Behind the Bluff

Your Skeleton Rebuilds Every Decade, So Train It

• Jeff Ford & Kendra Till • Season 1 • Episode 90

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We walk through bone and cartilage 101 with Dr. Gray Stallman, from Wolff’s law to why hips and spines fail, and how smart stress restores strength. Practical tools, from strength training to DEXA scans and nutrition, show how to slow loss, manage arthritis, and regain function.

• bone as living tissue that adapts to force
• articular vs fibrocartilage and healing limits
• osteoporosis risks, menopause, and fracture impact
• DEXA timing, spine changes, and posture decline
• use it or lose it applied to bone and muscle
• strength training, impact, and running mechanics
• nutrition basics for bone density support
• arthritis types, symptom drivers, and options
• injections, pros and cons, and surgical pathways
• mindset, technique, and consistency for long-term gains

Be sure to join us next week. We’re going to sit down with a registered dietitian that you know really well. Her name’s Lindsay Ford. And we’re going to talk about all things protein, how much you really need and how to use it to support your training and recovery.
We’re going to go ahead and put those in the show notes. This might actually be our first time doing that, but I’m excited that we could finally pitch some show notes.


SPEAKER_01:

Are you ready to live an active lifestyle? Welcome to Behind the Bluff, where we believe every moment of your life is an opportunity to pursue wellness on your terms. I'd like to welcome you back to our part three of the series we've been doing with Dr. Gray Stallman. In our first two episodes, we covered soft tissue 101. What are muscles, tendons, ligaments? How do they work in the body? And what's their general makeup from a healing perspective and a change perspective? We then delved into strength training and how it protects soft tissues like muscles, tendons, and ligaments, and how mobility and recovery need to fit into your overall picture when you're planning out a program. Today we're going to shift our focus to hard tissues, our bones and cartilage, to understand how they adapt, how they break down, and how we keep them healthy for the long haul. Let's start simple today. How would you best define hard tissues? What makes them similar to soft tissues, and what really sets them apart?

SPEAKER_00:

Well, that's a great question. So the hard tissues are the bones and the cartilages. They basically add structure to the body. Most people think that bone is hard, rigid, uh stone-like. It's actually not. It actually bone actually bends a little bit, bone responds to its environment, bone responds to its uh forces placed upon it, and um therefore it can change over time. In fact, a little um side note, you have a new skeleton every 10 years.

SPEAKER_01:

Every 10 years we have a new skeleton.

SPEAKER_00:

That's correct. You don't you don't have the same skeleton you were born with. Um, and that's because the bone cells turn over. Now you asked about um uh how bone is similar to the other soft tissues we've talked about. Uh it's made up of multiple parts, multiple cells. There are what are called osteoclasts, which are the cells that help break down bone. There are osteoblasts, which are the cells that help build bone. There's collagen, which is a connected tissue, and there's some other materials, including calcium, which is a mineral, uh, that helps give the bone stiffness. Cartilage, there's two types of cartilage. Uh the one that most people are familiar with is what's called articular cartilage, which is the pearly white stuff on the end of a chicken bone that you see. That's the bearing surface inside your knee or your shoulder.

SPEAKER_01:

So when we say we've lost cartilage in our knee, that's the type of cartilage we're talking about.

SPEAKER_00:

Most commonly that is correct. And it's a it's a tissue that's made up of uh collagen cells and uh proteins called proteoglycans. And those proteoglycans hold those t those cells together. It provides a cushioning and a gliding surface. It also produces a fluid that's a lubricant. The trouble with articular cartilage is it doesn't really have much of a blood supply at all. And as we talked about in our previous episodes, blood supply is very important to healing. Tissues that don't have a good blood supply don't heal well, if at all. Cartilage really does not regenerate. Cartilage does not heal. Articular cartilage.

SPEAKER_01:

So we're not getting new cartilage every 10 years like our skeleton.

SPEAKER_00:

No, sir. And so if you scuff it up, if you uh knock a divot out of it, if you wear it down just from friction day-to-day activities, it thins, thins, thins, and finally disappears. Uh the other kind of cartilage is uh called uh uh fibrocartilage.

unknown:

Uh-huh.

SPEAKER_00:

And this is kind of a transitional tissue. It's the tissues that make up the things called the labrum in the shoulder or the hip, the meniscus in the knee. And basically what they are is they're kind of rubbery inconsistency, and they help to keep a joint, shoulder, hip, knee, in a more central position. So they're essentially bushings inside the joint that helps to restrict some of the mobility of the joint. Essentially, people talk about a ball and socket joint uh of the shoulder. The the shoulder ball and socket joint is actually a very shallow socket. Uh it's kind of like a golf tee. What the labrum does in the shoulder is make the golf tee deeper so the ball can sit more firmly into the joint.

