Knee Replacement Surgery Alternatives That Actually Work

Nick Urban [00:00:01]:
You’re listening to High Performance Longevity, the show exploring a better path to optimal health for those daring to live as an outlier in a world of averages. I’m your host, Nick Urban, bioharmonizer, performance coach, and lifelong student of both modern science and ancestral wisdom. Each week, we decode the tools, tactics, and timeless principles to help you optimize your mind, body, and performance span, things you won’t find on Google or in your AI tool of choice. From cutting-edge biohacks to grounded lifestyle practices, you’ll walk away with actionable insights to look, feel, and perform at your best across all of life’s domains. If a doctor has ever told you that your knee is bone on bone, And your only option is to replace it. I need to let you hear this before you let anyone cut it. My guest today is an orthopedic surgeon who has spent almost 30 years doing knee surgery, trained under the most famous sports surgeon alive, and now spends his life trying to keep people off the conventional operating table. His whole argument starts with one question: why are we still using 1960s technology to fix knees in 2026? and hopefully beyond.

Nick Urban [00:01:31]:
Dr. Marc Pietropaoli, welcome to the show.

Marc Pietropaoli [00:01:35]:
Well, thank you, Nick. Thank you for having me on, and thank you to all your listeners and everybody watching.

Nick Urban [00:01:40]:
Take me back into the operating room early in your career. You were with Dr. Murray, I believe it was. It’s an interesting way to start your book. What happened there and what set it in motion?

Marc Pietropaoli [00:01:53]:
Yeah, so I was a 3rd-year medical student. It was back in 1991, and I knew I always wanted to be an orthopedic surgeon because ’cause I wanted to go into sports medicine. And my Uncle John was the original Dr. Patrick Pauling. He said, well, if you want to go into sports medicine, you have to be an orthopedic surgeon. So I was like, okay. So it was the end of my third year of medical school. And in your third year, you start to get into the clinical rotations like internal medicine, psychiatry, general surgery, et cetera.

Marc Pietropaoli [00:02:18]:
And orthopedics was my last one. So I was wondering to myself, you know, I was excited. I’m like, is this the right choice? Did I choose the right career path? And the night before, I found out I was going to be watching a total knee replacement be performed by Dr. David Murray, who was one of the original inventors of knee replacement surgery. He was actually going to be taking a chief resident who was in his 5th year of training, his final year, getting ready to go out, you know, through a knee replacement. So I was all excited. I got there early and the 3rd-year resident, the junior resident was like, well, Marc, you’re a medical student. You’re going to kind of stand in the corner over there, you know, but don’t touch anything.

Marc Pietropaoli [00:02:52]:
But, you know, feel free to ask any questions because there’s no such thing as a dumb question. That’s kind of what we get in medical school all the time. So the patient got wheeled into the room and nurses transferred the patient to the table. And the anesthesiologist put the patient to sleep. And then Dr. Murray walked in, a tall, stately man, glasses on, and the chief resident. And they prepped and draped the patient. And Dr.

Marc Pietropaoli [00:03:13]:
Murray said, knife. And they handed it to the chief resident who Dr. Murray was gonna take through the surgery. And next thing I know, it was like, you know, a dentist’s office on steroids. They made a huge incision about this big. There’s power saws, there’s tools, there’s hammers, there’s mallets, there’s bone, cartilage, and blood flying all over the place. And they’re putting metal, plastic, and cement in. And I was like, wow, this is really cool.

Marc Pietropaoli [00:03:35]:
I get to fix People with power tools. Like, my dad taught me how to use power tools. It’s going to be really cool. But then as I watched and I saw that blood and cartilage and bone flying around and the saws and, and all that, I was like, there’s got to be a better way though. Is this the best way we have of being able to repair somebody’s knee? So I remember what that resident said. He said, feel free to ask any questions. And my mom always said, you know, feel free to question anything. So I was really nervous though, and I raised my hand up.

Marc Pietropaoli [00:04:02]:
And he looked at me and he was like, oh, this guy’s gonna actually ask a question. But he didn’t acknowledge me. And the nurses kind of glared at me and the chief resident definitely glared at me. And, you know, anesthesiologist’s eyes kind of opened wide, but then nobody acknowledged me. So I started to put my hand down and Dr. Murray looked over his glasses and he said, oh, Marc, do you have a question? I said, yes, Dr. Murray. First of all, thank you so much for letting me watch this.

Marc Pietropaoli [00:04:25]:
This is amazing. But my question is, is there any way to cure arthritis? Is there any way to grow back new cartilage? Is there any way to repair a knee and not replace it? And before Dr. Murray could even get a word in, the chief resident was like, no, there’s no way to cure arthritis. There’s no way to grow back cartilage. There’s no way to repair a knee and not replace it. So at that moment, you know, other than feeling about 2 inches tall and very embarrassed, I realized there was such thing as a dumb question. And so even though I was embarrassed, a light bulb went off in my head and I said, I’m going to prove that guy wrong someday. So that was 35 years ago.

Marc Pietropaoli [00:04:59]:
You know, fast forward 35 years and you mentioned my book, and I’ve written the book Repair, Not Replace. And here we are now. So, that’s kind of how my journey started regarding specifically knee repair, not knee replacement, just because I was watching a knee replacement and that chief resident embarrassed me. And I’m like, I’m going to prove him wrong.

Nick Urban [00:05:18]:
I think it was on your website that I saw that we’re using 1960s technology still today. Why is it that we’re still doing this if people like you are having success, which we’ll get into later?

Marc Pietropaoli [00:05:30]:
Part of it, I think, is the way the system is ingrained. I mean, the technology was developed in the ’60s and ’70s. It has improved, but not that much, not light-years ahead to where it should be. And frankly, putting metal, plastic, and cement into a knee is not a natural thing anyway. I think anybody, even total joint replacement surgeons, would agree with that. But that’s what they were taught. That’s what I was taught as a surgeon. I eventually did become an orthopedic surgeon, and I did have to go through all that training, and I did perform knee replacements myself.

Marc Pietropaoli [00:06:03]:
And for the time when they were developed, it’s, it’s really amazing technology. It’s amazing that it even works. But now that we have more biologic techniques and our incisions and our surgeries have gotten smaller and smaller and less invasive and less invasive, I think it’s kind of crazy that we’re still that joint replacements are going up so massively as opposed to trying other things that we know work. And there is science to back it up. And, you know, we can go into some of those things as well if you want.

Nick Urban [00:06:35]:
Yeah, let’s go into that. When someone walks into a Victory in Motion clinic instead of a standard ortho clinic, what happens differently?

Marc Pietropaoli [00:06:44]:
Well, what happens differently is we actually take time. Most people, you know, let me ask you a question. The last time you saw your, your, your doctor, Um, uh, how long did that doctor spend face-to-face with you?

Nick Urban [00:06:59]:
Very short.

Marc Pietropaoli [00:06:59]:
Yeah. And in the US, the average is about 7 minutes. I mean, some people say 10 minutes, 15 minutes, but that’s still not enough time to really get to know and figure out what’s wrong. So I got completely out of that system after being in that system for 25 years. And what we’ll do is we’ll get all your old records ahead of time. So we’ll, we’ll look at all that. We’ll have all that in the system. Uh, we will interview you even before you actually walk in the door.

