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

22:34Dr. Jocelyn Wittstein: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 undenatured collagen. Yeah. And there's also studies on the different types. You know, the hydrolyzed ones are digestible and absorbable, whereas the, you know, UC2, the undenatured collagen type 2, which is the kind of, the primary kind of collagen that's in our smooth gliding cartilage, seems to have like a different effect, like something that is more of an oral tolerance effect exposure to your GI tract.

23:14Dr. Jocelyn Wittstein:But the measures are like looking at 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 need a knee replacement later on in life. Those studies don't exist. But some, again, pieces of scientific evidence to kind of suggest to me that I do think it's beneficial. And I like to use a collagen supplement that combines type 1 and 2 collagen because I do think there's also strong evidence for hydrolyzed type 1 collagen supporting bone health.

23:50Dr. Jocelyn Wittstein:And, you know, I kind of just lump them in together in my coffee. Yeah. 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. 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, well, like, what collagen do you use? I want to, 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 I use.

24:29But 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. Well, now you have to say what it is. Cause then we're going to get healthy bones.

24:41Dr. Jocelyn Wittstein:Okay. Total body one, the healthy bones, total 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 your cup of coffee and then you, I heat up my milk and And I like a ton of milk with really strong coffee. So coffee, I feel like, is like I'm getting some protein and some calcium. 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 satisfying to watch.

25:18Dr. Jocelyn Wittstein:You should try it. Okay. I have collagen. And literally, it's sitting in a cupboard and I never get it out. And every day I'm like, oh, I should get out the collagen. But here's my reason. is a good option because people, you know, like that's something that most people do every day. And, um, I also think get it done. Well, yeah. Like it's, there's other great things about coffee too, but I just, it, it's so easy to add in. So I'm with you on that. That's what sold me. I'm like, now I'm going to be very consistent with my college. So it's slightly smooth. It's kind of weird. Well, now you've intrigued me.

25:56Now I've got to go buy, I've got to go like, do this whole procedure and see if it if it's mesmerizing as it was for you first thing in the morning I kind of I love it so okay if we I want to really dive into these are the questions that that come up all the time jump training now this is how I found you yeah and I actually got served up on Instagram Laura was just asking me how did you find Jocelyn I said she got served up and then I saw that Dr. 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.

26:41Dr. Jocelyn Wittstein:Well, funny, I didn't realize how much that would grab people's attention. I just, yeah, it did. It's a little eight inch drop jump. And I didn't make this up. I, 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 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 primarily affects our hips. And so the specific study of the amount of impact you get with an eight inch drop jump and a rebound came from a study done by a researcher named Tracy Klissel and her group, the group of researchers she was working with.

27:26Dr. Jocelyn Wittstein: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 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 do a couple days a week but jump training you can do like anywhere plyometrics you can do pretty much anywhere yeah okay so we have the the jumping and and from the Tracy Klisseld's from her research she recommends landing with like a a straight leg like not really absorbing the bounce.

28:16Is that, um, more what you were doing or like 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 plyometric thing. And so I had a lot of people write to me, oh I forgot 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 want to say I'm immature but I love doing like I was a gymnast I'm always like this is the gymnast in you coming out I like doing things if I'm at the playground I do some pullovers I do the monkey bars or I like jumping around and, but I, 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.

29:18Dr. Jocelyn Wittstein:It just felt really weird. But I think jumping is like that. If you haven't done like a jump landing in a while, it feels weird and you forget how to drop and do 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 got to get that effect on the, 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. Yeah, no, it was great. And I love it. Like, I remember this was years ago when my daughter, who's now 21, when she was, I think in kindergarten, probably kindergarten, and there were monkey bars.

29:55And at the time I wasn't doing any lifting. I was doing triathlon and I just didn't do any lifting with it. And I tried to do the monkey bars. I thought my arms were going to fall like out of this. It's well, cause your people don't use their lats very much. Yeah. Clearly I wasn't. It was terrible. So, okay. So we have to jump and then other options. So we, we, we know that, you know, we're looking at, and not the osteoporosis doesn't happen anywhere else, but we get tested at the risk that the, the, um, femoral neck and then the, uh, lumbar. So, so if we're looking at like the wrist, so if we were doing overhead, um, you know, a barbell overhead press, we're loading the wrist.