SPEAKER_01:

And then the ball is surrounded by cartilage.

SPEAKER_00:

Well, the ball has cartilage on its surface.

SPEAKER_01:

On its surface.

SPEAKER_00:

Yeah, and the cup has cartilage on its surface. That's the articular cartilage.

SPEAKER_01:

And is it fair to say cartilage and ligaments are pretty close from a standpoint of function? Like they are in the same vicinity, it feels like.

SPEAKER_00:

So uh the fibrocartilage, yes, that's correct. Um, they're similar makeup. They have collagen, they have um different levels of collagen and fibrous tissue. The fibrocartilages also have a better blood supply uh than, say, articular cartilage. So there are certain injuries to a labrum or to a meniscus that can heal because blood flow can get to the damaged area and reconstruct it. So it's a they're they're both called cartilage. Articular cartilage is the one that we think about when we talk about arthritis. And then meniscal cartilages or fibrocartilages are those things that athletes tear. I tore cartilage in my knee. That's almost always a meniscus cartilage rather than the articular cartilage.

SPEAKER_01:

That's helpful, Gray. This is a great setup to dive a little deeper into cartilage, arthritis, and most importantly bone, first and foremost. So I've I've heard in passing and through conversations, Gray, that we've had that you refer to bone as far more than lifeless scaffold. Can you explain in simple terms more detail behind bone and how it's structured? I can.

SPEAKER_00:

An homage to Halloween coming up. Uh, bone is a living structure. It's made up of living cells, osteoblasts and osteoclasts, that kind of live in balance. Um we destroy bone, we we the way bone changes is we take a bay away bone with the osteoclast and build up bone. Bone follows what's called Wolf's law, and this is really important in our bigger picture what can we do to help improve our bone health. Wolf's law states that bone responds to the forces placed upon it. So areas of high stress or high force, the bone changes or remodels to become stronger in that area. Now, we could think of bone as a solid tube down your thigh bone, for example. But if all of our bones were solid, completely solid, not hollow, or not um kind of spongy in certain areas, we would weigh a gazillion pounds. And so the body has adapted to that, to gravity and upright lifestyle by changing bones to address the patterns of force that they are seeing. So the long bones, the the hollow tubes in our thighs, our shins, our upper arms, and our forearms are cylindrical tubes rather than solid rods, because that helps lighten the weight of the bone and they're still as strong. The ends of the bones where the joints are tend to be kind of strangely shaped. They're kind of three-dimensionally shaped, and they actually have a hard outer coating of bone, which is called cortical bone. That's what the shafts of the long bones are made of.

SPEAKER_01:

Am I imagining like the end of a drumstick almost?

SPEAKER_00:

Absolutely. So if you look at the end of the drumstick with the articular cartilage, the pearly white substance on the end, if you look at the piece of bone that's attached to the drumstick at the end, it's kind of an odd shape. It's kind of a three-dimensional, bizarre shape. And if you cut that open, what you'd find is a bunch of um bone spicules, bone, um, uh it's almost like a spider web looking spongy, we call it, um structure. And what that allows is a very lightweight part of the bone that's strong on the outside, but more flexible on the inside. The area where the bone marrow is, is where your blood cells are produced, and that's in all of those nooks and crannies of the spongy bone and in the center of the cylinder of the long bones. That's where your bone marrow is. And so actually, bones are vital to our general health because that's where our red blood cells, our white blood cells, are produced.

SPEAKER_01:

How does bone marrow interact with the health of our bones? What's the relationship there?

SPEAKER_00:

Aaron Powell, it's kind of a symbiotic relationship. I don't think marrow actually nourishes the bone specifically, except the marrow has a very rich blood supply. And so the bone, bone has a surface coating of soft tissue called periosteum, which has is where the blood flow comes from to the bone. And then blood also comes from the marrow side. So you're kind of providing blood to the bone, both from the inside out and the outside in. Wow.

SPEAKER_01:

Yeah, the more I hear you dive deeper into how bones are structured and their function, it's it's quite amazing of how our body responds and what it's doing just in this one section of our heart tissues.

SPEAKER_00:

And that's very important because uh to our topic here, which is how do we help ourselves improve our bone health? Um, strength training, weight-bearing exercise, increase forces on bone. The right kind of stress. That's correct. Which then increases the bone density in those areas that are needed. So the big ones in the body where we really want to have good bone density is the hips.

SPEAKER_01:

100%.

SPEAKER_00:

Because that's the the transition point between the ground through our legs up to our torso.

SPEAKER_01:

And I would add just anecdotally through body composition screens that I've done over a thousand at my period of uh tenure now, you always see soft tissue decreases in the lower body before you do in the upper body. And I think we can make the association or the inference that our bone health of the lower body and our muscle health of the lower body tend to be the issues later in life that cause the most problems with health span and the quality of life.