Marc Pietropaoli [00:07:23]:
So we have all your past history in the chart. Then when you come in, we can concentrate on, you know, we’ll still want to hear your past history from you, but we can concentrate on what’s currently going on. We can get updated diagnostic imaging, which includes digital X-rays and ultrasound, which a lot of people don’t do. Ultrasound’s great because for a knee, for any joint, but especially even for a shoulder, you can really see that joint move live. And we can see things that you can’t see on a static X-ray or a static MRI. We’ll also do special MRI images that look specifically at the bone underneath the cartilage. We can get into that in a minute on why that’s so important. And we look for bone marrow lesions, stress, or microfractures, which can oftentimes be the underlying cause of the pain in the patient who has arthritis.

Marc Pietropaoli [00:08:09]:
It doesn’t really come from… the pain doesn’t come from the cartilage, it comes from the bone underlying. So we’ll look at all that, but then we’ll also do a total body fitness evaluation. We have medical providers, they might be a doctor, physical therapist, certified athletic trainer, but they’re also certified in strength and conditioning. So their total body fitness, strength, and conditioning experts with medical degrees. And they will evaluate you from your head all the way down to your toes, because I can’t tell you how many people who come see us who have knee pain, and it might be coming from their hip or their back, or there’s a contribution. And so, we look at the whole body and try to figure out what the root cause is first. Then, we’re going to also sit down and interview and find out what your goals are. Some people want to walk the dog, they want to sleep through the night without pain, go up and down the stairs without pain.

Marc Pietropaoli [00:08:58]:
Other people want to play pickleball, other people want to play with the grandkids, other people want travel the world. Other people want to hike mountains. Other people want to run marathons. So, whatever your goals are, that’s going to be how we tailor the plan. And we’re going to use regenerative medicine techniques and many other techniques that are not available in many other places to tailor that plan to you and what your goals and what your dreams are. That may take about 4 or 5 hours, about a half day, but we call that a clarity day. At the end of the day, We’ll know what your root cause of your problem is, and we’ll have a plan or plans for you that you can choose from.

Nick Urban [00:09:34]:
And later in your book, I saw the graphs of your success plotted on 2 different charts, the function maintained or regained, I guess. And then also the pain compared to what’s classical, the traditional conventional model. And it seems that your results therefore speak for themselves.

Marc Pietropaoli [00:09:55]:
Well, first of all, I appreciate you reading my books. I think that really helps in the conversation. And so, thank you. And yes, we are in a national registry, research registry called Data Biologics. So, all the regenerative medicine clinics, not all, all the ones who really care about the results, which is over 200 in the United States, are in this registry. And we compare all our results with each other. And so, we can compare our results to ourselves and always try to get better. Our patient satisfaction rate was 93% 2 years ago, 94% last year.

Marc Pietropaoli [00:10:29]:
It’s now 95%. So we’re always trying to get better. And we can compare ourselves to other clinics with regard to probably the 2 most common things patients come to see us for. They’re in pain and they can’t do the things they want to do. They have dysfunction. They can’t do the functional things they want to do. So we measure those 2 things, but we measure a lot of other things as well. And in the book, you’re right, we showed how that pain goes down over time with our programs, and it goes down a lot faster and stays down longer than other types of regenerative medicine clinics.

Marc Pietropaoli [00:11:00]:
And that’s probably because they’re doing more maybe just a shot or just a treatment or just a procedure versus a full holistic program. And we feel as though in our programs, you know, we’re going to follow people for, um, you know, for a full year and sometimes even longer, uh, with check-ins. But the 3 months of it is probably the most intensive part of it. And then the same thing, function goes up really fast in that first 3 months, and then it tends to stay up. In other clinics, it’ll still go up, but not quite as high or as far or as long. Yeah.

Nick Urban [00:11:36]:
Well, that’s something that I appreciate about the way you operate, because there’s a tendency in the regenerative medicine space to essentially just like do the greenwashing approach where it’s like, okay, we’re going to do This operation, this procedure, but it’s going to be using these products instead. So yeah, it might be better. It might be more compatible. It might be more effective. It might result in lower pain. But at the same time, you’re not looking at the full picture. Why did the knee wear out faster? What are the influences, the factors that went into this? Like, what are all the other explanations? What’s the story around it? Because all of those make a huge difference. And if you don’t look into those, then at the end, you’re just left possibly needing a follow-up procedure in a shorter timeframe than you would otherwise be able to achieve.

Marc Pietropaoli [00:12:22]:
I completely agree. I mean, that’s amen. I totally agree.

Nick Urban [00:12:27]:
So I just recorded a podcast recently about referred pain. How often are you seeing that people come in for, let’s say, to keep on the example of a knee, how often do people have imbalances and compensation patterns elsewhere in the body that are showing up As a knee that’s wearing out faster.

Marc Pietropaoli [00:12:44]:
Yeah. Almost every single time. I think that’s a huge thing, whether you start from the feet and work your way up or the top and work your way down. Just a quick kind of a historical thing, even starting from the feet down, Roman soldiers, they used to march 20, 30, 40 miles a day, and they didn’t have a higher incidence of arthritis because we’ve looked at skeletons of these Roman soldiers even into their 20s, 30s, 40s, 50s, 60s. And so, even your footwear has, it has has a place in your mechanics. And they wore sandals that allowed their feet to splay out more, and that allowed for more normal mechanics. So, right off the bat, right when we start getting put into sneakers and shoes as kids, we start messing up our mechanics right away. So, even that can have an influence on mechanics.

Marc Pietropaoli [00:13:33]:
But, I can also tell you, I mean, almost everybody has some other factor affecting… let’s just talk about the knee because we see all kinds of joints, but the knee, You know, the back very often is either causing the knee problem or contributing to the knee problem. And if we take care of the back as well, that can help the knee pain. Same thing with hip or a tight ankle. So almost everybody we see has some other form of imbalance. Now, sometimes the knee was the problem and that can cause the compensatory abnormalities and problems in other areas and, or vice versa. So chicken, egg, it doesn’t really matter. It’s figure out what actually is wrong and then kind of treat all those different areas as a whole person versus just as only a knee.

Nick Urban [00:14:23]:
What are some of the other factors that you see that are often missed?

Marc Pietropaoli [00:14:30]:
I think the biggest thing that we see that’s often missed, and this goes for other joints as well, but again, let’s stick with the knee here because I can quote a study here for you, is these bone marrow lesions. These, Arthritis is nothing more than the cartilage on the end of the bone wearing down. So we have cartilage on the end of all our bones. It’s kind of like the white on the end of a chicken bone that you see when you rip a drumstick off the chicken. So that white cartilage is called the articular cartilage. And that is like the tread on a tire. When that wears down, that’s what arthritis is. But articular cartilage does not have any nerve fibers.

