Watch This Before You Get a Knee Replacement (99% Chance You Won’t Need One)

Added: 2026-05-28

[00:00:00]Age is not the cause of knee arthritis.

[00:00:02]I am staunchly firmly a believer in that. Stop walking to help your knee pain. I've helped over a thousand patients with knee arthritis. And the difference between those that end up having a knee joint replacement and those that end up cancing their surgery is these following 11 rules. Rule number one is to accept that it's not an age related condition, but instead it's a pressure over time condition. This is an important distinction because if you think about a knee joint, everybody thinks that as you age, you're going to develop arthritis. And that's the correlation we see. An important thing about a correlation is that it does prove cause and effect. When you look at the research world, there's not a a clear cause and effect connection when you say that something's got a correlation. All you're saying is that as this tends to happen, this also tends to happen. As and so what we're seeing is that as you age, knee arthritis gets worse. But it doesn't mean that it's the cause of knee arthritis. Age is not the cause of knee arthritis. I am staunchly firmly a believer in that. And here's why. It's a pressure over time problem.

[00:01:19]If you have an imbalance of strength around the knee, if the quad muscles right here above the knee joints are too strong, let me use the big one. If the quad muscles above the knee joints are too strong, then they're going to pull the kneecap up against the thigh bone harder. And then there's a connection between the kneecap here and the shin bone. That's also going to pull the shin bone up against the thigh bone. That causes increased pressure in the joint.

[00:01:46]And just like if I took my hand and pressed it on top of this hand like this, if I kept it there for a long time, I mean, I'm talking hours or even days, weeks, it would have hurt my hand.

[00:01:59]I can sustain it here for a few minutes.

[00:02:01]No big deal. But it starts to get uncomfortable after a while. I'd start to cut off the circulation. It's the same reason why you shifting your seat if you think about it. Like if you sit in the same position for too long, you have to just scoot over a little bit and you're you're just repositioning the weight through your butt because you're literally pushing the blood out of certain areas of your body and it your body just has this reflex where you just shifting your seat to redistribute the blood to make sure that the tissue stays alive that it doesn't get injured. Well, in your knee joints, if you have too much pressure sustained over time on the cartilage surfaces of the bones because you're the quads are just pulling up, you're damaging your cartilage over time. You're killing it essentially and that's why it's susceptible to injury.

[00:02:49]So, if you accept that it's not an age- related problem, then you can open your mind to the possibility that despite your age, you can improve your knee arthritis situation. And we see this all the time because how is it that we get somebody who's in their 70s with severe knee arthritis, grade three, grade four knee arthritis.

[00:03:09]They're a candidate for surgery. They come into our clinic. This happens on a consistent basis and they're trying to avoid surgery. We go through the process of depressurizing their knee by fixing the muscle imbalance and a few months later they're feeling fantastic. They're able to walk for long periods of time without swelling or knee pain. They're able to sleep at night just fine, but they technically got older. It's not an age related problem. It's a pressure related problem because that's what we fixed. And as we decrease the pressure over time, the knee joint improves.

[00:03:42]Number two here is stop walking to help your knee pain. This is huge because it's the first recommendation often that doctors and other health care professionals will give a patient with knee arthritis. to tell them, "Well, you should start walking." And it's terrible advice. And here's why. If you've got that muscle imbalance where the quads are too dominant, usually the glutes aren't very strong.

[00:04:08]They're part of the problem. As they get stronger, the quads can relax and not be so dominant. But if you haven't figured out how to properly activate your glutes, and if you don't have enough strength to sustain good glute activation throughout your walking time, then what's going to happen is your body's going to compensate because your body is taskoriented, meaning when you tell it to do something, it just figures out how to do it. It doesn't care how it's done. Doesn't care how you achieve the walking. Your body isn't thinking, well, let me make sure I use my glutes most of the time. It just says, "Walk this distance or walk for this amount of time. Do it however you need to do it."

