Notes On Midlife Fitness
An orthopedic surgeon of more than thirty years on why most of what we call aging isn't aging at all, and how a handful of fundamentals decide whether you thrive or decline. Short, plain-spoken, evidence-based episodes on movement, metabolic health, the brain, sleep, strength, purpose, and the connections that keep you living well, not just living long.
Episodes
You Just Need to Begin
Welcome back to Note on Midlife Fitness. I'm Dr. Howard Luks, an orthopedic surgeon, and this is the show about what actually keeps you strong, independent, and out of my operating room. This week, we're talking about why movement was never really about fitness in the first place and what stillness is quietly costing you at the cellular level, long before you'd notice. This is a public episode. If
Episode 6. Just Begin: The Power of Going From Zero to Something
You're waiting for the right day, the right program, or the right pair of shoes to start. You don’t need to… let’s get into this. Because… Here's what the research shows: the biggest leap in longevity gains doesn't come from training like an athlete; it comes from going from nothing to something. In this episode, I explain why stillness isn't a neutral state but active harm, measurable at the cell
Enough
The wellness industry thrives on making us feel like we’re always falling behind. More tracking. More supplements. More gadgets. More optimization.In this episode, I make the case for a different word: enough.If you’re walking regularly, lifting a few times a week, sleeping reasonably well, eating real food, and staying connected to people who matter, you’re not doing the lesser version of health.
More Years Is Easy. More Good Years Is the Whole Game
Everywhere you look, someone is selling you ‘longevity’. Live longer, add years, hack your biological age. Most of them are aiming at the wrong target. Living longer means very little if those extra years are spent unable to move well, think clearly, or take care of yourself. We have gotten good at extending lifespan, the length of the movie, while healthspan, whether the movie is any good, has ba
You're Not Broken
Episode 3 — You Are Not Falling ApartWe have spent so long warning people about the dangers of moving that we have forgotten to warn them about the dangers of staying still. And stillness is the far more reliable source of harm. When you do less, your body loses more, and it loses it quietly: muscle, bone, balance, cardiovascular fitness, insulin sensitivity. After 50, if you’re not training, you
Labral Tears of the Shoulder... The Three Boneheads Podcast
Episode TitleLabral Tears After 40: Why Your MRI Is Lying to YouPodcastThe Three BoneheadsHoward Luks, MD · Jeffrey Berg, MD · Jonathan Hirsch, MDEpisode SummaryIf you’re over 40 and have shoulder pain, there’s a very good chance your MRI report mentions a labral tear. And there’s an even better chance that tear has nothing to do with your pain.In this episode, three experienced orthopedic surgeon
The Rotator Cuff: The Three Boneheads Podcast
Rotator cuff tears. MRIs. Fear. Surgery.Three words that often get tangled together—and usually in the wrong order.In this episode of The Three Boneheads, we unpack why MRI findings often matter far less than people think, how age-related “abnormalities” are frequently normal, and why pain, function, and real-life goals should drive decisions—not radiology reports.Please leave a comment. We need
Why Some Surgeries Fail — Even When the Surgery Was Done Right
After more than 30 years in practice, one truth has become impossible to ignore: a technically successful surgery does not always lead to a successful outcome.In this episode, we unpack why “failed surgery” is often the wrong question—and why outcomes are shaped by far more than what happens in the operating room. From biology and inflammation to expectations, secondary gain, recovery, and communi
Meniscus Tears: Podcast Episode 9
Meniscus tears are among the most common reasons people walk into an orthopedic office, and also among the most misunderstood. The word tear carries a psychological weight that often sends people straight to panic mode—and straight to a surgeon—before anyone has examined them, before we know if the tear even matters, and before they understand that many tears have nothing to do with their pain. In
Episode 8: What We Would Tell Our 25 Year Old Selves About Building A Sustainable Career As A Surgeon.
The Three Boneheads sit down to answer one question: What would you tell your 25-year-old self about building a career that lasts? The answer isn’t what you’d expect. It’s not about technical skill or case volume. It’s about protecting your humanity while doing hard work for decades. It’s about the sleepless nights that never stop, the weight of worrying about every patient, and learning that you
Why Our Tendons Hurt: The Three Boneheads Podcast.
