about 10 other doctors and friends who want me to answer it.

Dr. Howard Luks: Right. And, and I will, but my answer is going to get, you know, a thousand views. Right. Because yeah, it's gonna be based on science and [00:24:00] Yeah. It's so challenging. It's so hard to peel back the truth and instruct people when a video like that surfaces. 

Jarlo Ilano: Right. And I think, you 

Dr. Howard Luks: know, 

Jarlo Ilano: overall, now that's, you know, the state of where we're at, not just the, you know, with social media of course.

Jarlo Ilano: And, you know, the, the virality thing and people just wanna rack up views. But also there's just this sort of general feeling of distrust, you know, towards experts. Right? Right. I mean, we have it in our government right now, which is just ridiculous. And this anti-intellectualism, right. You know, people that are just, well, how do you know?

Jarlo Ilano: And then you, you say, oh, there's this research, these studies, there's, I have my experience, and they're just, you know, people aren't going to listen in that way too. So it's, it's super tough. Right. It's super tough. But it's also like we can't stop. I mean, we all, we want to help people. [00:25:00] No, the only reason we're doing this is 'cause we wanna help people and we know it helps people.

Jarlo Ilano: Right. And so yeah, I would, I would love to see you. It makes your face sag. That's just, oh my God. It's just brutal. It's brutal. What's out there. That's again, that's why I'm so happy to have you on it because I. I read all that stuff too. I read all that stuff too as part of our job. And you're like, I can't unsee that either.

Dr. Howard Luks: Right, exactly. 

Jarlo Ilano: So a lot of this is, is, you know, right in line with, you know, our work here at GMB Fitness, we really try to get people to understand, you know, for their own autonomy. You know, you, this is what you can do for yourself and you don't have to go. And the hard thing about social media is you see the outliers, right?

Jarlo Ilano: You see people that maybe you should aspire to be. I mean, you have triathlon, you have ultra marathoners, you have people that are, you know, crazy ripped and strong. And, but a lot of times if you don't have the information, you think, well, I [00:26:00] gotta do that level of work, you know, to get better, to get healthy, right?

Jarlo Ilano: For example, we talked about your zone two article and zone two is that hot buzzword in the last, you know, 5, 6, 7 years. There's a lot of that stuff out there that's like, oh, you won't even, you won't even move the needle until you're doing four or five, six hours of zone two work. And I read that. I'm like, yeah, maybe, I guess, but how are you gonna talk to someone who's doing zero, right?

Jarlo Ilano: Like they're doing zero and you're telling them right, four or five hours, or you're not gonna see anything. I think that's harmful too. So how would, how do you approach that? Yeah. How do you approach that? Yeah. Well, 

Dr. Howard Luks: so that's what I started back in April on my subset. I spent some time to you, you know, deciding what audience do I want to approach, right?

Dr. Howard Luks: There's a lot of people in the fitness and performance [00:27:00] space and the training space who are better educated than I, you know, if you wanna run a faster marathon or faster half marathon. I don't follow. But because, you know, I see hundreds of people in my office every month, and I know where most people are at.

Dr. Howard Luks: People know that they need to be active to be healthy. They don't know what that means, right? They don't understand or appreciate how little activity we actually need. So, you know, some of the most pop popular posts on Substack is, you know, what happens to you after a year of walking just 30 minutes a day?

Dr. Howard Luks: That's where it begins, right? So [00:28:00] if we look at the health improvements from movement, 7,000 steps a day gets you there. It gets you substantially he healthier and more fit than what you're doing now. 12,000 is better, but the curve flattens between between seven and 12,000. The curve is pretty flat between 12 and 20,000.

Dr. Howard Luks: Right. So, you know, if you enjoy it, do it. Right, right. You know, I run a long run on Sundays. It used to be longer. I can't anymore. Things do ache, but I do that because I love it. Not because I have to, but yet if I have a tough day at work and if I had a late morning and couldn't walk or run in the morning when I come home or during a lunch break, yes, I take a lunch break.

Dr. Howard Luks: I leave the office and walk and I'll look [00:29:00] for a hill because I wanna walk the hill. And I'll do the same at home and I'll bring my dogs along. And that's it. I'm just gonna get my steps in. So there's times when I'm doing it because I'm enjoying it and there's times when I'm doing it because I know that I have to, and the most important runs I do are the runs that I wake up and I'm not sure that I want to.