[00:04:46]And so your quads start going and you exercise your quads, which feeds into them being dominant and strong and overused and it keeps pulling that poor kneecap up against the thigh bone. And it keeps pulling that shin bone up against the the thigh bone as well and messing with the cartilage right here on the end of the thigh bone. The cartilage in the back of the kneecap also gets worn out. Your meniscus gets torn. All that happens is a result of walking more. Now, people do get relief right away sometimes. I think this is attributed to the the fact that they probably just haven't been walking. And so, doing any physical activity can begin to feel good. But if you keep walking sustained, like if you do on a consistent basis for weeks at a time and you have that muscle imbalance, then what I often see is people end up running into worse knee pain. They worsen their knee arthritis after a few weeks, maybe a month or two. And then they're scratching their head thinking, "How am I going to walk now? Cuz my knee hurts and it swells after a mile and I'm I'm out." And that's what the doctor said. I'm trying to do right and follow the doctor's instructions, but walking isn't working for me right now. And they don't understand that it's a muscle imbalance problem that needs to be fixed first. The doctor is going to be able to tell you that. So, stop walking. Number three is bed rest is not a good idea.

[00:06:06]Now, when I think because you'll hear this recommendation from the doctor, too. They'll say rest your knee if it's really swollen. You'll you'll say you'll start walking and rest your knee. And some people will take it to the extreme because they're literally following the doctor's instructions and they won't do anything. There's this idea of relative rest, meaning you still need to do some things. You still need to move. There's certain exercises that you should be doing that's active. It's not technically rest, but bed rest where you just stay in bed, don't do anything, it's not a good thing for you. Now, in the short term, like within a few days, maybe a week or two at most, you'll get relief if you're very flared up. Like, if you have a swollen knee, if it's red, if it's hot, if it hurts to put weight on it, and you go bed rest for a few days, you're probably going to feel better after a few days just because you haven't been doing anything to irritate it. But what happens as a side effect of resting too much is your muscles start to get weaker. This can be bad because it takes way more effort to gain strength than it does to lose it. A little bit of bed rest equals massive losses in strength versus a little bit of exercise means a little bit of strength gain. You have to strengthen a lot more in order to get little bits of strength. So it it just takes more effort. But what I recommend instead is you need to start doing the right kinds of exercises. So if you're very flirted up, you can't even walk around, you can't do normal tasks, then just getting the muscles to activate. I mean, you might be in bed resting and just tightening your glutes, working your foot muscles, doing exercises that you can do that are productive for the muscle imbalance, but don't hurt your knee because then you're not flaring it up. You basically have to find what you can tolerate without aggravating your knee. That's relative rest. That's how you properly should rest your knee. Just don't do anything to piss it off. Don't do anything to aggravate it. Number four is don't rely on pain medications. Now, I'm not saying don't ever take pain medications. Don't take my words the wrong way. What I'm what I mean by this is I see people sometimes that carry around Advil, Eedrin, some sort of pain medication, usually over the counter, that takes the edge off of their pain so that they can grit their way through the day and that's how they live dayto-day.

[00:08:32]That's relying on pain medications. Now, I'm okay if you take one or two here and there just to get through a an especially difficult time. Like, I've had patients that that say, um, you know, I've got to take care of my grandkids. This just happens once a week and they're on summer break. We're going to go to the park. Like, they're telling me all the details of how they have to be on their feet a lot. I'm going to go on this vacation is another example. I'm going to go on this vacation and we have to walk three miles this day and I can take breaks and all that, but maybe I should take some pain medication. And I'm always from the from the camp of like, yeah, in that circumstance, do it.

[00:09:10]But if it's your regular day, if you're just at home, it's a laundry day, it's a cooking day, it's a a an easy day, don't take pain medication if you can at that point. You have to figure out what you can tolerate. I'm not saying, you know, don't be uh suffering. You have to be suffering. Don't don't take it that way.

