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Dr. Howard Luks: The Surgeon Who Says We Do Too Much Surgery
54 Plays13 days ago
“To say that many surgeries we do shouldn’t be done is a bold statement”—and today’s guest stands firmly behind it. In this episode of Pain Coach, we’re joined by Dr. Howard Luks, a leading orthopaedic surgeon specialising in shoulders and knees. Dr. Luks brings decades of clinical experience and personal insight to a conversation that challenges conventional thinking around pain, aging, and the role of surgery.
Dr. Luks understands firsthand what it means to move through pain. He shares how his own journey helped him reevaluate long-held medical advice—like bed rest for back pain—and shaped his belief that movement is not only safe but essential for long-term relief and recovery.
This episode dives into how physical activity, not inactivity, fosters healing and resilience. We explore the disconnect between imaging findings and actual pain, the link between metabolic health and joint degeneration, and why fear-avoidant behaviour often does more harm than good. Dr. Luks also explains why surgery isn’t the quick fix many believe it to be—and how empowering patients with the right education can change lives.
If you’re navigating persistent pain or questioning the next steps in your care, this episode offers both hope and clarity from a voice of experience and reason.
RESOURCES:
- Dr. Luks' Website
- Lachlan's Pain Relief App
- Follow Lachlan on LinkedIn and Instagram
- Book a Clarity Call with Lachlan
KEY TIMESTAMPS:
1:10 – Introduction to Dr. Howard Luks and his background
3:00 – Living with chronic back pain: personal insights
6:40 – The link between metabolic health and joint pain
8:30 – Movement as medicine: The science behind pain relief
14:00 – Myths vs. real lifestyle interventions
16:20 - Lachlan's pain relief app
19:25 – Gut health and joint pain
26:35 – Should we run with arthritis?
32:00 – When surgery is necessary—and when it’s not
36:39 – Joint replacement decisions
46:00 – MRIs, joint abnormalities, and pain perception
54:00 – Longevity Simplified: Tips for those in chronic pain
1:00:00 – Final thoughts: There is hope—and help
DISCLAIMER:
This podcast is for educational purposes only. The views expressed in this podcast do not constitute medical advice and are general in nature. You should obtain specific advice from a qualified health professional before acting on any of the information within this podcast.
Recommended
Transcript
Introduction and Controversial Views on Surgeries
00:00:00
Speaker
and to say that, you know, many surgeries that we do shouldn't be done is is ah is a bold statement. Have you copped any flack for that? Yes, of course.
00:00:12
Speaker
Welcome to Pain Coach. Today we're speaking with Dr. Howard Lux, shoulder and knee orthopedic surgeon, fitness and longevity coach, and the author of Longevity Simplified.
Dr. Lux on Surgery and Exercise Medicine for Longevity
00:00:25
Speaker
Dr. Lux blends the sound use of surgery with a deep belief in exercise medicine, positioning movement as a foundational pillar of healthy aging and longevity.
00:00:37
Speaker
This podcast is for educational purposes only. The views expressed in this podcast do not constitute medical advice and are general in nature. You should obtain specific advice from a qualified health professional before acting on any of the information within this podcast.
Dr. Lux's Professional Journey and Personal Back Pain Story
00:00:56
Speaker
I would like you to start with just a brief summary of of who you are and what you currently do. Yeah, sure. My name's Howard Lux. I'm an orthopedic surgeon in New York, a little north of the city.
00:01:10
Speaker
I've been an active athlete my whole life, have had my share of pain, still have my share of pains. And I'm yeah I've been teaching and educating an orthopedic audience across the world for about 20 years.
00:01:28
Speaker
And doing that is how I meet great folks like you and yourself. So I'm glad to be here. Awesome. Tell me, so you said you have a few pains of your of your own. Are they recent pains or have they been sort of ongoing pains?
00:01:45
Speaker
Tell us a little bit about that. Yeah, so I played tournament-level tennis when I was really young. and I attribute my lifelong history of back pain to that.
00:02:01
Speaker
had I've had back pain since I was 18 or so. um Used to be one or two really bad episodes a year, you know, put me on the floor.
00:02:12
Speaker
Then it became just that this chronic ache that eventually ended my golf game.
Finding Better Back Pain Solutions Through Exercise
00:02:18
Speaker
But over, you know, mean when we were trained, when I was trained, feels like 100 years ago, we told people for back pain, you know, bed rest for a week.
00:02:31
Speaker
yeah it's It's insane that we said things things like that. And so I never really listened to that. But my inkling was always to rest, rest. And even the surgeons that I spoke to when I was young said the same thing and and and physios.
00:02:52
Speaker
Eventually I figured out it's obviously quite the opposite. And the more that I do, the more the concentrate, I know you hate the words core, et cetera, but you know, in that vicinity, the better I feel, the fewer episodes I have,
00:03:09
Speaker
the less severe each episode is and the faster that I recover from each episode. So it's something that I've managed you know my whole life. And despite that, I've gotten back to golfing.
00:03:23
Speaker
ah rock line ah run I work out a few days a week. So yeah despite the pain, it it doesn't own me. It's always there, but I've taken back control.
00:03:37
Speaker
and Yeah, that's ah that's a very important message for people to hear. And it's ah you know it's a very common story. And yeah, I mean, it sucks. You'd rather not have it.
00:03:49
Speaker
But the fact that you can sort of reclaim your life and sort of build a life around it despite it is awesome. I don't know many 60-year-old athletes who are pain-free.
00:04:03
Speaker
yeah it's And this is a very challenging thing to discuss with patients because yeah if I told people not to run with pain, I would practically never run.
