How To Run Into Your 80s and 90s

Finn Melanson [00:00:14]: Hello, fellow runners. I'm your host, Finn Mollansen, and this the run to the top podcast.

Finn Melanson [00:00:20]: The podcast dedicated to making you a better runner with each and every episode. We are created and produced by the for team of coaches at runnersconnect.net, where you can find the best running information on the internet, as well as training plans to every runner and every budget. One of the universal interests of this audience, of course, is how we can stay injury free longer, recover faster and stronger if and when we do get injured, and generally to increase our health spans such that we can participate in and enjoy running for as long as possible. That's what today's episode is all about. Joining run to the top is Doctor Kevin Stone whose new book, play forever, details a revolutionary approach to sports medicine, that will put listeners in a position to thrive in our sport well into their eighties nineties and beyond. Specifically, we examine why some people in their eighties nineties remain competitive athletes while others struggle to walk up the stairs, how the musculoskeletal system can be repaired through certain cutting edge therapies, additional strategies for how to come back from an injury to your sport better, fitter, faster, and stronger than before. As well as case studies of ethics that illustrate outcomes from following all of the latest research here. There's much more to it as well. Let's get into it. Today's episode is sponsored by Magnesium Breakthrough from By optimizers. Their industry leading magnesium supplement helps you sleep better and reduce stress. Head to magbreakthrough.com. Forward slash run to the top to a groundbreaking product called Mydopur that revitalizes your mitochondria, which create energy in nearly every cell in your body. Head to timeline nutrition.com to learn more.

Finn Melanson [00:02:19]: Heaven Stone, it is a pleasure to have you here on the show today. And the first thing I wanna talk about, you have worked in a lot of impressive Olympic and elite athletes centered medical and consultative roles in the past. I'm curious how has that influenced what appears to be your life's work here, which is helping people increase their health spans and get them get the most at themselves, athletically, pretty late into life.

Guest [00:02:48]: Well, I think first of all, I'm I'm an orthopedic surgeon in San Francisco, and so I get to treat athletes like me which is the fun of what I the sport that I do. And in in hours in inspired when I was out for a run once with my mentor who looked at my bow legs while I was running and knew that I had had the meniscus cartilage in my knee taken out and said, you know, Kevin, if you could ever figure out a way to replace the meniscus, you'd make a big contribution to athletes everywhere and to orthopedics. So I said, sure. Sounds like a good project, and this was in 1984. It's been added ever since.

Finn Melanson [00:03:27]: How much has changed in those 40 well, I guess it's just about 40 years now in terms of how optimistic you are about longevity as an athlete? Like, how how much have we made in terms of strides in that area?

Guest [00:03:41]: Huge. We are in what I call the anabolic era of sports medicine. So in the past, when you'd have an injury, you'd get told to go home and rest your knee, Unfortunately, you might get cortisone jammed into it, which we all know shuts down protein and cell metabolism and damages the very tissues that we're trying to heal. And now we're in this era where we have injections and therapies and growth factors and cells. All of which can stimulate the body to heal. And so the whole focus now is if you have an injury, figure it out early, get an accurate early diagnosis, repair torn tissues, augment the healing with growth factors and stimulation, And then, of course, we'll get to talking about augmenting healing with mindset and nutrition and everything else, but the whole focus on now so much different than when I first started is repairing, regenerating, replacing torn tissues, keeping people biologic, And our hope is that you can drop dead at each 100 play in the sport he love and not for a run one day. It's sort of the ideal way to go.

Finn Melanson [00:04:47]: This is a really interesting conversation to me on a personal level. You know, I'm I'm thirty two years old, relatively intact, still running, but I do have family members, my dad in particular, who No. He had a pretty traumatic ankle injury back in the early eighties, and in the 40 years since he's had every surgery in the book, he's had the ankle fusion surgery, just had total ankle replacement surgery. I'm sure you probably have a lot to say against those, courses of action but the thought had always been that, you know, when you lose cartilage in those areas of your body, it's, it's sort of like a death sentence in you've you've lost a lot of, the ability to ever return to normal sports, range of motion, walking without, you know, soreness or pain, but and we're gonna talk about this. What you're suggesting today is we've, we've hit a point technologically and, from sort of like a course of action standpoint where this isn't like a doomsday scenario for people that have had pretty traumatic injuries.