[00:09:29]Like if you're suffering, you need to go figure this out. I'm here to help you with that. But relying on pain medications besides the obvious of injuring your organs, you know, your liver, your stomach, your other your kidneys of there's a bunch of other organs that can get very affected if you're taking medications on a regular basis. The more important thing that I'm um worried about for you is that you're not allowing you your body to feel what you're supposed to feel so that it can guide you through the activities that you're supposed to be avoiding or modifying right now. You need to have a sense of this hurts if I do it too much or I shouldn't be doing it this way. I need to tweak the way that I'm doing it so that I'm helping my knee, not not hurting my knee. So only use pain medications in extreme situations where you know you have to go through it. Uh and another just a side note on that one. Another one that's important is relationships. You know if you say you're married your spouse and and uh you are grumpy right now because of pain. It might be a good idea for the health of your marriage or your relationship with your children or or whoever it is, you know, somebody that you're taking care of to take that pain medication so that you're nice today because maybe you haven't been nice for the past few days because you've been in pain and it's just not normally you. But if you can set yourself up to feel good for a day so that you can put some good love deposits in your relationship's bank, then do so so that you're good with that person. But that's just intended to be a temporary thing. Make sure you start fixing the long-term problem. Get that muscle imbalance fixed so that you're not having to rely on pain medications. Number five is don't do quad isolation exercises. Now, I explained earlier how those quads can be dominant and they squeeze all the everything in the joint. The kneecap gets pushed up against the thigh bone and the shin bone gets pushed up against the the thigh bone, too. So, the obvious is that if you keep strengthening your quads, you're just going to feed into the problem. Now, this is harder than than you think for people because what I've experienced is, you know, I'm a guy on the internet and I'm talking to you about how to do your your treatments for your knee arthritis.

[00:11:47]I'm guiding you on the on the way to do it. And you might be seeing a health care professional in person who's telling you to do your quads. They're telling you to strengthen your quads.

[00:11:57]They're putting you through exercises to do to do this. They're having you do quad sets where you lie with your legs straight or you sit with your legs straight and you tighten your quads and you're pushing your knee down to straighten it out and it's making your quads tired and maybe even get some relief temporarily.

[00:12:16]You have to figure this out for yourself. Is this beneficial for you or not? What I find most of the time is that it it tends to not be. You tend you tend to fire your quads easily. They tend to get tired quickly. If you feel like you have good control over your quads and you can easily work them out, you need to stop working out your quads.

[00:12:34]It means that you've probably have a massive imbalance. And compare it to this right now in your seat or standing, however you are, whatever position you're in.

[00:12:46]tighten your glutes.

[00:12:48]If you can't do it very well, if you struggle to do it or or you can't even do it at all, but you can tighten your quads easily, then you absolutely have a muscle imbalance. And the fact that you can't fire your glutes is of serious concern for me because it means that anytime you do any activity that requires a little bit more intensity than your normal, you call on your quads right away. Maybe you do kind of use your glutes, but as soon as it gets hard, as soon as it gets difficult, as soon as you're doing it for too long, you're on your feet for too long, you're walking for too much, boom, quads take over, and now it's compressing your knee joint, it's pressurizing it, and you're going to be doing that over time, and it's it's progressing your knee arthritis rather than helping it. And you need to go through the difficult, time consuming task of figuring out how to get your glutes to work. and then strengthening your glutes over time so that your quads aren't compensating all the time. You just have to figure that out. Don't be doing quad isolation exercises. It's only setting you back further and further gradually over time. Number six is get stronger foot muscles. And let me show you the foot model for this because there's two situations that are especially important for you to get stronger foot muscles. Number one is if you have a flat arch. So, if you're looking at the arch of the foot right here, and when you stand up, it flattens out. You can see what it does to the ankle joint here and the shin bone. As soon as that arch drops down, it moves the ankle and the shin bone inwards. And the way that affects the knee joint, this is the this is the left side. So, the arch is on this side. If that drops this way, you can see the knee moves inwards. and that inwards, it's a it's a combination of a of a side motion inwards, but also a rotational motion.

