The irony I find myself returning to is that MRI technology has not made us better diagnosticians. It has, in many cases, made us worse ones, because the image is so concrete and the language of the report so authoritative that it takes deliberate effort to resist anchoring to it. When the MRI arrives before the history is fully taken, the finding shapes what questions get asked and which ones don't. Bias abounds throughout the encounter. The encounter organizes itself around what the scanner found rather than what the patient experienced, and that is very difficult to undo once it has happened. Don't look at the scans first... the basics matter. Take a history... confirm it with an exam, then see if the MRI findings make sense in the same context.

We've been told for decades that osteoarthritis is "wear and tear." But.... it's mostly wrong. If mechanical wear were the primary driver, runners would all need knee replacements. They don't. In fact, recreational runners have lower rates of knee OA than sedentary people. Most research shows that running can be protective. Go figure! We've been told to rest. No... that's makes things worse. People who are active and strong keep their joints longer. No matter what the crays hsows. One thing that's changed is metabolic health. Elevated blood sugar, insulin resistance, chronic low-grade inflammation — these degrade cartilage at a cellular level. Inflammatory mediators circulate through our bodies and affect joint tissue from the inside. I see this every day in my office… people (with solid metabolic health) with horrible-looking X-rays and very little pain, and people with mild arthritis on imaging who are miserable. The difference isn't the X-ray. It's the inflammation. I put out an entire book on knee osteoarthritis on my substack lat summer. So to answer the question… it hasn't always been like this. But our metabolic health hasn't always been like this either. And far too many people are not being given proper guidance on how to manage their OA.

Here is the foundation of a message I have been repeating for decades: you are not broken. Aging tissues adapt and remodel. They accumulate structural changes that look dramatic on a screen or report but often function remarkably well in real life. When we frame every structural variation as pathology, we risk overdiagnosis and overtreatment. When we instead recognize that many imaging findings are common, or age-related phenomena, we can shift the focus back to capacity, strength, load tolerance, and resilience. open.substack.com/pub/howard…

Ahem…👉🎙️ *tap*…this thing on?? 🗣️📣 MEET UP FRIDAY NIGHT AT CSM! 5:10pm at Conference center lobby. Brief announcement followed by followed by 🚶‍♂️ to Harpoon Brewery for an @TheAPHPT sponsored #HappyHour 🍻 . Hope to see some old & new faces there!

I ran a half marathon this past weekend. I feel quite honored to work as a cardiologist and use my training for the benefit of others, but I never expected those skills to be needed in this manner outside of work.

Insurance isn’t the only model and I don’t think will remain the same. I think direct to employer services will become more popular model for health care benefits, especially for large companies. That will put pressure on insurance agencies since it could make them obsolete.

And we're looking forward to the next one with @apta_ga where we will cover the element of Endure. Registration for @apta_ga members here: forms.gle/263LxHDwcY8F2tSG7

SLIDING TO VICTORY! @ChicagoBears

what the metaverse would look like in the real life

Five more days until our virtual @LongCOVIDPhysio International Forum! We have an incredible, accessible, and inclusive program planned. 11 PT & AT CEUs. Full scholarships for patients. More info and registration: longcovid.physio/forum

Exercise is probably the single best way to extend lifespan. You need to exercise like your life depends on it. Because it does. Here's why. 👇🧵 /1

This angle is wild!!!

The more that evidence accumulates on the topic, the more confidence we have that whole muscle growth is very similar regardless of repetition zone provided sets are carried out with a high degree of effort. Provides a wide-array of options based on preference and abilities 💪

READ: “Sprawl in America is not good for our climate. And so we have to think about creating livable density that allows us to take mass transit & take bicycles." — @BarackObama Very good to see former President Obama weighing in on better city planning. dezeen.com/2022/06/27/barack…

Really cool event @MarkCiolek is spear heading, NYC PTs / HC pros - check it out! 👀

You know why I hate the 0-10 pain scale? Me: How Ya doing today? Pt: I’m about a 6. ... I hate that. We condition people to identify as a number. We’ve placed so much emphasis on it, that patients often believe that number dictates their life. Give me something of substance.

Ugh! Absolutely the WORST luck in weather. Can’t wait to hear how the squad on the ground did! Whether at #APTACSM or not, the innovator-seed grant is happening again in 2022.