Guest [00:05:49]: So let's step back for a minute and just give a little anatomy lesson, so we're all on the same page. So if you crack open a chicken wing or chicken leg, their white shiny surface That's articular cartilage. That's the bearing surface of all joints. Inside the knee joint, there's a second type of cartilage called meniscus cartilage. That's the fibrous shock absorber that so many people tear and, unfortunately, dooms the knee, and we'll talk some more about that as well. But that articular cartilage that white bearing surface, that's as slick as 5 times ice on ice. It's extremely slick and it can last forever. You can run forever as long as you don't have an injury. So once you have an injury, then the game is up, meaning that slickness, that smooth surface on another smooth surface, becomes a rough surface in the where pattern starts. And since the old day, is that used to doom your knee eventually or your other joints and your dad's ankle joint? And now we have ways in which we can jump in there early, stimulate that cartilage to heal, regenerate that cartilage, replace that meniscus, do all these wonderful things that we just didn't have before. And so if you come back to your dad's example where he was told to have a joint fusion or a joint replacement in his ankle. Those are a godsend to people who have severe ankle pain and have lived with it forever. And really are suffering. However, if we can get to them early enough, which these days is getting later and later and later, we can -- restimulate that cartilage down a healing path. We can do injections of growth factors and lubrication to keep the joint moving. We can, graft some of the cartilage We can even take these old arthritic ankles and reopen them up a bit, stimulate a new cartilage repair process. And feed lubrication and growth factors to provide nutrition to that joint and keep those otherwise quite severely damaged ankle joints going. So we're in this wonderful era right now where we have to change the thinking. The thinking isn't, oh, I've injured my joint. I'm doomed. I've gotta, you know, really change all my life activities to how can I stimulate healing? How can I provide nutrition? How can I stay active? And I wrote a book about this called Play Forever, which on Amazon, and I go into a lot of these strategies. So if we go over anything a little too quickly today, people can take a look at that book play forever and get some more information, but I'm happy to go as deep or as shallow as you want in every one of these topics.

Finn Melanson [00:08:26]: No. I appreciate it. And you know, after reading the book and just doing a little bit of research on your background, it reminded me of a quote that I came across 4 or 5 years ago that I think is relevant here. And it was, it was about entrepreneurship in Silicon Valley and all these new advances in tech, but I think it relates to medicine. It's the future is here. It's just not evenly distributed yet, or it's not universally marketed yet. And that's kind of how I felt after reading your book, like, there are a lot of truisms in here that just maybe haven't reached the mainstream quite yet. And one of the things that you mentioned is this need or maybe even a responsibility for the patient to investigate their doctors bias for treatment. And I'm so curious if you could go into what it means or what it looks like to investigate that, especially for somebody like myself and a lot of people in the audience who don't have a medical background and generally might have a hard time distinguishing quality of procedure or appropriateness of procedure from, you know, really slick marketing or, you know, what we have, been told in the past.

Guest [00:09:35]: Sure. So let's let's think about this the way I think about it for a minute. So the way I think about it is that we're in a very primitive sport the sport of orthopedic surgery. Almost everything that we do and everything I see and everything I touch, I think about how can I make this better? It's gotta be a better way to improve on this. There's gotta be other ways to improve on this. And so much of the field of orthopedics in so much of the field of sports are often inhibited by saying this is, you know, all we can do. This is the best we can do. This is, you know, what you have to accept. And then you look at in our field where ideas come out that really change the way we think, a whole host of the biologics right now, or in the field of running, a Courtney comes along and blows the doors off everybody. And now all of a sudden, you rethink about what's possible in the endurance sport or in the field of running or in the mindset or in the training or in all the things that she does a great job of long everyone's mind about, and it makes you step back and realize that much of what you were fixated on or thought was possible might not be the limit. And so I've learned so much from my patients who cheat. And what that means is that over the years, I said, listen, you can do this. You can't do that, or you need to arrest this long or that long, or and they come back in, you know, carrying their crutches a few weeks after a surgery that we thought they were supposed to be on crutches for weeks for, and and they just showed us how much you can push and how much healing varies individually. And so what I've learned is that each person who comes along has got their own unique biology, their own unique way of thinking about things, their own approach towards healing, And if we can figure out what's gonna work for that person and try to figure out how much where can you push the limits? How can you stimulate things to heal that we didn't think could be healed. How can you get someone back to running who was told they couldn't run again? You know, take every one of those nose and try to turn them into a maybe it's possible. Let's think about how to make that happen. And it changes your whole approach to it. Everything we're doing, and and I think everything you're doing and running too.

Finn Melanson [00:11:50]: And how can you become a more intelligent consumer of medical services and, you know, approaching medical, procedures that might be best for you in these scenarios. Like, I'm sure, you know, there have been a lot of people that have, for example, gone and worked with you. Perhaps they are fortunate compared to other people that they've gone and consulted with or or done procedures with, what is your advice for people in this audience that may have issues that are relevant to what you're working on? Like, how can they become you know, a more intelligent consumer of of these services?