Understanding Pain Management and Movement Importance
00:04:17
Speaker
yeah There's always something that's bothering me. And and You just develop, you know, an understanding of what pains that you can run with, which ones are warning signal, when you got to cut back.
00:04:33
Speaker
Same thing with rock climbing and everything else I do. you know, you you become very good at reading your body and what those signals are. But many people aren't. And I see a lot of them in my office. And I'm sure you see a lot of them professionally as well, where people the fear of pain and the fear of making things worse is far more severe than the fear of the deconditioning that's going to to occur by doing less.
00:05:05
Speaker
And that, if when you get to my age, has a very, very serious repercussions, right? If I led a sedentary life, I would not be able to do half the things that I can do now.
00:05:17
Speaker
and Oh, 100%. No, I see it all the time. There's the two types of people, and I think I've sort of placed you. Like, you know, there's the fear avoidant, and then there's the ones that are just boom busters. Although it sounds like you've learned to manage that and to know to not bust so much.
00:05:37
Speaker
Well, yeah yes and no. I mean, I'm very i'm very good at hurting myself. Yeah. Yeah. You just got to know how to titrate it and Sometimes I'm good at it and sometimes I'm not, but, you know, it's okay.
00:05:54
Speaker
Something that comes through with all of your writing is that movement is is really good. It's healthy. And yeah i would say – To coin the movement, well, I didn't coin this, but movement optimist, I would say that you are definitely a movement optimist. Where does this come from?
Linking Overall Health and Joint Pain
00:06:17
Speaker
It's just, you know, powers of observation. One, as a clinician, know, for 20-something years, And then research, you know, it became, it became obvious that talk to any orthopedist in terms of who they're, who's a typical knee replacement patient is, you know, it's typically not an athlete, right?
00:06:41
Speaker
It's not someone owner who's thin and fit, generally overweight, generally little belly, a few medications, et cetera. And, I would see athletes with pretty severe arthritis on x-ray, yet they had very mild symptoms.
00:07:00
Speaker
So yeah it very it became very clear that your overall health has a lot more to do with your joint pain than the joint itself. And we now know that's true, right? We know that inflammatory mediators associated with metabolic disease, such diabetes or fatty liver, are going to affect your joint because those inflammatory chemicals are gonna get inside your joint.
00:07:29
Speaker
And that's gonna increase the amount of inflammation that you have. Or we have white blood cells in our joint. They're called macrophyses. and everyone has them, but there's two types and they can change.
00:07:45
Speaker
There's an M2 type, which is a very benign, actually kind and healing type, but then they can change to M1 or their vicious little sister or brother.
00:07:56
Speaker
And those are mean and they're very destructive and highly inflammatory. So in people with with metabolic disease, they tend to have more of the M2, I'm sorry, the M1 or the inflammatory type.
00:08:12
Speaker
So you'll see people with mild arthritis on x-ray, but pretty severe pain. And so it became quite obvious over the years that movement was key.
00:08:31
Speaker
to joint health, to to tendon health, to pain relief, pain avoidance and living longer.
00:08:42
Speaker
ah so you're saying that the old mantra of wear and tear is is is outdated. Yeah, i yeah i don't I try to break people of that because we're complex biological systems.
00:08:59
Speaker
We're not like your engine. you know We have repair mechanisms. Those repair mechanisms and in our joint are accentuated or activated by activity.
00:09:13
Speaker
So if you're still still or sedentary on a couch and you think that you're gonna heal you know a cartilage injury, it's not gonna happen. Same with tendons, right? We have to move tendons, load tendons in order to get them to heal.
00:09:29
Speaker
Jill Cook, right? You know, an Australian colleague of yours, one of the greatest tendons researchers that we know. She'll tell you every day, if you want a tendon to heal, not a torn one, but a painful one, you need to load it. You need to load it a lot heavier than you think.
00:09:50
Speaker
And yeah, again, this filters back to pain, the pain avoidance type. And it's very easy to get stuck in a rut when you're in pain, especially if you have questions, what's causing the pain? Am I making it worse? You know, you get these thoughts in your head, I'm grinding my my joint away with those sounds.
00:10:14
Speaker
So these are useful visits in my office because you can cure a lot of people of those fallacies and myths. Yeah, for sure. Do you find that they see the same value in it? Because I find that, you know, sometimes talking and educating people don't seem the same value as this like sort of physical structure or something that you've, you've done to them.
00:10:37
Speaker
You know, well, It works for many, you know, what I've learned from being active in social media and writing all these years is you're never gonna please everyone.
00:10:54
Speaker
You're not even gonna please 60% of them. So just write for the people that you can identify, who can identify with you, who you can help.
00:11:07
Speaker
And hopefully the others are going to find someone else that they can identify with. But I've received so many messages over the years that these books I've written or these things I've written on various platforms have been useful in gaining back, you know, an active existence.
00:11:29
Speaker
So it's getting through on some level. Yes. Yeah, for sure. No, definitely is. The tide is changing, albeit slower than i think you and I would hope for.
00:11:41
Speaker
I think broadly, you you're really quite bullish on what I would call, like broadly, lifestyle interventions. Tell me what the lifestyle interventions are for, say, knee osteoarthritis. Yeah.
00:11:57
Speaker
with touchstone ones. Yeah, so they're basically, right, so they're basically the same interventions that you would undertake to live a longer, a longer healthier life, right?
00:12:10
Speaker
Social media is awash with so much garbage, and especially in the longevity space, right? Because everyone wants to take your money from you.
00:12:20
Speaker
They're going to sell you everything. You can spend $5,000 on an ice plunge. You can spend $5,000 a sauna, stack, whatever. a thousand dollar supplement stack People are ordering, people don't want FDA approved medications, which have been tested and validated and verified and have hundreds of millions of dollars behind their research.