Marc Pietropaoli [00:15:05]:
So the pain from arthritis does not come from that. As that cartilage wears down, more and more force gets transmitted to the bone underneath, and the bone starts to break down faster than the body can heal itself, and you get these little stress or microfractures. Bone has millions of pressure-sensitive nerve fibers, so that’s mostly where the pain comes from with arthritis, not all. And people who get these stress or microfractures… back in 2008, the radiologists figured this out, it wasn’t even the orthopedic surgeons… people who have these stress or microfractures, even in one bone around their knee, they’re 9 times more likely to go on to need a knee replacement. People who have it in more than one spot are 13 times more likely because they’re soft spots, they’re abnormal areas of the bone, And when the bone gets soft, the cartilage over the top doesn’t have as much support and it starts to break down just like a pothole in the road forms. And, and so these bone marrow lesions, a lot of doctors don’t even know that they exist, or if they do, they just kind of call ’em bone bruises and they kind of blow ’em off. And a lot of patients don’t know anything about ’em. But there was a French orthopedic surgeon, he’s still around.

Marc Pietropaoli [00:16:10]:
I just was hanging out with him in Denver this past year at a meeting. His name is Dr. Philippe Hernigou. Brilliant. Brilliant. Orthopedic surgeon from France. And back in the late ’90s, early 2000s, he was looking into these bone marrow lesions. And his thought was that as we get older, we have less good stem cells in our extremities, our arms and our legs.

Marc Pietropaoli [00:16:31]:
And that’s another reason why our bodies don’t heal as well. We have less repair cells. So we still have really good repair cells in our pelvis, not our hip, not the ball and socket, but the pelvis, which the best spot to get that is right above our buttocks area. It’s called the PSIS. You can feel a little bump there. And those are great, easy spots to get bone marrow from. Just numb the skin up. You can do it in the office.

Marc Pietropaoli [00:16:54]:
And we can take good bone marrow cells, which in, in your pelvis, they stay good till your 50s, 60s, 70s, 80s, concentrate it and inject it into those soft spots and get those soft spots to heal. And if you get them to heal, the pain goes down. So what he did was, it was like late ’90s, early 2000s. He had 140 patients. They all had severe arthritis in both knees, bilateral knees. And what he did was he took took bone marrow concentrate, he injected it into those lesions, those soft spots on the one knee of each patient, and on the other knee of each patient, he did a knee replacement. And he compared these people and followed ’em for a minimum of 10 years. By the time he was done with all 140 patients, the average follow-up was 15 years.

Marc Pietropaoli [00:17:38]:
So at the end of 15 years, 82% of the knees that just got the little poke holes, not the big huge incision with the saw on the bone and all that stuff, 82% of those knees never needed a knee replacement for that 15-year average. And they said that knee felt more normal than their knee replacement knee. I mean, the other interesting thing is 15% of the knees that got the knee replacement in that 15 years wore out and needed another knee replacement, a bigger surgery or revision surgery, which is more risky, doesn’t work as well, doesn’t last as long.

Nick Urban [00:18:10]:
So if it’s so effective, then why not just do that methodology? It sounds much more simple.

Marc Pietropaoli [00:18:16]:
Oh, I, that, that is all I do now, actually, frankly. I mean, ever since COVID hit and I couldn’t do surgeries during that timeframe, I put all these different modalities that we had, like I would do laser by itself, or I might do an injection by itself, or I might do nutrition. I might mix some of these things together. But when COVID hit, I couldn’t perform any surgery. And I was doing some of these things already and trying to get patients convinced. But once it hit and I couldn’t do surgery, these patients had no choice and they were willing to open their mind up to other alternatives that the insurance industry and other doctors weren’t throwing at them. And it turns out they did better than anybody would’ve ever thought, even myself. And so what happened was, even though the insurance didn’t cover it, we tried to get it approved through emergency use.

Marc Pietropaoli [00:19:06]:
And some things like telemedicine, we were able to get approved, but we weren’t able to get these programs approved. The insurance company said, oh yeah, go ahead and do it and then we’ll let you if, if we’ll pay you for it. And we’re like, well, that doesn’t work out good. These people may have to pay thousands of dollars to get this done. And if you don’t, you know, if you don’t reimburse ’em, they don’t want to know that after the fact. They’re like, well, that is the way, that’s the way it is. So it took a lot of times 3 to 6 months to finally get a, a, you know, back and forth, get a final decision from the insurance company. So by then I have to go in the room, these patients, I, I think they’re going to kill me because I’m like, actually your insurance company said that they’re not going to pay for this.

Marc Pietropaoli [00:19:46]:
And almost to a T, almost every single person said, well, I don’t care. I’m better now. I didn’t have to go undergo the surgery. My buddy down the road, he had to come outta work. He lost a lot of income that way. And, you know, we’re doing great and I didn’t have to get, you know, the knee replacement and I’m ecstatic. So, I was like, okay, we’re onto something here. Let’s, you know, let’s start doing… I stopped doing knee replacements and many surgeries.

Marc Pietropaoli [00:20:11]:
I still do some because some you need to do, but I stopped doing those completely in 2020 and haven’t looked back since. And, And there’s a lot of doctors like me who are starting to get on that bandwagon. And we teach doctors all over the country, all over the world, but it’s still a tiny tip of the iceberg. So, part of it is the insurance issue as well, that a lot of insurances will not pay for this, at least in the United States. I’m not, you know, I know Canada, they don’t as well. And then some of the other countries, they don’t either. So, part of it is just that. And I’m not exactly sure why it is.

Marc Pietropaoli [00:20:44]:
I think it’s partly because your body is healing itself. So, how are they going charge for that? You know, your cells that we’re using are your cells. You made them. Your platelets, you made your platelets. You’re healing yourself. So, these weren’t made in a factory, so they can’t kind of charge and there’s no middleman and all those things. I mean, I think eventually you might, you’re going to see donated stem cells get on the shelf, quote unquote shelf. And then, you’ll start to see this because people can start to, you know, the big pharma can start to make money.

Marc Pietropaoli [00:21:14]:
Insurance companies can start to make money off of it. You’ll probably see that more. I’m generalizing that all these things things are truths, 100% truths, but there’s a lot to what I just said.

Nick Urban [00:21:26]:
Unfortunately, a lot of what is outside of the insurance model is already fighting an uphill battle. And then to top it off, I’m sure you hear this, that people have a lot of skepticism. They’d say, oh, I talked to a friend, a family member. They tried these stem cell things, these exosomes, PRP, whatever it is. There’s a bunch of different regenerative medicine procedures. And it didn’t work. They spent a lot of money. They didn’t get results.

Nick Urban [00:21:50]:
So I’m just going to go with the tried and true because at least I’ll get some results, even if it’s not optimal, at least I won’t waste my money.

Marc Pietropaoli [00:21:59]:
Yeah. And that’s where I can do a couple of things. First of all, some people you can’t convince, but most people we see have been through some form of the, you know, cycle of insurance cycle insanity. Some of them have tried other other quote PRP or stem cells or things like that. But that’s where knowledge and staying calm and expertise come into it. And, you know, a lot of those people, they weren’t really truly stem cells. They were freeze-dried placenta that when you rehydrate it with saline saltwater, there’s no live cells. Studies have shown there’s no live cells in it.