Guest [00:12:25]: Sure. So in the old days, it used to be, you know, Google your symptoms. Right? And today, that's now changed because you will never go in to see a doctor a year from now who doesn't have AI in their pocket. And you have AI in your pocket. So you're gonna have an AI assistant, like a voice agent, like a Siri, was ai powered so that when you're giving your history, it's gonna remind you, hey, but what about this? And you forgot to mention this. Or this might be related to something your doctor needs to know, and your doctor is gonna be listening to you empowered with the world's knowledge not just their own knowledge. So that's the stage we're in right now. Now the important part of this is not just that you as an injured athlete are gonna be empowered with a lot of knowledge. You next need to say, what's my own bias and what's the bias of my doctor? Meaning if it's a doctor who always does a total joint for every arthritic joint he sees and tells them to go home and rest their knee because they don't wanna wear it out, That's probably not the doctor who's gonna help you get back to running on your either biologically replaced knee or your artificially replaced knee, all of which is now possible. So you need to kinda get to figure out what's the bias of your doctor. Just simply ask them, you know, how do they think about certain things that you've learned about And then think about what your own biases. Are you willing to put in the work or take the time that one procedure might require versus another procedure might not? Are you willing to treat yourself like a pro athlete? So -- Yeah.

Finn Melanson [00:13:58]: --

Guest [00:13:59]: every patient who comes in to see us, one of our jobs is to help them see their injury as an opportunity. Because all great athletes get hurt. The best ones use the injury to come back as we say fit or fast and stronger than they were before they got hurt. And so any pro athlete coming in is gonna line up their trainer, their nutrition, their sports coach, their sports psychologist, their whole life around. How do they get ready for next season with their injury and recover from it and come back better. And my job is to convince everyone to treat themselves like a pro athlete. You might not have all those resources, of course, or able to spend the time or have the the money to do that, but you can design a lot of what you're doing to professionalize your nutrition, your activity, the time that you wanna take for your sport, your mindset about it. And so that's our job. How do we help you No matter what your stage of athleticism, no matter what your stage of injury, how do we help you see yourself as a pro athlete?

Finn Melanson [00:15:01]: It's a lot of really interesting stuff. You said that the two things that come into mind. You said, see every injury as an opportunity. I loved that. And with the recovery process, treat yourself or imagine yourself, take on the role of a pro athlete in terms of your seriousness in all of the the work you have to do and There was a question I had written down for you here. And, I guess, you know, you do say in the book that you can use these injuries to, come back to your given sport bed than you were before. And I'm wondering, I mean, that that's that's gonna be a novel, interesting statement to a lot of people, do you think that most people in society think that when you get injured, the best outcome is is either returning to the previous baseline or a percentage of it from yourself because they there are shortcomings in the recovery process. Like, what do you attribute that sort of common knowledge out there about the the fate of of life post injury to be?

Guest [00:15:58]: Well, first of all, it's a bummer to get hurt. And so And there's a and there's something we call post in post knee injury or post ACL depression syndrome where you get hurt. You get excited about getting it fixed. You're kinda in rehab here. The surgery done, you get everything organized, and then, you know, 2 or 3 weeks or 2 or 3 months later, you just say, oh, man, I'm sick of this. I'm so ready to be back to where I was or my own mindset. This has really changed my life. And so number 1, getting ready for that kind of impact. An injury isn't just physical mental. It's life changing in so many ways. It's disruptive. So putting together the pieces so that you can approach injury when it happens. And have your tools ready to to address it. Number 1, number 2, avoiding injury. As we talked about in the beginning of this segment, you can run forever as long as you don't have an injury. So if the mechanics are reasonable and you're running gate and a host of other things we can talk about, then your joints are built to last forever. They don't unless you have the disease, a genetic disease, or an injury, you can run forever. So the key is to figure out how not to get injured. And most of the injuries that I see and across all sports, including running, our mental errors. Your mind just wasn't in the game at that minute. You stepped where you knew you shouldn't step. You reached out for that ball. You just knew it was a little bit too far. You were skiing just a little faster than you meant to. You were thinking about your girlfriend or your boyfriend or your cell phone, even worse. You just got distracted and you made a move that you intuitively knew you shouldn't make. And almost all injured athletes can kind of remember that moment of injury. And sort of think I could have avoided that. So if you can just drop your distractions before you go for your run, put your mind in that space. Enjoy the time out there, all the celebration and and the endurance and the sweat and the hard work to it, and just keep yourself in that wonderful mind space. You're far less likely to get injured and staying uninjured is the best way to stay out of my office. And to not deal with all the things that we're trying to help you overcome. So a big part of my mission is to help you not get injured at first.

Finn Melanson [00:18:25]: So when you think about all of the people out there that are in their eighties and their nineties and you see them on Instagram or Twitter and there's the they're on these videos, you know, setting age group records in a hundred meter dash, or they just completed a through hike of a long trail or or a marathon, are are are the vast majority of those people a class of people that avoided significant injury, injury altogether, or, does it include people that, you know, did have injuries, but they were just serious about it, and they, you know, embraced all sorts of protocols that just got them to this point.

