Aaron Perez

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/howardluks…

…don’t hesitate to reach out if you’re curious and want to learn more! open.spotify.com/episode/4GBfKD…

Physio Friends, Wanted to share this podcast episode from Erson Religioso III interviewing Mike Eisenhart which gives a great lens into the work that we do at Pro-Activity. Pro-Activity has some incredible career opportunities opening up…

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.

Cortisone injections for knee osteoarthritis are harmful in the longer term, so doctors should stop doing them authors.elsevier.com/a/1g4sk3npMrUY…

@mcalonanl All in all, I think there are at least as many opportunities as there are challenges. Change is hard, but I'm hopeful that since traditional practice models don't seem to be serving us sustainably, enough momentum will build for us to innovate and something better will emerge.

@mcalonanl in the role of Primary Care Provider for MSK health, I think really owning that role requires us to become experts in lifestyle intervention and utilize it as our primary intervention with our patients. I was excited to see this published recently: optp.com/Integrative-an…

Am I the only one that just feels like our profession is kind of doomed. Where do we see ourselves in 20 years? Just seems so daunting constantly seeing the uphill battles we face.. someone give me something positive here.

@mcalonanl 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.

@LennartBentsen @phys_sam Now I know that's getting away from your original point about the idea of an "annual PT screen" which there isn't a standard for. But personally I think it'd be fantastic if an evidence-based standard were established for such a service. I think it could be high value.

@LennartBentsen @phys_sam I'm in agreement that we want to avoid over-medicalization. But I don't think we do appropriate screenings enough (BP as a common example): uspreventiveservicestaskforce.org/uspstf/recomme… Yet only 10-15% of outpatient PTs report screening for HTN: academic.oup.com/ptj/article/10…

The idea of physio annual screening / check-ups doesn't just smell like overmedicalization, there is a hint of healer syndrome as well.

@BillingMartin Considering BP is the leading risk factor for the #1 killer in the world (heart disease) and often asymptomatic...and since BP will be impacted by our primary intervention (exercise)...I'd argue it's negligent not to routinely include it in our eval process. #VitalsAreVital

It is not within the scope on an msk physio to test BP in routine/community msk services Potentially within FCP, or ACP setting relative to role Id wager we need to stop adding complexity to clinicians inappropriately

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/263LxHDwcY8F2t…