Can we be “healthy” if we’re not active? Human evolution is deeply intertwined with movement. Throughout evolution, our bodies were engineered and optimized for movement. Our ancestors roamed vast landscapes, gathering food, hunting, and surviving through constant physical activity. In stark contrast, modern sedentary behavior, facilitated by technological advancements and conveniences, has made physical inactivity more common. Unfortunately, this shift away from movement has profound implications for our health, particularly when we examine the physiological processes that rely on regular ph ..read more

VO2 max… why is it one of the most vital determinants of health? We are now obsessed with VO2max. I hear it all the time in the office. But so many people don’t understand why their VO2 max is important, all the factors that go into determining it, and how to improve it. VO2 max, or your maximal oxygen uptake, is the highest rate at which your body can consume oxygen during intense, whole-body exercise ..read more

Many awful consequences occur from being sedentary. Face it, over hundreds of thousands of years, our bodies were engineered to move. Many of the normal reparative, regenerative, and restorative processes that our body has are activated by physical activity. Otherwise, they lie dormant. Lactate, a critical signaling molecule, triggers robust beneficial reactions to an acute increase (from a low baseline) following exercise. However, chronically elevated lactate associated with metabolic diseases such as diabetes has significant negative consequences ..read more

Understanding Central Fatigue: When to Push Through and When to Rest “Obviously… a ton of nuance here. But many workouts or runs suck because our brain is telling us to stop, although our legs and heart feel fine. Fatigue is a fascinating topic… and central fatigue can be challenging to overcome. We’ve all had those workouts that sucked because our brain wouldn’t shut up. Telling the difference between those and the times when our body tells us to rest is a worthwhile skill to develop ..read more

Every Pain Doesn’t Mean Harm: Understanding Discomfort and Movement Pain is a natural signal from the body, but not every ache or discomfort we feel is a sign of harm. In fact, many types of joint pain or muscle soreness are part of the normal human experience, especially as we age or engage in physical activity. Understanding when pain is a cause for concern and when it’s simply a normal part of movement is crucial for maintaining a healthy, active lifestyle ..read more

A paper we are going to discuss raises an important question: Can you be healthy despite not moving enough or exercising? Based on the paper’s results, I believe that the answer is clear—no, you are not healthy. You just aren’t aware of it yet. We’ve discussed the reasoning behind this statement many times in the past, and I also went over this in my book. Most metabolic disease states that lead to our demise are “area-under-the-curve” issues ..read more

As an orthopedic surgeon, I often see patients who struggle with “exercise.” Why don’t they see the benefits of walking, I often wondered.  At the same time, they suffer from common diseases caused by or worsened by a lack of physical activity. The human body is a complex set of interrelated processes. That is to say that one system affects all of our other systems.  Very few issues within the human body exist in isolation.  ..read more

The treatment of rotator cuff tears is far more nuanced and complicated than you think. As with many Orthopedic Surgery topics, the treatments we offer people require far more nuance and are far more complicated than most realize. Do all rotator cuff tears need surgery? No. Should some be operated on? Yes! Which tears should be treated, and which shouldn’t? It’s not as easy as you might think it is. Besides… should we be using the word “tear” to describe the changes we see on an MRI when most people we see in the office have not had any trauma or serious injury ..read more

The treatment of meniscus tears is far more nuanced and complicated than you think. Meniscus tears are one of the most common knee issues, often leading to a cascade of nuanced decisions regarding the best course of treatment. For decades, the prevailing approach had been surgical intervention, primarily through procedures like meniscectomy (removal of the torn meniscus). However, emerging evidence from numerous randomized controlled trials (RCTs) suggests that routine surgery may not always be the best option ..read more

In the land of the free and the home of the brave, a troubling reality looms large over the American dream: our healthcare system is broken. Despite being the world’s wealthiest nation, the United States consistently ranks VERY poorly among industrialized nations regarding healthcare outcomes and costs. Let’s touch on the labyrinth of America’s healthcare landscape, uncovering the stark disparities between our system and our global counterparts. A fundamental misalignment lies at the heart of the issue: our healthcare system is structured around acute, expensive care rather than preventative ..read more