00:12:49
Speaker
But they'll go to Joe's website and buy peptides that they're injecting into themselves. So this is not longevity, right? The path to longevity and wellness is really simple.
Lifestyle Changes for Longevity and Joint Health
00:13:04
Speaker
You know, we need to move more. We need to lift on occasion. We need to eat well. You know, the Maha movement here isn't finding out anything new. You know, they're not going to cure chronic disease because people have known for forever that the better you eat,
00:13:20
Speaker
the healthier that you're going to be. So you need to buy your own food. You need to prepare your own food. Hopefully slightly more veggies than meat.
00:13:33
Speaker
Hopefully fewer carbs than veggies. You need to have friends. You need to get out. you need to have a sense of purpose. You need to sleep well.
00:13:44
Speaker
You can't get wasted and drunk every night. And that's it. You know, there's no magic to this. yeah We're not going to cure aging, not in our lifetime.
00:13:55
Speaker
and It's not going to come in a pill or a supplement bottle. And yes, can you sauna? Sure. So if you're doing, you know, if you're exercising a number days,
00:14:06
Speaker
of days a week, if you're eating well, if you're sleeping well, you're not if you're not drinking you're yourself to sleep every night and you have friends and a sense of purpose, then you can maximize your potential.
00:14:23
Speaker
You could sit in a sauna for 20 minutes a night and it's gonna maybe have, you know, 1% addition to the overall benefit. But there's really no magic to this because as I alluded to, your metabolic health contributes a lot to your joint and tendon health and how much pain you're gonna be in and how severe that pain is going to be.
00:14:47
Speaker
But so yeah you need to pay attention to your overall health because that's going to improve your joint health.
00:15:00
Speaker
No, I need just a second. Give me more. Yeah, no, you're all good. Listen. Come on, dogs. I got outside. go. All good. Sorry. let's go all good sorry No, you're all good. I think the listeners will enjoy that. My dog's at my feet as well. So he's just sound asleep though.
00:15:20
Speaker
He might start snoring. That's probably probably as bad as it'll get. um Yeah, look, what you say is so true. And i think it's, you know, the more I learn about pain,
00:15:33
Speaker
the more I realized that the things I knew as a nine-year-old are actually the things that really move the needle today. Like things like we've mentioned sleep, exercise, nutrition, social connection, psychological distress or the lack thereof and and and having some stress management strategies. All of these things Just really for people with chronic pain, persistent pain, those things make a huge, huge difference in their life.
00:16:08
Speaker
The problem is is that habit change is really hard and especially probably in the climate that we're already in. And this was not...
00:16:20
Speaker
this is not meant to happen, but I'm actually developing or building an app with ah with a friend of mine who's he's a computer scientist. And we're we're hoping to put these things into to a lifestyle diary that basically works out well what what things are triggering triggering your pain. And those factors are the factors that we look at. And it's interesting that you have those same factors.
00:16:46
Speaker
um and And it's not that, you know, as you know, and correlation doesn't mean causation, but it's ah it's a start ah for people that are sort of drowning in the complex complexities of the things that could be contributing to their their pain.
00:17:02
Speaker
Yeah, absolutely. No, you're right. And and I always say the interventions to improve pain are important. are simple, right? Because they really are simple, but they're not easy.
00:17:17
Speaker
tight and yeah And getting some people to change is very hard. And getting people who are in chronic pain to trust the movement and to get off the couch and get us outside and get beyond the pain that they're in can be very challenging. And, you know, I can, you know, I understand that. Every time that I go to the gym and look at like a trap bar or a deadlift, I think...
00:17:50
Speaker
I just feel it in the back of my head. I know, you know, the fear is there. I can't get past it, even though I know I'm going to feel better. and Yeah, fascinating.
00:18:03
Speaker
it's so much Sometimes it's it's, and I think what's helpful for you is that you have that that experience as well, which I also have um with my own sort of pain problem.
00:18:15
Speaker
And that experience There's nothing like, you know, you can know the facts, but if you don't experience something, um but you don't, there's a certain level of expertise that comes with the experience of it and the real life, like flesh and blood struggle with a particular issue or concern that puts the textbooks into some sort of or brings them to life.
00:18:44
Speaker
Absolutely. No, you're 100% correct. But... but Those are great moments for patients. If they trust us, trust you that it can happen or might happen and they're willing to give it a try, when they start to see the changes, yeah it's life-changing for them.
00:19:09
Speaker
for And they never want to stop. Yeah, yeah. No, it's awesome. it is It is awesome when those things, and they when they take them and they run with them. I'm interested the research around gut health and and joints.
00:19:25
Speaker
Do you have a bit of a snapshot or a summary of
Gut Health's Role in Inflammation and Joint Pain
00:19:29
Speaker
that? Are you across that research? You know, I've read most of that research when I was researching my book.
00:19:40
Speaker
And yeah. yeah You know, the concept of a leaky gut, I don't really like that idea, but it sort of makes sense, right, that if your gut health is poor,
00:19:55
Speaker
you're going allow you know bacterial products into your bloodstream. You're not going to allow bacteria in because if you did, you'll get septic and die. So it's not that simple, but it's allowing some products in which can heighten your inflammatory burden.
00:20:13
Speaker
But I think the most important thing is, you know, our foods are highly fiber deficient, right?
00:20:25
Speaker
We have trillions and trillions of bacteria and viruses, et cetera, in our gut. And our gut was meant to house them.
00:20:36
Speaker
We rely on them. And those bacteria, yeah to for they thank us for for allowing them to live there by releasing a lot of compounds.
00:20:51
Speaker
They're all in the family called short-chain fatty acids. All these short-chain fatty acids are released by the bacteria into our gut, and we absorb them.
