← Rena Malik, MD Podcast
Rena Malik, MD Podcast
Moment: This Is Why Your Knees Hurt More Than They Should
00:16:17
In this episode, Dr. Vonda Wright joins host Rena Malik to reveal why jumping and resistance training are crucial for bone health. They address common exercise mistakes and offer practical advice for safely building bone strength while overcoming barriers like stress incontinence.
Loading summary
Transcript47 lines
- [00:00]
A
REI has ultralight backpacking gear. So for you gram counters and ounce shavers, we made this ad ultralight with a base weight of just 13 seconds. The next 17 seconds, pure trail. Find more with less in store and at rei.comk pop demon hunters, Haja Boy's Breakfast Meal and Hunt Tricks Meal have just dropped at McDonald's. They're calling this a battle for the fans. What do you say to that, Rumi? It's not a battle. So glad the Saja Boys could take breakfast and give our meal the rest of the day. It is an honor to share. No, it's our honor. It is our larger honor. No, really, stop. You can really feel the respect in this battle. Pick a meal to pick a side. Ba da ba ba ba. And participate in McDonald's while supplies last.
- [01:00]
B
I've been watching you for some time and I really get a sense that, like, I need to be jumping more.
- [01:05]
A
You do.
- [01:07]
B
So let's tell our audience because I guarantee you, 90% of people watching this don't think about jumping. Don't jump at all. So why should we jump?
- [01:15]
A
Well, remember we were talking about the dynamic, the fluid dynamics that happen inside, the physics of it, that happen inside of a bone. Well, one of the best ways to impact your bones is to jump. Now, I did a study so long ago, 2010 or something, where I looked at master's age athletes. So you have to be 50 and over to be a master's age athlete in competing in the National Senior Games. And I looked at who had the best bone density. Well, the first question I asked was, can we maintain our bone density late into our 80s? And the answer was yes. But then we had to go back and say, well, which activities?
- [01:55]
B
And.
- [01:55]
A
And it was all the jumping sports, volleyball, basketball, anywhere that you were jumping up and down, not so much swimming and cycling as you would expect. Right. How much jumping do we actually need to do? Because probably not many people to your point jump anymore. Not because they're incapable, it's just they haven't. Right.
- [02:12]
B
They haven't had any.
- [02:13]
A
Why would they jump?
- [02:14]
B
Jumping jacks or.
- [02:15]
A
Right. Why would we. So, you know, if we're walking, that exerts about 1.5 times body weight. If we're running, jogging, it's about 1.2.5. The science tells us that we need three and a half, four times body weight to cause the impact that will cause the osteoblast to build better bone. Right. We can get that by jumping. So the recommendations are anywhere, depending on who you read. And there's several guidelines, but either 10 minutes of multi directional jumping three times a week or every single day jumping broken up in a couple sets 50 times a day. So 20 here, 20 there. It's better to do it multi directionally because if you do 50 in a row, the fluid dynamics will equalize and they won't stimulate the osteoblasts. But if you're jumping ahead and back and like hopscotch, I did a post recently where I was reintroducing hopscotch to the world. Because think about it, you jump in a line and then you jump side to side and, and so it doesn't have to be arduous, it can be fun. But there's a difference between jumping up and down the way I'm talking about now and jumping on a plyo box for type 2 muscle fibers. Because when I also demonstrate that online on line, I often get comments of, oh, I could never do a 24 inch box. Well, I'm actually not asking you to. Jumping up and down on the ground can take you a long way. And then even 8 inches, which is the height of an average stage step, will give you four times body weight.
- [03:53]
B
What about wearing a weighted vest and going for a walk?
- [03:56]
A
So you know why I love weighted vests? It is not for building bone. I love weighted vests because it will increase your workload about 10%. And, and I give it that number based on my own experience. When I wear a weighted vest to do my zone 2 or my baseline training on a treadmill, it increases my heart rate about 10% with the same incline and speed.
- [04:21]
B
Yeah.
- [04:22]
A
So I think weighted vests are a great way to add workload to your walk or something. But it's not enough weight to really add impact to your bones. Now there are some very small studies as they tend to be weighted vest with weight lifting can have an impact on bone. But then we know weightlifting alone will have an impact on bone.