Marc Pietropaoli [00:22:33]:
So they didn’t really get stem cell treatments. They might’ve got some growth factors. Also, PRP, Platelet-rich plasma is where we take your blood. You know this, but your listeners, you know, we take some blood and we spin it down in a centrifuge. And the platelets are those things that when you cut yourself, you form a scab, you stop the bleeding so you don’t bleed to death. But they also have growth factors, and those growth factors are released by the platelets. And it’s kind of like fertilizer. It helps you heal, especially if you have an injury that hasn’t, you know, that, that’s having trouble healing.

Marc Pietropaoli [00:23:02]:
So, we know dose matters. This is something we didn’t know maybe 20, 30 years ago, but now we know what the proper dosages are for many things, not everything, but especially knee arthritis. You know, you might need 10 billion platelets, a dose to get 10 billion platelets for a rotator cuff. You might need 5 billion platelets. These are somewhat averages. If you only draw 10 cc’s of blood, a little tiny bit, that’s not going to be enough platelets even when you concentrate it to give you enough dose to have an effect. So you’d be surprised when you look back. That’s why I like getting the old records.

Marc Pietropaoli [00:23:37]:
Oh, well, they only drew 15 cc’s of blood. It makes some sense that it didn’t work for you. Here’s what we’re going to do. And also explain, Dr. Hernigou, explain that, you know, there’s literally hundreds of PRP studies out there. 80% of them show it works for knee arthritis and like tennis elbow, for instance. Those are probably the 2 most studied. The 20% that don’t, if you look at those 20%, most of them either didn’t report the dose or the dose was too low, not enough blood was drawn.

Marc Pietropaoli [00:24:06]:
So, you know, and of course, not everything’s 100%. Even knee replacements, you know, 15 or 20% don’t, don’t work, you know, and 30% of people are on, they still have some pain. So even surgery, we consider, hey, 85 to 90% is considered a success in surgery. Well, most of these treatments that we’re talking about are 82 to 95% success rate. So having your data, keeping your, you know, I just love that we work with Data Biologics to keep all of our patients in a registry so we can keep track of their results and we can show patients data that shows them, you know, what, ’cause they’re going to ask you, what are your results? And most doctors can’t show that, but we can show that. And I think that helps a lot as well. I mean, writing a book helps too because educating people, the more educated they are, the better they understand things. And that’s why we spend 4, you know, we might, our team might spend 4 or 5 hours with you.

Marc Pietropaoli [00:25:04]:
And then people are like, well, I don’t want to spend 4 or 5 hours. I’m like, well, you’ve already spent 4 or 5 months and don’t have an answer. So, would you, you know, 4 or 5 hours and we’ll send you to lunch too for that matter. So, you know, it’s, it, people really, even at the end of that day, if they choose not to go forward, they’re very much more well-educated and understand what is going on and things they can do, whether they choose to go through a full program or not. Because 60% of people go through the programs after we figure out what’s wrong, 40% don’t. I still love those 40% because they came in and they were proactive and maybe think they can do some things on their own to start with, and hopefully they do. And if they don’t, we’re always here for them.

Nick Urban [00:25:45]:
Yeah.

Marc Pietropaoli [00:25:46]:
Yeah.

Nick Urban [00:25:46]:
I’ve really avoided the regenerative world pretty extensively because there’s so much confusion out there. Everyone complains their form of stem cells are the best form of stem cells, and it goes on and on throughout. And really without having transparency into like, okay, what are the actual outcomes here? What are patients actually experiencing? What are the What’s the success rate? What’s the pain reduction? All these different outcomes that matter. What are these? Without knowing that, it’s like saying that you did regenerative medicine and it didn’t work. It’s kind of like saying I ate food and I didn’t get healthy. Well, it’s like, yeah, but it matters what kind of food you ate, when you ate, details around the food.

Marc Pietropaoli [00:26:28]:
So much, so much. And even doing these treatments on people, it, we, I like to say again, it’s a program because we like to figure out what your genetics is, what’s the best diet diet for you. We try to get your inflammation down ahead of time. It’s kind of like a garden. You want to prepare the fields beforehand, put the topsoil down, get the weeds out of there, which is kind of like inflammation, before you even plant the seeds. So what, what, you know, even surgery, we like, we call it prehab. You want to get somebody as optimized as you possibly can before you do a surgery or a procedure or something like that on them. And then obviously afterwards as well.

Marc Pietropaoli [00:27:04]:
So the prehab, the stuff really makes a big difference. Not everybody, you know, some athletes, they don’t have time to do the prehab and they tend to be in better shape anyway. But, in general, you know, timing matters. But, in general, if you can prehab someone ahead of time, it really makes a big difference. And, you know, to answer your question about what the best stem cells are, I mean, the best stem cells are still your own cells because even into your 70s and 80s, they’re still pretty darn good and your body will not reject them. Whereas, Whereas I don’t care what other type of stem cells you get donated to you, and these may prove to be better in the long run. We don’t know that for sure. There’s no definitive studies that show that donated stem cells are better yet.

Marc Pietropaoli [00:27:48]:
But all the good studies are with autologous using, you know, the person’s own stem cells so far. And, you know, your own stem cells are going to, as Dr. Chris Centeno says, stay and play. They’re going to come in, they’re going to help, they’re going to work, and they’re probably going to incorporate. Whereas donated stem cells, they’re immune privileged, meaning your immune system’s not going to massively attack them and reject them like if you put someone’s liver in you that wasn’t compatible. But in the long run, your body’s very smart and it’s going to figure out those are at… those are not your cells and it will kill them eventually. So they don’t get to stay. They play for a while and they do have a positive effect, but they do not stay as of yet.

Marc Pietropaoli [00:28:30]:
I mean, Some of the things I’ve seen that are going on, even with animal cells being used in humans around the world, are really fascinating. A lot of this stuff isn’t totally tested yet, but I mean, we’re just on the very edge of the frontier of regenerative medicine, but for the time being, there’s nothing wrong with using your own cells. It’s, it is the best treatment right now. It is the best, you know, it is the best. stem cells to use, I think.

Nick Urban [00:28:59]:
Well, there’s no, also no issue of host mismatch, kind of like you were saying, like at some level we might not understand all of the mechanisms and how it works, but of course the body in some capacity can figure out this stem cell didn’t actually originate from me. And eventually, maybe in 5 years, 10 years, we’ll understand more about how that looks. But it seems that there’s a debate in the community, the regenerative medicine community, how important that is. But you can just also just sidestep it altogether and use your own.

Marc Pietropaoli [00:29:26]:
Sure. Yeah, I totally agree.

Nick Urban [00:29:28]:
With an injury, if I have a knee that is starting to go bad, I have pain in the knee, I go into the ortho, the first line of defense, the first recommendation probably isn’t going to be a knee replacement. What usually happens?

Marc Pietropaoli [00:29:47]:
Yeah. What usually happens, you mean in the standard insurance Based United States system, is that kind of what you’re asking?

Nick Urban [00:29:53]:
Yes.