00:21:04
Speaker
And they have tremendous effects throughout our body, largely very beneficial effects, heart, brain, muscles, et cetera. And we rely on those. And the bacteria produce those short-chain fatty acids in response to fiber that's it.
00:21:25
Speaker
And, you know, in order to allow for a long shelf life, they've washed the fiber of most of our foods. That's what packaged foods really aren't all that good for you.
00:21:39
Speaker
And we used to get tremendous amount of fiber in our diet in, in our previous centuries. And,
00:21:49
Speaker
and even longer ago. And if you look at the Hadza and other groups, they get a tremendous amount of fiber, over 100 grams a day.
00:22:00
Speaker
And even though they have cholesterol levels 100 or, LDL levels above 80, they have no heart disease. And it's attributable most likely to the fiber, short-chain fatty acids, and their physical activity.
00:22:19
Speaker
Again, simple things work. And if you provide your gut bacteria with fiber, they provide you with short-chain fatty acids,
00:22:30
Speaker
you are healthier. So that's how the food part of my advice works to your benefit. Yeah. And what is the, do you know what the mechanism is for say joint health?
00:22:48
Speaker
Sure. Well, again, you know, i keep tying it back to joint pains are very commonly ah sign of a systemic problem, right?
00:22:58
Speaker
Your tendon health, is related to your to your cholesterol level, your uric acid level, and uric acid is a compound that's in your blood.
00:23:11
Speaker
And sometimes the less healthy you are, the higher your your uric acid is. And tendons, for example, your risk of rupture tendon or partial tear or tendinopathy is increased if your cholesterol levels and uric acid levels are high because those compounds will deposit inside the tendons.
00:23:39
Speaker
So you can see them. You see little white pockets of crystals or you see little yellow deposits you know because of the fat and cholesterol. So your tendon should be all collagen, perfectly aligned, and that is thrown that is thrown off if you have these space-occupying lesions made up of these crystals.
00:24:08
Speaker
And it also is inflammatory. You know, the uric acid at least is is inflammatory. And if the LDL is oxidized or changed chemically, it's inflammatory too.
00:24:21
Speaker
So you're getting these little inflammatory reactions in your tendons as well. so this is going to affect your level, your risk for pain, ah your risk of injury, and your joint health, quote, unquote.
Blood Health and its Influence on Joints
00:24:37
Speaker
Your overall health has a lot to do with the health of your cartilage or your or your cushioning that's in your knee. Your cartilage has zero blood supply, none.
00:24:53
Speaker
That's how every other tissue in our body gets nutrients. It comes through the blood. But the cartilage is nourished by joint fluid.
00:25:05
Speaker
So we all have a little bit of fluid in our joint for lubrication and to nourish cartilage. The substances that are in your blood find their way into the synovium, which is the lining of the joint, just lining around the outside of the joint.
00:25:22
Speaker
Those synovial cells make the fluid, the synovial fluid. So whatever substances are in your blood is what the synovium will put into the joint fluid.
00:25:33
Speaker
So if there's a lot of inflammatory mediators, uric acid, et cetera, it's going to end up in your joint fluid. Your cartilage is then going to be exposed to them. So just like you wouldn't want to go into a va of acid, you your cartilage cells want to be bathed you know in healthy fluid too.
00:25:55
Speaker
And so you expose them to these noxious substances year after year after year, those cartilage cells are going to break down and lead to arthritis or lead your arthritis to progress further and faster.
00:26:09
Speaker
And it's also, as we discussed, going to lead to more pain. Yeah, so it's all connected. It's very fascinating because this is what how how new would you say this science is? You know we've just started to unpack this in the last what would it be 20 years, 10 years? You know, yeah, yeah, yeah. But it's been a lot more a lot more recent that it's starting to get attention.
00:26:35
Speaker
But there are still plenty of doctors and and healthcare care professionals out there who think matt think mechanistically and think that running will cause arthritis or you shouldn't pound on a painful joint.
00:26:51
Speaker
So we still have a lot of work to do. We still have lot of people to educate.
Running with Arthritis: Movement as Medicine
00:26:57
Speaker
What are your thoughts on that? Should should we run with arthritis? Of course.
00:27:04
Speaker
Why not? It depends on your level of pain. Yeah, I have a little bit of arthritis in one of my knees ah from an old injury. If I run, I feel great. you know It's a little stiff when I first get up in the morning, a little sore for the first mile, then I'm fine.
00:27:23
Speaker
And then I get home and I feel great. So i you know if you are still and sedentary, you have higher levels of inflammatory mediators inside your joint.
00:27:38
Speaker
Interleukin-6 is a prime example. If you run or just move, your IL-6 goes down and your IL-10, which is and anti-inflammatory, goes up.
00:27:55
Speaker
That's why people with arthritis are stiff after they go to the theater or they were out to eat and they sat with friends for an hour and a half because they built up inflammatory mediators in their joints.
00:28:10
Speaker
That's the stiffness feeling. ah Yet they get going and they feel good. So running has been proven not to cause arthritis or initiate arthritis,
00:28:24
Speaker
Running is proven to not cause the arthritis to progress faster. obviously this is dose dependent, right? I'm not talking about people who run a hundred miles a week.
00:28:39
Speaker
We don't know about that. We haven't tested it, but for your average runners, If your pain is not severe enough to change your cadence, your gait, your strike, your form, then you should run.
00:28:55
Speaker
And if it is enough to change all that, then you need to find a new hobby. and I think that's awesome news for a lot of people listening. i Is that consensus across orthopedic surgeons?
00:29:09
Speaker
No. No, every every every month I see a number of patients who are seeing me for a second, third or fourth opinion. And typically they're runners and they had a little pain.