SPEAKER_00:

I think that's absolutely correct. And that's a big fault of modern society. Because we're sitting. That's correct. We are no longer bearing weight through our legs, bearing weight through our bones nearly as much as we were designed to. And so the muscle mass and whatnot in the upper body, those are not bearing weight-bearing bones, particularly. Uh you can flail around with your arms and you're not pushing a whole lot of weight. So you don't have to have a huge muscle mass there. Um, so it's lower than typical lower body muscle mass. But when we become sedentary, now the loss of muscle mass and therefore the loss of bone mass in the legs, the pelvis and the spine, kind of catch up with the upper body. And so we become, you've probably heard this term sarcopenia, which is the which is the time-related loss of bone muscle mass.

SPEAKER_01:

Yeah. Muscle loss as the result of aging.

SPEAKER_00:

Due to aging. And the number one reason why sarcopenia occurs other than time is lack of using those tissues.

SPEAKER_01:

100%. So you're right there, Gray. Let's dive into that term that we many of our listeners have heard, use it or lose it. Where does that stem from and what does it mean in the context of bone?

SPEAKER_00:

Sure. So, again, um, in general in the body, if a part is not utilized, it withers away. It becomes weaker, it becomes less mobile, it becomes uh uh uh less functional. In bone, the big topic in bone health is osteoporosis. Osteoporosis is a disease uh that naturally occurs in everyone to some degree. Uh we have our peak bone mass, and I'm gonna use several terms that are interchangeable bone mass, bone density. Uh uh, but we have our peak bone mass in our mid-20s to early 30s, and then it goes downhill as we start to age.

SPEAKER_01:

Very similar to muscle.

SPEAKER_00:

That's correct.

SPEAKER_01:

It's almost probably at the same pattern as well. I would assume.

SPEAKER_00:

Probably so. Now men start with a higher bone mass than women. They're heavier, they're bigger, and they start with a higher muscle mass as well. So we percolate along and lose bone mass just naturally, 1% or so per year. Um and men kind of follow a linear pathway downward until they get to be about 70, and then they drop off in bone mass fairly substantially. Women, because of the estrogen effect in their body and menopause, start that dramatic loss of bone strength far earlier. Imagine ballpark 40, 45 years old, that most women go through menopause. They go from a peak bone mass at age 20 to 30, they lose a little bit, and then they dramatically lose a lot more once they go through menopause.

SPEAKER_01:

So there's a precipitous drop-off.

SPEAKER_00:

Absolutely. And that's why, and and women have less bone mass to begin with, so they have less reserve to give up.

SPEAKER_01:

No way, you're almost making the case that strength training is more important for women.

SPEAKER_00:

Oh, I think I think it's vital for women. And unfortunately, in my generation, um, strength training in women was either ignored or poo-pooed because people were worried about getting big or whatnot. But I think frankly, it's a vital, and it's one of the few things we can do ourselves to help improve our general health and improve our health span and therefore hopefully improve our lifespan as well. Um imagine losing bone mass at age 40 in a woman. If a woman goes through early menopause, say 30, now they have another 40 years of accelerated bone loss. Um, and so um it's really quite important because the the result of osteoporosis of losing bone density is the risk of fracture. And fractures are extremely important. Most people think fractures, oh, it's a broken bone, it's a nuisance, it hurts for a while, it heals. But actually, there's a substantial health impact to certain types of fractures. Fractures of the hip, fractures of the spine in particular, are two of those related to osteoporosis that cause substantial mobility. I mean, literally in the United States, there's about two million osteoporosis-related fractures in a year at this time point. It's estimated that to double by 2040. Globally, it's estimated to increase from about 7 million to about 16 million fractures. Now, about three in the United States, about 300,000 of those fractures are the hip. About 700,000 of those fractures are of the spine. The reason why the spine breaks is it's more of that spongy bone, so it's a little bit more brittle than the big, thick, heavy bone of the hip. But the the statistics are absolutely staggering with regard to morbidity and hip fractures. In an elderly person, older person above age 55. Sorry, that's elderly. That sounds terrible. Um, a hip fracture can result in a mortality, a death, somewhere between 20 and 40 percent of people die in one year as a as a result of that hip fracture. And it really has to do with the fact that the fact of the loss of mobility and then the secondary problems. So these people don't die of the hip fracture, they die of pneumonia or cardiovascular problems, or they develop a blood clot, um, and that gives them an emblem and they and they die from that. And so this the statistics are absolutely staggering. The good news is we have tools to try to help improve bone density and therefore bone health. So the first thing is awareness, knowing the statistics, how grave it can be. Number two, being proactive and looking for this. We have a test called a DEXA bone density scan that can help us determine where we sit in our strength of bone. Um, unfortunately, the the um current recommendations are starting DEXA scans in a woman at about age 70. When it's too late. Many times too late.