Guest [00:19:00]: It's both. And it's also when you look at women runners, so my sister-in-law just completed 100 Miles at UTM B. Ice. And so and she's in her sixties. So she was 2nd in her age group. And, so I think what happened to many women runners like her who entered into running at, you know, 35 or 40. They came to the sport with a level of maturity. And a level of confidence that they were ready to take on endurance sport, like long distance running. And there's something about that mental mindset that maturity. And believe me, they come to that that stage of life with injuries. They come to that stage of life with years of of things that took them away from exercising the way they would have loved to, and many women in particular hit that age group when they take on an endurance sport because it's the right time in their life and their mindset and their maturity and their ability approach it. So I think we have a lot to learn from those athletes. It's not just that they avoided injury. Sure. You know, a lot of times when I see my eighty year olds and you know, I I put a new meniscus cartilage in a seventy year old because he wanted to, you know, get another belt buckle in in the desert and then that run. And so you know, there are people who have arthritis and have injuries and just say, I'm just not gonna let anything get in my way. And they'll they'll come in for whatever therapies we can help them help keep them moving. So I think we've got a pretty wide range. And what I the message is to the listener is that just look at yourself, take your own inventory, set your own goals, and then find the people around the world who can help you. And that brings up one other point, not about physicians. So many people who want to run and run better and run longer or enter into running miss the fact that if they'd take on a great coach, their entire enjoyment of the sport, and their entire improvement in the sport, would be so much better because we think about coaches and so many other aspects of life, you know, team sports. We think about yoga coaches. We think about mind coaches. Not as many people think about getting a running coach, and a running coach can really help your gate, your training program, your way you approach the sport. And I think that's one big deficit that we see where people could get more out of running

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Finn Melanson [00:23:32]: First of all, that well, there's a lot to say there, but the fact that your sister completed UTMB is very impressive trail running is my first love for those that aren't in the know in this audience because a lot of Listeners here are from the road seen, UTMB is widely recognized as sort of the Super Bowl of our sport, also one of the most difficult races I had a couple interesting stats handy about this race that might be relevant to this conversation. 93% of the elite athletes at this race were over the age of thirty. So this distance. It's it's an older person's game, which is interesting. And there was even a guy on the men's side who finished 5th overall 5th overall, and the most competitive race in the sport, he was forty eight years old, which is fascinating to me. But, anyways, I would love to break up sort of the middle part of this conversation into a discussion about protocols you recommend first around injury avoidance and then around how you approach injury repair. And I guess as it pertains to injury avoidance, Is there anything you believe or that you execute on with your patients when it comes to avoiding injuries that that might be counterintuitive or uncommon in the medical community? And if so, what are those practices?

Guest [00:24:49]: We well, much of it will come back to what we mentioned about getting your mind in the game. But, you know, I think just personally, for me, I share personal stories. So I start every day and end every day in the water. So for me, it's a hot tub or a swimming pool or if I can get out on the I am in San Francisco. So if I this time of year, if I can get on the bay in Windsor or efoil or or a stand up paddle. Any way I can find getting on the water, you know, puts me physically and mentally in this space for me to be able to do everything else I wanna do all day long. And whether that's operating or exercising or any other sport I might wanna play. So I think finding the way that works for you to get your body stretched and loose and warmed up and prepared for whatever it is you wanna do is a big part about not getting injured. And I think what happens is a lot of us will roll out of bed and roll right into border roll right out of bed and just go to work or, you know, all the other variations on that theme. And if you can just take some time for yourself in the beginning of the day and the end of the day and take inventory, do things that you know helps you be flexible, be happy, physically and mentally happy. And I think happy patients get injured less. People in the in the present thinking get injured less. People were present in their sport is the way I should say it and present their activity. So that's probably the most important stuff. Clearly on the other side of the world, nutrition, optimizing your weight, optimizing all of the things about your body or super important for not being injured. So we mentioned early on in this, in this segment that you take 2 to 3000000 steps per year and up to five times your body weight. And so if you optimize your weight, let's just say you lose £10 that can be up to £50 2 to 3,000,000 times per year. It's an enormous force reduction on your joints. And so optimizing your weight, is a big part of not being injured in in not degrading joints. Optimizing your nutrition, thinking about nutrition as fuel. I think we get distracted by lots of different diets and lots of different -- advice, but I think one of the best ways to think about this is simplistically use food as fuel. So gauge what you're gonna do that day, gauge where you are in your whole fitness program and figure out the foods that work for you that fuel your body and your energy needs, which generally brings us back to protein as the primary food source because your muscles need protein. And they need it more than anything else. And we can talk about nutrition during competition because I've also have some thoughts about where we are in that space these days. But I think coming back to your question about how do you stay out of my office? How do you stay fit and healthy? How do you drop dead age one hundred playing the sport you love? Be present, optimize your body in all the different ways, and it really helps.