30:46That's one way where we could load the wrist, but what are other ways that you could add more dynamic to it? So I think that people should, yeah, try to load your wrist. Now the funny thing about your wrist, you know, so like, first of all, when you talk about the wrist, we're usually talking about the distal radius, the wider bone here. Of course, there's smaller bones in the actual wrist here and your ulna is small, but the thing that people break 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 it's kind of like a canary in the coal mine 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.

31:33And for instance, like there are some studies that show if you break your wrist, you have a 40, 50 % greater chance of having a hip fracture later on than someone who like has never broken their wrist because it's an indicator maybe of your bone health or maybe your likelihood of fall, who knows. But so wrist fracture can be, I always tell people the silver lining of a wrist fracture is this can be a bit of a wake-up call. Like maybe you just have some osteopenia.

31:57Dr. Jocelyn Wittstein:yeah also it's so often happening to people who are like in their early 50s when maybe they're making decisions about like hormone therapy or not which is prophylactic against osteoporosis so not that i want people to go around breaking the wrist but like if that happens to you like take advantage of that situation go get your bone density checked you know pay attention but anyway the interesting thing about the wrist it doesn't have like a ton of large muscles attached like right here. So like in addition to like impact, strength training, carrying things, putting load across your bones, 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.

32:38Dr. Jocelyn Wittstein:But this is kind of an area where like a lot of tendons and 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 wrist bone density, that doing some load bearing on it is good. It could be, as you said, an overhead press, which of course is part of the lift more 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, walkouts.

33:14Dr. Jocelyn Wittstein:I shared a video the other day of like kind of a drop onto your arms. Yes, I saw that. I loved it. Great. You know, like when you're a gymnast, we used to do like handstand pops, but people aren't going to 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 17 year old. And, but, you know, you could do some pushups or load bearing. um honestly pushing a lawnmower as someone suggested the other day like 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 or with a push off um i kind of showed you can do like a little drop onto your hands from um hanging out at the pool is great relaxing and playing vegas style games on my phone at the same time.

34:10Drink in one hand and a blackjack in the other. It's all at SpinQuest. Over a thousand games, including your favorite slots and table games. Be cool with this summer special. New players get$30 coin packs for 10 at SpinQuest.com. SpinQuest is a free-to-play social casino. Avoid where prohibited. Visit SpinQuest.com for more details. a yoga block or um someone suggested um pt for women on instagram suggested doing like a bear walk to drop into a push-up position like a plyo push-up i love bear walks because that's a core exercise but you're 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 walkouts with a plyo ball You know, you're basically walking.

35:00Yeah. That's tricky. Yeah. I think a lot of the 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 so I think it's good to put some weight on your arms. Yeah, for sure. Even if it's depressing, yeah. I'm super impressed with that because I always get asked, well, what do I do if I have osteoarthritis in 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, you can't jump, but you can load the wrist, how you said, um, you know, you can still load the spine, but what else do you have for, um, women that, that have osteoarthritis and they can't jump and they feel left out of the party.

35:50And I never want anyone to feel left out of the party. Yeah. So this is where like what you can tolerate comes into play and something is better than nothing. And like the concept of it, I don't know if you know the term weight bearers tolerated that we use in orthopedics. Like I have a nerdy hat that says it, WBAT, which I'm going to make some t-shirts of, but some of my lady residents, we have a little WBAT club, we call it, but anyway, so we're obsessed with weight bearers tolerated. It's, 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, weight bearers tolerated, but it, it's a term that I think people can apply to so many things.

36:34Like

36:34Dr. Jocelyn Wittstein:at what can you tolerate? 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. Um, you can do using like a rebounder or a mini tramp, um, jumping on there. It's not as effective for simulating bone density at the hips as jumping on the 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.

37:17Dr. Jocelyn Wittstein:It's not as much as jumping on land. So like find what you can do and do it and keep doing it. And it's not going to help you if you have really bad knee arthritis and you're like, I'm going to 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 to like listen to their bodies. Not everything is for everyone and that's okay. And there are modifications and And just the hard thing for women, especially in your, like, say, 50s, is you're trying to navigate doing exercise to maintain your bone density, but at the same time you're at risk for arthritis.