[00:14:43]Those two motions together make your quads want to fire more and it actually wants to deactivate the glutes. This is the way the body's wired. So, if you don't have good support in your arch, it means you're going to start to compensate with those quads right away.

[00:15:01]If you have a flat foot and you can't activate your your toe muscles properly to get an arch to to create an arch, then you need to get in insoles right away just for the short term. But for the long term, you need to be doing toe curl exercises. Exercises that make you curl your toes like this. Because when you do that, the muscles that curl your toes end up passing under that arch and it helps to support the arch naturally without you having to be so conscious of it. Because you might be able to consciously raise your arch and you might need to pay attention to it for sure, but the ideal is that your strength in your toes is so good that you don't have to focus on it so much and it just wants to activate because you've been repetitively practicing it.

[00:15:47]You've been doing it while you walk.

[00:15:48]You've been doing it while you're doing the laundry. You've been doing it while you cook, while you're walking to the grocery store, while you're running your errands. Anytime you're on your feet, you're using your toes and you're strengthening them. That's going to allow you to more consistently post up your shin bone properly so that the forces are normalized in your knee joint. Now, that's the first one. If you have a flat arch, if you have a really high arch, that's another problem that people have. That's we call it um ri oh oh gosh, pez rigidus. Pez cavis is the the flat foot. Pez I think it's pez alta or pez rigid. There's different terms out there, but it's when you have a a high arch like that. If it's usually very rigid, it's very stiff. The reason for the stiffness and the rigidity is because your bones in your foot right here have figured out that if they just lock in, you can create an arch better, but it's at the expense of foot muscles.

[00:16:46]Your your foot's figured out how to get support without strength from your toes.

[00:16:50]So, if you can start to strengthen those toe flexors, you can start to loosen up that rigid foot. Often people that have rigid feet have foot pain. They have pain in the middle, like in the arch of their foot or either on the top or on the bottom. It's because those joints get stuck. They can even get arthritic.

[00:17:07]But if you can free up those joints by getting the toes to curl all the way, then you can begin to loosen this up and create a more normal impact whenever you hit the ground, which is going to be healthier for your knee and your muscle imbalance, your your muscle balance overall. Number seven is you need to get conscious control over your glutes. Now, I I kind of started to mention this a moment ago, but when you are trying to fire your glutes, like if you if you can't get them to activate, that is a huge problem. This is like a milestone that I run into with all of my knee arthritis patients. And it is shocking how many times I hear patients come in and say, "I've done physical therapy here. I've tried this thing. I've tried that thing. I've tried this, this, and that." And then I I get to the point in treatment where I have to tell them, "Can you tighten your glutes?" And they go to try to tighten their glutes and nothing activates back there. The most common is nothing activates or like it kind of wants to but it doesn't. But then their quads boom, they take over right away. And I have to point it out to them. I I'll they'll be standing right in front of me right here. They'll be like this. Let's say this is the the person. And I tell them, "Okay, here's glutes. Here's quads." And and I'll even poke the glutes like this. I'll say, "Okay, make this muscle tight." And and they're like, "I'm trying. I'm trying."

[00:18:27]And then meanwhile, this muscle is going, "It's tightening up a ton." And I point out to them right away and I say, "This is the huge this is the biggest problem that you have right now. This is your imbalance in action. You're trying to cognitively, purposefully, intentionally tighten your butt muscles and your thigh muscles activate.

[00:18:51]How did you do all those exercises and physical therapy? How have you been walking around? How have you been doing anything in your life? It's no wonder you have knee arthritis because every time you do anything, your quads are just going crazy when it should be glutes and your poor knee joints taking the brunt of it. So, let's start there.