Finn Melanson [00:27:54]: I like that your your first recommendation wasn't necessarily to have the audience open up their pocketbook. It was to create space at the beginning of each day to warm up. I think that's a great lesson. How about on and there there is more stuff I wanna talk about there, but just just to talk about, you know, addressing injuries what are what are some of your protocols here? Like, are you someone who, as much as possible, you you wanna avoid a lot of these, intensive sort of last resort surgeries. How do you think about that?

Guest [00:28:28]: So Where are you going with that question? So the the

Finn Melanson [00:28:31]: Like, for example, if you have a if you have a, you know, an ankle, a pretty traumatic ankle injury or a meniscus tear, or, you know, an issue with your calf, anything in in in the running chain. And and maybe one doctor says, you know, I think you should, you know, you should look into this surgery as sort of your first option. How are you breaking all that down? Like, where where would you first lead people?

Guest [00:28:56]: So it depends on the injury. So there are certain structures that need to be repaired right away. Doc I twisted my knee. I heard a pop. My knee swelled. That is a 90% chance that you have damaged torn a key structure in the knee joint that needs to be repaired. It is a torrid of meniscus damage the Articulate cartilage or toward the ACL. So the important part there is get an accurate diagnosis for the injury that you have as early as possible. An accurate diagnosis usually means physical exam, history, x-ray and MRI for most soft tissue injuries. And that combination will give you a very, very clear picture of what's injured and how to repair it. So many of the things that we used to think required surgery, we now are having The thrilling time of augmenting them with injections and stimulating healing with soft tissue massage and icing protocols. In the past, we didn't think would work. So let me give you a couple examples. The hamstring ruptures from proximal hamstring rupture dreaded injury for almost all runners because it takes you out of your sport for almost a year. We used to repair, surgically repair a lot of those. And it turns out that if we make the diagnosis early and bathe that tissue in PRP, the the blood that we take from the patient, Get the platelets out of it, get the growth factors in those platelets, invade the tissues with that early on. We can combine that plus lubricants and get many of these tendon tears to heal. So my primary treatment these days of torn hamstring tendons is bathing them with PRP and hyaluronic acid on day 1. Soft tissue massage, gentle stretching, and exercises, and seeing whether or not I can get that athlete to go down a healing path rather than a surgery path. Another example is torn rotator cuffs in the shoulders. So many of our runners will fall on an outstretched arm, and we see them with They're not an overhead athlete. They're been purely a runner, but they took that bad fall. They injured their shoulder. They showed up with a rotator cuff injury. They have night pain. MRI shows the rotator cuff injury. Many of those can also be treated with growth factor injections and lubrication and exercises as opposed to repairing them early on, which we always did in the past. So differentiating which ones need surgery and which ones can be treated with injection and rehab as part of the art form. The other things like a meniscus cartilage and the knee That when torn does not heal no matter what we do to it. And it it's a devastating injury for the knee. It has to be surgically repaired whenever possible or replaced if it's significantly missing because the joint goes downhill down in an arthritic pathway. So early diagnosis, not living with that is really an example where surgery early is so much more important.

Finn Melanson [00:32:04]: Is that PRP procedure that you were describing earlier? Is is that one of what you would call sort of like the cutting edge therapies to repair some part of the musculoskeletal system. And and if so, what else would you put into sort of that, that that area of treatments that we now have at our disposal that we might not have had, you know, 10, 15 years ago.

Guest [00:32:27]: Sure. So many of our athletes have traveled around the world to get, quote, unquote stem cell injections. And they've gone to the Caymans. They've gone to Mexico. They've gone to Germany. To try to get needles stuck into their bone marrow or into their fat. Their cells taken out of the body, grown up in tissue culture, and then injected back into the body. And it turns out that many of those cells simply die too quickly and don't stimulate the kind of healing response that we were hoping for. Sometimes they do, but nowhere near often enough. And what we've learned is that everyone, even my eighty year old runners, have billions of stem cells within their body. Stem cells are perisights. They live on the walls of vessels. And so when you have an injury, there's a clarion call that goes out to those cells and say, hey. I'm injured. Direct my healing and the cell divides. And it divides in 2. 1 is a daughter cell that mimics the stem cell, which is why they last forever. And the other cell is a progenitor cell. Migrates to the site of injury and directs the healing response. And so our job recently in our research and that of others is to figure out how do we inject the most potent recruitment factors to stimulate your body's own stem cells to divide and rush to that site of injury and instigate the healing response rather than taking out cells, growing them, and injecting them back in. And so PRP is the most widely available, combination of growth factors and recruitment factors. There's a whole class of other ones that are coming down the pike. We used to be we did a number of studies with them. We used to be able to use them. The FDA has just shut processed down until there's more data, but the source is birth tissues. Wharton's jelly from a young, healthy woman who's at the time of delivery is a product that's thrown away as is the placenta and the umbilical cord. And rather than throwing it away, that those tissues are rich in growth factors and cells and recruitment factors that we would love to use to stimulate healing for all of our athletes. And we were doing that for a while. We, as I mentioned, we ran a prospective double blind randomized trial, demonstrating their efficacy. However, the FDA has said, listen, we need more data. They're so potent. They're like a a drug, and they're gonna make those products go through a drug approval process. They will come back to the market. The future for all of our athletes and people with arthritis will be injections of growth factors and stimulating factors to augment our surgical repair of these tissues or to try to help avoid surgical repair. So you might ask yourself, why does it take a year to come back from an ACL injury, or why does it take a year to come back from a bad hamstring injury? I don't think it's going to soon, I think we'll be able to augment these things and accelerate the healing. We have a public nonprofit research foundation where I work at Stone Clinic and the Stone Research Foundation, and a lot of our work is on this specific area. How do we accelerate healing?

