SEAPT

I’ve seen it time and time again throughout my career: a new patient walks into my office with knee pain, shoulder pain, or an MRI showing a meniscus tear, rotator cuff tear, arthritis, or “degeneration.” The implication is often immediate but that something is damaged, worn out, and in need of fixing.

But pain is rarely that simple.
One of the hardest and most important lessons I’ve learned in 30 years as an orthopedic surgeon is that imaging does not reliably tell us what hurts. Structural changes on an MRI do not automatically mean there is tissue damage requiring surgery. In fact, many of the so-called “abnormalities” we see on scans are often age-appropriate findings, not a sentence about your future.

I’ve seen far too many people rush into surgery because of frightening words on an X-ray report. But imaging alone should never guide the entire decision-making process. I run with people who have “bone-on-bone” knee X-rays and remain active, strong, and functional. There is far more to the story than what appears on a scan.

That realization changed the way I think about osteoarthritis. In the summer of 2025, I published a book here on Substack about knee osteoarthritis (OA), built from decades of clinical experience and conversations with thousands of patients living with knee pain. This series challenges the outdated “wear and tear” narrative and the myth that arthritis means you need to stop moving and start resting.

Instead, it explores what the evidence actually shows: how metabolic health, strength training, movement, recovery, and lifestyle profoundly influence pain, function, and long-term outcomes. It walks readers through the treatment process step by step and helps them understand if and when surgery should truly be considered.

If you’ve been told you’re “bone on bone,” that your joints are “worn out,” or that you need to stop being active, this is where I would encourage you to start.

The link is here: https://howardluksmd.substack.com/p/knee-osteoarthritis-book?utm_source=publication-search

Most people fear movement because they think it invites injury. The truth is the opposite. Not moving is what erodes strength, balance, and confidence. You don’t need intensity. You just need consistency. A few minutes a day. A walk. A bike. Anything that gets you going. The real danger isn’t in doing too much — it’s in slowly doing less until your limits disappear.