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- [00:04]
A
Welcome to youo Are Not Broken, the podcast that challenges everything we've been taught about midlife hormones and sexuality. I'm Dr. Kelly Casperson, board certified urologist, author, and a leading voice in women's sexual and hormone health. Enjoy the show. Hey, everybody. Welcome back to the youe Are Not Broken podcast. Very excited today to have on. Lisa Moore, who is a physical therapist, has an amazing YouTube I've been referring a lot of people to lately called Brick House Bones. And thank you for being here on the youe're Not Broken podcast.
- [00:32]
B
Thank you so much for the invitation. I'm really, really happy to be here.
- [00:36]
A
So a lot of people don't know physical therapists exist, which is very weird. And a lot of people, I think, assume doctors know more about the musculoskeletal system than physical therapists do. And I'm like, dude, my physical exam is amateur hour. And I'm pretty good at examining the pelvis compared to most doctors. Physical therapists, that's what it's literally graduate training in. Can you talk about your journey on how you got to be specifically in your niche?
- [01:05]
B
Oh, yeah, it was a long journey actually. But yeah, we're all about the muscles and the bones and the bodies and the joints and how do we help people function in real life with less pain and more confidence? And that's what I like to do. In the near the last few years of my career, I was working in oncology rehab, which was such a gift to be able to help people through their cancer journey. The science behind oncology rehab is really fascinating as a specialty physical therapy thing too, and just how we can really improve outcomes and everything. But many of my clients were people who were experiencing breast cancer and going through breast cancer treatment as part of the treatment, including the chemotherapy and the radiation as subsequent aromatase inhibitors or estrogen suppression, they were at really significantly increased risk for osteoporosis and even a 10% increased risk for fractures over women who don't have breast cancer. So they were coming to me saying, hey, what do I need to do to protect my bones? And I didn't know that wasn't part of my oncology rehab training. And I don't like not knowing. I knew enough to tell them to be more afraid of movement. I didn't know enough to help empower them in the right movement. So that's the deep dive into figuring it out. And along that journey, I said I should probably get a DEXA scan and find out.
- [02:20]
A
Right?
- [02:22]
B
I'm not 65 yet, but I Don't want to wait that long to learn this. So I had my own DEXA scan and found out, surprise. I had osteopenia as. So this deep dive took a few years because the information out there for women is confusing and conflicting and it's muddy water. And if it was difficult for me to sort out what to do, I couldn't imagine somebody going through treatment or somebody just trying to understand what clear steps do I need to take. Was not clear at all. So that's what led me to do this. And the more I found out that there were very few people specializing in this kind of education and training and I needed to start to make content so people could have access to free content on YouTub. Begin to take steps, not be stuck in fear.
- [03:05]
A
I love that. Yeah, I think that's what I would have added to your thing of like, it's confusing and I'm like, there's a lot of fear inducing stuff also. And I think there's also a lot of like not meeting people where they're at. So there's people who are like, they've never lifted a weight in their life. And then people are like, lift heavy, right? And it's like, don't read the ending of the book before you read the introduction, you know. So meeting people where they're at I think is super important. Lisa practices in Tacoma, Washington and the YouTube is available for everybody. I think people can take your YouTube and bring it into their either sports medicine person, personal trainer, to be like, here's some exercises. You know, this person's been thinking, how do you see people using your YouTube?
- [03:47]
B
Well, YouTube is organized into playlists because exactly like you said, I have people who have never exercised before that want to learn what to do. And so we've got some of the basics that we know are helpful, protective and safe for people to do if they have low bone density. But there were people like me who were otherwise active and fit and wanted to still be able to exercise at a certain intensity, but didn't want to do the wrong things or didn't want to have risky moves in their program. So I have beginner stuff, beginner balance playlists. I have playlists that are more moderate intensity, all full body, covering all the major muscle groups. And I have some other programs that are a little bit more robust along the way as well. I have a workshop, it's on my website. It's a low cost workshop, but this is appropriate for anyone who is curious about how to manage bone density, anyone who's working with somebody to help them exercise with their low bone density is appropriate for both patients and exercise professionals and other rehab professionals because all the education is in there.
- [04:44]
A
I love it. What's your website?
- [04:46]
B
Drlisamoordpt.com Love it.