Marc Pietropaoli [00:29:53]:
Okay. Usually what happens is in most orthopedic offices, the patient is going to get some x-rays, that’s it. And the doctor’s going to throw the x-rays up, maybe do an exam. I mean, I can’t tell you how many patients that I’m doing a physical exam on tell me, wow, you’re the first one who’s done that. I’m like, what do you mean? They’re like, well, you’re the first one who’s actually done a physical exam on me. I’m not trying to talk bad about other doctors because I think the system is the biggest problem. These doctors are given, you know, they work for a hospital. They’re like, you have to see a patient every 10 minutes.

Marc Pietropaoli [00:30:25]:
And what are they going to do? They can’t do everything that they have to do, even though they know that they have to do it. So, they might not have examined them. They got an X-ray, they come in, they throw it up, they poke around a little bit, and they’re like, well, you’re going to need knee replacement, but let’s send you to physical therapy first. Or let’s try a cortisone shot. Or let’s try, you know, why don’t you just take some medication that’s It’s going to rip your stomach apart, frankly. But, you know, so usually it’s just a slow process, this cycle of insanity, you know, where maybe you go to your primary care, they start you on some anti-inflammatories or tell you to go get some because they don’t have time for you. You come back in 2 months, you’re still in pain. They send you to an ortho that takes 6 weeks to get into the ortho.

Marc Pietropaoli [00:31:06]:
The ortho sees you and says, you got to go to PT first before we can consider surgery or an MRI. So you gotta go to physical therapy and they tell you, oh, even though both your knees and your shoulder hurt, we can only see one thing because we don’t have time for it and the insurance won’t let us. And then, yeah, you get a little bit better with the PT, you go see the ortho, you’re like, I’m not that much better. They give you cortisone shots that just mask things. We know that cortisone damages…

Nick Urban [00:31:31]:
Let’s go into that. Cortisone is one of the first lines of defense, and there’s an insidious reason that it shouldn’t be something that we use as a crutch.

Marc Pietropaoli [00:31:40]:
Totally agree. Yeah. I mean, cortisone damages cartilage, tendons, ligaments, muscle. It does a lot of other bad things too, raises blood sugar. But, there was a study, there was a couple studies done that showed that people who got cortisone injections in their knees ended up getting knee replacements faster than people who didn’t get cortisone injections. So, it does, it does do some damage. I’m not saying it can’t a decrease in inflammation.

Nick Urban [00:32:07]:
But guess what?

Marc Pietropaoli [00:32:07]:
There’s plenty of other things that we can decrease inflammation with, including laser therapy. No needles, no shots, no known side effects. Very, very safe. Laser stimulates the mitochondria, decreases inflammation, increases blood flow, and it also has a direct pain-relieving effect. So, there’s a lot of other things that can be done other than cortisone shots to decrease inflammation, even though cortisone can decrease inflammation, but it has a lot of side effects. Even if they’re insidious, as you said, insidious means, you know, you might not notice it’s damaging your cartilage, your tendons, your ligaments little by little, but it is. And, you know, then eventually it’s too late. And the same thing, like you get cortisone shots in your shoulder.

Marc Pietropaoli [00:32:47]:
If you get cortisone shots in your shoulder and you have a rotator cuff repair, even if your cortisone shot was a year ago, 6 months ago, you have a much higher risk of it not healing or retearing. It’s so cortisone has a detrimental effect on many areas of the body. And that talk about 1960s or ’50s or ’40s technology. That’s crazy. You know, it’s, it’s not, it’s crazy. It’s just not needed.

Nick Urban [00:33:16]:
Well, the reason that most people use it in the first place, and the reason it’s continued to be used and recommended by people is because they do it, they feel better shortly thereafter, and they don’t notice the long-term damage. So, they’re noticing a beneficial effect without the massive long-term consequence, which then perpetuates its use.

Marc Pietropaoli [00:33:36]:
Yeah. And then, and they don’t notice it till it’s too late either. And, and yeah, you’re just masking the symptoms and trying to get a quick fix. And I hate to say it, there’s no such thing as a quick fix. Even with all these exosomes and stem cells and everything, there is no quick fix. There is no magic pill. There is no magic shot yet. There just isn’t.

Marc Pietropaoli [00:33:55]:
It’s not even close. And trust me, when it comes down the pike, I’m going to be one of the first ones to, you know, if I believe it’s, it’s legit, I’ll be one of the first ones to use it, try it on myself, or, you know, use it on somebody else, but they’re there. It’s not there yet.

Nick Urban [00:34:11]:
So, if a doctor says to someone that they are bone on bone, that’s like a common phrase that you hear. What should their mental reframe be and any follow-up questions they should ask?

Marc Pietropaoli [00:34:22]:
Well, first of all, show me the x-rays. Like, show me the money, show me the x-rays, because a lot of patients have never seen their x-rays. And patients can… I give a lot of seminars and webinars. I ask patients, what do you think of these X-rays? And they can see if it’s bone on bone or not. It’s, it’s, you don’t need to be, you don’t need to be a radiologist to do that. So I can’t tell you how many times we have patients who were told that they have bone on bone, never saw their X-rays. We repeat their X-rays and they’re not bone on bone. Yeah, they might have some narrowing and, and there might be some arthritis, but it’s not bone on bone.

Marc Pietropaoli [00:34:57]:
And by the way, even if it is bone-on-bone, that’s just a term that people use that kind of, you know, it’s just a generic term that doesn’t really mean much of anything because I see people who one knee is bone-on-bone and they have no pain in that knee and their other knee looks normal on X-ray and they have tons of pain. So it really comes down to, as I was talking about earlier, the bone underneath the cartilage, if that has the stress or microfracturing, It’s more likely if they’re bone on bone to have that, but it doesn’t always guarantee that. So it really comes down to looking at everything. The X-rays do help. And if someone is bone on bone, I do feel as though they’re going to need more maybe ongoing help or realistic expectations. And hopefully, you wish it didn’t get that far because that does mean they’ve lost a lot of their shock absorber, their cartilage, you know. But it doesn’t mean that they have to have pain and can’t do the things that they want to do or quote unquote need a knee replacement. just because they’re bone on bone.

Marc Pietropaoli [00:35:55]:
I mean, I have patients who hardly have any pain. Yeah, their X-ray looks bad and they’re being told that they need a knee replacement. We work on their back, their back gets better and their knee pain goes away. I mean, we had one lady, she was literally told she needed a double knee replacement because she had bone on bone. We got X-rays, she wasn’t bone on bone. We worked on her back and her knee pain went away and she’s never looked back. She didn’t need any surgery, didn’t need any injections, anything. She just needed someone to work on Did you ever come across the study?

Nick Urban [00:36:27]:
I’m sure you have, where I think it was the back and they did imaging of some kind and they looked at the people who reported pain and then they looked at the X-ray and they looked at the other group who didn’t report pain. They looked at the X-ray, maybe it was an MRI. Do you know that study?

Marc Pietropaoli [00:36:46]:
Yeah. And I mean, I, there’s several studies that look at that, but first of all, A lot of those people have the same exact, you know, X-ray, another, or MRI, whatever, whatever study you want to look at. So the bottom line is the X-ray and the MRI don’t always predict what level of pain that person’s going to have. It’s one piece of the puzzle. I, so people might say to me too, like, why are you getting an X-ray and an MRI and an ultrasound? And what, you know, well, because I’m spending the whole day with that person. I’m getting their history matters too. We just had somebody, one of our staff members, she She was, she thought that she hurt her back. And so she had an MRI of her back and x-rays, et cetera.