37:56Yeah.

37:57Dr. Jocelyn Wittstein: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, I mean, I don't think anyone – I don't think you have to go past 90 of knee flexion. And so maybe you can do that, or maybe you do your squatting with moderate intensity, not high intensity. Maybe you can do higher with deadlift. And if you don't have shoulder issues, maybe you can lift heavy with overhead press. You have to listen to whatever issues you have going on. And I always give the example, I actually am never going to be a high intensity overhead presser because it always gives me a recurring injury or tendonitis or whatever.

38:38And 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.

38:45Dr. Jocelyn Wittstein:And that's fine. I'm still contributing to my maintenance of muscle mass. And it's and moderate intensity lifting still helps 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 you have 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 share with people data and options. And 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 they're limited.

39:33It's the worst. I hate it for them. And so I 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 good hip mobility, like rowing is a great option. It's actually quite tolerable to arthritic knees. and because of 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

40:11Dr. Jocelyn Wittstein: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 maintaining their bone density. Okay. So this is the last question on, on this, but well, first of all, I have to say I had knee surgery, uh, eight years ago where I had a full meniscus root tear. So I couldn't, I was non-weight bearing for six weeks. That's non-weight bearing six weeks. The worst, the worst, but I would go and sit at my physical therapist's office and they had the arm bike and I would sit on there for 45 minutes.

40:48They were the crazy ladies in here again, doing sprints on the arm bike. It was all I could do. I was like, I have to move somehow. it's too bad that we didn't know each other then because i could have told you about three limb biking which is where 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 oh i'm so mad well it's everyone else work around and and that's the i think that's the best way to get your heart rate up when you have like one leg that you can't like do cardio with. Oh, yeah. Because the arms don't get enough. Or you can do a ski erg if you have the ability to balance on the one leg.

41:32Yeah. I mean, I eventually got in the pool and just put a buoy in between my legs so I could just – It's maddening. It's maddening. Meniscus root tears, I really – Also, by the way, I think people need to choose carefully because if you already, I don't think you had arthritis, but if you already have some arthritis and you tore your meniscus root 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 root repair, touchdown weight bearing for six weeks, their muscles atrophy so much on that leg.

42:07Actually, 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 benign. So it's like, you have to choose wisely if you're going to have a root repair because that six weeks on crutches can... And then you're already in a situation, like let's say you're a woman in your 50s where you have a hard time building muscle. So you get atrophy and disuse And then you have to, you know, disuse is, is hard. It's true. I, I hate to put weight bearing restrictions on people, but that's one surgery where I told them you can't put weight on your leg for six weeks.

42:44And so it's a big deal. Yeah, no, I, my doctor, I had a 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 Ironman. 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 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.

43:26So I just don't do it. I do it in other ways. But let's go over when you said the high intensity, you're meaning 80 % or more of your one rep max. The high intensity is that 80 % single rep max, which since most people don't know their single rep max, 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 where 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 your, and then you have to rest before you do another set. That would be like your, that version of your 80 % single rep max.

44:06And, and I, 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, the, there is more return on investment, 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 trial showed safety in these women who are average age 65 osteopenic. There weren't any injuries, but those are studies and they're not

44:51Dr. Jocelyn Wittstein:real world and people are screened out because they had that root repair or can't do something because of some preexisting injury or whatever. So in real life, we're not subjects in studies that met exclusion and inclusion criteria and we have things. And I think the messages are very good that heavy lifting 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 still a positive.

45:33Dr. Jocelyn Wittstein:And so I mean, 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 rotator cuff repaired 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 farmer's carries with something heavy or, or maybe you can do like, I prefer hex bar squatting over back squats more or less kind of thing. But yeah, so I think real life doesn't always, like I said, match these inclusion and exclusion criteria and people have actual issues they have to work around.

46:15And so I just don't want people to feel excluded from the strength training process or the benefits of it, or think 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. 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 in this 80 percent one rep max or four sets of four or five sets of 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 as much of that benefit but can we can we do the the uh 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 one, one leg instead of bilateral?