Jarlo Ilano: Right. 

Dr. Howard Luks: Right. Because it is as much a brain training as it is anything else. 

Jarlo Ilano: Right, right. I think we're both talking about this balance, right? Of you have to get away from an all or nothing type of mentality. Like either I gotta do, you know, four or 5, 6, 7 hours of training a week, or it's not worth it. Or you're gonna go, well, I'm, I'm gonna do what I can and then when I feel better, I'm gonna do more.

Jarlo Ilano: Right? And a lot of that is right, this, this sense of kind of, am I doing enough? I get a lot of that right [00:30:00] from our clients and, and my patients absolute too, right? Am I doing enough? And that can be its own thing. It's like, well, if I'm not doing enough, then I, you know, why bother? And you're right. I mean the, it's asymptotic, it's like it from zero to one is the most, right?

Jarlo Ilano: Zero to one the most. One, two. And then after that it's just gravy. And a lot of times when we're working with our clients and where our clients are in that sort of early middle age, right? You know, that 30 to 40, you know, going into 40 more. We have a lot of older clients too. But it's, a lot of times it's the ones where life just, you know, their kids are getting, have all these activities.

Jarlo Ilano: Work is tough. You know, they can't do all the things that they used to do a lot of time 'cause of time and energy. And so they fall into this. I'm not even gonna be doing enough. How can I, how can I get into this, you know, back into this Or they've been [00:31:00] broken, right? They've been broken because they did all that stuff in college in their early years, and they're like, right, well, I don't wanna be broken, you know, for the rest of my life.

Jarlo Ilano: And so, you know, they don't wanna go see you, they don't wanna go see the orthopedic surgeon. So I think we're dealing with that in terms of education too. It's not just a right, it's just not someone that's not doing anything. But it's also the people that are like, they wanna do stuff, but they just don't have that education of like, okay, what can I do And, and not, and not get broken.

Dr. Howard Luks: I mean at some point in time people realize they just have to do it. Right. Right. You know, we have to work on mindset to some degree. You know, as I say, often, you know, exercise is a celebration of what you can do and not a punishment for what you ate. We don't need to look at it like that.

Dr. Howard Luks: Absolutely shouldn't. You know, we shouldn't be, we shouldn't be harming ourselves. [00:32:00] But look, we, people, people attribute so much to aging. And yes, we decline with aging, but we decline far greater than what aging has in store for you, simply because we don't train it or do it anymore. Right. Absolutely.

Dr. Howard Luks: Like the movement patterns that you put out videos about. Right. You know, I do these things all the time, you know? I do, my bear crawls and my monkey walks and you know, I'm not as mobile as your instructors. They make it look so easy. It's ridiculous, right. But I'm doing it right. Absolutely. And that's the reason why it's 63.

Dr. Howard Luks: I'm still rock climbing and doing half the things that, you know, everything that I used to do. So yes, [00:33:00] my VO two max was lower than it was, you know, a dozen years ago. I can't, you know, push as much weight. My recovery burden is higher. I do have to take, I do have to take Monday off after a long run now, but.

Dr. Howard Luks: At some point in time, and I see this in a lot of forties, I see it in a lot of 40 somethings. They see the, you know, the, the changes that we described, like the loss of muscle mass, the loss of power or quickness, the loss of balance starts in our late thirties, sorry to tell you. Right, right. It's not perceptible at that point, but it will be soon.

Dr. Howard Luks: And so a lot of people in their forties and certainly fifties start to wake up to this and they realize, you know, that fitness or movement is just something that they have to do. Absolutely. [00:34:00] And you have to, they have to start somewhere, you know, e even if it's just walking every Saturday I put out videos.

Dr. Howard Luks: That can be done on your living room floor whether it's movement or balance or power changing on a set of stairs or a box, whatever you have available. So you don't have to go to a gym, you don't have to get laced up and go outside for half these things. And if you don't do it, you're gonna be challenged.

Dr. Howard Luks: You, you don't have to assume that you need a walker or a cane when you're older. Yeah, we have to change this mindset hopefully before your lack of ability changes your own mindset, 

Jarlo Ilano: right? Absolutely. And I think you know. Really important for what we're both doing, I think Absolutely. For reducing [00:35:00] these barriers, right?