Finn Melanson [00:35:40]: And so I guess if you put this in a historical perspective, is it fair to say that in the same way we think about the potential impact of of stem cells and in growth factor procedures, it would have a similar impact to the orthopedic surgery realm as maybe you know, like antibiotics did in the in the fifties sixties for, you know, common, common illnesses, stuff like that. Like, the it's like the penicillin of orthopedic surgery.

Guest [00:36:11]: I think a better analogy might be the joint replacement of orthopedic surgery. Artificial joint replacement has been a huge gods sent to people with severely bad arthritic joints. It changed the world, really. These kinds of anabolic injections may be far more ubiquitous than artificial joints because everybody gets injuries, and nobody wants to wait around for healing. So I think what will happen over the next decade is that we will have better and better injection therapies to accelerate healing of all types of injuries. So the ubiquitousness of it, I think makes it, something that we're super excited about and trying to optimize for our athletes.

Finn Melanson [00:36:52]: One more question on on this front. And I I love just imagining the future. And so I I a lot of a lot of this would be conjecture. I'm not expecting you to have like, you know, like, a verified answer here, but I'm I'm in my thirties. There's a lot of people in this audience that are, you know, between the ages of let's call it 30 and 55. So, you know, in that era of raising families and such, a lot of us, myself included, are are very it in testing the bounds of longevity. I I would love to increase my health span as much as possible. I'd love to be one of the people in that data set that are doing ultra marathons at age ninety or, you know, doing these long trail hikes at that age, what do you what do you anticipate is gonna be either different for us in terms of the the health care access that we'll have and the procedures we'll have access to. And or, what will be, like, more verified in the future versus what's experimental in nature right now?

Guest [00:37:50]: Sure. So let's talk about several parts of the whole longevity space that I I know everyone wants to have and spends a lot of money taking supplements to try to make happen. So when I look at the data and and, again, we started out this this program as well with always knowing the bias of your surgeon. So in this case, you'll hear my bias about a lot of the longevity space. And, When I look at the data from all of the different longevity studies, mostly done in worms and in other small rodents, None of the data of using one supplement or another at Foreman or NED or anything else is ever better than exercise alone. And so when you compare the animals, the animals that were -- rested the animals that were exercised and the animals that were then or the animals that were just supplemented with any longevity supplements. The goal was to get them to do as well as the animals that exercised. So The takeaway for all of us is every day. So we tell our patients, you know, you need you need to. It's helpful to exercise every day. Why because essentially I'm a drug pusher. I'm pushing adrenaline, endorphin, testosterone, pheromones, All the things that I can get out of your body by just having you exercise. And those things are directly correlated with longevity. So the first part of you being in your thirties and dropping debt at age one hundred is keeping your love of exercise and keeping your ability to do it every single day no matter what your injury. So if you have if you injure your knee, my job is to teach you how to exercise around your knee. And all the other parts of your body. So that's step 1.

Finn Melanson [00:39:40]: You know, you you talked earlier about how that sort of the first hunch of the medical community during the joint replacement era was to think about solutions biologically. And now you're sort of offering this biological alternative. Why did, why did we have it reversed? Why are we coming to the biological solutions after the Bionic era?