[00:19:11]just literally all have them do is is in sitting, in standing, and in lying down, lying on your back, lying on your side, lying on your any position your body can be, let's practice how to just tighten your glutes. And I'll tell people, your homework, step one, if you can't do this, is set a timer that goes off every 15 to 30 minutes. And when the timer goes off, tighten your glutes and hold it for 10 seconds. and do it like five, 10 times or more and just become a master at contracting your glutes on command and then being able to contract one and the other because that's important for walking. You have to be able to have good control over your glutes. I mean, just like my hands, like everybody has pretty good control in their hands for the most part, right?

[00:20:00]You can make each finger work individually. You can operate one hand apart from the other. You should be able to do something similar with your glutes, at least where they operate independently of each other and that you can make them turn on. You know, I'm not trying to squeeze my my hand and my foot's going, my bicep isn't going and making my arm bend. I'm not trying to like raise my arm up every time I use my hand. That's kind of like what's happening when people don't have good glute activation.

[00:20:27]They they can't even turn the muscle on.

[00:20:29]They don't know how to operate it. And it's not something the medical community gets either. This is this is the cutting edge information like I'm giving it to you right now. This is the crux of my treatment approach in helping people resolve their knee arthritis naturally without surgery.

[00:20:47]If you can just do this, if you can just get your glutes to turn on and then translate it into everyday motions, you're probably going to get 60 70 maybe even 80% better than where you're at right now. is probably enough to cancel the knee surgery. For most people, if they only do this thing, forget the foot.

[00:21:07]If they just do the glutes and do it well, they're probably going to say, "You know what, doc, I'm feeling so much better. I don't need the surgery right now." Add on the foot. Add on the other things that we have in our treatment approach, and then you're probably going to feel tremendously better, 100% better. So, get your glutes to activate properly. It is absolutely key in making sure that you fight knee arthritis to the point where you feel fantastic again. Number eight is you need to figure out how to walk properly.

[00:21:38]Now, the way to walk properly is you have to be able to fire your glutes independently. So, whenever you step on a foot, whenever the the foot hits the ground like this, at that moment as you're loading pressure on your foot, proportionally your glute should be tightening up a little bit. Now, never it never needs to get to 100%. Maybe just when you're learning how to do it, but in normal everyday motions, your glute should just tighten up subtly every single time you put weight on your foot. And as you alternate to the other leg, the other glute should al should tighten up. So just like your feet alternate touching the ground, your glutes should alternate tightening subtly. If you don't do this, like if you go try walking, you're thinking, "Oh, I'm not doing this right now." That means that other muscles are contracting in place of your glutes.

[00:22:36]And chances are it's your quads. Very often it's the quads. In fact, think back to the last time you took a long walk. What got tired? Very often, it's the quads. You shouldn't have that experience. That's not proper muscle balance. You're you're in an imbalance.

[00:22:54]What should happen instead, this is the feedback that you need to be getting from yourself. This is the the teaching, the learning that you need to figure out so that you can know how to fix your knee arthritis problem without having to have surgery is you need to go on a walk 5 10 minutes at the start usually is enough and be it of course shouldn't hurt. It shouldn't bother your knees.

[00:23:16]You need to be at a certain point in your knee recovery where you you can tolerate this without hurting your knee.

[00:23:22]But then you should feel like your glutes got tired. Yeah, other muscles might get tired too. Your foot muscles might get tired. your calves, your hamstrings, maybe even your quads will get tired, but you should say, "Wow, my glutes are most tired of all." If you did that, then you're on the right track. You're doing what you need to be doing, activating your glutes while you're walking. Super important. If that is not the normal for you, then you're making your knee arthritis worse. The people that that are successful with improving their knee arthritis figure this out. They figure out how to tighten their glutes properly without their quads going crazy too, without their quads activating and dominating the motion. And then they figure out how to translate it into walking because walking is very important. You need to do that all the time. You wake up and you walk to the bathroom, walk to the kitchen, you walk to appointments, you walk to do things with people. You have to be able to walk properly. And it doesn't need to be perfect. This is something else that I run into with people all the time. They think that every step needs to be perfect and they start to get in their head about it.