Jarlo Ilano: Reducing these educational barriers, reducing these access barriers or time, you know, that's a lot of this is time, energy, education. You know, what are we supposed to do? Should I do this? And I think that's a lot of the issue I have with, you know, the social media and, and all that. It's just the bomb bombardment of information.

Jarlo Ilano: It's really hard to pick and choose for a lot of people. Even, you know, even you, you have a, you know, a degree in something and it doesn't mean you have, you know, you can sort through a lot of this stuff. So I really appreciate Right, what you're doing. So that if we could talk a little bit about I think it would be really helpful for people to get some insight into, well, when.

Jarlo Ilano: When should you have a surgery? I mean, that's just a massive thing. Of course, it depends on individual, right? I'm not gonna ask you to, to tell all these people. But for example, you in, you have some older articles on, on specific things like, you know, for runners that [00:36:00] you mentioned, a high tibial os osteotomy.

Jarlo Ilano: I had a, a friend that, you know, she's a marathoner, a triathlete, very young, only a few years younger than me, like 46, 47, but she had one of those you know, not the UKA, she had a patella femoral replacement. A lot of that was kind of, she had an Ilanomaly. But, you know, these are the types of things that are, they're lower percentage where people would, you know, need it.

Jarlo Ilano: Right. Absolutely need it. But would you have any kind of insight into, you know, those, those particular things where like, okay, this person needs a surgery. 

Dr. Howard Luks: Okay. Yeah. So. As I mentioned earlier, it's far more than just what your MRI shows, right? There are certain types of meniscus tears. We call them root tears or bucket handle tears, where they just make your life miserable.

Dr. Howard Luks: Gotcha. And they threaten the longevity [00:37:00] of your joint. Now we are capable of repairing those, stitching them together, not removing the pieces when that will preserve your function. So, but those are rare. They're not the most com mo most common type of tear. So the most common types of tears almost never need an operation.

Dr. Howard Luks: And so I'm gonna wait on someone, you know, rehab them, try and distract them. While, while their body heals. Because I know after a few months they're gonna be fine, right? But on occasion someone has a small little flap and they don't get better with time or rehab and you have to go in and snip that little flap out.

Dr. Howard Luks: So I am a surgeon. I do enjoy operating. I just find that you don't have to do it as often as you think. [00:38:00] Same with rotator cuff tears. You know, a lot of people have small rotator cuff tears in one of the tendons on top of the shoulder, and

Dr. Howard Luks: that just occurs because of atrophy. You know, the tendon gets thin, it loses a part of the blood supply, it doesn't heal well, and eventually it disappears and you can live a long, healthy.

Dr. Howard Luks: Productive life and serve a hundred mile hour tennis ball without this tendon. Yeah, 

Jarlo Ilano: amazing. But on 

Dr. Howard Luks: occasion, but Right. But on occasion, someone is going to have terrible pain even with injections or physical therapy, et cetera. So I'm gonna fix that. Right. But I'm not, I'm not gonna schedule you to fix it.

Dr. Howard Luks: Only because, because your MRIs sh showed a tear. [00:39:00] I'm gonna fix it because, because you have a tear and you didn't get better with, with not with non-surgical modalities. You know, you mentioned a high tibial

Dr. Howard Luks: osteotomy. That's where we cut the tibia right below your knee. And that's to change someone who's a little, a little bo, a little bow-legged. Back to being straight. And those are useful for people who are very athletic and want to continue with those activities. There, there situation where a knee replacement won't allow them to return to those level of activities.

Dr. Howard Luks: Right. And you know, it's a big undertaking, you know, a long recovery. Most of the [00:40:00] people who would do them on are runners or triathletes and they don't wanna stop. Right. And they're very successful. So, you know, if I get a runner in who stopped running four to six months ago, hasn't been able to, despite everything else, I'm gonna put that on the table immediately.

Dr. Howard Luks: Gotcha. As an option for knee arthritis, pa patients. I'm not the one who determines when you need an operation. You are. Yeah. I've run with people who are bone on bone arthritis. I've replaced knees on people who aren't even close to bone on bone arthritis because your x-ray doesn't tell the whole story.