Guest [00:40:00]: That's a really good question. And it it turns out that that People knew about things like Wharton's Jolly was used over a 100 years ago by abdominal surgeons to decrease it adhesions after they would operate on someone's abdomen. Getting adhesions was a terrible complication of any abdominal surgery. And in the literature, there's all this data on surgeons that use these natural growth factors and lubricants to decrease adhesions. We also were in the knowledge base of thinking that certain types of tissues couldn't regrow or regenerate. And we've learned that that just wasn't true. We we all believe that Articulate cartilage, the bearing surface of the joint, once injured, never healed, and that was the mantra throughout all of orthopedics, which pushed towards artificial replacements rather than biologic replacements. But during my lifetime and early in my career, I worked with folks who showed that you could take articular cartilage cells out in tissue culture and grow them up. And if they could grow in tissue culture, could we figure out how to grow them inside the joint? And the fact was we could. And so the whole biologic repair process, you know, came into being and came became much more popular so that today, 80% of the people who are told they need an artificial total knee. Do not. And that's not just my data. That's other people's data as well. They could have one of several things. They could either have injections and lubrication and growth factors. They can have a biologic replacement if there's still some joint space there, meaning they're not truly bone on bone. Meaning they could have their meniscus and articulate cartilage replaced and regrown, or they could have a partial knee replacement just resurfacing only the one part of the joint that's worn out. So 80% of the people told they needed to join could have one of these other options. And then if you need to have a full joint replacement, We've learned in the biology that we can stimulate the bone to grow into a porous metal implant. So we no longer need to use cement, which used to limit people's or turn to sports. So now we can get our total need to join patients back to playing singles tennis and climbing and running and doing the things they want to do. So I think the evolution is learning about the biology. It's understanding that what we thought wasn't possible as often possible. We just restricted our own thinking. It comes back to the wonderful runner in Courtney. You know, nobody thought someone could run at the pace and endurance that she does and do it at their times and the whole performance level. So I think you have to look at the athletes in our society. Use them as great examples for busting your own limitations on what's possible.

Finn Melanson [00:42:49]: And and the Courtney example is so interesting too, just for further context, in the same summer, she won and set a course record at the Western States 100 miler, then 3 weeks later, set and set a course record and won the Hardrock 100 miler and then did UTMB. So 300 milers, 3 wins, 2 course records all in a less than 90 day time span. So in, in our sport, totally redefining, not just performance expectations, but what's possible from a from a recovery cycle standpoint and getting to a start line that soon in such a demanding sport and being able to give your best. It it boggles my mind.

Guest [00:43:31]: But it so I don't want it to bother your mind. I want it to stimulate your mind in everyone. Everyone's mind to say, okay. We didn't think that was possible. Why didn't we think that was possible? What held us back from thinking that that could be done. And so use that. You know, we talked about earlier, how does a injured sleep, figure out what his doctor's bias is, or what their own possibilities are for return. Simply listen to what you're told. Get the best advice you can. And then think about is this limited for some reason or another? How can I how can I bust the bubble a little bit? How can I think outside the box? And think about what might be truly possible.

Finn Melanson [00:44:11]: I think one of the most maybe the most important takeaway of this conversation you said it a couple minutes ago is just how critical, how essential daily exercises, exercises the crux for so many positive health interventions. And in the book, play forever, we'll talk about it more at the end of the episode. But in that book, you talk about all of these, like semi annual fitness tests, these pre season education and training programs, regular in season tune ups. What can and and there's a lot there, but like picking any one of those areas, what can you say about how to approach those pieces of your annual fitness schedule in the context of a running lifestyle. Cause most people listening to this are training for a 5 k. They're doing multiple marathons a year. Some are doing trail races. Some are doing ultra marathons. How do you think about it in a running context?

Guest [00:44:58]: So what I think about is take take a mini break every once in a while and ask someone else to evaluate you. So it's whether that's a coach, whether that's a great physical therapist, whether that's a great fitness trainer, whether it's an orthopedic surgeon interested in running and other sports, just step back and let someone else objectively look your fitness, your flexibility, your program, your nutrition, your mindset, and your goals. And I think, as we said earlier, Not enough people take advantage of the fact there are some really smart people in this space in the whole running space and the whole field of fitness and exercise. And I think especially with the internet, of course, but there are really a huge amount of opportunities for everyone everywhere to either virtually tap into an expert or to physically tap into an expert. I think if I were to give one bit of advice, it's just think about taking on that expertise. No nobody's a CEO of a major company without a great board of directors nobody's the president of the United States without a whole bunch of advisors. You know, nobody really gets to the level that they wanna get to and achieves more. Without having a team around them that helps them.

Finn Melanson [00:46:12]: You know, especially with that example as well. Another thing that struck me in this conversation is and and to back up a bit. I I was gonna ask you in this interview, you know, are the most current ineffective options out there for increased health span, increased longevity limited to people of a certain social class. Like, if you're rich or in luck, you have every single you know, procedure and remedy at your disposal. If you're middle class or blow your at you're out of luck, it's out of your budget, but it seems like a lot of what you're suggesting, You know, is is independent of of maybe overburdens in financial demands. Is that something you would agree with, or do you still think that this is sort of a rich person's game?