00:29:25
Speaker
They saw someone, they got an x-ray. They were told, oh, you have arthritis, you have to stop running. And many did. And they're devastated by it. you know If you're not a runner, you'll never understand that.
00:29:37
Speaker
But ah if you're a runner, you will understand it. Runners have to run. That's how we feel whole. We just love it. And others hate it. I get that.
00:29:48
Speaker
I'm sorry. But to take running away from a runner or tell them, just ride, just ride a bike or just swim. no yeah it you know it doesn't work.
00:30:02
Speaker
And so, yes, so that thought is still out there in in the physio community, still out there in the doctor community.
00:30:13
Speaker
and But it's changing. So I hear it a lot less often than I used to. Yeah, i was I thought you were going to say, no, it's not consensus because I i hear these these stories as well. Definitely riding and swimming seem to be the go-to advice for right yeah for the orthopedic surgeons in this area.
00:30:37
Speaker
um And yeah, I've read the research that you're referring to and it's hard for me though as a physio to sort of push back against any of that so um yeah it's it's it's softly slowly because from from a little bit of time yeah from a patient perspective they think who who do you think you are and i don't i just sort of open up the like the discussion around it with the with the research and sort of just leave it in their their hands to discuss i think the patients tend to believe the physios sometimes more more than their physician
00:31:17
Speaker
you know, because they're interacting with you two, three times a week, you know, as opposed to me who they're seeing whatever, every two months, three months or, you know, what have you.
00:31:29
Speaker
oh That's true. That's true. Possibly. Yeah, there's definitely some trust. I, you know, because i I live on the other side of this relationship.
00:31:39
Speaker
So I see it all the time. a lot of patients, and it works to my advantage, if we're on the same message, and to my disadvantage, if they told the patient to stop running, you know, or stop working out.
00:31:57
Speaker
Yeah, then I have to claw that back. But But no, they they do listen to you. yeah Well, that's good to know. That's good to know. I think we should switch gears into surgery because you are a surgeon and we haven't discussed it much.
00:32:14
Speaker
I want to know what what you believe the role of surgery is in knee pain.
Rethinking Surgery Decisions for Knee Pain
00:32:19
Speaker
I know that's a very broad question, but we'll start there. Yeah, so there are...
00:32:27
Speaker
As a whole, we do too much surgery. There are a lot of meniscus surgeries that don't need to be done. You know, we know a lot of meniscus tears are normal age appropriate changes.
00:32:41
Speaker
I happen to have them in both knees that have never been operated on. And run, rock climb, et cetera. and They'll act up every now and then, or at least I assumed that that's what's acting up, but the pain subsides and will go away.
00:32:57
Speaker
yeah, The world thinks that surgery is a quick fix, right? Because I'll tell people nothing gets better in six weeks.
00:33:08
Speaker
You know, it can take, say, you know, 50-year-old, you know, with some knee pain from running. Now the knee is a little swollen. It's going to take about two to three months until that knee, on average, feels better.
00:33:22
Speaker
And they think that that surgery is a quicker fix. Now, there are meniscus tears that do need to be fixed, right? Root tears, bucket handling, you et cetera.
00:33:35
Speaker
But the majority of meniscus tears, what we call degenerative tears, do not require surgery. They're going to feel better. Just have faith. Do you see it?
00:33:47
Speaker
do your therapy and things will work out for the majority of you. So I reserve surgery for those who need it those who have failed period of non-surgical management, runners who still can't run after a number of months and they have a repairable tear.
00:34:10
Speaker
I don't I try not to take and any meniscus out. you know That's important. and We are capable of fixing most meniscus tears these days, and many will heal.
00:34:24
Speaker
The whole red-white zone, red-red zone, that's out the window. now Now, arthritis is larger group. ah larger group of the pain sufferers.
00:34:38
Speaker
And, ah you know, we're, we, we're at a loss because we have a group of people who let's say they have to stop their sport, right? They can't play tennis anymore.
00:34:54
Speaker
They can't run. The pain is too much, but yet they don't have too much pain walking and they can hike. If they don't have pain at night, They don't need a knee replacement, right? They're not ready for that yet. So we don't have anything to offer them.
00:35:10
Speaker
you know That's where all these stem cell clinics you know are starting to come into play. Unfortunately, stem cells aren't going to go to cure arthritis, even if you paid $20,000 for it, it's not gonna work.
00:35:27
Speaker
It might make the pain a little better, but it's not going to repair, rejuvenate anything. And so we don't have much to offer except for physio, lifestyle changes, lose weight, et cetera.
00:35:42
Speaker
We don't have much to offer those people who have now have to stop their sport, but the pain is not severe enough to have the knee replacement. And what I see, unfortunately, is a lot of people choosing to have the knee replacement.
00:35:57
Speaker
because they think they're going back to running, you know, and playing tennis. And I can certainly show you videos of many patients of mine who have gone back to running or sports, you know, in tennis, but the majority can't, you know? So, you know, you know, it's easy to come up with the one successful one for your commercial on TV, but, but the rest aren't ready and can't.
00:36:23
Speaker
And so i don't, I try to, People, especially tennis players and golfers, you know, if, and yeah, sports should not be the reason for your joint replacements.
00:36:39
Speaker
pain should be. It's a quality of life decision. And ultimately, you know, it's your decision. It's not mine. You know, when you feel that your quality of life has been altered to the point that you are willing to take on the risks of surgery, and there are risks, then do it.
00:36:59
Speaker
Yeah, I think that's sound advice. I really appreciate you. And on a the integrity that you have, because it's not easy to be in a particular profession and call it out.