Marc Pietropaoli [00:37:31]:
And I was actually out of town and it did show some abnormalities, a bulging disc, but not a herniated disc. And it wouldn’t with her. Once I got to listen to her history, her history is she was walking up and down a bunch of bleachers. You don’t usually get a herniated disc from that. And her pain was more in the buttock and on the side. So it turns out it was a bursitis, greater trochanteric bursitis, which is that kind of on the side of your hip there. And we ended up evaluating her hip and it was her hip. So yeah, she had some abnormality on her MRI and everybody got like focused on that, but that wasn’t even her problem.

Marc Pietropaoli [00:38:11]:
Her problem was her hip. hip, and we treated that and got her, you know, better from that. So you can have abnormalities that don’t really cause any symptoms, and sometimes you can have no abnormalities on your MRI and there are symptoms. So you got to figure it out. And that’s where becoming, you know, that’s where, that’s, that’s my job. That’s our job, my team’s job. And that’s where years of training and experience does come into play. And even then it’s hard sometimes.

Marc Pietropaoli [00:38:37]:
But if you have all the information and all the pieces of puzzle, it’s not that hard to figure out actually. But when you only look at one thing like, oh, here’s the X-ray or here’s the MRI, you can’t tell anything from that without getting a full history, doing a full physical exam, you know, evaluating this person while they’re moving, not just standing there. And, and, and so that’s why we call it a clarity day. We evaluate all that stuff all in one day. And, you know, sometimes friends or family members or people get upset with me when they send me a picture, one image of their MRI scan, which I mean, MRI scans, or hundreds of images, by the way. So one image and it shows one thing and they’re like, what do I do about this? It’s like, I can’t answer that question from that. Come on in for a full evaluation. Oh, I don’t have time for that, you know, et cetera.

Marc Pietropaoli [00:39:24]:
And they get upset. Well, you know, I would be doing them a disservice if I tried to make a diagnosis off of one MRI image. It’s just not fair to them or to us either as providers. But a lot of providers Kind of get bullied into doing that. And I think that’s a mistake.

Nick Urban [00:39:41]:
For people who are earlier in their journey, perhaps they don’t have any knee, significant knee wear. They’re not in pain. And in fact, they want to actually avoid getting into that situation as long as possible. How do you recommend they work on the prevention side of things? Are there any besides like the basics of like nutrition, sleep, proper movement, with the right biomechanics. Are there things that like technologies that you like? Do you like rebounding or vibe plates or anything like that?

Marc Pietropaoli [00:40:13]:
Maybe PEMF? I think all the above can help and I would agree with all the above. I’ll give you one specific example though, especially for, let’s say, athletes because people who are people who want to stay active. And, if you’re doing a cutting or pivoting sport like basketball or soccer or lacrosse or volleyball or anything. I mean, even honestly, even, you know, if you’re climbing mountains and things like that, you’re doing cutting and pivoting. So there’s preventive programs because strengthening in general is good, but like strengthening the right way and fixing the proper mechanics is really important. So females tend to tear their ACL, the main kind of rotating stabilizing ligament inside the 5 to 10 times more commonly than males. But even males, females and males, 80 to 90% of the injuries that occur are non-contact. The person is just running or cutting or landing from a jump and they tear their ACL.

Marc Pietropaoli [00:41:18]:
No one even hit them. And so, how do we prevent that? And there are specific ways to retrain the body to lessen the risk of of tearing your ACL by, or having a serious knee injury by 50 to 75%. Sportsmetrics, which was developed by Dr. Noyes and his team in Cincinnati Sports Medicine way back when, that’s one example. There’s several examples, but that’s a great one because they have a lot of data and a lot of studies. And we’ve run that program many, many, many years and significantly cut the risk of tearing the ACL. And how that applies to knee repair, not knee replacement, is when you tear your ACL, you got about 50% chance of developing arthritis in 4 or 5 years. When you tear your ACL and undergo an ACL reconstruction, where we take a tendon from one area of your body and reconstruct and make a new ligament, which is kind of the standard of care, that’s very good for restoring stability and getting you back to sports, but it doesn’t lessen the risk of arthritis.

Marc Pietropaoli [00:42:23]:
You still have a 50% risk of arthritis. It just pushes it out 10 or 12 years. years. And, if you’re a 14-year-old girl and you tear your ACL, 14 years from then is only 28. You’re in your 20s and you’re getting a 50% chance of arthritis. So, preventing those injuries in the first place is huge. That’s going to lessen the tears, that’s going to lessen the risk of arthritis. And then, the less arthritis we have, the less knee replacements.

Marc Pietropaoli [00:42:50]:
And also, if you do tear your ACL, we even have newer ways now of growing back the ACL instead of doing a reconstruction. It’s called a BEAR surgery, Bridge Enhanced ACL Restoration. Dr. Martha Murray came up with that procedure at Boston Children’s. And I tried to get in to be one of the clinical… in the study clinical sites, but they were closed. So she said, when it comes out commercially to the general public, I will contact you. And she was true to her word. So I was able to do the first non-research study FDA-approved BEAR surgery back in 2021.

Marc Pietropaoli [00:43:23]:
And back And then we knew in the animals that doing, repairing the ACL pretty much prevented arthritis in the animals, whereas cutting the ACL or doing an ACL reconstruction in the animals, they still developed arthritis. Well, now we know 6, 7 years later, and the FDA has recently given this label to the BEAR surgery, that it significantly lessens the risk of post-traumatic arthritis compared to standard hamstring ACL reconstruction. So we’re even getting better at repairing And even this is off-label, but I use, I always use bone marrow, which has stem cells and other cells that help the stem cells and PRP when I perform the BEAR surgery, which is, again, that’s off-label. You have to talk to patients about that. But it, I feel as though, knock on wood, we haven’t had anybody retear who we’ve done that on as well. But, you know, the sample size is small. It’s not been, it’s not been 20, 30 years yet. But we do have a good enough sample size that the FDA said, yes, doing a BEAR surgery, repairing the ACL, growing it back, gives you a lot less risk of arthritis than a standard ACL reconstruction.

Marc Pietropaoli [00:44:36]:
So that’s some of the preventive stuff. Everything you mentioned though, right? The proper hydration, proper diet, staying strong, staying fit, the proper sleep, some of the modalities that you mentioned, all those things certainly can help. And the problem is sometimes that gets overwhelming for people. So, you know, the diet and the exercise, that’s always going to be… that’s since the ancient Greeks, right? Let food be thy medicine, medicine be thy food. Motion is medicine, all those things. We’ve known that forever. But some of these newer electromagnetic things and stuff like that, you know, pick 1 or 2 things. You don’t have to do every single one of those things.

Marc Pietropaoli [00:45:16]:
And we don’t even know what doing every single one of those things all at once, how that’s going to affect to, in general, I think, you know, it’s not going to harm, but find someplace where it’s relatively simple but works, if that makes sense.