47:21Uh, yeah, I, I think that actually is sometimes better at identifying asymmetry. Sometimes we're compensating on, you know, um, you know, we all have a dominant leg, Like, you know, for instance. So, yeah, I think that there's definitely a benefit to unilateral strengthening and also certainly helps with balance and things like that.

47:46So, yeah, 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 not an issue. Yeah. Okay. Well, lots of options, ladies. I hope you're taking notes. Something is better than nothing. Yeah. I always 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.

48:27but I just think people also need to think of use as the opposite of disuse. I mean, I don't want to say 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 repair and you 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 atrophy and you have to build your muscle back up.

49:03One of my good friends who's chief of orthopedics and sports medicine at University of Wisconsin, Tammy Skripal has done some work on this. Like even a person who had an ACL reconstruction, 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 osteoporosis at a ridiculous rate. So, you know, weight bearing on your limbs, whether you're walking with or without a vest or jumping, or if you're on your arms, if you're load bearing, like these are things that are the opposite of

49:42Dr. Jocelyn Wittstein:disuse, which would be in an extreme version, being an astronaut or being on crutches or something like that. Yeah. Yeah. Bless the astronauts. Yeah. That's why they have a special thing. What's going on, everyone? It's Bluff here and we're driving through the States in the Bluffmobile. And the best thing that we can do is play our favorite casino style games on Spin Quest. They have over a thousand games, including live dealer blackjack and craps with tons of slots and unlimited options. You can get a$30 coin pack for just$10 for new users. Sign up today, Go to spinquest.com right now. SpinQuest is a free-to-play social casino.

50:20Avoid where prohibited. Visit spinquest.com for more details. They have a special resistance training thing on the ship that is, it's not weights. It's like basically super resistance bands. 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 the astronauts are doing strength training to maintain their bone density. You have to. Going back to the ACL, what factors can contribute to ongoing atrophy and imbalance? and after a full ACL and meniscus tear and reconstructive surgery, what are the most effective ways to restore full strength?

51:17Well, I think one of the key elements is when you tear your ACL, the knee swells, you get fluid in it. And then after surgery, there's usually swelling 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 quadriceps inhibition. And so someone will come in and they like won't even be able to lift their leg off the table or they can't walk because their knee 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 post-op 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 activate their quad.

52:02Like 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 hyperextension can do it. It just immediately helps them restore their function. So that's one

52:13Dr. Jocelyn Wittstein:thing, getting the swelling out of the knee 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, 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 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.

52:57Dr. Jocelyn Wittstein: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 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 they don't think about it in that way, but it's kind of your workout. And I had this hip surgery last July and I 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 atrophy.

53:41That's what I was doing, the three limb biking. I would do it like two hours. I'm jealous. It would have saved me a year of working back until I got, I mean, I think it was more like 18 months before I got full strength back in that leg. Man, that would have been helpful. Well, what if it's been a couple of years and you're doing pretty good, but you're not a 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 a hundred percent. Yeah. So most people do end up losing, it's common to lose about 10 % of your strength in the leg that like had the surgery.

54:22That's a good, we like people to get to 90 % limb symmetry. Um, you can try to use blood flow restriction therapy, uh, later on, if you're just kind of like struggling to like get stronger, um, that can be an option to kind of help with muscle hypertrophy. Um, return to running, is, well, one thing that can make that 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 gait analysis and sort of just make sure that they're striking evenly and their stride length is even. Because people really sometimes up until a year will have this altered gait where they spend less time on the surgical leg and more time on the other leg.

55:10And that's just they're compensating. And so I think sometimes we need to work on that. Do hormones play a part in recovery for women? 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. and we have a study upcoming where we're like actually currently looking at this. Um, but, um, yeah, there's some theory that estrogen makes the ACL like more lax and more likely to tear. Um, on the other hand, there's some theory that it also kind of helps to organize the fibers of, of the ACL.

56:00Uh, also the low estrogen state may be of the cycle, may be associated with more like muscle fatigue. So, you know, is it more likely to tear your 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 bottom of with these kind of 3D MRI models we make of knees and have people do this jump task. And then we measure how much their ACL 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.