SPEAKER_01:

Well, not too, yeah, I'll be careful with that because you can improve at any age. It's just you're playing from behind.

SPEAKER_00:

Very much so. And and all of the tools that we have to improve bone density work, they work slowly. So the more time you have to do it, the more likely you can see gains.

SPEAKER_01:

And I'd love to jump into those tools in a second. I'd like to take a step back and talk a little bit more about spine and degeneration, because there's a lot of blanket terms that I believe people hear where there's the change in their spine over the years. And this might lead us into osteoarthritis and some of those things in the future. But I could you speak to the spine a bit more? Because we've spoken a lot about the hip.

SPEAKER_00:

Yeah, that's kind of my area of expertise anyway. Thank you. Um yes, so spine degeneration is really a wastebasket term. It's a it's a big nebulous term that can involve lots of different things. The changes that we see in our spines are really related to the forces of gravity and the balance of that with the muscular strength and flexibility that we retain as we age. Um there are a lot of factors. You mentioned degeneration. So the discs, which are the rubbery shock absorbing pads between the bones, as time goes on, thin, they get narrower, they get shorter, so our posture changes. The joints in the spine, um, there are there are two joints between each pair of bones, um, develop degenerative arthritis of the articular cartilage, they start to break down and they can cause deformity. And then osteoporosis on top of that uh can lead to whether they're painful or silent fractures of the bones, collapse of those in the spine. Yes, sir. Um I treated nearly a thousand patients in my 30 years of practice with osteoporotic related compression fractures. And what they what I was treating, I wasn't treating the osteoporosis, I was treating the severe debilitating pain that came from an acute or new fracture. And we had some fun techniques that actually worked really well, where we could minimally invasively go in, inject a bone cement, a glue that we the same stuff we glue hip replacements in with, into the bone and expand the bone, and it became more rigid and um pain decreased. Uh incredible. Anecdotally, my mother-in-law fractured her spine. She lived in South Carolina. I lived in Nashville. She was incapacitated, couldn't get up out of bed. We brought her to Nashville. I did a this procedure called kyphoplasty on her. She got up the day of her surgery and was pain free, and we took her back home the next day.

SPEAKER_01:

Wow. Our medical system allows you to do surgeries on family members? That's an ethical question, not a legal question.

SPEAKER_00:

Okay. I actually operated on my wife as well. Wow. Who's going to take better care of them than somebody you love?

SPEAKER_01:

Yeah. And I I I I mean, I think the same way. I've just watched all these medical shows where it's like, you can't be in the room.

SPEAKER_00:

It's really more of an ethical question, but and and and it's a judgment call. I mean, I didn't know.

SPEAKER_01:

I'm proud of you for fixing your family.

SPEAKER_00:

Well, I was the only one in town doing kyphoplasty either. Wow. What a great story. Yeah. Um so where were we? Um spine and changes. And then gravity pushes us closer together. Our posture gets worse as our strength decreases over time, our muscle mass decreases over time. These are all natural aging changes. And so the spine doesn't just settle like a foundation straight down. It often settles kind of jiggy jag curvature. And so that's where you get increasing deformity. And then the last factor that can happen, and it particularly happens in our current age group of 50 on up, is a lot of people have a naturally a little bit of scoliosis in their spine that may never have been diagnosed. They may never have really noticed it. But as time goes on, that curvature gets worse as the settlement.

SPEAKER_01:

The angle increases.

SPEAKER_00:

And so you add a significant change in the angle with a fracture. Think of a block turning into a wedge and how much difference of an angle that is.

SPEAKER_01:

I'm almost imagining books where like one book is, you know, out of the perfect alignment too.

SPEAKER_00:

Sure. Or you've torn a bunch of pages out of the book and now it's a wedge shape rather than a rectangle shape. So those are all factors involved with how the spine kind of deteriorates and changes. And that's a whole another topic.

SPEAKER_01:

Yeah. Well, I appreciate the deeper context into degeneration specific with the spine because we we hear these diagnoses a lot and understanding like what's actually happening in the spine, I think is extremely helpful. I'd love to get practical on preventing bone loss now. And starting with, okay, what are the main risk factors? And then back that up for me, Gray, with what are the key ways that we can improve our bone should we see the DEXA scans showing us that we need some help?