[00:24:24]Think of it this way. If at least 80% of your steps are good, you're using your glutes properly, then you're going to be on the right track. So, said differently, if every eight out of 10 steps are good using your glutes, then then you're fine. That's that's going to be it's okay to have a bad step here and there. But if it's the inverse of that, if only two out of 10 steps are good, you need to fix that. You're still going to have knee problems. you're still going to be using your quads the other eight times and it's not going to be helping you out. So, you got to figure out how to how to do this walking thing properly. And for some people, it's even like embarrassing because they'll tell they'll say out loud when we're working with them here in person, I have to learn how to walk again. I thought I knew how to walk. Are seriously we're spending time on walking? I I can walk.

[00:25:16]They're debating it with me. And I'm thinking in my head, I have to run them through this logical part of it. I have to tell them, do you use your glutes when you're walking? Cuz if not, you're you're making it worse. So, yeah, you have to learn how to walk again. Get those glutes working while you're walking. Number nine is you need to get on the walker or the cane. If you're having pain while walking, while on your feet, if you weightbear, if you put weight through your foot while standing and your knee hurts, it means that your knee is so irritated that it can't take your normal body weight right now.

[00:25:51]Forget losing weight. We're just talking about right now in this moment because you can't shave off 10 pounds in an instant. Even in a day or two, even in a week, it's not the healthiest thing to do. So, if you hurt when you're on your feet, just get the cane out. What people are afraid of with the cane and the walker is that once they start to use it that they're never going to stop using it because that happens a lot. But the reason why it happens is because those people don't have guidance on how to get out of it. They don't have guidance on how to strengthen properly. They keep doing quad exercises and so they end up continuing to have knee pain. Their knee arthritis stays flared up and it progresses over time because they're not doing the right things to reverse it or to to calm it down and get the muscle in proper balance to reverse the muscle imbalance.

[00:26:46]But if you're following what I'm giving you here, these 11 rules that people are following to get out of knee arthritis problems, then use the cane wisely. Use the walker wisely. If you have to get around throughout the day and you know it hurts you to do so, you know, if you your normal chores, tasks you have to do, but if you get that cane out, it's going to buy you more steps. It's going to buy you more time because if you can put pressure on the cane with your hand and offload your painful knee, then you all of a sudden you have an extra 5 10 minutes each time you go up and and walk. And that adds up to 30, 60, maybe even 90 minutes in a day. So you can still be productive. You don't have to cut back on as many things to rest your knee. So use the cane. But as long as you're doing the glute strengthening, you're getting your glutes to activate properly. What you should find is there comes a point where you say, you know what, I don't why am I even carrying this cane around? I can walk. My knee doesn't hurt anymore.

[00:27:46]That's a good place to be. Your balance is probably going to improve too once you work on your glutes properly. A lot of people have balance problems. They get this isn't even related to this tip list, but it but you might have balance problems. If you're primarily using your quads every time you stand and lose your balance and you don't have much activation from back here, well, it's no wonder why you take spills every now and then. It's no wonder why you have to catch your balance. You don't have proper balance. Number 10 is don't freak out when the surgeon or a doctor tells you that you've got arthritis in your knee. This happens all the time. I get patients that come in, first diagnosis ever of knee arthritis. they haven't been anybody else yet and they're so worried because it's a sign of their age. It's a sign of their that's how they interpret it anyway. It's a sign of of their their knee actually having a real problem tied to the pain. And the doctor might even drop, hey, you might need a knee replacement someday, which just scares the be Jesus out of people.

