Train With Age, Not Against It
Midlife and Master's Athlete Training: The Biological Realities We Face For the better part of 15 years, I have been training in the gym, running, cycling, climbing, and more. But the biology of aging and the physiological changes that come with it are real. We cannot outrun them, and we should not pretend they aren't happening. What we can do is adapt to them. My experience watching patients in my office for nearly 30 years, combined with my own curiosity about why some people thrive, and others don't, has shaped how I train now at 62. I use that clinical wisdom to change my approach, to work with the biology of aging rather than against it. This post and the long article below is the result...
Intensity Is Fine; Insufficient Recovery Is the Problem
Intensity remains highly trainable... But the dose matters. Intensity isn’t the enemy. Frequency without adequate recovery is. https://t.co/drZfgaCvpJ
Warm‑ups Activate Your Nervous System, Not Just Muscles
How and why I warm up : Most people think of a warm-up as something you do to “get loose.” That’s not really the point. The real goal is to wake up the systems that control movement, coordination, and energy delivery...
Listen to Your Body: Rest When Aging Signals Slowdown
Midlife/Master's athlete training... the joys of bucking up against the biology of aging. I've been training steadily and was gradually increasing my distance over the past month. But my times have been slower, and my heart rate has been...
Consistent Training Outweighs Intensity for Lasting Fitness
Age-related muscle loss (sarcopenia), reduced circulation, and reduced tissue repair capacity all contribute to slower recovery. Unless training… muscle mass continues to decline with age, and deconditioning following injuries or illness can happen quickly. This creates a cruel paradox: It takes...
Seeking Boston‑Area Trail Half‑Marathons for Family Run
What’s your fav 13.1 in or near Boston ?? Looking for something to run with my daughter. Trail decade preferred. 😎
Endurance Exercise Protects Joints, Boosts Fat Oxidation
Ha... no. He's wrong. Yes, there's an Afib signal. But his other conclusions... no. Run and cycle... we know why we do it... and my patients who run/ride are by far better off than those who don't. You need...
Bone Spurs Aren’t Behind Shoulder Pain, Study Shows
Bone Spurs Do Not Cause Shoulder Pain or Cuff Tears. Ten Years of Data Just Confirmed What Never Made Sense To Me. It's amazing how many people are still told each year that they need shoulder surgery due to a...
From Zero to Change: Your First Critical Step
Starting From Zero... 1/ Starting from zero is hard. You have many questions and many doubts, but you have the desire to make a change in your life. That is the first critical step. Maybe you see your physical capabilities changing, or...
Start Small: One Simple Goal for Any Day
Many folks want to start a fitness journey. But they have no idea how to do it. Most of what’s seen on social media is for those of us already established. The key to success… a very simple goal…...
Most Rotator Cuff “Tears” Aren’t True Tears
Are Most Rotator Cuff Tears Actually Tears? This topic is far, far more complicated than most think... and it's certainly far more complicated than the discussion in most office visits portrays. 1/ If you have a rotator cuff tear on an...
Take Control: Knee OA Progression Isn't Inevitable
Knee Osteoarthritis... Why Rest and Wait For Surgery is Not the Answer 1/ You have more agency than you have been told you do. The X-ray is not the verdict. The trajectory is not fixed. There are many things you can do......
APOE4 Raises Alzheimer Risk, but Lifestyle Can Shift Outcomes
APOE Status and Dementia Risk... APOE4 is the strongest common genetic risk factor for late-onset Alzheimer's. About 25% of the population carries at least one copy. It's a risk modifier... not a guarantee. And the levers that change the trajectory are...
Revamping Substack to Boost Content Discovery, Seeking Feedback
My entire substack was revamped... the process will continue. Content can die on Substack, so we're working hard on ways to help folks find what they need... I would love your thoughts... be kind🤣🤣🤣 https://t.co/bRFuvuEU45
Longevity Needs Purpose, Not Just Optimization
Longevity without purpose is just survival. 1/ We're optimizing everything: sleep, nutrition, biomarkers, training zones. But have we forgotten to optimize meaning?
Why Your Medial Elbow Pain Gets Worse Before Healing
Medial Epicondylitis.. Golfers' Elbow (stupid name). The most common cause of pain on the inner side of your elbow. A thread... If you lift, and certainly if you climb, you'll likely experience medial elbow pain at some point. Heck, most...