- [04:49]
A
I think I have a lot of doctors, nurse practitioners, physician assistant associates, lots of clinicians who listen to this podcast. Having you as a resource to be able to say, hey, go watch this. Go start learning about this. Because a lot of clinicians are like, we didn't get trained. And furthermore, we don't have the time to say, do this, don't do that. Let me show you how to do this. The importance of balance. I think let's start with balance. I think a lot of people don't understand mobility. Balance work. Just understanding where your body is in a three dimensional space. It's so underrated, the balance work. But catching yourself when you trip, right, that's balance work. It's best to train for it. The whole thing is a don't fall, baby. Know how to get up once you fall.
- [05:34]
B
Yeah, 100%. Yeah. Balance. So when we look at some of the stats on fractures, so that's really what osteoporosis is, is a risk factor for a fragility fracture, a low trauma fracture. So my number one goal, working people, is to prevent a fracture. 80 to 90% of all fractures happen because of a fall. Right. So if we want to really target, one of the most important ways that almost anyone can access, it's balance exercise. And balance exercise is more than just standing on one leg when you brush your teeth. Okay. So it's not just tree pose and yoga, which is a wonderful thing.
- [06:05]
A
I love that pose.
- [06:06]
B
I do too. But we can dynamically train balance. That's when we fall, when we're moving and we're distracted and our head turns when we need to step over an obstacle, when we're doing more than one thing at the same time. So we like to do dual task training with balance activities, dynamic training, which means we're perhaps doing a movement with our arms and turning our head while we're performing a balance exercise. Maybe we're putting on on a jacket and zipping it up while we're performing a balance exercise. Maybe we're looking for an address on our phone while we're doing a balance exercise. These are real life things.
- [06:41]
A
That's so smart.
- [06:42]
B
And this is how people get tripped up. So if we train this, it gets better. Strength training also improves balance. Here's the secret sauce. The thing that I think is Missing in a lot of conversations about exercise training for fall prevention is power. Power training is strength plus speed. It's that agility, that quickness to move our body through space and prevent that fall from happening in the first place. So power training, I think, is a really important component of that comprehensive exercise plan for bone health and preventing falls and fractures.
- [07:15]
A
There's data on that too. You know, they're looking at like, is it just your muscle size that matters? Is it your muscle strength that matters? And they're like, it's power. The ability to move something like three dimensionally, like physics. Right. Is actually power is very strongly correlated with longevity. So it's not just like bigger is better. You know, you could have small, strong, powerful muscles. But I think everybody kind of gets. They think size and power are the same thing, but they're not exactly right.
- [07:45]
B
Right. It's just that, can you move quickly, can you respond quickly? And we think about things when we used to run up the stairs, or we could do those really agility things that were easily. I can just ask someone to skip and I can see that they're having trouble with power because they've forgotten that little bit of explosive agility coordination.
- [08:04]
A
Ooh. So I had a patient come and I have a in body scanner. So it does body composition, muscles and lean body mass, visceral fat. And it's just like a little scale, like 3 or 4 inches off the ground. It's just a little teeny step up. So it's less than a step is right. It's just like getting on a scale, basically. And she had trouble getting on the scale and doesn't use an assist device in person. She walked in, walked out, sat down, stood up, but had trouble getting on that scale. If you see that, what are you thinking of, like, we need to work on, is that balance, is that strength? Where would you start with her?
- [08:40]
B
Well, number one, I'm identifying a fall risk. That's absolutely identifying a fall risk. So I'm always thinking multi components. So I would want to do an assessment of what are the areas. Is it. Is a vision impairment, is it limits of stability, how far they can reach, Is it a strength? So testing strength, testing range of motion, testing sensation, testing the ability to step over obstacles. What is their walking speed, how fast can they walk? So we have a timed up and go test. We have a 30 second sit to stand test. It's gonna give me a measure of their lower body strength. And I want to address all of those things. I want to address functional strength, functional Activity strength, which is squats, hinging, pushing, pulling. I want to address the balance. So we have to start with the base of static balance, which could just be feet together, holding, and then we move to dynamic balance. Stepping over obstacles, working up and down a step, making that step taller and taller as we go, adding load. I always want to add load as we go. I don't care how old my client is, we want to add load and work on that muscle strength.
- [09:44]
A
Yeah, I love it. And I think a lot of people who are inactive think that their trainer or whatever is gonna throw them, you know, 120 pounds on their back for a back squat on the first day of, like, they're probably just gonna start with you squatting your body weight or like, very simple stuff. Right. Like, how can you move again through time and space? Of like. Some people are so deconditioned. We just have to start there. Yeah.