SPEAKER_00:

That's a great question. And it's really the crux of this whole discussion. Um the number one risk factor for osteoporosis is genetics. So if a woman gets osteoporosis far more commonly than men, men do get osteoporosis. Um, but if a woman has a first-degree relative, so a sister, a mother, or a grandmother who has osteoporosis, the likelihood of them being diagnosed with osteoporosis is very high. Um, other factors that can be involved, and there's a whole slew of potential risk factors, but the main ones are use of steroids, corticosteroids for things like respiratory diseases or cancer or lots of steroids related to arthritis treatment. Um, that that deteriorates bone. Smoking, big one. Smoking decreases oxygen to all of our tissues, and decreased oxygen makes our tissues, including bone, much weaker. Umuse of alcohol. Um, I would never say that alcohol should be stopped completely, because that's a personal choice, but excessive use of alcohol, and nobody has a real firm definition of excesses. What's the line? Two drinks a night, one drink a night, depend something like that. More than that really deteriorates the bone. And then there's some medications that can cause um bone loss, such as uh uh certain types of seizure medications can lead to bone loss. The second, the face of osteoporosis, if if you had to ask me what does a person with osteoporosis look like, it's going to be a small framed, so short or thin, white or Asian female. African Americans, while they do get osteoporosis, rarely get osteoporosis compared to Caucasian women. And so if I was walking down the street, I would say the likelihood yes or no of osteoporosis, white, small frame female is the number one in, you know, elderly. So 60 on up.

SPEAKER_01:

So it sounds like an overall awareness on what you're taking in, what your family history is like, and then of course, smoking, alcohol use, we've got to keep an eye on those things.

SPEAKER_00:

Bad behaviors.

SPEAKER_01:

Yeah, yeah, lifestyle stuff, right? And it's all figuring out that balance that works for each of us. We've spoken about strength training and how powerful it can be. What are other ways that we can improve bone health?

SPEAKER_00:

So the mantra is weight-bearing exercise. Remember Wolf's Law, bone responds to the forces placed upon it. So we want to put force through the bone.

SPEAKER_01:

So let's walk a lot and let's not be seated as much.

SPEAKER_00:

It's actually an interesting concept. Walking is weight-bearing, but it really does not put hyper-physiological forces on the bone. So if you're trying to slow the natural loss of bone, or even better, trying to reverse the loss of bone that has been diagnosed, you actually need to bear weight more rigorously.

SPEAKER_01:

You need a bit more force. Now let me take us in a selfish direction. Running gets a really bad rap. And yet there are always these stories of runners who have really strong bones and really good muscle mass. And I'd like to clear the air on that because I'm a big believer how you do things is what impacts your joints the most and those potential changes. But running is high impact force and it is much obviously higher impact than walking.

SPEAKER_00:

Could that be good for someone? Oh, absolutely. I think you know, the degree of force, the amount of force per unit time. So when you run for an hour, how many steps you make versus when you walk for an hour at a more pounding rate? So you're strengthening muscle, you're pounding on your bones, you're strengthening your tendons and your ligaments while running. Now, with that said, the downsides to running are the excessive amount of activity or the ancillary or sidebar kinds of issues like not good nutrition, um, not resting, not recovering, um, those types of things are the negative side. But I think you definitely running, if you had to pair running versus walking as far as bone health, running more weight bearing.

unknown:

Yeah.

SPEAKER_01:

Yeah. And that's where uh Ashley Romine and I are going to be doing a workshop here in a couple months uh on how to run and where your foot should be landing in relation to your hip. Because the biggest thing I've learned over the years is you know, landing on your heel, which is doesn't have much elasticity, is what causes the issues with running that we see. So um how you do things is important. And then just for the folks who aren't runners out there, interval-based running for short periods of time is just one option.

SPEAKER_00:

And I think it's a great advantage. I think it's a great ad to work into your resistance training program.

SPEAKER_01:

Love it.

SPEAKER_00:

Um so I'm gonna give you an anecdote because this falls into, and I was given permission. My wife Mary, who is very active, at age 54, she had her first bone density test and it showed some tendencies toward osteoporosis, osteopenia. Her mother had severe osteoporosis. Her mother had multiple compression fractures in her spine. Her mother ultimately fractured her hip and never walked again. Uh, but and that was kind of toward the end of her life. So Mary took it upon herself to kind of change some lifestyle. Um, she had gone through menopause, and her doctor at the time had not recommended uh hormone replacement therapy with estrogen. And that's a big factor in how women accelerate their bone loss. Um she started on estrogen. That helped with her menopause symptoms. It also, in my opinion, helped to kind of push back against that natural flow of bone loss. It didn't help build bone back at that point, but it helped slow the makes sense. And then about two years ago, when she was diagnosed with osteos. Which is one to two standard deviations away from the normal, and that's a fairly substantial place because it substantially increases your risk of fracture. She began a strength training program here.

SPEAKER_01:

Yeah.