[00:28:47]It it's should I mean, maybe they should say that. I don't know. I debate on whether or not they should be telling people they need knee replacements or not. I think it's okay in that they're telling them where this could lead to, but to say something like you're going to need a de with definitiveness, like they'll jokingly say, "Come back and see me in 5 years. We'll replace that need for you." I think that's not being courteous. But I think they're also saying that out of their experience and what they what they tend to see. So, you know, they they're trying to help people at the end of the day, but they freak people out when they say that. And it's not nice in my opinion because I'm having to undo all that because in reality if you have, you know, grade 1 2 3 4 knee arritis, whatever it is, it could be it could look like the worst knee arthritis in the world on your X-ray.

[00:29:36]If your knee can bend pretty good and straighten pretty good, then chances are that you're going to get better if you do the right things.

[00:29:45]Now, if you just acquies, if you just give up and you're and you just say, "Well, I'm I'm 75 now. It's happened to my dad. It's happened to my mom. Grandpa went through this back in the day. It's my turn." If you have that kind of a mentality about it, then you're Yeah.

[00:30:02]You're going to get worse because you're not going to take any active steps towards fixing the root muscle imbalance that could actually make you better and enjoy the last years of your life.

[00:30:11]Because if you get those quads to calm down, get those glutes stronger, get the feet stronger, figure out how to get your glutes to activate at the right times, walking, offloading, you can probably be just fine despite what the X-ray says. And this is being shown in research. You can have terrible looking X-rays, terrible looking MRIs, but feel painfree, but be active.

[00:30:37]The X-ray is a definitive. It's just a snapshot of what your joint looks like on the inside, but it doesn't mean that the joint can't function. It doesn't mean that you can't improve the muscle imbalance. So, don't worry about what the X-ray says. It's It's good to know.

[00:30:52]I'm not saying ignore it completely.

[00:30:54]It's good to know. It's good to have an idea. It's good to have it helps us to set expectations because yeah, if you have grade four knee arthritis, it's if it's pretty far far gone and then I'm putting that if I'm seeing you in person or if I'm talking to you on one of our group coaching calls or if we're helping you in one of our one-to-one coaching calls as well, then we might be able to have a better idea on you might not be able to get back to running. You might not be able to get back to kneeling down this much or for this long. we can build some some better expectations for you.

[00:31:28]It helps in that sense. But what you shouldn't do is just give up and say, "Well, I'm screwed. It's grade three. I might as well start making arrangements to have a a knee replacement and and you know, get let's get the walker out now.

[00:31:42]Let's just let's just give up. Let's have them both done at the same time." I have people do that all the time. Well, this one's grade three and this one's grade one. This one's going to get catch up to this one anyway. might as well do both knees at the same time. And the surgeon's happy to do that because it's a two for one for them. Don't do that.

[00:31:59]Do the right thing. Do do the strengthening. Do right by your knees.

[00:32:04]Those knees have carried you around for a long time. They've carried you through relationships, family, kids, great achievements in your life. Don't replace them if you have the potential to get them better. Strengthen your glutes first. Fix the muscle imbalance. Get your feet stronger. Figure all figure out all those details. And I bet your knees still have a lot to give you.

[00:32:27]Number 11, it's kind of the next level of the number 10.

[00:32:32]Bone on bone. That's the other thing the doctors will say. They'll look at your X-ray and then they'll say, "Oh, it's bone on bone."

[00:32:40]As if as if you're you're done. Like it's the death sentence for your knee.

[00:32:45]That's how people accept it or interpret it. I get them to commit. They're convincing me. It's hilarious because I'm looking at them. They walk normally.

[00:32:54]They'll walk in the room and I'm watching them pass by. I'm I see them get in and out of chairs, get up onto the treatment table. I'll physically bend their knee for them and I'll compare to the other knee and I'm there's there's no major swelling going on. Nothing nothing looks extreme.

[00:33:13]And I'm telling my my patient the skinny patients too. Yeah, we have some overweight patients and they're concerned about their weight, but then we have some very thin patients that are bone on bone according to the X-ray.

[00:33:25]They're so worried and they're thinking about having a joint replacement already and they're coming to me as a second opinion.