Atraumatic Joint Pain Signals Lost Muscular Capacity
Most of the joint and tendon pain I see in the office is atraumatic. No fall, twist, and no activity anyone can point to. The shoulder that's been sore for three weeks or the knee that aches when going downstairs....
When Recovery Fails, Overtraining Triggers Injury
A 47-year-old runner came to see me many months after surgery. His knee hurt. We dove deeper. He had returned to training, but recently his times had slowed, his heart rate had risen, and his legs had felt heavy. What...
Metabolic Health Drives Knee Osteoarthritis Progression
Knee Osteoarthritis Thread 4: Metabolic Health and the Knee. Your metabolic health will directly impact how your knee feels more than you can imagine. Your metabolic health directly influences how quickly your arthritis progresses and how your cartilage responds to...
Tailored Training Guide for Midlife Athletes
I recently created the Midlife Athlete's Training Guide. Why? Because many of you have asked me to write these up. So... Here's my first guide. 36 pages... why we need to train differently than when we were 30. How to...
Aging Decline Is Optional: Midlife Athlete Playbook
I'm a 62-year-old orthopedic surgeon, trail runner, climber, and cyclist. This is my Midlife Athlete's Playbook. I've combined what I've learned from 30+ years of treating active adults, and from training through my own 50s and 60s. The physiology of...
Stop Letting Your Body Quietly Narrow Your Life
Don’t let your life "narrow." I’ve been an orthopedic surgeon for 30 years. The thing I watch happen to people — more than any injury or surgery — is what I call the narrowing. Most of my patients have no idea it’s...
Your Muscles Shield the Brain’s Energy‑hungry, Non‑repairing Organ
Brain Health... Your brain weighs 2-3 pounds and burns nearly 20% of your daily energy. It doesn't store fuel. It doesn't repair itself on its own. And the organ that does the most to protect it isn't the one you'd...
Heat Spikes Heart Rate, only Brady Thrives
Hahaha. Last week was 35-40 degrees. Could keep a 10 min pace at 120 hr. So… today is 85 and humid 🤣🤣 HR was 135 at 12 min/mi Heat sucks. Except if you’re @Brady_H
Recovery Becomes Your Superpower as Performance Slows
Recovery is a superpower... A thread... 1/There's a moment most aging athletes eventually hit. You finish a routine workout, but the next day, something is off. You're not just tired. You're slower. Less inclined to train. Your body is responding differently to...
Strength Training Beats Pills, Injections, Surgery for Knee OA
Knee Osteoarthritis: Thread Number 3 The most powerful intervention for knee osteoarthritis is not a pill, not an injection, and not a surgery. It's not PRP and certainly not stem cells. It is the muscle above and below the joint. If you...
Same DEXA Score, Different Fracture Risks Explained
Your DEXA scan gives you a number, your doctor gives you a category, but the conversation often ends there... there's so much more nuance. Two people with the exact same T-score can have completely different fracture risk, and DEXA...
Keep Moving: Rest Worsens Knee Osteoarthritis
Knee Osteoarthritis... Thread #2 ! Your knee hurts. Your instinct is to rest it. Please don't. That instinct is very often wrong — and following it makes osteoarthritis worse, not better. Movement is one of the best evidence-based primary treatments for...
One Year of Training at 63 Reveals Surprising Aging Insights
Interesting post today. I’ve written about how and why I trained at 62. Now I’m turning 63 and I always look back… But this post is different. It isn’t a rehash of the same program with a new number...
X‑rays Mislead Knee Osteoarthritis Treatment Decisions
Osteoarthritis Of The Knee... Thread #1... of 4 "Bone on bone." "Your cartilage is worn away." "You have the knee of a 90 year old." I've heard these phrases bantered about thousands of times in 25 years. They are very common...
Most Tendon Pain Is Self‑Inflicted—Here’s Why
Tendon pain is the most common reason people come to see me. Most of it is self-inflicted — from doing too much, too soon, or from doing too little for too long. Let's review what most people (including many doctors) don't understand...
Consensus on Amyloid Hypothesis Delayed Alzheimer's Breakthroughs
The Amyloid Hypothesis: How Research Consensus Cost Us Decades. A Dive Into The Likely Contributors to Alzheimer's... https://t.co/ctsXwZPJTX
Training at 62 to Prevent Gradual Decline
Why I Train This Way at 62 1/ I’ve been an orthopedic surgeon for nearly 30 years, and over that time, I’ve watched something happen to many of my patients that isn’t dramatic or sudden, but ends up being far more...