SPEAKER_00:

And she took it on full force. And she just got a bone density test just a few weeks ago. And she not only stopped her bone loss, she actually reversed her bone loss. So her DEXA scores now place her in the normal range. And the scores are logarithmic in nature. They're standard deviations. And so a change of the value one is not one, it's 10. And so she improved her bone mass back to the normal range at least 10 to uh 15 times where she was before. That's incredible. Now, if she stopped her strength training, the process continues. So she's pushing back. She's been able to reverse her bone loss. Now she she's a pretty special person if you've ever seen her pushing a sled around. She does it all out. This is not something that's easy, simple, um pink Barbie weights doing dumbbell curls. Sorry. No. Um it is hard work. It's dedicated work multiple times a week to build that strength.

SPEAKER_01:

And in that vein, it isn't, you know, more than three times a week of that cut type of intensity from just my experience in this example, where it's the intensity that she is putting in to that force of strength that is creating this change in the bone.

SPEAKER_00:

Absolutely. So she's multiplying that benefit by not only doing it several times a week, but doing it all out a week. Yeah, doing it well. Technique is really important. So is that a prescription for everybody? No, but um there are certain restrictions, but I think it is the one thing that we can do that has the most bang for its buck.

SPEAKER_01:

Yeah.

SPEAKER_00:

The other things that we can do to try to help stop the flow, the decrease of bone density or improve bone density is good nutrition, which is high protein, lots of leafy vegetables, um, calcium supplementation with vitamin D. Typical ranges for recommendations for calcium are about 1,200 milligrams of calcium per day, uh 1,000 to 2,000 international units of vitamin D per day. Uh vitamin D is used by the body to help absorb calcium from your from your gut. Um and those help build backbone. Don't smoke, minimize the amount of alcohol you drink, cross your fingers a little bit because again, it's it's genetics that is the biggest factor here. You can't change your your race or your your height and that type of thing. Uh but those tools, strength and resistance training first, weight-bearing exercise multiple times per week, good high intensity, uh diet, restriction of certain medications, if you can, uh restriction of lifestyle choices such as alcohol and smoking, if you can, um, are the biggest factors in trying to help stabilize your bone so it doesn't get worse, and especially improve it if you can't. Because you don't want to be that person who's 70 years old, laying in the hospital bed with a broken hip, uh facing surgery and facing the possibility of not walking again.

SPEAKER_01:

Yeah. No one wants that. We have been saying it throughout every episode. We want you to be able to participate in life on your terms. Absolutely. And keeping your bones healthy is one of one of the many key ways of ensuring that.

SPEAKER_00:

Well, she looked at me when I when she told me her numbers, and I just my eyes got really big, my mouth fell open, and I said, That's you don't understand. That's not just good, that's super good. Yeah, and we rarely see that degree of improvement. Um, but that's all about the dedication, yeah, the work.

SPEAKER_01:

Yeah, the effort that you put in, it's it's like anything in life. And super proud of Mary, you know, I've seen her evolution here and just the effort that she does put in can be found within yourself as well. I know many of you have have seen Mary train on property here, and it's finding like how that works for you and what that looks like, and just you know, trusting the professional to guide you if you are dealing with bone loss. The coolest part is we have the strategies and the tools to make an impact on it with your behaviors and how you train. Gray, I think you've given us an excellent picture of bones. So, with the rest of our time, I think it's critical that we discuss the often overlooked hard tissue that does cause problems, the the loss of cartilage. So let's dig in a little bit deeper there. You've explained the types of cartilage. You I'd like to kind of understand a little bit better what makes it unique and the relationship with cartilage and arthritis.

SPEAKER_00:

Great question. So uh we'll be specifically talking about articular cartilage, because that's the most important uh tissue that with related to um osteoarthritis. So there are various types of arthritis. Arthritis just means inflammation of joints or deterioration of joints. There's osteoarthritis, which is the degenerative age-related wearing out of the bearing surface, and then there's the inflammatory arthritis. And these are diseases such as rheumatoid arthritis, lupus, um, psoriatic arthritis, where the body is actually attacking itself and the location where the attack is is in the joints. So the joints are destroying themselves by this inflammatory attack.

SPEAKER_01:

Very different than osteoarthritis. Very much so.

SPEAKER_00:

Um typically the inflammatory arthritis are rapidly progressive, the deterioration of the and destruction of joints is profound, and it leads to the generalized term of arthritis, which just means uh worn-out joint, um, more quickly. Uh osteoarthritis can occur slowly or acutely. Uh most commonly it's just a wear and tear phenomenon as a bearing surface bears load, friction causes the surface to break down. You start developing little cracks and crevices, little chunks potentially fall out. Think of uh uh potholes in the roadway. Um over time, as potholes get bigger, they tend to get bigger more rapidly because of the size of the potholes.

SPEAKER_01:

And just so I'm clear, when cartilage is breaking down, that is what's leading to these inflammatory osteoarthritis symptoms.