- [10:09]
B
That's actually my absolute favorite client to work with, is somebody who is starting from no exercise background or experience. Because we have the principle of initial values that tells us people with the lowest functional capacity to start have the greatest potential to gain. And they can see it really quickly. And when they can feel and see that change in their body in just a matter of weeks, it accelerates the momentum and it keeps them consistent. They have that motivation because they can feel the change, and it's just remarkable to see happen. But it doesn't matter how low you're starting, the change and improvement can absolutely happen. And it can be life changing, literally.
- [10:46]
A
Yeah. I mean, I think about, you know, listening to, like, the pro, the pro bodybuilders, the pro people, when they're like, it took me six months to put on another half a pound of muscle. Right. Like, once you're up at that level, it's like, very hard to see the gains because you're so optimized. But you're right. The people with a lot to gain, it happens fast. And those people sometimes need that quick feedback to be like, oh, well, I'm showing up and whoa, the results are actually happening pretty darn quick.
- [11:13]
B
This is a paid message from GoFundMe. Meet Juan Naula.
- [11:17]
A
When his son was hospitalized for a viral infection, Juan started a GoFundMe to pay for medical expenses.
- [11:23]
B
It was 5k to pay the bill for my son, and I need only 22 hours. It was amazing. People really trust on GoFundMe. How did Juan raise $5,000 in less than a day?
- [11:35]
A
He posted a short video on GoFundMe telling his story in 30 seconds.
- [11:40]
B
30 seconds. Be specific, be quick and tell. What are you going to be using the funds for? I was nervous to do it because it doesn't feel okay to ask money. But you shouldn't be nervous. Sometimes you just have to do it and see the results. We were able to save my son's life thanks to gofundme that we still have my son with us.
- [12:03]
A
Start your GoFundMe today at gofundme.com that's
- [12:06]
B
gofundme.com gofundme.com this message reflects one person's experience. Yeah, those little successes are really fantastic. And it takes away because we have this thing where we feel like we need to do it perfectly or the perfect amount or if we do it wrong, we're going to get hurts. We don't want to do anything at all. And really, if we can just start simply, start small, stay consistent, and see those little gains, it really lead to the momentum that creates the change we want. It keeps us independent. That's the key.
- [12:35]
A
Totally. I think most people want to be independent. If they don't want to compete on stage in a bikini competition, that's fine. Most of us don't, but we want it. I don't want my brother wiping my ass, frankly.
- [12:46]
B
Exactly. Exactly.
- [12:47]
A
You recently got back from a very large trip across the world. Give us tips for. I'm pretty good at home in my gym routine, but, like, travel throws people off. What do you do when you travel to stay active? I mean, airplanes are horrible for musculoskeletal issues.
- [13:06]
B
Yeah. So, yeah, this week just had a wonderful trip to New Zealand. Started off so we had a little pit stop in two days in Honolulu and we had a hotel gym. So hotel gym's marvelous. Get up in the morning, go do a simple work. I don't do anything aggressive while I'm there. I just try to keep it simple so I'm not sore. I don't want to be extra tired. But just if I can get a hotel gym workout, great. We'll go do a little bit of that the rest of my trip. Well, we did bring exercise bands. I didn't use them once, to be perfectly honest, but we did incredible hikes. We were very active. We were walking, we were canyoning. We were like adventure capital of the world. And I was adventuring. So mostly when I'm on vacation, I don't stress. I don't, because I know my routine consistently is to do this at home. I'm not the guilt police about exercise. That's not my thing. But my vacations tend to be active. Whether I'm swimming or paddleboarding, I'm doing things I enjoy. And that's why I strength train on the rest of the time. Right. So I can do those things I enjoy and I'm not sore and I'm not getting injured and doing anything like that.
- [14:04]
A
I love that. So let's talk about a new woman comes into your practice. Because I see this all the time and this is kind of myth busting. People think osteoporosis is a fixed entity. It's just, those are my bones. That's how it is. This is how it's going to be. You know, doctors play a role in that because we're like, we kind of discuss it like it's a fixed state, but bone is constantly changing and remodeling and listening to signals. Can you talk about kind of the myth of like, once you have it, you have it and it. Cause people are like, what do you mean you can reverse osteoporosis?