Bones Remodeled Constantly: Your Skeleton Evolves
The skeleton you are walking around in today is not the one you had ten years ago. Most of it isn’t even the one you had three years ago. Your bones are continuously being broken down and rebuilt by an...
Early Heart Rate Spike Is Normal, Not a Problem
Aerobic base building - the Cliff Notes version. This is for two groups: those just starting out and those who've been sidelined for a while. You lace up, head out, and ten minutes in, your heart is pounding, and you're breathing...
Intensity Sits Atop Foundation, Not Building It
Intensity does not build the foundation. It sits on top of it... Module 6: Intensity and Locomotion. https://t.co/jGp9VQeU4a
Muscle‑Brain Dialogue Holds Key to Dementia Prevention
Your muscles and your brain are in constant conversation. Most people have no idea this conversation is happening — or what's at stake when it goes quiet. Many of you fear dementia far more than a heart attack or a diabetes...
Squat‑Induced Heart Rate Spikes Aren’t Cardio
I hear this every week in my office: "Doc, my heart rate hits 150 during squats — that's cardio, right?" No. And if your cardiologist hasn't explained why, keep reading. 🧵
Educate, Don't Convince: Respect Patient Autonomy in Surgery Decisions
Yesterday's post prompted a number of practitioner responses expressing frustration that "patients don't listen to them". Well.... that's okay. One of the hardest conversations in this profession is between the patient who wants something done and the surgeon who...
Atraumatic Joint Pain: 5 Surgeon Tips You Need
Having been an orthopedic surgeon for 30 years...5 things I wish someone had told you before you walked into my office — in atraumatic joint and tendon pain. Most of you will present with atraumatic joint and tendon pain... traumatic injuries...
Progressive Load, Not Rush: Protect Your Season
When intensity is layered onto a system that is not prepared, the result is predictable. The cardiovascular system adapts quickly, but connective tissue does not. Tendons, fascia, cartilage, and bone all require time and progressive loading to develop resilience. When...
Training for Life: Fitness That Fuels Longevity
I’ve had the privilege of practicing in the same region for nearly 25 years. I’ve gotten to know many of my patients well. Some thrive despite the years; many don’t. Long ago, that observation started to quietly shape how I...
Holistic Training Counters Aging’s Multi‑Faceted Decline
Training for life means deliberately resisting the narrowing that accompanies aging without training. It means building and maintaining the full spectrum of physical capacity: aerobic base, strength, power, rotational core, lateral movement, balance, and landing mechanics. Not because any single...
Science-Backed Training Week Explained: Methodology Revealed
Long post. What my training week looks like… and why it looks like this. Sometimes understanding the science and theory helps anchor the methodology. Link for there 👇 https://t.co/2Xzne078WC
Your 70‑year‑old Self Depends on Today's Activity
A patient asked me yesterday why so many orthopedic surgeons seem to be in good shape. I told her... Because we know what happens to the human body when we're not. We see it every day. The loss of muscle that...
Tennis Elbow Affects Everyone, Not Just Athletes
Why Does My Elbow Hurt So Much? Tennis elbow affects 1–3% of the population at any given time. Over a lifetime, virtually everyone will experience it. The vast majority of people who develop it have never played tennis. They are carpenters,...
Perimenopausal Women Remain Grossly Undertreated in Orthopedics
Nearly 30 years in orthopedic surgery. Another pattern that is impossible to ignore. Perimenopausal women are some of the most undertreated patients I see. One unfortunate paper is blamed... but often, it's because the conversation never happens. https://t.co/6m6AxUhRKF
Train for Longevity: Modular Fitness for Ageless Resilience
I've spent decades watching people limit themselves, not because their bodies failed them, but because they believed their bodies were fragile. So I built something different. A modular training library for people who want to stay capable, resilient, and independent as...
Age 62: Keep Moving, Learning, and Embracing Fatherhood
I turned 62 this year. Still running trails, still on the bike, still in the gym. Still making mistakes and learning from them. A few thoughts on fatherhood, time, and what it means to keep moving forward when some things are...
Perimenopause Is a Metabolic Shift, Not Just Hormones
Perimenopause is not just a hormonal event. It's a metabolic one. Estrogen decline affects muscle, bone, tendons, cardiovascular capacity, and insulin sensitivity — often simultaneously. Most women aren't told this. Most training advice doesn't account for it. Here's what the evidence...