56:41Because unfortunately, you know, someone asked me like, why are you so interested in midlife women's joint health?

56:49Dr. Jocelyn Wittstein: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 your ACL, you're also more likely to get post-traumatic arthritis. And that's another area that we study. But then, you know, women are more likely to get arthritis regardless as they age. So for a teenage athlete who tears their ACL when they're 16, you know, when they're maybe coming up on 30, they may start to have some arthritis in their knee from post-traumatic arthritis. And then you may arrive at adulthood, you know, and be even more at risk.

57:25So for people

57:26Dr. Jocelyn Wittstein:who are teenage athletes who tore their ACL, they're really high risk for arthritis as they as they age. Wow. Okay. So if we move on and I'm glad that you mentioned weight bests. So there, there's a lot, I've, I've now been online for four years and, uh, the last year of the space has gotten really wow. Wow. All I can say is there's really not any, any, like 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 vest or yes, do the weight vest. And I'm like, why is it that it shouldn't be that big of a deal. I'm curious on your thoughts.

58:09Yeah. As you can tell, I'm a big, uh, kind of, it's not middle of the road. Yeah. There's nuance, nuance. I'm a nuanced person. There's a lot of nuance. Me too. Um, so I, I think I don't ever want someone to think that wearing a weighted vest is the thing that's gonna, you know, improve or restore or maintain their bone density. Um, 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 training and jumping and stuff. And so, so there's this one study that showed some improvement in bone density, but it was like a component of a program and a subset of a group of women.

58:54So it's not something to necessarily hang your hat on, but, um, I have, I have a weighted vest and I have a rucksack actually like a rucksack 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. Um, but I don't necessarily use it for maintaining or building bone density. It adds to my cardiovascular exercise. I put it on, I walk my dog, 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 any definitive study that shows that walking with a weighted vest is definitely like increasing your bone density.

59:41But it is taking your walk up a notch. It is a little bit more load. There's, again, I think these things are cumulative and it's, it's more use than less use. Um, now the conundrum I kind of struggle with for some people is if you have some knee arthritis and we're telling you, if you lose five or 10 pounds, your knees will notice a difference and they'll feel better. Do I want to tell someone who has, who's dealing with knee arthritis and trying to find ways to maintain their cardiovascular activity and not get knee swelling? Do I want to tell them to put on a 10 pound or a five pound 13, whatever, most of them are, you know, you can get five, 10 % of your, do I want to tell that person, I just told you your knees would feel much better if you lost five or 10 pounds.

1:00:27So 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 feel so much better when I'm five or 10 pounds lighter and they're trying to walk for cardiovascular activity that's probably not the person i'm going to tell to put on a weighted vest yeah so as with for someone whose knees are feeling good and they want the added cardiovascular exercise great and some of the studies show like it did help with hanging out at the pool is great relaxing and playing vegas style games on my phone at the same time drink in one hand and a blackjack in the other it's all at spin quest over a thousand games including your favorite slots and table games.

1:01:09Be cool with this summer special. New players get$30 coin packs for 10 at spinquest.com. SpinQuest is a free-to-play social casino. Avoid where prohibited. Visit spinquest.com for more details. Strength or maybe like parameters that would be associated with fall risk like balance and things like that. So it's in the category of I definitely don't think it hurts you and there are definitely some positives it's just i wouldn't i wouldn't portray it as this is the way to like this is the path to preventing it's not the path to preventing

1:01:44Dr. Jocelyn Wittstein:it's not enough by itself to prevent osteoporosis just a deeper i mean there's always a deeper conversation than just wait best yes or no um but it is it's it's funny i want to say the internet needs to chill chill yeah i don't i don't think we should villainize people who um who are supporting them or or yeah it's almost like uh become a are you a vest person or not and um i i think it's certainly getting people out and walking and um i see a lot of women at my ymca day, um, 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.

1:02:33Some 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, the, the exercise. So I, I do think it has benefits for sure. Okay. So this is my last question before we wrap it up. and this just popped into my head and it wasn't on the list or anything, but do you think, 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. 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.