- [14:39]
B
Absolutely. And I want to talk about what you say about the messaging to it first, because this is something I hear every single day from clients that meet me that are asking for help. Recently, a client said, you know, I met with my doctor yesterday and talked about the osteoporosis, and I left there feeling like it was the end of my life. I was so sad and so scared. And she said, I asked about exercise and activity and working with a trainer, and she said, it's too late. She said, I felt as if my life was over and that I couldn't trust my body to do anything. We meet one time and just talk about empowerment, what you can do. She starts doing it and she's someone who wasn't exercising. She was active, like dancing and playing active, but not really exercising. Starts doing 30 minutes twice a week of exercises from the YouTube channel Life Changing. She emails me, lisa, you wouldn't believe it. I can go up and down the stairs multiple times and I don't even think about it. I can do my daily chores without ever questioning it. It used to be something I worried about, can I accomplish this today? And now I don't even think about it. This is as simple. But I hear this message from people who are not exercising and I hear it from people that are triathletes that are working out five and six days a week and they find out they get osteoporosis and they stop doing everything
- [15:53]
A
because they're afraid they're going to break
- [15:54]
B
something that to Me. Yes, exactly. They feel they're not confident in their body. They're afraid of what they're going to do. They don't know what's safe and what isn't safe. And so it doesn't matter if they're experienced or not, they freeze. And that's what I'm trying to counteract. I'm trying to create that positive experience with exercise and knowing what people can do. And yes, if you have low bone density, there's certain steps we can take. And we've seen multiple studies that support the lift more trial is one, but there's more than other studies, not just on high intensity, but also include moderate intensity exercise that you can have a positive impact on bone density and increase bone density. And typically the changes we may see would be somebody may go from osteoporosis to osteopenia or osteopenia back to normal bone density. We don't typically see that big jump from osteoporosis to normal.
- [16:43]
A
I've seen it though.
- [16:44]
B
Fantastic.
- [16:44]
A
Yeah, I've seen it multiple times.
- [16:47]
B
Right. And when we're getting that comprehensive approach, when we're looking at medical treatments and therapies and hormone therapies and the right type of exercise and impact for people who can do impact training. Yes. Bone is constantly changing, remodeling. And we can absolutely see positive changes in bone density testing and bone quality. Not just bone density, but and bone quality. So bone density is how much bone you have. Bone quality is how well is that bone organized. And I like to use the analogy of a bridge. When you look at a bridge, you just see the road that goes over the water and that's your bone density. We just see the external of the bridge and the road. When you look at the internal parts of the bridge, you see all the these cross links and hatches, these triangles and these wires, and that's what gives the bridge the little flexibility and strength. And how the bone is organized is what helps us be kind of more fracture proof. And bone quality in and of itself is a fracture predictor.
- [17:45]
A
Yeah, I think it's kind of like carbon fiber, for lack of a better word. But like carbon fiber is incredibly light but incredibly strong. Right. Versus something like super rigid and brittle. It might be big and dense, but it breaks easy. And I think people don't understand that. The DEXA scan is a proxy for bone strength via measuring density. And where we see this especially is in thin boned women. I'm one of them. Right. So small people have smaller bones that might be interpreted or misinterpreted as osteopenia because they're light, that doesn't mean they're not strong. And that's. I mean, Australia's ahead of us, several countries are ahead of us in basically looking at ultrasound to measure the microarchitecture instead of just using X ray. And how well the photons go through the X ray plate is a measure of density. So I've had dexas that say osteopenia. And then I get the REMS ultrasound and it says, excellent bone architecture. And that is a perfect example of thin, small bone, but strong. And I think, you know where I hope we're going to get with this because I think it's going to freak people out to get an osteopenia diagnosis. But again, are you made of carbon fiber, right? Or are you thin and frail? And I think, you know, what do I hope in 10, 5 years, 10 years these ultrasounds are coming to America. They're not that expensive. And I think that's going to be more and more. And you can get DEXA with trabecular bone score. Not all DEXA places do that. In my town, I've got two places that do dexa. Only one does a trabecular bone score, which it measures the microarchitecture. So there's a lot to do, but I want to just educate people on that to be like, just because you're small and might be not dense doesn't mean it's not strong.
- [19:36]
B
Exactly. And things that can change bone quality density may not change, but exercise can improve bone quality. Exercise, estrogen therapy, adequate vitamin C, adequate protein, that vitamin C, I meant calcium protein, managing our blood glucose and inflammation. All of these things can help impact our bone quality totally.
- [19:58]
A
I think if I could get anybody to understand, everything is like the bone responds to the world around it. For example, like the International Space Station people, right? Like, they come back with beat up bone quality because there's nothing putting any force on their bone. They've got zero gravity, right? So like just gravity itself tells the bone, hey, be strong. You take the gravity away, their bone quality will suffer.