00:37:14
Speaker
And, and to say that, you know, many surgeries that we do shouldn't be done is, is a, is a bold statement. Have you copped any flack for that? has That has there been pushback?
00:37:25
Speaker
Yes, of course. I mean, yeah, yeah, but, Look, I'm 62 years old. You know, I'm um'm at the end of my career. And what I have to imagine is there are, I have a lot of doctors as as followers on various social platforms too. And a lot of training a lot of our training doesn't take place in the office, right? It takes place in the operating room.
00:37:59
Speaker
So I don't necessarily fault the surgeons, especially the newer ones. I fault their training because, look, you when I was a resident, we did very little office hour work.
00:38:13
Speaker
ah And so you went to the operating room to work with all these guys who were training you, and all you did all day was meniscus tears and rotator cuff tears and knee replacements.
00:38:27
Speaker
you didn't see the other hundred or so people that they didn't operate on. So it was logical to assume, Oh, you know, you have this torn, you know, we better fix it.
00:38:41
Speaker
But it takes a lot of time to, to figure out that they don't need it. Um, and sure the textbooks all, all say, right.
00:38:53
Speaker
Non-surgical treatment, non-surgical not, but it's, that's not what comes out of our training programs very often. So, yeah I think we need to do do a better job at exposing. Because it's hard. it's hard we we a lot of us think mechanically and mechanistically, right?
00:39:16
Speaker
How can this tear not hurt? right A lot of people believe you know there's no way that it can't hurt. But it's certainly not true. It it can not hurt.
00:39:29
Speaker
And it just takes a long time to believe that and to, you know, to be willing to treat these people without surgery.
00:39:41
Speaker
what do you What do you think the reasons are for what you'd probably describe as over-treatment? I think a lot of people honestly think that they're doing the right thing.
00:39:51
Speaker
I think that ah think that that's, you know, they're a product of their training. And for some, look, there's a monetary incentive to operate operate on people, right? I mean, if I see you in the office for an hour to explain why you don't need surgery, I'm getting paid $80.
00:40:08
Speaker
eighty dollars yeah I'm to get paid $800 to take that take that meniscus out. And honestly, a lot of people, despite having a surgeon sitting in front of you saying you don't need an operation, a lot of people don't believe you.
00:40:28
Speaker
So like, yes, I do need an operation. Like, no, you don't. So it's harder to convince some people that they don't need an operation than it is to convince them otherwise.
00:40:42
Speaker
So there are many reasons for this. Not all of them are monetary in nature. um Yeah, but yeah, it is what it is.
00:40:56
Speaker
Yeah, no, I do some shadowing with some surgeons on the Gold Coast here in Australia. And they're very, like the two that I've shadowed are very reputable, um lovely people and definitely have the best interest, the best interest of their patients at heart.
00:41:16
Speaker
But I do wonder, is there some and some cowboys out there that, quick to get the knife out i don't and and you know the monetary the monetary incentive is there obviously and that's not a that's not an orthopedic surgeon problem that's a that's a worldwide problem i i've been pretty vocal in in calling out physiotherapy for the the passive treatments that we that we give way too much and why do we give them because they make money that's
00:41:48
Speaker
Honestly, like, and look, I think I should so i should say that some physios or physical therapists, as you call them in the US, do believe that they that manual therapy does more than it then it really seems to say in the the research. But I think most people are, I think most of the, well,
00:42:14
Speaker
Oh, how do I say this? it's It's slow to shift. It's... it's it
00:42:21
Speaker
Most people know that it's not the appropriate thing to do, to be honest. Most people know that it's just what keeps people coming back through the door because people love short-term relief.
00:42:32
Speaker
and it's And it is hard. Like it is probably hard for you to convince people not to have surgery. It's hard for the for you to convince them that manual therapy is not what they need yeah when they have that expectation. Yeah.
00:42:47
Speaker
Yeah, it's not – I guess I say that because I don't want anyone listening to think that this is particularly an orthopedic surgeon problem. No, come on. You know, if you can call a repairman into your house, then there's a decent chance that you're going to have to pay to have something fixed out, you know, swapped out that you didn't need swapped out. Same thing with your car.
00:43:12
Speaker
So this is the world. This is this capitalism. at play, you know, unfortunately it's lives on the line and, you know, and pain and suffering too. So it's a little different, but it exists everywhere.
00:43:28
Speaker
a um've I've watched a YouTube video of yours recently where you were discussing a neurosurgeon that has sort of left the the field because of the discouragement that he had around this particular problem.
00:43:48
Speaker
So, yeah, it's definitely, it is it is a problem. Yeah, yeah. Yeah, I mean, look, I think he went overboard in his reaction.
00:44:00
Speaker
i wouldn't, you know, i wouldn't leave. I would just practice the way that you think that medicine should be practiced. um I mean, I could double my surgical volume tomorrow if I wanted to, but I don't have to and I don't i don't need to, um so I'm not going to But, yeah, I'm not going to bail on medicine.
00:44:23
Speaker
It's too much fun. I really like what I do. Yeah, for sure, for sure. No, change needs to come within from within if it's going to come at all. Correct.
00:44:36
Speaker
I don't think it will fully ever come completely because the reality is, is people like making money out of other people and it doesn't matter what industry you're in, that's that's going to be the reality. So yeah, they could do better maybe at cracking down on the the bad eggs that spoil the bunch, but yeah.
00:44:57
Speaker
That's in my industry too. That's in my industry
Interpreting MRI Findings with Patient History
00:45:01
Speaker
too. Explain the relationship between the m MRI findings of an a knee and knee pain.
00:45:08
Speaker
How does that all line up? Sometimes they correlate really well and sometimes they don't correlate at all. And you know the most important thing is like every person over the age of 40 that I send for an MRI, I tell them, I expect to find these four things.