Guest [00:46:51]: Oh, the beauty of running is that everyone could do it. I mean, every city I ever ended up with, I could always take out my running shouldn't go for a run. It cost me nothing. And then And so I think that that beauty of the independence, the inexpensiveness of it, the access to it is what made the sport so ubiquitous throughout the United States and around the world. And what I'm trying to say is that be careful that we didn't fall in love with that total independence of it completely. Because if you want to continue, if you want to have that longevity, if you're gonna spend your money on vitamins, spend a little bit of time and access on getting the other information, and it doesn't cost a lot of money. This podcast doesn't cost anyone to listen to. And, so there's so many phenomenal resources online. But there are also a lot of people who are interested in helping athletes do well. The fun of my practice is that I get to see someone who's injured, help them get back to their sport, and see them do well. And so what I do is I ask them to come back once or twice a year forever to have our rehab and fitness team test them and say, okay. We fixed your knee. You got to this level. You're back doing your sport, but come back next year and let's see where your week, where your favoring where you're overlooking the parts that you didn't focus on, let us help you every year get better and better and better. And so that's our passion about it, but there are lots of people like me out there who love helping athletes who enjoy what we do is seeing people excel And I think people maybe are hesitant to or or forget to take advantage of them. And and the point of today is to help people encourage to do that because it'll keep you running forever.

Finn Melanson [00:48:38]: One of the last questions I wanna ask you, and I I'd be remiss not to ask, because I think a lot of people when they when they think about wrapping all this up and, really applying it to their lives that stories help, case studies help. So when you think about what we've talked about today and how you can become a better athlete, how you can do it for a longer period of time, have there been any interesting case studies over the years that show the success of your philosophy that show how important these associated treatment protocols are.

Guest [00:49:10]: Oh, so many. I don't know where to begin. Let's begin at the end. So end stage disease. So, many of you know, Richard Donovan, a fantastic marathoner who who is, in Durham's athlete who is interested in promoting marathons around the world is done among 7 Continents and 7 days was one of the things in so many others. So in his case, he was at the end stage where he had bone on bone on one part of both of his knees and was told he was done. And so in that case where we do a partial replacement for him and then he comes back on both knees and then he comes back and runs across the United States on 2 partial replacement knees. So That's one end of the of the stories that that we're able to save truly, bone on bone end stage joints. And then the other speck end of the spectrum was all the kids that we get to take care of who, come in with severe cartilage injuries and, are told not to be able to play sports again or told to take their high school years off, and the ability to regrow that articular cartilage is a disease in kids called OCD or osteochondritis desiccans that stopped so many kids, high school, sports programs, and we've developed a way of regrowing that cartilage and and one of our kids just came back from a water polo championship after he had not been able to exercise throughout high school until he came in, and we repaired his car. So we see both ends of the spectrum. It's, excitement of our where we are in the whole field of orthopedics and our passion for keeping people active.

Finn Melanson [00:50:40]: So the book you have just written is called Play Forever. It's excellent. There are some parts of it that we talked about today. But for folks that are interested in, seeing this conversation continue maybe in text form, is there any topics that you can hint at here that we didn't cover today that are in that book that, we'll we'll sort of close the gap.

Guest [00:51:02]: Lots. You know, I I wander around in that book a little bit about how you keep people playing forever, starting with kids and, just saying yes to so many of the things they wanna do. So being an empowering parent and helping kids do more and more than they ever thought they could, to looking at yourself as an athlete and training, whenever you have an injury, and all the different ways to do that. Thinking about how the sport, how the whole field has become biologic and the ability to think through your body's injuries and your body's ability to heal, salamanders clearly knew how to regrow their tail. Children when they cut off the tip of their finger, very young children can regrow it. We have the genetics inside body to regrow of many of these tissues. Our job as scientists and physicians is to figure out how to stimulate that genetics again and add all the tissues. So you have a trellis And then as your age, aging is one of the wonderful aspects of being an athlete. You have you've got the mind that goes along with your aging body that permits you to make good decisions, both for women and middle ages, they then take on running and as our older patients who take on and continue to run into their eighties nineties and continue to play sports. And so I think harnessing what's inside us Being respectful of it, being thoughtful about it, trying to avoid injuries, and treat them right away is the is the story line that I try to write about, and give people tips in different areas on how to do that.

Finn Melanson [00:52:32]: Awesome. Well, Kevin, it's been a pleasure to have you on the show. We will make sure to link to the book in the rest of your social media and the show notes. And I think if there's one question that I could encourage listeners and viewers to think about in their day to day life in any area is why didn't I think that was possible? That's something that's gonna stick with me for a while. I think it's a it's a good, it's a good heuristic to walk around life with. Anyways, pleasure to have you. Thank you so much.

Guest [00:52:56]: Great to spend time with you.

Finn Melanson [00:53:12]: Thanks for listening to the run to the top podcast. I'm your host, Finn Malanson. As always, our mission here is to help you become a better runner with every episode. Please consider connecting with me on Instagram at wasatch Finn and the rest of our team at Runners Connect. Also, consider supporting our show for free with a rating on the spot and and premiere access to contests and giveaways, and subscribe to our newsletter by going to runnersconnect.netback/ podcast. Until next time. Happy trading.