#36 - Eric Chehab, M.D.: Extending healthspan and preserving quality of life

1. Prioritize Exoskeleton Health

Focus on maintaining the health of your musculoskeletal system (your “exoskeleton”) as a critical component of living better and ensuring a high quality of life, not just extending it.

2. Understand End-of-Life Failures

Reflect on common failures and limitations experienced by people later in life to identify and implement preventative strategies earlier in your own life.

3. Prioritize Injury Prevention

Make injury prevention the paramount rule of exercise, as getting injured can set back your progress significantly and undermine your overall health goals.

4. Minimize Sedentary Time

Actively reduce the amount of time you spend sitting throughout the day, as prolonged sedentary behavior can lead to hamstring shortening and hip flexor tightening, predisposing you to orthopedic injuries during exercise.

5. Move Consistently Throughout Day

Instead of relying solely on one or two dedicated exercise sessions, aim for consistent, generalized movement throughout the majority of your day to foster better orthopedic and musculoskeletal health.

6. Adopt Holistic Orthopedic Health

Improve your orthopedic health by focusing on modifiable factors such as better sleep, stress management, improved nutrition, and more efficient exercise, rather than just isolated treatments.

7. Reduce Joint Pressure Through Weight Loss

Understand that every pound of weight lost can reduce pressure on your knees by four pounds when walking, six pounds when using stairs, and eight pounds when running, significantly mitigating joint strain.

8. Manage Weight and Exercise

Recognize that while cartilage loss is inevitable, you can influence its timing by managing your weight and engaging in appropriate exercise, which are modifiable factors.

9. Build Bone Density in Your 30s

Prioritize weight-bearing exercise, especially in your thirties, to stimulate bone growth and build up bone density before the natural decline in bone mass begins.

10. Exercise Efficiently, Not Excessively

Shift your exercise mindset from simply burning calories or doing high volume to activating your metabolism and moving efficiently, as excessive or inefficient exercise can lead to injury.

11. Avoid Poor Form Under Load

Be highly mindful of your exercise form, especially during repetitive movements and under load, as poor technique is a primary cause of injury, particularly when trying to compensate for a sedentary lifestyle.

12. Seek Expert Exercise Guidance

Work with a knowledgeable trainer to ensure correct exercise form, especially for movements like squats, lunges, and weightlifting, as poor technique is a common cause of repetitive strain injuries.

13. Activate Muscles, Protect Joints

When weight training, aim to activate the target muscle with just enough light weight to initiate contraction, allowing you to voluntarily flex the muscle further without excessively loading the joint, leading to a safer and more effective workout.

14. Protect Back with Micro-Movements

Proactively protect your lower back by consciously adjusting everyday movements, such as squatting to pick up objects or bracing your core when bending, to avoid sudden torque and prevent injury from seemingly minor insults.

15. Caution with Squats and Lunges

Approach squats and lunges with caution, as excessive or improperly executed repetitions can place significant strain on the knee joint, leading to pain, swelling, and cartilage damage if your knees or surrounding muscles aren’t adequately prepared.

16. Master Correct Lunge Form

When performing lunges, ensure your front knee is not under load and that the movement is primarily glute-based, ideally with guidance from a knowledgeable trainer, to prevent anterior knee pain and injury.

17. Prioritize Pulls Over Presses

To reduce joint load and support shoulder health, especially when recovering from or managing shoulder injuries, emphasize pull exercises (e.g., pull-downs, rows) more than press exercises (e.g., bench press, military press).

18. Walk for Cardiovascular Health

Incorporate walking into your routine as a safe and effective way to achieve cardiovascular benefits, minimizing the risk of injury often associated with more intense exercises.

19. Pivot to Alternative Activities

If a beloved activity like running becomes too painful, pivot to alternative, lower-impact exercises such as swimming or biking, focusing on what you can do to maintain activity and cope effectively.