A month or so ago, I wrote a post about why our tendons hurt. The most common reason is a process known as tendinopathy. It can be caused by excessive or insufficient use. Believe it or not, insufficient use is more common. Your metabolic health plays a significant role in whether you experience tendon pain, how severe it is, and how long it lasts. Read the post below for some background info
Pain... A Fascinating Conversation About a Frustratingly Complex Topic
Pain is not a linear equation. This is an incredibly complex topic. I think you’ll like it. At least you’ll learn something about a subject that all three of us think about a lot. We can see the same pathology in various people, yet their expression of pain will be vastly different. Why is that? Is pain more prevalent today? Is pain more severe today?When is pain adaptive? When is pain malada
High-Tech Low Touch Medicine... Not a Great Trend: Episode 5
The emergence of a high-tech, low-touch healthcare environment is not beneficial to the human condition. The second quote from my portion resonates deeply… but it’s at the end of the pod ;-). “… Visits have become transactions and volume is the currency… but volume without value is noise…”“… We (3) still believe in traditional medicine… where visits go back to where it belongs… in a space between
Imaging. The Three Boneheads, Episode 4
Only a handful of you received this yesterday, so I am republishing it to everyone this morning. Sorry… Your comments will drive the topics and quality of this podcast. So, thank you, and keep them coming.Many people come to the office expecting… or even insisting on an MRI. It seems like a high-tech tool worth considering. But sometimes it’s not. Can you be harmed by seeing a result? Yes, m
Episode 3: Why We Operate Far Less Than We Thought We Would
In episode 3, Jeff, Jon, and I start to peel back the layers on what wisdom looks like at the tail end of our orthopedic careers. We see things far differently than we used to. We operate far less than we used to. We discuss the reasons that have led to this realization and perhaps teach you how to think about your own orthopedic issues when confronted with the option for surgical intervention.
The Three Boneheads... Episode 2
We’ve been doing this for decades. We talk to each other a lot. We are surgeons. We were taught to operate and trained accordingly. But decades later, we operate far, far less than we used to. Why is that? The first reply is from Jeff Berg. He’s a sports medicine doctor in Northern Virginia. The second reply is from Jon Hersch. He’s a sports medicine doctor in Boca Raton, Florida. This is a
Episode 1
Jon, Jeff, and I are three Orthopedic Surgeons with 75+ years of experience between us. We have a lot to say… but finding time for all three of us to sit together to record a podcast is challenging. We wanted to gauge your thoughts on this format. In this format, I posed a question to them. They each answered asynchronously, then I answered. The podcast contains our answers, but with no back-
A New Podcast... The Three Boneheads
This should be interesting. 3 Orthopedic Surgeons with 60 years of experience between us. We have a lot to say… and a lot to share. This is the welcome message about the format and structure. Stay tuned for our first episode coming soon. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit howardluksmd.substack.com/subscribe
How to prepare if you're about to undergo surgery.
Attention to detail before surgery has a significant impact on your ability to recover and your risk of complications. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit howardluksmd.substack.com/subscribe
Howard injures himself... again.
Exercise is the risk you take to avoid the consequences of being still. In the past, I often had issues or injuries related to improper load management, either ramping up too quickly or adding too many activities into a day. Some folks tolerate amazing load rates…, but that’s never been me. I learned many lessons in the past because of these injuries… but I still have some work to do. My middle s
Low heart rate or Zone 2 training... why it's important, and what we get wrong. A podcast
Zone 2 training is an overused term. It is important, especially for people with poor endurance abilities. More importantly, low heart rate training is the best way to improve overall health and limit the consequences of metabolic diseases such as type 2 diabetes and insulin resistance. Google recently released NotebookLM, a fascinating AI platform that can synthesize various sources and produc
Exercise is the risk you take to avoid the consequences of sitting still
This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit howardluksmd.substack.com/subscribe
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