00:45:27
Speaker
We're not going to care about them. This is exactly what I'm looking for or a surprise, right? Because there are many age-appropriate changes that we accumulate across our life.
00:45:40
Speaker
You know, every living human over 35 or 40 has a disc abnormality on their lumbar spine, you know, a cervical spine MRI. Most active adults have have a label tear in their shoulder and their hip.
00:45:56
Speaker
Many have meniscus tears, rotator cuff, et cetera. So a lot of these are just age activity appropriate changes. And So that's what the history, the story that you give me in the office, that's why that's really important.
00:46:15
Speaker
My exam to supplement that and the imaging findings, all three need to correlate. All three need to arrive at the same conclusion for me to consider, you know, an operation or to consider that the diagnosis is accurate because We're chock full of things. you know Some doctors will say, oh, we wrinkle on the inside, we wrinkle on the outside. Some will say, and you know whatever whatever analogy that you want to use, that's fine.
00:46:50
Speaker
But you put these structures through a number of cycles over 40, 50, 60 years, they're going to change. And a radiology colleague still call these changes, tears,
00:47:04
Speaker
when in fact most aren't. And you know, and face it, most of your listeners who have joint pain probably were never injured, right? They didn't fall off a ladder, fall off their bike. They just woke up one day or, you know, they stepped off a curb and something started hurting.
00:47:23
Speaker
That's not an injury, right? An injury and implies trauma. Although I do proclaim that I'm now at the age where I get injured sleeping because I wake up with things in the morning, you know, that hurt.
00:47:35
Speaker
God knows what, what, what what reason. But so we didn't tear these things, right? Cause if you think of the word tear, that's forced, right? it's you ripping something or, you know, you caught your jeans on a nail and it ripped the whole yeah But that's not how our tissues age. Now, if you go fall off a ladder and fall onto the side of your arm, you are going to potentially rip your entire rotator cuff off.
00:48:07
Speaker
But it's not going to be a tiny little tear. It's going to be very big and very consequential. So, you know, I will tell tell people, you know, I'm going to send you for an MRI.
00:48:20
Speaker
I'm not going to care if there's a tiny little tear in the front. I'm looking for a big giant tear. And I tell them that because I don't know what it's like in Australia, but in the U.S., a lot of patients get their MRI results before they get back to our office to review them.
00:48:36
Speaker
So there's a lot of confusion out there and a lot of panic and fear when they read their reports. So MRIs can be can be overused because if, you it can give...
00:48:52
Speaker
you are licensed to say, okay, you need an operation. Look, you you have this, you know. And if you're in someone's office who's not examining you, they're not talking to you, they're not giving you a chance to talk, and they're not sitting there and listening to you, then they can't make the right diagnosis because the MRI is only a very small part of the overall puzzle.
00:49:15
Speaker
and the and and the data set. and The information that you give me, the history, is probably the most important part of the data set.
00:49:26
Speaker
If I listen listen long enough, you're going to tell me what your diagnosis is. I just need to know how to question you to get there. Yeah, 100%. I think that'd be a surprise to to many people listening perhaps that because I should hear it hear it all the time where People sort of even when they're feeling better and they're sort of coming through physio and they're starting to improve and their their pain's resolving, they sort of still wonder, is there still a tear there?
00:49:57
Speaker
Right. Because they think it's it's really important to their function and their their ability moving forward. And I guess it's always also a little bit natural just to to be inquisitive about that.
00:50:11
Speaker
But they sort of expect that the reason why the pain is resolved is because the meniscal tear is no longer there. and some Right, exactly. Some of them even want sort of follow-up imaging to sort of see whether it's right resolved or not. um And, yeah, it's an interesting thing. And I think that this is...
00:50:34
Speaker
Hearing you speak hopefully will continue to get the word out there um because for for whatever reason, it's still it's still not commonly thought of that we have all these funny structural abnormalities, which the word abnormality is a little bit questionable when when over 50% of people have some of these things at a certain age.
00:50:56
Speaker
But yeah, we have we have these findings and they don't necessarily mean pain. It's not a common understanding in the general public. Right. No, their expectation is that, you know, is that the MRI should say normal.
00:51:11
Speaker
Yeah. And it's just not going to do that. Look, you can have a hole in your, you know, the front of your knee on your, on your favorite pair of blue jeans and they're still pants and you can still wear them and they still stay on.
00:51:25
Speaker
They still function. We, we have a lot of redundant systems. Right. In our body, we have a lot of excess capacity yeah that's built in And we're pretty damn resilient structures.
00:51:42
Speaker
And we can we can handle a lot of damage before there are consequences. So I don't worry about these little age-appropriate changes that I see on imaging.
00:51:55
Speaker
And I see them on my own. yeah I'm no different. I'm wearing out too.
00:52:03
Speaker
Yeah, we all are to some degree.
Dr. Lux's Focus on Longevity
00:52:07
Speaker
You shifted gears a little bit from looking from the outside and you you sort of got this interest in longevity and you've written a book recently called Longevity Simplified.
00:52:19
Speaker
What was your, tell me about your transition into that space and and how that came about? Yeah. Yeah, sure. So, uh, you know, after, uh, my third child, I was running less, working more, gained a little weight.
00:52:37
Speaker
Uh, I had to have an ultrasound on my belly for some pain I was having. And, you know, the radiologist was like, you're fine. It's just a little fat in your liver. What the hell that?
00:52:48
Speaker
And we didn't really know much about that. Uh, but I read whatever I could. And what I read wasn't good. So i spoke to a lot of people about but how to fix it. And it was exercise and eating well and everything else.