- [20:24]
B
Yeah, absolutely. That's why load when we can, when we can load the body as something as simple as a farmer's carry or weighted carry is a great way to help stimulate bone growth.
- [20:34]
A
I love the farmer's carry. I feel so fricking strong. It's not complicated either, you know, it's not like you're lunging and twisting or anything. You're just like carrying something which Translates to carrying kids, carrying groceries, carrying something into the house, moving a piece of furniture.
- [20:49]
B
Right.
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A
Like it's such a translational exercise. Yeah.
- [20:53]
B
We all try to grab every single grocery bag and get it in one trip. That's what we're training for.
- [20:59]
A
I absolutely love it. I see a lot of women who think, you know what? I'm blaming, I'm blaming. Remember the Drink, the Got Milk campaign of like, I don't know, it was what, 20 years ago? Now I blame that. I could be completely wrong, but women are like, I'm taking a calcium supplement. And I'm like, that's all you're doing for your bones. Like, number one, I'm a urologist. You kidney stones happen more when you take pills of calcium instead of dietary calcium. So I'm like, I'm the urologist who's like, watch it. Because too much calcium at once, specifically in pill form is a huge load of calcium on the kidneys. The kidneys will filter it and just dump it out in the pee. And that's where the kidney stone risk comes from. So food is best, like you said. But I think again, it's like, if you think just taking a calcium supplement is bone health, you're missing the other big drivers.
- [21:47]
B
Yeah, I'm not a big supplement person when it comes to that. I mean, there are a few of the basics when we look at, we do want to make sure we want to get enough calcium. Food first approach, always. And I use a food based supplement when I need it, so that just fills the gap. And I know it's not like calcium citrate or something like that, synthetic calcium. We want to get enough protein because bone is one third protein by mass. We want that protein. Protein is the structure that the minerals adhere to to give bone its flexible, strong structure. So we have to have adequate protein if we want to build bone. You gotta get enough protein intake, period.
- [22:25]
A
Especially like, say a woman's coming in with osteopenia or osteoporosis. Are you asking her, you know, how many grams per pound of body weight? Like, are you addressing that? Cause I think a lot of women certainly like my women in their 70s, so they were around before the 90s is like thinner as a sign of beauty. Like completely failing women. Like, it's. And I tell people, I'm like, I'm not in the business of creating frail women. Like, you have to eat.
- [22:50]
B
Protein is priority. I address it with every client. How much are you getting? Are you measuring? Are you calculating? And then we talk about. Because they Think they're getting enough and they, you know, sorry, one egg is only 6 grams. I'm sorry, that's what I said.
- [23:00]
A
They're like, I have an egg for lunch. I'm like, great, that's six. I love the egg for that because it's like so simple to count grams of protein with the egg, but it's only six.
- [23:08]
B
No, we have to look at it, we have to measure it. And I think when we can break things down into smaller meals and spread it out, it's really not that hard to get. And especially if we can take our traditional kind of sweet high carb breakfast and make it a little more savory and add more protein, we can get a great jump start on the day. It's just finding these little strategies to make it happen. But it's imperative. And I'm with you. I am not in the business of helping women take up less space in the world and be smaller. I'm helping them be stronger. And in order to be stronger, they need to get enough fuel. And we can't under fuel our bodies. And that messaging we've had that how we look and how appealing we are to somebody else is not how we want to present in the world anymore. It's how well we can be independent and continue to do what we love to do with the people we like to share that with for as long as possible.
- [23:57]
A
Yeah, the feeling of being strong, which is it's very hard to like communicate this because it's like if you know, you know, sort of thing. But like the feeling of being strong feels very good. Like there's a level of confidence that comes with that. And it's not just because, like jeans look really good on strong people, but like, it's like a confidence in your body almost. And like you had shared with that, that patient of like, she's like, oh, I got this now. Life's just a little bit easier because you're just stronger.
- [24:25]
B
It's a youthfulness too. I mean, actually, as we were approaching some of the activities, they had an age limit on them and we were looking to do that and we were at the top of the age limit. But I'm like, I don't care. I'm fine. I'm prepared to do this and better prepared than somebod. These people 40 years younger than I am.
- [24:40]
A
Yes. Your driver's license is not an indicator of overall like health, vitality, wellness, or risk. I and I see that women get that a lot more than men do. I think we aren't like, well, you're 65. No testosterone and Viagra for you. Like, we never do that with a man, but with women, we're like, you're too old. You're too young. And it's like, I don't think age is as important as people think it is. And certainly data doesn't support that.