20. Replace Stopped Activities

If you must stop a primary physical activity due to pain or difficulty, actively replace it with alternative forms of exercise to prevent a precipitous decline in your physical quality of life.

21. Adapt Running Technique

If running, consider adapting your technique, such as barefoot running, focusing on lighter steps, or taking shorter strides, to reduce impact on your joints and potentially prolong your ability to run.

22. Preserve Meniscal Tissue

Understand that losing meniscal tissue, even partially, can accelerate the wearing down of hard cartilage in the knee, leading to pain and dysfunction at a younger age.

23. Conservative Labral Tear Treatment

If you have a labral tear identified on an MRI, understand that it’s a common finding even in asymptomatic individuals; prioritize a “test of time” with physical therapy before considering surgery.

24. Start PT for Meniscus Injuries

For meniscus injuries, it is reasonable and often beneficial to begin with physical therapy and conservative management, reserving surgery for those who do not improve with initial non-operative approaches.

25. Allow 1-2 Months for Meniscus PT

If you have a meniscus injury, commit to physical therapy and conservative treatment for at least one to two months, and if you are seeing improvement, continue with that approach.

26. Support Foot Arch with Orthotics

Consider using orthotics to support your foot arch, which can help prevent the stretching and attenuation of the posterior tibialis tendon, a common mechanical issue that leads to foot shape changes and pain over time.

27. Recognize Age-Related Tendinopathies

Understand that tendinopathies (e.g., tennis elbow, Achilles tendonitis) commonly arise in your 40s and 50s due to declining blood flow and reparative mechanisms in tendons, indicating a uniform biological problem across various joints.

28. Understand Surgical Setbacks

Recognize that many surgeries, especially complex reconstructions, involve a period of significant setback and that not every patient will fully “bounce back” to a better state than they were before the operation.

29. Extreme Caution for Spine Surgery

Exercise extreme caution when considering elective spine surgery, as even orthopedic surgeons acknowledge the potential for very poor outcomes and significant long-term difficulties.

30. Urgent Spine Neurological Care

If experiencing neurological compromise such as weakness, especially in the cervical spine, seek urgent medical attention as it can rapidly lead to loss of balance, walking ability, and hand function.

31. Select High-Volume Surgeons

When considering complex orthopedic procedures like knee replacement, prioritize surgeons with very high case volumes (e.g., several hundred per year) as this is generally a good indicator of expertise and experience.

32. Inquire About Surgeon Complications

Do not hesitate to ask your surgeon directly about their infection rates, re-operation rates, and other complication statistics; a surgeon unwilling or unable to answer these questions is a red flag.

33. Surgeon Reputation for Complications

Select a surgeon who has a reputation, often through word-of-mouth, for actively addressing and managing complications, as all surgeons encounter them and you want one who will stand by you.

34. Welcome Second Opinions

Choose a surgeon who openly welcomes and encourages you to seek a second opinion, as reluctance to do so can be a significant red flag.

35. Focus on Capabilities to Cope

When facing physical limitations or complications, actively shift your mindset to focus on what you are still capable of doing, rather than dwelling on what you have lost or can no longer do, to improve coping and adaptation.

36. Modulate Activity Threshold

For chronic joint pain, understand your personal activity threshold (where pain or swelling begins) and actively work to modulate it through strengthening exercises, weight management, and education, aiming to stay active right up to that limit.

37. Educate Yourself on Health

Proactively learn about your specific health condition, illness, or injury, as a deeper understanding will significantly improve your ability to cope and manage it effectively.

38. Adapt to New Physical Trajectory

After an intra-articular joint injury, accept that your physical trajectory may change and actively manage it by focusing on what you are still capable of doing, rather than comparing it to your past abilities, to preserve mental and physical health.

39. Cultivate Insightful Questions

Focus on asking thoughtful and insightful questions (“How can I change this?”, “Why does it work this way?”) rather than just seeking answers, as this approach can lead to significant differences and personal growth.