00:53:05
Speaker
And so, you know, I just started to become a lot more active again. and it was easy for me because I had done it before. i just had to find the time to do it. But I...
00:53:17
Speaker
In order for me to learn, I write. So I've had, you know, a big website for a long time and i love writing on it. And, Initially, it was only orthopedic information.
00:53:31
Speaker
But then as my interest in longevity grew and all these chronic chronic medical processes grew, started to write about them too.
00:53:42
Speaker
And enough people read them, read those articles, like, why don't you write a book? So that's what I did. Yeah, ah that's awesome. I haven't read it, but I would love to i'd love to get a copy of it. So I'll have to have to jump on Amazon, I assume, after this.
00:54:00
Speaker
Correct. Yeah. What are some key tips? And like this isn't a longevity podcast. It's for people with with chronic pain. But if you can speak to that population, what are some tips and tricks for people suffering with with pain when it comes to longevity?
00:54:21
Speaker
It's hard. And again, it it depends on how affected you are by your pain, right? You know, if you're incapacitated and you can't move, there are very serious consequences to your longevity and your health span, which is the quality of your years that you have left because Everything that we talked about in terms of a lifestyle changes that are necessary to to achieve joint health, those are the same things you need to achieve longevity, right?
00:54:59
Speaker
You're not going to find longevity in in a bottle or in a pill or in an injection. and so... you have to, if your body allows you to you have to find the means to be as active as you can be.
00:55:16
Speaker
Right. yeah And walking works that that's, you know, I, I titled it, I titled it longevity simplified because it's,
00:55:29
Speaker
The data really is simple. and And what we need to do is simple. All the initial long longevity studies were done in in Western Europe, like postmen, train conductors.
00:55:47
Speaker
These were done in, I think, the 40s and 50s, where you had – people who were walking a lot for their, along the look the course of their employment.
00:56:01
Speaker
And yet they shared the same other habits as their friends, you know, drinking, smoking, whatever. Yet they lived years longer. And the only difference between them was movement and walking.
00:56:15
Speaker
It wasn't running. wasn't a 10K. It wasn't ah you know an ultra marathon. It was walking. So when I, you know, I have a lot of longevity clients and patients as well. And, you know, I try and get them to start with just walking 30, 40 minutes a day.
00:56:35
Speaker
That's it. whatever pace you want, bring a friend, bring a dog. don't care. Split it up into two walks. Fine. Do I think that that's enough? Quote unquote. No, but I, but that's a start and six to 8,000 steps a day makes a tremendous difference.
00:56:55
Speaker
in your longevity and health span. So it's not complicated. You don't need to sweat. You don't need to knock yourself out. You don't need to kill yourself. So yes, it is worth the effort to just walk, right? A lot of people who have pain like, oh, I can't go to gym. I can't swim. I can't bike or ride. i can't run. That's okay.
00:57:17
Speaker
If you can walk, walk. Because every little bit is going to add something. Yeah. So, yeah. Yeah. And I think like for people that are, do you have debilitating pain where there's certain activities that are off? ah Yeah.
00:57:35
Speaker
That they are unable to do. There's always things that you can find to do. i don't think I've come across a direct patient that I haven't been able to get more active than they previously were.
00:57:49
Speaker
Sometimes it's working around their particular problems. And then other times it's sort of graded exposure. and And what they're surprised by often is that as they start to expose themselves to more and more activity, their pain actually resides, or at least if it doesn't resolve or start to start start to reduce, at least their life sort of gets bigger around it and they realize what they're capable of.
00:58:15
Speaker
Correct. They're not controlled by it anymore. Yeah, yeah, exactly. have a question that I ask pretty much always. It's a tradition at the end of it.
00:58:26
Speaker
And it if someone, and I'll put it in the pain, you're primarily a knee surgeon, correct? Knee and shoulder. Knee and shoulder. Okay. Well, for someone with sort of debilitating knee or shoulder pain pain,
00:58:44
Speaker
you know, they've tried everything and they feel like a little bit helpless and like there's nowhere to go and and they don't know what to do. What would your words be for them? Usually there is an answer.
00:58:56
Speaker
You just may not have found the right person to provide you with it. So, yeah, you know, medicine is, again, i can't speak to how medicine is practiced in Australia, but most physicians in the United States now are employed by hospitals or by private equity companies that own large groups.
00:59:24
Speaker
And so they're sitting there, you know, come on. you know, six minutes, six minutes, seven minutes, eight, eight, eight minutes. But there are doctors out there who are going to spend some time with you and help you figure things out.
00:59:40
Speaker
Uh, it's, uh, you know, and look, you know, uh, You can do your own research these days as well, especially with all these AI tools that are available. You have to understand their shortcomings.
00:59:57
Speaker
You have to understand that it's just one piece of the puzzle. But, you know, hopefully you will find that that person who's going to help you address your issues.
01:00:13
Speaker
That's good message. is Yeah, because I think sometimes, and you'd probably experience this, sometimes people come to physiotherapy and they're sort of like, I've tried physiotherapy, you know, I've done i've done that.
01:00:26
Speaker
But, right you know, not not all physiotherapy looks the same. Like if people have, it's not a it's not a treatment it's not a treatment, it's a profession. And so I think that brings a lot of hope that there may be someone out there that can help them.
01:00:44
Speaker
Well, thanks heaps for coming onto the show. i think list the listeners will really appreciate some of your words of wisdom and your advice. And I think there might be some surprises in there too.
01:00:55
Speaker
If they want to contact you or follow your work, where would they where would they look? Yeah, so the best places are Twitter, my sub stack and LinkedIn.
01:01:08
Speaker
Awesome. Awesome. Thanks heaps. Appreciate it. Sure, like them. Take care.
01:01:17
Speaker
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