SPEAKER_00:

That's correct. So um, as the joint surface wears out, uh that is irritating to the joint itself. Uh that irritation leads to your joint to become inflamed. It's called sinovitis, inflammation of the tissue lining the joint. That produces more inflammation cells, and all of those can cause discomfort. So you have a mechanical discomfort of bone rubbing on bone or rough surface rubbing on rough surface, and then you have the inflammatory discomfort caused by that response to that broken down tissue. Now, we can't reverse osteoarthritis. We can't undo, we can't regenerate cartilage. It does not rebuild itself. No matter what people will tell you, up to this point, even things like stem cells or PRP cannot rebuild cartilage as far as we know. What they tend to do in some patients is help to reduce the inflammation. Or in some cases with stem cells, they might produce help promote some of the healing tissues to come uh cells to come into the joint and reduce the symptoms. But none of those at this point, there's no data to suggest that either of those rebuild cartilage. So that's something that you don't want to fall into the trap of when somebody's talking about alternate alternatives to say joint replacement surgery.

SPEAKER_01:

Yeah. And in episode two, if you missed it, check it out. Gray broke down PRP much further in stem cells. Now, Gray, that can sound a little depressing to folks. Man, I can't get my cartilage back. How do we treat it?

SPEAKER_00:

Well, uh the good news is it shouldn't be depressing. We have a variety of options to try to help. And frankly, in more modern literature, it's really been shown that strength training around the joints. So imagine the knee. What are the muscles around the knee? It's the quadriceps muscles of your thigh, front thigh, your hamstrings in the back of your thigh, your calf, and then what's called the tibialis anterior, which is in the front of your shin. All of those, if you can strengthen the muscles, you then strengthen the ligaments and the tendons uh associated with those muscles. That can help support the joint more and provide a more um cushiony or uh uh shock absorbing effect around the joint. So it's not just a uh bone surface uh bearing on a bone surface. You actually have a little bit of a shock absorber with those muscle tissues.

SPEAKER_01:

So more soft tissue, more quality soft tissue that you're contracting regularly is going to protect your joints.

SPEAKER_00:

It's the quality. Now uh people would say, well, if I move my knee, it hurts. Well, yes, it does. So it takes a little bit of work to kind of move past that.

SPEAKER_01:

Same conversation with fascial release, right?

SPEAKER_00:

Exactly.

SPEAKER_01:

You know what I love about this is all roads lead back to strength training. Aaron Powell, Jr.

SPEAKER_00:

Which is fascinating because it never was thought of uh back in the early days. So the early days would be considered when I trained 30 years ago, that that thought process was just in its infancy with regard to generalized health. It really has come to the forefront because people are looking for ways to try to help themselves without invasiveness or surgery, if possible.

SPEAKER_01:

And they have the time. A lot of our members here have the time to focus on this now. Trevor Burrus, Jr.

SPEAKER_00:

The more recent studies about exercise has actually shown that it is can be as effective as steroid injections in symptom management for knee arthritis. Steroids are a tool that we use. It's an anti-inflame inflammation uh chemical. Um, it's injected into joints, it helps to reduce inflammation. The downside to steroids is it's not curing anything in an arthritis standpoint, it's helping to manage the inflammation symptoms. Uh merely injecting something into the joint can cause more trauma to the cartilage. The steroid preparations can actually cause accelerated deterioration of certain cartilage cells, and so it's a mixed bag of benefit.

SPEAKER_01:

And as you mentioned earlier, the use of steroids could lead to bone loss as well.

SPEAKER_00:

Yeah, I mean it would take a lot of steroid injections into the joints, but I'll tell you, there have been quite a number of people in my experience who've received 10, 20, 30 joint injections of steroid. And that accumulation of insult over time definitely can have an effect on osteoporosis. There's a technology that came about 20 years ago called hyaluronic acid or cox comb injections, jelly injections into the joints. That is used as well for uh symptom management. Hyalururonic acid is produced by your joint and it seems to improve inflammation and cushioning for a period of time after those injections. And then lastly, for arthritis changes, if the symptoms are really bad and just not controlled, really impacting your life, there's surgery. And surgery is basically falls into partial or complete joint replacement. Basically, we resurface the joint, we take away that worn-out cartilage end cap on the on the two bones that make up the joint, three bones in the knee, and replace it with metal and plastic. So we have a surface that's smooth, we have a surface that glides, we have a surface that restores the shape of the natural bone, and um it doesn't have any nerve endings. It's not perfect. Joint replacement is not perfect, it's life-changing for those who go through it.

SPEAKER_01:

We see it here all the time.

SPEAKER_00:

I had a hip replacement done in 2017. It was the best thing I'd ever done at that time because I could not walk. Um, but they don't last forever. It's not natural. People can feel a difference in how their joint feels to them, how it moves, uh, but it can really get people back in the game. So I don't poo-poo um surgery. I'm an orthopedic surgeon, for example, but um it's one of those things you wanna you wanna try other things first unless you just can't tolerate what you're dealing with.