- [04:44]
B
So is weightlifting enough? Do you have to jump or is weightlifting enough to get that 4x weightlifting
- [04:51]
A
de novo has been found to be able to have a positive impact on bone density. But listen, why are we doing one or the other? Let's just do all eight things or seven or eight things and optimize our chances. You know, sometimes I get, I keep referring to social media, but I am on. We are both very big and very frequent active on social media. So I get, I get all kinds of comments and I get a lot of comments about. Well, there is no randomized control trial that a vest plus Jumping plus weights plus. Okay, so there is not a randomized study that tests all four things on bone density. It doesn't mean that we don't know individually these things can help and that perhaps by studying, stacking them, we can save people from the ravages of fracture. Because unless you have been at the bedside of a woman who is curled up in a ball writhing in pain, has a 30% chance of dying, do not talk to me about your experience with a woman with a fracture, because you don't know.
- [05:59]
B
Yeah. And there's no. It's not like we're harming anybody.
- [06:02]
A
We are not harming people.
- [06:04]
B
Right. Like jumping is not bad. Bad for you. Now, I will say a lot of women don't want to jump because of stress incontinence.
- [06:10]
A
There is that. Let's fix that for them. Let's do something for that.
- [06:14]
B
So please, you know, see your urologist, your urogynecologist, go to pelvic floor physical therapy, do Kegels do. If, you know, figure out there are so many things available. There are minimally invasive procedures. There are surgeries, but they're, you know, really minimal surgeries. So talk to your doctor. Don't suffer in silence. Don't use that as an excuse.
- [06:32]
A
Well, and I love that you're bringing that out, and it's so apropos because even I just don't want women to feel like they're alone or have to be ashamed when that happens, because I don't know. Tell me if these data are right, but I have in my mind 80% of women have some form of incontinence. And even the strongest women in the world, if you watch the Reebok CrossFit games, these are the strongest women in the world. And when they're box jumping with heavy weights, sometimes they're incontinent. So it's not because you are a failure. It's a physical manifestation of a skeletal muscle not doing its job in the pelvis.
- [07:11]
B
Right. And it's a skeletal muscle that we are often utilizing for walking, for standing on your feet all day, for coughing, for childbirth, for everything. And so it can get weak. Right. And just like any other muscle. And we are not really taught about the pelvic floor early on, and we're not taught to give it the attention it deserves. And so don't feel bad about it.
- [07:31]
A
That's right.
- [07:32]
B
This is the thing I will say for my female listeners is we suffer in silence too long. We're too busy taking care of our kids, taking care of Our aging parents, taking care of our spouse, taking care of everybody else before we take care of ourselves. And I see it every day in my clinic where women have dealt with it for 20 years, 30 years. And so I would say if you're bothered, absolutely, do something about it. If you're not bothered, it's not dangerous. But we're off the topic.
- [07:59]
A
It changes whole lifestyle. So let's address it.
- [08:02]
B
Yeah, absolutely. So we talked about impact.
- [08:04]
A
Yes.
- [08:05]
B
Now pulling muscle tendons. So resistance training.
- [08:07]
A
Yes.
- [08:08]
B
Tell me about training mistakes that people make that can actually hurt their bone. Because I think everyone hopefully knows, if they listen to my podcast, listen to you, that resistance training is important. But when are they hurting themselves?
- [08:20]
A
I think it is very common to hear a recommendation and think that everybody is going to start at the same place. I think you have to do an honest assessment of where you're starting. If you are literally an adult onset exerciser, meaning you never have done anything, but you've gotten the message. Now it takes a ramp up, sometimes a year to learn how your body moves, to build some reps so that your bones and tendons can bear the load, to learn the technique to lift in a proper way so that you're not going to hurt yourself, to not overdo it too much, too soon, too often. You can get a stress fracture from going from zero to, to hyper intensity over a short amount of time. So if you're an adult onset exerciser, give yourself a Runway. If you are a once upon a timer, which is those people who remember the athlete, they were in high school or college 20 or 30 years ago and think we're just going to go back and start where we left again, give yourself the ramp up. Nobody says that you have to arrive tomorrow at a place where you're lifting heavy, jumping up and down, doing plyo boxes, doing a lot of reps, that is a slow, steady progression. It is not a six week program because I want people to pivot their mindsets to this is how I live for the rest of my life, not a six week program and I'll be done with it. That's not how our body works.
- [09:55]
B
Yeah.
- [09:56]
A
So just give yourself the grace to be progressive. You will get there with consistency and
- [10:03]
B
if you build that consistency, it will continue.
- [10:05]
A
It will continue.
