Dr. Howard Luks

04/02/2026

Spring!! Bring it!
LFG :-)

04/01/2026

Strong muscles stabilize joints. Aerobic fitness improves metabolic health and tissue perfusion. Gradual loading restores tolerance. But people often don't take PT seriously prior to surgery. They often take PT very seriously afterwards. Therefore, PT is probably the reason you feel better, despite the surgery. The irony is that the treatment many people ultimately need is the same thing that might have prevented the problem in the first place. Staying strong. Staying active. Maintaining the reserve that protects our joints/tendons/muscles/abilities as we age. fix and make it a little emotional

04/01/2026

A 58 year old sits across from me with knee pain. She is otherwise healthy, but menopause has been difficult. The MRI shows some cartilage changes, age appropriate and not something that requires surgery. But she has not done anything physical in fifteen years. She stopped playing tennis at 43. Stopped walking regularly at 50. Now her knee hurts when she climbs stairs.

The knee is not the problem. The knee is the messenger.

What actually happened is fifteen years of progressive loss of capacity. Muscle mass declined, tendon capacity dropped, and her metabolic health shifted. Menopause plays a role in these changes as well.

The cartilage findings on the MRI would likely be there regardless, but the system around the knee lost its ability to support and protect it.

I cannot give her those fifteen years back, but I can help her start from where she is. And starting from where she is still works.

An 85 year old can still build new muscle protein after a resistance training session. The window of opportunity becomes smaller with age, but it never closes. Recovery takes longer. The risk of injury may be higher. Progress is slower. But the biology of adaptation does not abandon you at 58, or 68, or 78.

What changes is the cost of waiting. Every year of inactivity makes the starting point more difficult and lowers the potential ceiling. The advantage you have at 45 is real and meaningful, and greater than what you may have at 60. That is not a reason for despair. It is a reason to start, wherever you are now.

04/01/2026

Corticosteroid injections are the intervention I want to address most directly, because they remain commonly offered and the evidence against them, particularly for long-term outcomes, is consistent and compelling. Cortisone injections for tennis elbow should be avoided in most cases. Let me explain…

A well-designed RCT published in JAMA found that while corticosteroid injections provided superior short-term pain relief at six weeks compared to physiotherapy and watchful waiting, by 12 months the injection group had significantly worse outcomes than both other groups, with higher recurrence rates (Coombes et al. 2013). Short-term relief followed by long-term recurrence and potentially worse tendon biology is not a trade worth making for a condition that resolves on its own. I recommend avoiding corticosteroid injections for this problem.

PRP (platelet-rich plasma) injections are a different conversation, the evidence is more nuanced, and certain PRP preparations may have a role in recalcitrant cases. If you are considering PRP, understand that not all PRP is equal. Preparation technique, platelet concentration, and injection protocols all matter. This is a discussion to have with a physician experienced in PRP for tendinopathy.

03/30/2026

Meniscal tears aren't the crisis the MRI report makes them sound like.
Most people over fifty have meniscal changes on imaging. Most of them have no symptoms at all. The tear was probably there before your knee pain started, and in many cases it will still be there after the pain resolves.

What changes isn't the meniscus. What changes is the capacity of the system around it.
When the muscles that support the knee are strong and the joint is being loaded regularly, the meniscus does its job without complaint. When that support erodes over years of inactivity, the same tissue that was quietly tolerating load for decades starts to speak up. The MRI gets ordered. The tear gets named. Surgery gets proposed.

What does the randomized controlled trial evidence actually show? For the majority of middle-aged adults with degenerative (complex) meniscal tears, a structured physical therapy and loading program produces outcomes equivalent to surgery at one year, and in some studies better at five. The meniscus doesn't need to be treated. The capacity around it does.

This isn't a reason to avoid surgery categorically. There are presentations where it's the right call. But a tear on an MRI in a 52-year-old who stopped exercising a decade ago is not one of them, at least not before a serious attempt at rebuilding what was lost.

Load the system. Most of the time, the knee catches up.

03/30/2026

Exercises that help prevent falls part 2

03/30/2026

Pain is a signal, not a diagnosis. Your knee may be saying, “I’m weak,” but it’s often heard as, “I’m broken.”

Most people I see are scared. They stop running or going to the gym not because the pain is severe, but they’re worried they might make it worse.

That’s why it’s critical to ask: what brought you in, the pain itself, or the worry about what it means?
The answer shapes everything that follows.

In many cases, these aches and pains improve within a few weeks, and most people can expect a full return to their usual activities.
After an exam and sometimes an X-ray we may consider further imaging, but often we don’t need to.

When we don’t distinguish between pain and fear, it can lead to overdiagnosis and overtreatment. For some clinicians (not all), the presence of any abnormality on an MRI can lower the threshold for recommending surgery.

I’m actually writing a book about this exact issue, it’s far more complex than most people realize. Especially when you consider that an estimated 30–50% of commonly performed orthopedic surgeries may not be necessary.

03/30/2026

You don’t need to be fixed; you’ve carried yourself through decades of living, learning, loving, and surviving. What you need now is not repair, but refinement.

As we grow older, our bodies may change, movements may feel different, and energy may not come as easily, but none of that means you are broken. It simply means your body is asking for a different kind of care, a different kind of training.

Strength can still be built.
Balance can still be improved.
Confidence can still grow.

With the right guidance, patience, and consistency, your body can adapt, respond, and become stronger in ways that support your daily life. Training at this stage is not about pushing harder; it’s about moving smarter, respecting your body, and helping it do what it was always meant to do

03/29/2026

Don't choose the wrong option...

03/27/2026

Nothing to see here. Just a million dead from Diptheria.
Dont know what Diptheria is??
Right…
Because vaccines prevented it 😉

Researchers at Stanford University modeled how many people could die or be disabled in 25 years if vaccines for polio, measles, rubella or diphtheria were no longer available.

03/27/2026

Many people make the mistake of avoiding movement when a tendon hurts. Pain often triggers fear: “If I move, I’ll make it worse.” But in most cases, gentle, controlled movement is exactly what your tendon needs to heal and stay strong. Complete rest can actually make the tendon stiffer, weaker, and more prone to future injury.

Slow, targeted exercises like light resistance work, stretches, or controlled bodyweight movements stimulate blood flow, nourish the tendon, and help it adapt to stress safely. Over time, this helps reduce pain, improve function, and restore confidence in movement.

The key is to move thoughtfully, not recklessly. Pain doesn’t always mean harm tendons heal better when they are gently challenged.

03/27/2026

If you’re feeling anxious and your instinct is to sit still, it helps to understand what’s happening in your body. Anxiety triggers your nervous system, putting you in a “fight-or-flight” state. Your heart rate rises, muscles tighten, and your body prepares to act. When you stay still, that energy has nowhere to go, which can make anxious feelings stronger.

Movement like walking, gentle stretching, or standing and taking deep breaths, helps regulate your nervous system. It improves blood flow, releases muscle tension, and signals your brain that you are safe. Even brief, intentional movement can reduce stress hormones, calm your breathing, and improve focus.

The key is consistency and awareness. Moving regularly, even in small ways, trains your body to manage anxiety more effectively. By guiding your body, you guide your mind, turning moments of fear into opportunities to strengthen both mental and physical resilience.