SPEAKER_01:

Yeah, because no one wants to live in pain. And from a fitness perspective, I've seen many folks get a knee replacement, hip replacement, shoulder replacements now, and they come back stronger. The the range of motion actually normalizes, and you know, there there is a life without pain, and and we can't put a price on that. So it's always like our conversations are about prevention, staying ahead. And yet there are these other alternatives and these other steps that we may need to take depending on the situation we're in.

SPEAKER_00:

Yeah. And then the the the last little bit about the inflammatory arthritis uh problems. The only way to try to mitigate or reduce the impact of those diseases is to treat the diseases. Uh so reduce and and those are challenging for the endocrinologist, the rheumatologist, uh, to try to to try to help. The medications that are used in those um in those diseases are harsh on your body. Um, and so it's a balancing act. Uh, but the way that people with say rheumatoid arthritis um try to decrease the amount of bone the joint destruction is get after those diseases early and consistently.

SPEAKER_01:

Well, great. This gives us an excellent picture of bones and cartilage and arthritis, all in 45 minutes or or less. And I just love how that has tied everything together here. I before we close out, I just want to thank you for sharing your app your expertise through all three episodes, spending time with us. We know that uh recording podcasts is a journey sometimes. And um just really appreciative that you've been able to give our listeners a greater understanding of how our bodies can stay strong, become strong, and become adaptable inside and out. So just want to thank you.

SPEAKER_00:

Well, Jeff, I appreciate it. It's been a real fun adventure. We've kind of worked on this together and kind of figured it out. It's a little different than many of your podcasts, um, a little bit more basic science, but I've always been a believer that once people kind of understand the language and what they're up against, healthcare situations become far less scary and anxiety provoking. And um uh I found in 30 years of practice that my favorite thing to do other than be in the operating room was educating people. And uh so I'm frankly always available. I'm not one of those doctors that gets upset if somebody taps me on the shoulder and says, Hey, Gray, um, could you answer a question for me? I I like those kind of conversations. So if you're if you're willing and want to, please reach out to me about anything musculoskeletal, uh, and I'd be happy to try to help.

SPEAKER_01:

And I'll add, Gray has created some excellent handouts for musculoskeletoskeletal hard tissue 101 and soft tissue one-on-one. So those will go hand in hand with episode one and episode three, and it'll give you just a great summary of what we've discussed in more depth.

SPEAKER_00:

Where are those found?

SPEAKER_01:

Uh so we're gonna go ahead and put those in the show notes. This might actually be our first time doing that, but I'm excited that we could finally pitch some show notes, Greg. You you you allowed us to do that, so thank you. Uh, for our listeners, be sure to join us next week. We're gonna sit down with a registered dietitian that you know really well. Her name's Lindsay Ford. I actually might know her a little better than you. And we're gonna talk about all things protein, how much you really need and how to use it to support your training and recovery. Because we didn't dig too much into nutrition, but nutrition paired with strength training, those are two of the secret weapons to allow you to live your life on your terms. And as always, don't go anywhere. Hang out with me for a few more minutes and get some healthy momentum for the rest of your week. So, what I gathered is that bone isn't as hard as we think, folks. It's living, dynamic, and constantly regenerating. And this is based off our inputs, outputs, and of course, time. And I hope you caught it. Our skeleton renews itself every 10 years. Did you catch that fact from Gray? In many ways, I made the reflection that our bones are like our minds. Every decade we grow, we shift, and we evolve. And not just physically, but mentally and emotionally. What mattered to us in our 20s rarely defines us in our 40s or 50s. And we're always rebuilding who we are. Just a few weeks ago, my wife Lindsay turned 40. And we had the opportunity to celebrate her birthday in her hometown. We went out to dinner with her friends, spent time with her parents, and being in our old stomping grounds brought back a lot of powerful memories of decades that she spent in Cincinnati. And it struck me every decade deserves this kind of celebration. Each decade is a gift that not everyone gets. And so to keep the healthy momentum takeaway short this week, I want you, I want us to start seeing ourselves as a living, changing system. You're not who you were 10 years ago, and you won't be the same ten years from now. The choices you make today, how you move, how you think, how you show up for people in your life, how you recover, how you respond, these choices are shaping the next version of you. So for this week, step into this next chapter with gratitude, with intention, and with strength. You're literally building the next you with one decision, one day, one decade at a time. That is a wrap on this week's episode and our entire series with Dr. Gray Stallman. The episodes included Soft Tissue 101, Stronger Tissues, Fewer Injuries, and today's conversation, hard tissue 101. If this was a value to you, we'd love to receive feedback and better understand how we can gear content in the future. Until next week, remember to actively participate in life on your terms.

Contributor

Jeff Ford

Host