- [10:06]
B
If you try to go hard and heavy, you'll likely burn out.
- [10:09]
A
Well, what happens is I see this my, my office, but purposefully, I put my office in this gorgeous performance center and my office has floor to ceiling windows that overlook a football field, an indoor football Field. And what I see happening day after day, because it's the same people, bless their hearts, they're trying so hard, they're doing so many reps at moderate intensity. They're not getting enough recovery. It's not periodized, light workout one day, really intense the next day. They're hurt all the time in my office every three weeks with another overuse injury because our body needs recovery days, Our body needs light days and really heavy days. And so those are all the ways we can get hurt while we're just trying to do the right thing.
- [11:00]
B
Yeah, yeah, I was. I've been talking to my husband about it. And we lift and we've come to a point where we're like, we're not always going to failure. We're not always trying to push ourselves because we don't want to injure ourselves. Like, the longevity of being able to continue going to the gym and lifting is so much more important to us than just making that day hit a PR the priority. So how can people know? Because I think this is the other thing people think, no pain, no gain. Right. So how can people know the difference between pain that's, you know, just physiologic adaptation versus pain that, hey, I need to slow down.
- [11:34]
A
Adults, midlife people have delayed onset soreness. So it's the day after your workout, you might not be that sore, but two days later, you're very sore. And then it should go away. By the time you cycle back to that, if it's a leg day and you get sore three or four days later, that soreness should be gone. And you could, you know, you're pretty well recovered. If you're not well, then give yourself the grace to do another body part that day if you're still so sore and inflamed. So that's one way to know. Also there, there is a character difference between sharp stabbing, ripping pain and fatigue and soreness. In all likelihood, intermittent sharp, stabbing, ripping pain is actual damage. It will be accompanied by swelling and redness and heat. That is an injury and should be treated as such. Versus I'm sore a few days after my workout. You know, I lifted really hard. Well, maybe that's a sign that we need more recovery.
- [12:36]
B
Yeah, absolutely. How can someone sort of pick up on the fact that they're over training? I mean, I see people all the time who say, I work out seven days a week, week, I work out six days a week. And some of them are doing it period with periodization. So they're having light days. But other Times they are just like CrossFit every day or they're, you know, they're really intensely working out. So how can someone identify like they're headed in that way?
- [12:58]
A
It's important to listen to your body because there is a certain reward system to being that intense every day. The reality is pro athletes don't do the same intense workout every day. If we're all trying to emulate the best of us, Right. They have light days, they have heavy days, they have very set schedules. So why do we think as mere mortal athletes doing the same high intensity, burn your brain out type thing is going to be helpful? Well, it feels good while we're doing it, but then when you start being more sore longer, if you start not being able to get your heart rate up to what you're used to, if your sleep becomes disturbed, if you're noticing that you're more susceptible to colds, then those are all signs that you're over training. Not to mention maybe you have a nagging ache and pain that's just not going away because you're doing the same thing every day, abusing the same muscle groups. Right. And that is, that is really important to realize if you are, and I'm not picking on cyclists, but if you're a cyclist and that is the only thing you do and you're doing the same intense uphill downhill because somebody's yelling you at the other side of the screen to do it and you're fatigued and heavy and you have to pains that won't go away. Your body is speaking to you about the fact that it needs more recovery. And when you look at older professional athletes, I mean, like Lindsey Vonn just won a World Championship at 41. Dara Torres came back to the Olympics twice in her 40s. A variety of hockey players, Tom Brady we're performing athletes into their 40s now when we never were before, but they do not train in the same way that they did when they were 20. When Dara Torres came back to the Olympics as a swimmer in her 40s, she was not swimming the same high intensity number of laps she did when she was younger. She had more recovery, she had more total body days. I mean, she's very open about talking about it. So why would we think as mere mortal midlife athletes that we could just go hard and intense every day?
- [15:14]
B
Yeah. And there's not a benefit to it. I don't think you're going to be seeing a long term benefit in terms of health by doing it every single day.
- [15:24]
A
Right. And especially those high intensity every day tend to be all aerobic exercise to the detriment of lifting weights, which we know really if cardiac is important but for preventing frailty, it's the, it's the strength training that will get us there.
- [15:43]
B
If you guys like that clip with Dr. Vonda Wright, make sure to check out the full episode right here.
- [15:48]
A
I didn't expect this. TikTok has more short dramas than I could ever finish. Each episode leaves you wanting the next. Download TikTok now and try it.