- [25:03]
B
Right? Exactly.
- [25:04]
A
Talk about, like, is walking. I love walking. And, like, there's something to 8,000 steps a day, and there's longevity benefits for it. I'm not saying don't walk. I think my question is, like, why is walking not the only thing we should do? Is maybe a better way of saying that.
- [25:20]
B
I'll say that to be clear, too, I love walking. Walking is phenomenal exercise. It's associated with longevity on so many different levels. To me, it's as much a mental health as a physical health thing. Being outside, it helps regulate my sleep patterns, all of it. Like, walking is a wonderful. We're not saying don't walk. Many of my clients have come to me and my doctor said, just keep walking. It's not enough. So when we look at bone health programs, we look at osteoporo programs. It should be comprehensive. There's not one magic exercise, like a deadlift. There's not one magic thing, just like walking or 12 poses of yoga. It should be a comprehensive program. You kind of addressed this earlier. We want to work on mobility, so our joints are moving through a full range of motion. We want to work dynamic balance. We want to work resistance training. Not just three exercises. We want to cover all the major muscle groups. Pushing exercises, pulling exercises, pressing exercises, squatting, hinging, carrying. These are functional activities that apply to daily life. So walking is great. I think yoga and tai chi and those things are also part of a comprehensive program. It's really more than one thing. So people always want, what's the one best this or the one best that? No, let's leave the whole symphony. Don't just pick one's instrument.
- [26:38]
A
I think of it as, like, it's an active week. I am an active person. Therefore, I walk, I do yoga, I lift weights. You know, all of the things. Instead of, like, well, I need to get 30 minutes of zone two on Tuesdays. You know, people are like, it's a lifestyle. And I just think it is a lifestyle. Like, you have to be like, this body is made for movement. It suffers when we don't move it. And how can we fit that into our week? Instead of, it's a chore of, like, it's an honor to Move.
- [27:08]
B
Sometimes I think we overcomplicate it. It's just there's too much information out there. Like you say, well, what's my heart rate? What zone am I in? Did I get? How many minutes was this? How many steps was it? Like, we're measuring everything to death instead of just getting out and doing it, right? What feels good to your body? Do that. People are like, well, what's the best aerobic exercise for my body? What do you enjoy? I mean, yeah, walking is wonderful, but if you rather go cycling, go cycling.
- [27:34]
A
I love it. I think that, like, the worst case scenario is people are like, oh, hand grip strength is associated with longevity, right? So they just like, sit in the chair and work on, like, hand crunches. And I'm like, I don't think that's what the researchers studying that had in mind.
- [27:48]
B
No, no, that's just really a nice little metric that tells us how much you push, pull, and carry all day long. It's just. It's a nice way to measure that. That. How active are you in general?
- [27:59]
A
I see a lot of people who are like, well, my shoulder or, well, my wrist or I can't lift heavy because this. Whatever it is, my elbow, my. This one joint, right? Give me the talk track for getting them over the hump of like, get in there anyways, see somebody who can work with that. Like, how would you respond to be like, I would love to lift heavy, but like, my shoulder?
- [28:22]
B
Yeah, yeah, I love this question. Actually, that question comes up all the time. And one of the things I say is there's always something somebody can do. We don't have to start at the top. So, one, if you have a bad shoulder, you got three other limbs and a core. So, like, we got other places to work. We don't have to just stop there. A lot of people say, oh, well, I had wrist surgery, so I can't exercise. Yeah, you can. You have two legs. Let's go. You know, like, there's still options that we can do things that aren't eliminated. Maybe they have Ms. Or Parkinson's or different things. There are other barriers to some of the higher intensity exercise. But nearly everyone can work on balance. Okay, Nearly everyone can work on balance and help reduce their fall risk. And nearly everyone can work postural exercises, whether they're lying on their back or lying on their stomach or doing and sitting in a chair. Nearly everyone can do postural exercises, which can also reduce fracture risk. And then we go there. We start with, where are you? What can we do? So you Have a bad shoulder, we can start to do sit to stands. We can hold weights in a different way in some cases. Maybe a weighted vest would help you do load where you're not having to use your shoulder. Maybe we're only holding it on one side. That still works. We're getting core strength and different dynamic stability. There's always an option. Even if one body part isn't working, that's not a reason to not strengthen. And we have evidence that tells us, say, that you did hurt your wrist or your elbow on one side and it's in a cast. If you're exercising the other side, we get some cross communication in the brain that helps that side in the cast. It's a miracle.