Dr. Howard Luks: Right. You don't look at the whole person and Exactly. And if you, so if you think that your quality of life is poor and other treatments have failed and [00:41:00] you think of that a knee replacement is the right thing for you to do, then let's do it. 

Jarlo Ilano: Yeah. 

Jarlo Ilano: With these and I think the, the main kind of common thing that we're talking about is, is the whole person.

Jarlo Ilano: When we say the whole person, it's like these multiple levels of where they're at. You know, the common thing with the rotator cuff tear, and this is something I've seen, you know, so much over the years, is people have a little bit of a tear and then they just, it gets catastrophized like, oh, I, I wanna be able to do this.

Jarlo Ilano: I wanna be able to that, and then I have to provide some, some examples for them. And then you go, well, any people that over the age of 55, 60, you're gonna see 60% of them have, you know, these tears. And it's just because the muscle thin, you know, I, I say all these things but I think a, a really good example that I've had recently is I had a patient I had seen her for a total knee [00:42:00] and she did really well, but she also had all these various things.

Jarlo Ilano: And she had like two, two full tears in her shoulder previously, before, before I even saw her. But she was still working her small farm. She's 50, you know, 50 pound bags of right, of you know, chicken feed. She's got horses, she got alpacas. So she was doing good with, so I like putting that example out.

Jarlo Ilano: But you know, of course there's all these other things. I had to see her later because she fell and dislocated her shoulder. Right, right. And so this, you know, this, you know, that had whole thing with dislocated shoulder and I saw her about four or five weeks. She had that se a second MRI, which showed, you know, of course the rotator cuff stuff, of course all this other stuff.

Jarlo Ilano: But we were working and just, but she got her range. She was, it wasn't frozen, you know, we're like, okay, I'm, I'm glad it's not frozen. I'm glad it's not gonna dislocate again. But now she couldn't lift up, you know, to [00:43:00] 40, 50 degrees. And I'm like. I think that's a really good example of, there are multiple factors.

Jarlo Ilano: She was doing fine with her cuff teared before, but now you added on this other stuff. Right. So I, I sent her back. I'm like, I think you first let's go through Ilanother clinic where they can, you know, do more stuff for you. But, you know, I had to explain to her all of these things, so that's why I knew my question was gonna be like, oh, there's that, this whole kind of question of this, because it's, it's so complicated.

Jarlo Ilano: But I think it's important for people listening to see, you know, don't schedule that surgery on the first day, probably. Right. Give yourself some time, you know, whether it's, you know, therapy, I'm gonna say, go to therapy for sure. Or, or you know, like you said, it's, sometimes it's just a tincture of time.

Jarlo Ilano: There's, there's lots of anecdotes where people can't go, can't get in to see the, the doctor or the surgeon for six weeks or so. Right. Because of the schedule. Then by the time that six weeks are over, they're like. I don't need to [00:44:00] go in. It's, it's better now. Right. I'm sure you've, you've heard of that before.

Jarlo Ilano: Of course. The, the next question I have because, and again, this is a really timely thing and it's also something that I don't expect you to answer very quickly, but, you know, there's a lot more treatments now. You know, there's, there's biologics, right? And peptides and PRP the latest thing that I've been kind of reading up on is 10 x, which is you know, this sort of intervention of a different type ultrasound guide.

Jarlo Ilano: Yeah, yeah. Ultrasound, and then there's shock wave. 

Dr. Howard Luks: Yeah.

Jarlo Ilano: And now you have to advise the patient on these things, right? And then there's the old standby, the cortisone shot, which, you know, I've had a couple myself and they've been great. Right. So, you know, how do you you know how I'm gonna ask you that?

Jarlo Ilano: Like, how do you navigate that with the person and, you know. Kind of help them decide. I, 

Dr. Howard Luks: yeah. You know, after having had a number of [00:45:00] tendonopathies myself mm-hmm. You know, at this stage of the game I had golf was elbow tennis, elbow puff tendinopathy. I had a case of Achilles tendonopathy as, as a runner.

Dr. Howard Luks: It was just awful. I mean, they're 

Jarlo Ilano: brutal. They're brutal. 

Dr. Howard Luks: About, about, about 14 months to go away. And that's not unusual. So if I see someone with achilles tendinopathy, right, they have the classic olive in the tendon and it hurts. I can go through the typical discussion, but they're going to get furious with me.