Nick Urban [00:45:33]:
Yeah. When it comes to the movement specifically, a lot of different schools of thought on that. It seems in general that at least for bone and for muscle preservation, you’d obviously want to be doing some kind of resistance training. What about the aerobics, the distance, Perhaps not ultramarathons, but something short of that. Is that going to be beneficial or is that going to help or not help? Is that going to wear out joints and cartilage faster?

Marc Pietropaoli [00:45:59]:
Okay. All amazing questions. So resistance exercises are great because they build muscle. And we have a lot of older people, especially older ladies who say I exercise, but they, you know, they just walk, which isn’t bad. But once they start getting addicted to the resistance exercise, it might just be resistance bands, kettlebells. It doesn’t have to be pumping iron. They get all afraid. They get addicted to it.

Marc Pietropaoli [00:46:21]:
They just love it. It makes them more stable, more steady, less risk of falling, and it really allows them to elevate their game. So, as you get older, you have to have some resistance exercise for sure. You want to keep and build muscle. It’s really important. It doesn’t have to be pumping massive amounts of iron. And also, studies have shown people in their 50s, 60s, 70s, 80s, even 90s respond very well to resistance exercise. So, you’re never too old.

Marc Pietropaoli [00:46:47]:
Now, getting back to your other question, I’m a runner. So, and even with our genetic testing for nutrition, we can test what type of an athlete people are. So, some people are more endurance, some people are more sprinters, all that stuff. So, that helps in that regard as well. But, in general, humans are still endurance animals. We developed based on our endurance to outlast when we would hunt whatever, the antelopes or the the lion or the cheetah or the elephants, and they would get out in front of us, but we were persistent. We had endurance and we could always out-endurance, you know, most animals. And that’s how we would win the hunt.

Marc Pietropaoli [00:47:29]:
So, humans are endurance-based in general. And so, endurance exercise, you know, it was like all aerobics, then it was like, you know, resistance. It’s somewhere in the middle. I mean, aerobic exercise slash Distance exercise, endurance exercise is still important. I personally love it, absolutely love it. And that is my genetics. And I still do resistance exercise too. But we are endurance athletes after all, or endurance species after all.

Marc Pietropaoli [00:47:58]:
And so, I think it’s just kind of natural human behavior to do that. And no one has ever proven that running will cause arthritis. Now, some ultra, ultra, ultra, there’s a few studies that show maybe ultra, ultra marathoners, maybe they wear out a little faster, but no one’s ever proven that running causes arthritis. Once you have arthritis, then it might cause you to wear out faster if you don’t do the right things. But I have people who are bone-on-bone who still want to run, and I give them my doctor spiel that that’s probably not the best exercise for you. And I give them my runner spiel, hey, I’m a runner. If you really want to get back to running, let’s try to do everything we can possibly do to safely get you back. So I hope that answers your question.

Marc Pietropaoli [00:48:41]:
But I think there’s, you know, there’s no evidence that I know of. And I’ve looked at a lot of this that shows that our, you know, arthritis is caused by running.

Nick Urban [00:48:51]:
How important do you think it is to move in different planes of motion then, and to do movements that are beyond just running in a forward straight line? For example, humans would previously squat, we would lunge, we would push things, we’d pull things. We’d We’d move and walk backwards. We’d climb up trees, do all kinds of stuff like that. And it seems like if you’re building a prevention plan, you’d want to have other movements. So, you’re not just giving the same stimuli to the joints hundreds or thousands of times per day.

Marc Pietropaoli [00:49:22]:
Completely agree. So, we call that functional movements, different functional movements. And our PTs, our Vmotion Fit experts, they will… it depends also what you want to do, you know, what your goals are. And so, we’ll tailor that, but absolutely functional. I mean, I mean, you got to get good on 2 feet first, then you got to get good on one leg. Then you can start get to like the jumping and the running and the plyometrics and all those things. So, we work, get your foundation squatting, for instance, kettlebells, things like that with 2 legs, progress to one, because actually most of the time we walk and definitely when we run, we’re on one leg and not 2, believe it or not. So, getting that single leg stability, then you can start getting more advanced into the cutting and the jumping and the plyometrics.

Marc Pietropaoli [00:50:11]:
metrics and all those more functional activities. So, we do progress people up that ladder. And, you’re totally right that just even goes to sports specialization. If you only do one type of exercise all the time, you’re only working one group of muscles, you’re going to be more prone to injury. So, variety, everything you just said is super important. Totally agree.

Nick Urban [00:50:32]:
I found it surprising when I was reading your book that at some point you became your own patient of your own What was that like emotionally and from like the whole experience?

Marc Pietropaoli [00:50:44]:
Yeah. Well, I mean, I, I, that just shows that I truly, truly believe in, and I practice what I preach. I would never put someone through something that I wouldn’t do myself, even surgery. I’ve had 5 surgeries for different reasons. And I know surgeons who say, I’ll never have surgery, or I’m afraid, like, you got it. You’re a surgeon and you put people through surgery, but you’re not willing to go through it. So, I can, I can see being against wanting to go through it. But, you know, you’re a surgeon and if you need surgery, you should, you should be able to, you know, handle that.

Marc Pietropaoli [00:51:17]:
So in regard to this, this isn’t even a surgery. It’s a, it’s a procedure. And I strongly, strongly believed in all the science and the method that we came up with and I came up with. So I trained. It was a great, it’s a great story because I had a terrible tennis elbow for many years and like most people put it off and I did try all kinds of standard treatments, etc. And then it got worse, I think the summer of ’23. It doesn’t really matter when it was, but the point is I trained my physician associate how to do all the techniques and the procedures and everything. So, you know, I taught him what to do.

Marc Pietropaoli [00:51:57]:
Then I went, I showed him, and then I watched him do it, and then he was on his own. And then his final graduation was to do, you know, a procedure on me. Knee. And he did great and he’s been doing, you know, so many since then. And so, I think you just got to practice what you preach. And if it just relied on me to do this myself, then we would never be able to… I can’t treat the entire world, right? I want to spread this word and I want to end the need for knee replacements by 2043. So, it can’t… I can’t do it by myself. So, that was just a good example of me training somebody else who’s going to then train somebody else, is going to train somebody else and having confidence in, you know, we call it the Victory Method, whatever you want to call it, having confidence in your method and your systems.

Marc Pietropaoli [00:52:44]:
And, 2 years, over 2 years later, I am like 100%. I still do my exercises that I, you know, to prevent it from ever happening again and practice what I preach.

Nick Urban [00:52:57]:
After going through it yourself, did you change any components Um, I…

Marc Pietropaoli [00:53:02]:
the only thing that, um, I did change a little bit is a little bit more consistency in our V Motion Fit part of it afterwards. Because sometimes when you have different providers, uh, they were all great, but some of them might be doing different, like, different angles. And so, I mean, patients want consistency. So I did recognize that going through that I had maybe I, I tried, I wanted to have all different work with different people in my, on my team just to see what it was like. Right. You know, and then I’m like, okay, I have 5 people and they’re all doing things a little bit differently. So that was kind of an eye-opener for me, which was good. Not that I want a cookbook and not that I want, don’t want people to think for themselves, but having a little more standardization, using everybody’s voice to standardize it.