- [29:50]
A
It's so cool. The body's phenomenal. Okay, well, so same scenario, except for now it's just kind of chronic pain, low back pain. Maybe they don't have a shoulder injury per se, so much. But I can't work out because I have pain. Let's tackle that one.
- [30:05]
B
Oh, okay. Love it. So pain is so multifactorial. So I like to try to really create a safe space for somebody who's experiencing pain. What is their understanding about why they're having pain in their back? Have they been told they have stenosis or, or bulging discs or what is the reasoning? Because a lot of it is, well, what do we think about what's happening? What is our prior experience about that? Has anybody told us that movement isn't safe? And so if we've been told that, then we are fearful of movement. So understanding kind of the root basis of what this pain experience is, what has worked, what hasn't worked. So if something already hasn't worked, that's not going to be where I start with somebody. I want to know what has worked for me, them, what movement feels good? We know what movement feels good, then we can expand on that. What movement do you enjoy? Okay, I really enjoy swimming.
- [30:57]
A
Great.
- [30:57]
B
Let's see how we break this down into components and parts so we can start to have small successes. Exercise can help pain. Exercise can help reduce pain. So that's part one is finding movement that feels safe, that they trust, that they feel listened, heard and validated in their pain experience. The next is how is their nutrition potentially contributing to inflammation and pain? What can we do to help guide them in ways that are going to help reduce inflammation? Help their joints feel a little bit better, help them have a little bit better fiber. How do we help nutrition to support that as well? Eliminate some things that may be Contributing to pain? How is their sleep? Are they getting adequate rest when it comes to managing their pain? So I'd really try to look at pain from a multimodal approach of what are some of the contributing factors, what are areas we can change, and what is movement that they feel safe doing so that we can start to get a little momentum and build from there.
- [31:54]
A
I love it. I think that's going to help a lot of people. How early should we start thinking about bone density and prevention?
- [32:01]
B
Young as kids? One, if we're kids and we're active and playing, great. As our bone is growing, so we're building our peak bone mass from teens into our 20s, right? We're still building that most bone density that we're going to have, hopefully in that time in our teens and twenties. We're getting enough calcium, enough vitamin D, and we're active, we're playing, we're climbing, jumping, running, hopping, doing those things that stimulate bones to grow. We're not on compulsive diets. We're getting adequate fuel for whatever activity we're doing. So we need to be paying attention to this early, and we need to help teach our young women how important that is. Some, some bone stress injuries in endurance athletes that are experiencing low energy availability because they're not getting enough fuel and they're doing these endurance sports. And bone stress injuries can be a big red flag. Maybe they're having changes in their period cycles that are showing some hormone dysregulation. This is a really big sign that they need to work with their provider to kind of sort this out and protect their bone density then. And as we're looking into perimenopause, we stay pretty stable until we start to hit perimenopause. And that last year of perimenopause was. And then those first two years after our last period, we can see a very accelerated amount of bone loss. So addressing that and talking to your provider about hormones before, right? This is your zone, Kelly. Yeah, well, yeah.
- [33:24]
A
And I want to remind people that estrogen is FDA approved for the prevention of bone frailty, prevention of osteoporosis. Because a lot of people, for a while it was like, are you suffering enough to justify your hormone use? The millennials are really taking this on to be like, well, how about we don't get low bone density in the first place? How about we don't suffer in the first place? And the shocking fact, like you just said, is bone density your greatest risk of bone density loss or greatest rate is in the Two years leading up to when your periods are going to end. Well, a third of people don't have periods to even know when that is going to be. And how do you know when your period's going to end? That's a date in the future. Right. So really thinking of hormones as prevention, protection, preservation, whatever non trigger word people want to use for that instead of are you suffering enough to justify this prescription is really becoming outdated pretty quickly.
- [34:19]
B
Yeah, absolutely. The earlier the intervention, the better. The more aware we are of our bone health, the better. And on that line, the standard is to get your dexa at age 65,
- [34:28]
A
which is like 15 years past average age of menopause.
- [34:31]
B
Right, Right. So you can talk to your provider about any potential risk factors. If you had a parent that had osteoporosis, sustained a fracture, that could be enough that you could get one covered. If you had absorption issues, celiac disease, if you had low intake of calcium and protein, if you had an eating disorder, if you had bariatric surgery, if you had to take steroids for long periods of time. These are all things that can help you get that test early. And if not even just ask. Hey, can I get my DEXA sooner than later. You want to know Dexa?