Dr. Howard Luks: Right. And I think we have some things available that we don't need to wait as long. As a year to get better. We, we can augment biology, we can augment the healing process. Yes. The tend can heal. Yes, it will heal if it's treat, if it's [00:46:00] treated right. But I think there is a role for shockwave therapy either radial or focused.

Dr. Howard Luks: I think there is a role for PRP, but understand that PRP all PRP is not created equal. 

Jarlo Ilano: Mm-hmm. 

Dr. Howard Luks: Right. For a long time there was a system on the market by Arthrex. It was a garbage system. Oh no. You know, it, it drew like 20 ccs of blood and spun it for two minutes or so, but it was platelet poor plasma.

Dr. Howard Luks: A lot of research has come out to show the dose matters, right? We need a certain number of platelets per dose for it to result in the, in the biological changes associated with healing. So, the dose of the PRP matters what, whether your white blood cells or not [00:47:00] matters whether you spin it once or twice matters.

Dr. Howard Luks: And so that is going to have a larger role going forward. And I think combining that with things like shockwave as a role do I think the typical ultrasound has a role? Not really. Right? Do I think that things like STEM have a role? No, but I also don't discount. The placebo effect, 

Jarlo Ilano: right? Absolutely.

Dr. Howard Luks: So if I have a runner who comes in and says, oh, I paint on the other side of my knee, but I foam roll it and it feels great, what am I gonna say? You know, the research right on, on, on this says no, of course. I'm not gonna say that. Right. 

Jarlo Ilano: Absolutely. I'm gonna 

Dr. Howard Luks: say, look, no harm, no foul. 

Jarlo Ilano: Exactly.  

Dr. Howard Luks: know, you know it's working for you, do it.

Dr. Howard Luks: So I think 10 x is an [00:48:00] option in certain cases. That's where we use an ultrasound machine. We find the area of the tendon that's degenerative and causing the pain. And I know we could suck it out using a small probe. But with PRP, shockwave and other things. I don't think that we have to use that off often anymore.

Dr. Howard Luks: Right. You know, tough tendons like hamstrings, patella tendinopathy even cuff tendinopathy, they respond well to this combined treatment, of course, with physio and exercise, right? Is that, as I mentioned, tendons need load to heal, right? So no matter what a what additional treatment you initiate, whether it be PRP, shock label, et cetera, you need that loading to complete the [00:49:00] healing process.

Jarlo Ilano: Yeah. You're still gonna need to, that's what I was gonna say. So for, for the people listening, you know, with PRP, the platelet rich you know, injections, 10 x shock wave, I think a lot of this is what we've seen, you know, over the decades is things look promising and then, you know, you get a lot of these effects with people with the early adopters and perhaps some of it's placebo, perhaps some of it is the thing itself, but a lot of it, you know, requires time.

Jarlo Ilano: You know, I, I mentioned to you in the email earlier I remember when those Synvisc, right, the, the, the root co rooster comb, you know, cartilage injections that was super popular maybe 20, 20 years ago. And I remember patients, they were like, yeah, I'm getting it every six months. I love it. Then I would see other patients like, ah, I try that.

Jarlo Ilano: I didn't do nothing. Right? And then we're seeing a lot of that now with, with you know, all of these biologics and PRP and it isn't that panacea. And, you know, I, I mentioned [00:50:00] 10 x 'cause that's the, just the kind of the newest thing and people are. Loving it. Patients ask about it. Like I looked it up and okay, yeah, it kind of makes sense, but you, you're still gonna have to exercise after, you're gonna still have that kind of period of the proper loading.

Jarlo Ilano: Right. Heavy, slow loading. A a lot of times. So tendon itself, I mean, we could talk about for forever, like, yes, it, it requires a lot of, of load and speed and stuff later on, but initially you're gonna need that sort of long tension, you know, to get, get out of that stretch. Right. You know, stretch, shielding, and get into that stress, relaxation, you know, I mean, we can talk about this forever.

Jarlo Ilano: I think the hardest part when we're dealing with patients is not to get too specific, too early and, you know, just overwhelm them with information. Right. So I, I love it when, when we can just say properly, you know. It's going to, we're gonna give it this time and we're gonna do this and, you know, explain what we can.