1:03:22Pick and choose, like, sure, you should do a little bit of this, a little bit of that. But the perfect prescription doesn't exist because it's not unique to you. But what are your thoughts on that? Do you? What? Yeah, I do think online resources could certainly be lacking in the nuance. and yeah, I think a lot of people are very just kind of black and white in their opinions and it's, yeah, you could easily find one person saying one thing, one thing. 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 asks me a question with the nuance related to them, but it's hard.

1:04:15Even if someone is giving me information specific to 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 people need to still consider their own individual circumstance and not just put expectations upon themselves. Like, I don't think everyone needs to look at everyone on the internet and think, what I worry about it actually is people feeling like inadequate, or like I said, excluded. Yeah. If they maybe can't do like what someone is saying they should be able to do, and that's okay.

1:04:52So I think people need to start somewhere, do something.

1:04:57Dr. Jocelyn Wittstein:Raper is tolerated. You know, these are reasonable expectations and, and you can always start, it's never too late to start. Like I, I like to say, like so many of the studies on even bone density are on women who are 65. And some of these studies are following people for 15 years and, you know, reporting decreased fracture risks and things like that. so um i i think the other thing people hear is that the it's too late speak um and i don't ever want anyone to think it's too late when you hear it's too late oh you should have had a dexa when you were 50 you didn't get it until you were 65 it's too late for you it's like this i don't want anyone to like hear like fear mongering i i just think like sometimes when we're saying things like current recommendations seem too late.

1:05:54It's more like wishful thinking. I wish people could get, you know, something studied earlier, or I think 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. Um, but yeah, there, there's always going to be some, some extra of opinions. There's, there's data overload, frankly. Yeah. Yeah. Yeah, for sure. Well, I want a hat.

1:06:33I want one of your hats when you make them. I do too. They're really cute, by the way. My, my residents made that for me and, um, she's really interesting. There's actually two of them are really interested in this. She's actually currently studying estriol application to fracture sites, you know, estriol, the stuff that's in the face cream to see if that will help with bone healing. That's one of, one of those, one of the two residents that's in the Wabat hat. I love it. Oh, we're staying, 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.

1:07:20I feel the same way. This is why I want everyone to join in on the party. I'm like, we don't want to leave anyone out. I can, I just love your, your 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 17 had, you know, 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 as good. none of us are immune to these things.

1:08:01I, I mean, I had a hip surgery last summer. Um, and like nine months ago I had a frozen shoulder, um, which is extremely ironic because I'm a female hip surgeon and I studied frozen shoulder and I was like, I have, so yeah, we're, no one is immune to these, these things. And none of us are like immune to aging. And it's just, I think we can try to, um, age wisely and, and, um, you know, be proactive about our, our health. So, yeah, but thanks for having me. It's so nice to actually, um, meet you guys.

1:08:41Dr. Jocelyn Wittstein:I want to say in real life, but we're on zoom. I'm hoping, I'm hoping in real life one day. Yeah. In real life someday. So, okay. While we're wrapping up and we're done, we're logging 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? Yeah. I mean, maybe the easiest way is my Instagram page, which is just Jocelyn underscore Whitstein underscore MD, which full caveat, my 19 year old daughter showed me how to use in January of this year. Uh, so, uh, but she's taught me well. Um, yeah. And then, um, I, I practice full time as an orthopedic surgeon at Duke university.

1:09:32Um, but in terms of like the information I try to share and sort of, you know, data-driven digestible bites, I think is in a lot of Instagram reels. 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. So thank you again. Yeah, thanks for having me. Thanks for listening, everyone. If you enjoyed this episode, please consider giving us a five-star rating and sharing the BodyPod with your friends.

1:10:09Happy birthday, America. It's time to celebrate and play your favorite Las Vegas casino games by American-owned SpinQuest.com. What's better than fireworks and American pie? Hitting a blackjack in the palm of your hand and you won't lose your fingers. Over a thousand games including slots and live dealers. And$30 point packs are on sale for$10. SpinQuest.com. Buy American players for American players. SpinQuest is a free-to-play social casino. Avoid where prohibited. Visit SpinQuest.com for more details.