- [35:00]
A
Depending upon the town you're in, Dexa in my town's like $100 cash. Like this is not expensive technology. This has been around for a very long time and again you might have to take it with a grain of salt. Know how? If you can be with somebody who knows how to interpret, especially if you're a thin boned, smaller bodied, you know, and to be like, okay, well it says osteopenia at age 48, but let's optimize everything. We'll recheck it in a year and we'll recheck it either with the ultrasound or we'll recheck it with the trabecular bone score included because we care about the that microarchitecture because I think DEXA does and we have data on this. This isn't just my opinion. DEXA will over diagnose osteopenia in thin boned people. So you want to make sure the test you're getting is as accurate a representation as it can be.
- [35:46]
B
And it's one factor of a risk for fractures. One factor of, well, you know what else is happening? Yeah, one factor. So what are the other other factors that we can look at? Well, you're already exercising, you already have a healthy diet, you know, you're already getting adequate sleep. You're not, you know, you're not a smoker, you're not a drinker. You're. All the other factors that can play into your risk for fracture. It's just one.
- [36:07]
A
Yeah, it's just one. I think there's interesting data coming out. There's multiple papers on this looking at women with an estradiol of zero, so undetectable, versus an estradiol of, say, 20, meaning it's still a post menopausal estradiol level. It's still lower than a man's.
- [36:24]
B
Right.
- [36:25]
A
They use kind of 30 as the cutoff for menopausal estradiol level, just 0 to 20. The risk for fracture skyrockets when it goes down to zero. So where I think this might be going at some point is, should we just get everybody off the floor? Because getting you to still have a postmenopausal estradiol but still better than zero estradiol gives you huge gains in fracture prevention.
- [36:51]
B
Yeah, that's great. I mean, I think that's where we need to keep our focus, is fracture prevention.
- [36:57]
A
Yeah, absolutely. Anything else we missed? What do you want women to know going into this? I think we tackled fear wonderfully. We tackled multifactorial lifestyle wonderfully. What do you want to leave us with?
- [37:09]
B
Muscle loss and bone loss are two branches on the same tree. Leaves are falling off one branch. They're falling off the other branch, too. And working on your strength to whatever capacity you're capable of is one of the greatest gifts you can give yourself to stay independent and active for the second half half of your life. It is one of the greatest gifts to not have the same change that you perhaps saw in a parent or grandparent or aunt and uncle. Movement doesn't have to be perfect. Any movement you do is better than no movement at all.
- [37:40]
A
I love that. I think there's a lot of black and white thinking in the world, and certainly we apply that to this, too. Of, like, this is how it is. What's the point now? When I was a child, my great grandma was still alive, and she was very short, and she had the classic dowager's hump that you learn about in school, which we don't see much of anymore. Correct me if I'm wrong, that's a kyphosis.
- [38:04]
B
Hyperkyphosis.
- [38:05]
A
Hyperkyphosis. Curvature forward of the upper spine. Right. And apparently it's supposed to be very painful because your bones are basically like riding on each other and they're not in alignment. And I remember that as a kid of that's what Great Grandma looked like, and I don't see it much anymore. And it's like we're getting to the point where culturally we're seeing people age and we're starting to think, what if frailty's not inevitable? And I think you're part of that movement, and I thank you profoundly for your work in this space.
- [38:38]
B
Thank you.
- [38:39]
A
All right, everybody. Brickhouse bones on YouTube and your website. And if you're lucky enough to be on the i5 corridor in Washington state, you work in Tacoma?
- [38:50]
B
I do. Come on down.
- [38:52]
A
Awesome. Thanks for being with us today.
- [38:54]
B
It's absolutely my pleasure.
- [38:56]
A
If you found this episode funny, helpful, insightful, please take a moment to follow, rate and share the youe Are Not Broken podcast with someone who might need this conversation, too. That support is how this information reaches more people. And thank you. For courses, books and my monthly membership and the Casperson clinic information, visit KellyCaspersonMD.com this podcast and all content from Dr. Kelly Casperson is intended for educational and informational purposes only, and this is not a substitute for individual medical coaching or psychological advice, diagnosis or treatment. Always seek the guidance of your qualified healthcare professional with any questions you may have regarding your health. Health Never disregard or delay medical advice because of something you've heard on this or other podcasts. Thanks for being here. And remember, you are Not Broken.