Jarlo Ilano: The [00:51:00] hardest part is, is absolutely what you were saying earlier when you're telling someone, well, it could take a year, it could take 12, 12 months, you know, 14, 16 months. That's hard. That's really hard to wrap your head around. It's definitely easier when you have someone that's been in pain, you know, 5, 6, 7 years.

Jarlo Ilano: They're like, okay, I can deal with that. It's much harder when someone is just coming in to see you and you know, they, you know, maybe they've had pain two, three months, but then you're like, okay, right. It's super tough, you know, I really commend you for, for spending time with your patients and, and really trying to educate them well, and especially again, on the, on social media.

Jarlo Ilano: There's so much, it's so much easier to tell for someone to go, don't run, you know, if you're, if you don't want to facelift. Don't run so much to you to say that versus what we've tried to go into the nuance, you know, in this last 40, 40 minutes. [00:52:00] Right. It's tough. So I thank you so much. You, 

Dr. Howard Luks: you know, and one thing just to add on, like, you know, you mentioned peptides.

Dr. Howard Luks: There are some things that are out there like no, I think placenta cells and ah, exo exosomes, et cetera. I mean, there's a lot of research that shows they don't work. And a lot of doctors, I know some, you know, they're charging $6,000 an injection for this. Wow. Or they're injecting stem cells in knees and telling people that they won't need a knee replacement.

Dr. Howard Luks: I mean, this is wrong, right? Yeah, yeah.

Jarlo Ilano: Yeah. 

Dr. Howard Luks: And it's unfortunate, but we also have to understand glycopeptides. There have been many times over the last few decades when the Jim Bros and Bro Science was telling [00:53:00] us as physicians and physios that, that something works. Right? We said, no, there's no research, and now we, now we find that, that there is and we agree with them.

Jarlo Ilano: Right. That's, yeah. That's the hard part. Right. 

Dr. Howard Luks: So it is true that we don't know everything and we have to be open to that, 

Jarlo Ilano: but that's how science works. That's how science works. That's, 

Dr. Howard Luks: yeah. You're absolutely correct. Yeah. So I'm not going to, unless there's reason to slam something 

Jarlo Ilano: mm-hmm. 

Dr. Howard Luks: Like a $10,000 stem cell injection.

Dr. Howard Luks: Right. Or an exosome injection. I'm, I'm. I'm cautiously optimistic about, about some peptides. I just, I want the research to catch up to it. 

Jarlo Ilano: Right, exactly. 

Dr. Howard Luks: Right. But I'm not so firmly against it. I have issues with [00:54:00] some research grateful formulations. You know, the, the the expensive versions, which are medical grade are just that they're super expensive.

Dr. Howard Luks: So a lot of people are buying something online for $30, where the real version costs 300. You know, we see this a lot with the GLP ones as well. So there's gonna be some harm induced by that along the way. But I think the science is going to catch up little bit in the next decade. We'll find that some of these things work, 

Jarlo Ilano: right.

Jarlo Ilano: I think that 

Dr. Howard Luks: we have to wait. 

Jarlo Ilano: That's the key. A lot of this is that balance between, you know, keeping an open mind and, you know, wanting, or, you know, not just putting the C wash on a person right away. Well, we don't see it. Any, that's the, that's a lot of the things with the evidence-based practice, [00:55:00] well, the hard part is if you're in an area where that evidence evidence-based is shallow, you know, what are you gonna do?

Jarlo Ilano: So there's, it is the nuance and balance between the, you know, the cost benefit ratio. Yeah. Like a six to 10,000 unproven injection, dollar unproven injection, you know, versus, you know, going and seeing if a little bit of vitamin C and collagen, right. You know, cost like 20 bucks. You see if that might help you for a few months.

Jarlo Ilano: I, I remember a patient saying that. I was like, yeah, that's fine. It's not gonna kill you. Vitamin C, collagen, there's some research that could be useful, right. But if someone's saying, well I can, I'm gonna go to Mexico and get, you know, like, you know, these stem cells, I'm like, ah, let, let's wait a little bit on that.

Jarlo Ilano: So again, it's the, it's the balance. It's the nuance. A lot of these, you know, we can't tweet out, you know, the, the balance of this in, in a way that, you know, will go viral. So, 

Dr. Howard Luks: and look, you've had a lot of [00:56:00] influencers with a wide reach promote things over the years, like metformin, right? Exactly. That was promoted for a long time as a longevity drug and in certain instances it's very useful medication.

