08/09/2026
Elective orthopedic surgery is the very last resort
I dislocated my shoulder years ago snowboarding. I tore my labrum with a Reverse Bankart fracture.
There was a very small study out of Japan that I followed for non-operative management. I also dedicated myself to a functional shoulder stabilizing rehab protocol and PRP. It healed and I have zero issues with my shoulder.
Trauma is a different story. However, fractures don’t have to happen when a traumatic event occurs. If you have great bone structure, mobility and good muscle support, your bone is protected to a certain degree.
Functional MSK medicine is legitimate.
The pillars.
-You must maintain muscle strength your entire life. Resistance training with heavy weight is key.
-You also must increase functional mobility and maintain muscle “Power” as much as possible.
This is more than just stretching. It’s called perturbation which is loading the body while encountering an unforeseen force.
-High intense interval training increases your bodies ability to use oxygen for more efficient enzymatic processes. This increases Vo2 max.
Studies prove high Vo2 max in late life decreases morbidity and mortality by 60 percent.
-zone 2 cardiovascular (aerobic) exercise helps support mitochondria function and helps increase your metabolic rate for more efficient use of calories. It also helps support blood pressure and vascular wall inflammation.
-Misogi. Doing a physical/mental challenge every year is great for mental health. It provides a goal to drive discipline. Humans must strive for adventure and purpose. This should be done with a very close group of people you love. The Japanese developed this ideology as to push the human spirit and maximize growth through stress and failure.
-Rest and recovery is an absolute must as to reset the sympathetic and parasympathetic nervous system. Some great evidence supports cold plunging, sauna, red light therapy, laser therapy, evening walks and of course sleep. If you task your mind and body with high stress, you must allow the brain to detoxify. This is REM sleep.
-Hormesis is a term where the body turns on its scavenger system as to help cleanse the body of dying cells during periods of stress. This can be done with intermittent fasting. Or periods of high stress to the body. Encountering high environmental stress by doing physical exercise in very cold or hot weather can help support Hormesis.
-Nutrition. This basically comes down to proper micro and macro nutrients that support your immune system and MSK system. Proper enzymes and co-enzymes require plentiful replenishment of nutrients used with these molecular reactions. Stay away from any man made preservative, pesticides, artificial sweeteners, hormones, antibiotics….
-hormone balance. Be careful using exogenous hormone replacement before you do all the above. Exogenous hormone replacement is good only if conducted by a well trained physician that is able to understand the foundation of why your hormone levels are low. Be careful, once you use artificial hormones, your body won’t produce them anymore. So why not try to ramp up your natural process first?
Instead of giving some doctor a five star review give yourself a 5 star review with your own health investment.
Ps. Surgical procedures return the highest reimbursements to your community hospitals and doctors. Human nature will create bias as the numerical value of money is the top metric. While surgery could be needed, make sure you get well evidence based information regarding the whole picture. Most orthopedic surgeons see 40 patients in clinic. This usually equates to 5 of those patients requiring surgery. Meaning 35 of those patients are in pain and surgery is not the current answer. If the provider does not provide adequate time and effort discussing the deep foundation of your pain with non-surgical options then I would be concerned about their bias.
-Dr V.