Marc Pietropaoli [00:53:51]:
And we’re still even working on that, but we’re much better now. So I did, I did refine And, you know, I would also say, and you can read the book, you can see it. It’s like, yeah, it’s one thing to do it on other people. It’s one thing to know it works, but when you go through it yourself and, you know, it does, you know, you’re going to have some pain the first few days because you’re waking the body up. You’re kind of reinjuring the body to restart the healing process. And, you know, when you’re in pain, of course, little bits of doubt come into your head. Like, hey, is this going to, you know, I know it works, but maybe what if it doesn’t work for me? So, it was good to go through that, you know, the doubt and all also feeling good and then overdoing it like an idiot and flaring it up a little bit at 2 weeks because I was feeling so good. Things like that, going back to work.

Marc Pietropaoli [00:54:35]:
So, I had it, I think it was on a Monday, and Friday I was back in the operating room doing surgery where I didn’t have to lift anything. Arthroscopic surgery is pretty… it doesn’t require a lot of heavy lifting or anything like that. And, I just had a little tape on my arm. And I was able to get back. So I didn’t miss any days of work. So it’s good to go through that and talk to patients about what your own experience was. And I recorded a lot of it too, as I went along, so I could have a record of it to look back on, but also show other patients.

Nick Urban [00:55:08]:
We’ve talked mainly about knees so far today, but obviously there’s other parts of the body that commonly have issues, shoulders, back, et cetera. What would you say are the other…

Marc Pietropaoli [00:55:16]:
And my elbow for that matter. Elbow.

Nick Urban [00:55:18]:
Yeah, yeah, exactly.

Marc Pietropaoli [00:55:21]:
What are the big ones? I mean, shoulder and knee by far are the 2 most common things we see, but we see lots of hip injuries, lots of elbow injuries like I had, wrist, thumb, thumb, this joint in the thumb, the basal joint tends to wear out, ankles, Achilles. So, pretty much everything Including backs and necks. Now, I don’t perform these type of injections on backs and necks, but I have colleagues who do that. So, if I have a patient and they need these regenerative medicine treatments on their back or their neck, I have a couple of very trusted colleagues that I have do that. Because, I mean, you can only be so good at so many things and you can’t be the jack of all trades, master of none type thing. So, I’ve never done surgery on backs or necks. I leave that to to the specialists in that field. And I’ve never done procedures on backs or necks, but we see a lot of people with back and neck pain.

Marc Pietropaoli [00:56:21]:
And a lot of them we can get better without doing anything, you know, as far as surgery or injections. A lot of them, they require these specialized exercises. Laser treatments work great for back and neck, and that’s, that’s not invasive. So, yeah. Cool.

Nick Urban [00:56:35]:
We will touch on a couple more topics, but first, if people want to connect with you, perhaps they want to come visit you and go through the process, They’re ready to repair instead of replacing. Where do you want to send them?

Marc Pietropaoli [00:56:50]:
Sure. So, our website is victoryinmotion.com, victoryinmotion.com. I mean, our phone number is 315-685-7544, 315-685-7544. But, I mean, any social media, Dr. Marc Pietropaoli, Instagram, Facebook, TikTok, YouTube, et cetera, linked And Victory in Motion One is also our social media. You can go to Amazon and Repair Not Replace. You can DM me on whatever, on Instagram if you want. But I think going to the website and calling, or even we have a lot of webinars and seminars.

Marc Pietropaoli [00:57:31]:
So people, we get people. I just did a webinar last week and we had someone sign up from Maryland and someone sign up from New Jersey. So we can treat treat patients from all over the world. We’ve had a woman in Belgium that we treated, lots of people in Canada, people all over the US. So, a lot of… I mean, the procedures need to be done in the office. So, people do need to come visit us to kind of get figured out and if they need a procedure. Not everybody needs a procedure, but if they do, then everything else can be done telemedicine. We even have handheld portable laser that we include in those programs for remote people.

Marc Pietropaoli [00:58:05]:
So, you can be in Africa, you can be wherever, and we We can, we can work with you. So we do a lot of remote, have a lot of remote patients.

Nick Urban [00:58:18]:
Let’s do a quick rapid-fire round now. What is the most common thing people do that wrecks their shoulders without them even realizing it?

Marc Pietropaoli [00:58:32]:
Ah, God. The most common thing they do that wrecks their shoulders without them realizing it. I think when they have pain, not moving it, because then it gets stiff and trying to get stiffness out of shoulder is a disaster. So there’s lots of different reasons people get shoulder pain, but the biggest thing that they do that wrecks it is they don’t move it and it gets stiff. So get in. If you hurt your shoulder and it’s not better in like 2 or 3 days, it’s getting worse, get in because your natural inclination is to not move it. And sometimes that makes things worse.

Nick Urban [00:59:02]:
So get in and get Tell me a belief in orthopedics that you hold that most of your colleagues disagree with.

Marc Pietropaoli [00:59:12]:
That you don’t need to replace as many knees as there are out there. Matter of fact, I think 82 to 95% of knees, that’s my, this is my thought, 82 to 95% of knees don’t need to be replaced who’ve been told that they need to be replaced. But the studies show, and there was an Australian study and there was another study that that show anywhere between 25% and 30% of joint replacements are unnecessary. So even the studies back that up.

Nick Urban [00:59:36]:
What’s the cheapest intervention with the biggest payoff for a bad shoulder?

Marc Pietropaoli [00:59:42]:
Well, I think again, if it’s, it depends on what the bad is, but moving it and not letting it stiff, get stiff is a big thing that you can do that’s free, but you still kind of want to figure out what’s wrong first. So, I would say don’t let it get stiff. So moving it.

Nick Urban [01:00:03]:
The most overrated knee solution or product without mentioning a brand per se that you see sold online?

Marc Pietropaoli [01:00:10]:
Cortisone. But as far as online, probably there’s a ton of them, but probably like these braces that they tell patients to wear because they have arthritis. Well, the Arthritis isn’t instability. You don’t need a brace for that. So, there’s a lot of those type of things that are sold to patients that are not really even taking care of the underlying problem, like a knee sleeve or whatever. I mean, it might make you feel better, but it’s not really taking care of the underlying problem. But, I would say cortisone, you can’t get that online, but that’s the worst of all for sure if we haven’t already figured that out and beaten that dead horse today.

Nick Urban [01:00:49]:
Perfect. Well, thank you for joining me on the podcast.

Marc Pietropaoli [01:00:52]:
Nick, this has been a pleasure and I love what you’re doing. And everybody should listen to him because look at all the things he’s saying and he’s advocating for. He really knows what he’s talking about. And I really enjoyed being on this. I really like listening to you and also especially talking to you.

Nick Urban [01:01:11]:
Thanks for tuning in to High Performance Longevity. If you got If you got value today, the best way to support the show is to leave a review or share it with someone who’s ready to upgrade their healthspan. You can find all the episodes, show notes, and resources mentioned at outliyr.com. Until next time, stay energized, stay bioharmonized, and be an outlier.