Dr. Howard Luks: But if you are a healthy male, let's say and you're exercising and you're in the gym and you're not diabetic or insulin resistant. It's gonna be a net harm probably, because you're not gonna build the muscle, you're not gonna have the same mitochondrial response or rapamycin. You know, it's, it's prolonged the life of every organism that it's been tried in except for humans.

Dr. Howard Luks: There's no harm. I'm sorry. There's no, there's no data that it doesn't produce longevity in humans. But you talk to people who've tried it and they get these mouth sores and they get this, and Oh, wow, you're playing with the immune system. [00:57:00] And I'm just, you know, if you're getting mouth sores, then you have viruses that are growing in your body that weren't growing when your immune system was functioning well, that can't be good for you.

Dr. Howard Luks: Right, right. So, you know, yes, you're, you are killing you know, senescent cells, but you're letting other things grow in you. So there are instances like that where we have to wait for the research to come out. Right. Because otherwise there's just a significant risk of harm. 

Jarlo Ilano: This goes back to we had in the introduction mentioned your book, longevity Simplified, and I think it's an excellent book for like cutting through a lot of what you, what we just talked about.

Jarlo Ilano: You know, there's so much fabs out there and there's so many things where people are sort of, kind of majoring in the minors to speak of, you know, should I be on metformin? Should I, [00:58:00] you know, do this when they aren't, you know, they aren't doing a couple hours of exercise a week, that would be way more beneficial.

Jarlo Ilano: Right. Or, or they, you know, God forbid we tell you, don't go to McDonald's, you know, six days a week, you know. The, so those types of things are, are super tough to sell, but they are absolutely true. So that's the hardest part to think of all of this and, and trying to help people is like things that are fundamental and true and will really help them just aren't as, you know, as sexy as, as you know, again, a stem cell injection or, you know, trying this, this thing where you don't, you know, don't, don't eat for three days, so you can kill off a lot of these, you know,

Dr. Howard Luks: Right.

Dr. Howard Luks: You 

Jarlo Ilano: know, whatever, you know. 

Dr. Howard Luks: Yep. So, you know, I, I see a fair number of people in my office for, for visits because of my book.

Jarlo Ilano: That's great. It's a, 

Dr. Howard Luks: that's awesome. And they'll, they'll talk about and ask about [00:59:00] supplements, peptides stem cells, et cetera. But I always go back to the same thing if you are not moving a lot.

Dr. Howard Luks: Strength training, power, balance training, sleeping well. If you don't see your friends, if you don't wake up and have a sense of purpose. If you don't, you know, if, if you're in bed with someone that you don't enjoy anymore and adding, adding stress to your life, you know, life. Unless you address these huge buckets, then the 1% that the peptide or the supplement is gonna bring you is absolutely irrelevant.

Jarlo Ilano: Right. Gotta get those big. Yeah. Throw the 

Dr. Howard Luks: other buckets first. 

Jarlo Ilano: Yeah, absolutely. Gotta get those big blocks down. One last thing before we go. You have a new book that you're about to release, and this is, is this an arthritis in general just, or needs arthritis [01:00:00] in specific? 

Dr. Howard Luks: It's specific to the knees, but it's relevant to both.

Dr. Howard Luks: It's, it's relevant to any low extremity arthritis. 

Jarlo Ilano: That's great. It's, when is that gonna release? 

Dr. Howard Luks: So I've, I'm putting out a chapter a week on Substack. It'll be done in about six months five months. And then I'm going to publish it in about a year. 

Jarlo Ilano: Oh, that's great. So we'll definitely be on the lookout for that.

Jarlo Ilano: I'm gonna put in the show notes here, links to your site your substack, your site, and also the links to longevity simplified. So that's for our listeners, you know, thank you very much for your time. I really appreciate it. And it's what a great talk, Thank you so much, Dr. Luks 

Dr. Howard Luks: Sure Jarlo

Dr. Howard Luks: enjoy it. 

Jarlo Ilano: Well, thanks everyone for listening. So that's GM B in this podcast for today. You can look into our archives. If you have any questions, please email us, [01:01:00] howdy@gmb.io, and then we'll see you next time. Thanks a lot.