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Howard Luks MD

@hjluks • 90,471 subscribers

Orthopedic Surgeon, author, trail runner, very amateur cyclist. Exits x 3. Join 20,000 + subscribers on Substack.

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Nobody comes into my office and says they've been losing ground for years. They come in for a knee or a shoulder. But when you ask the right questions, a different story emerges. They stopped hiking because it got too hard. They gave up tennis. They hesitate before the stairs they used to take without thinking. They've quietly rearranged their lives around what they can no longer do... and most of them didn't notice it happening. This is what I think of as the narrowing of people's lives. It's not a dramatic event. Instead, it's a gradual shrinking of what's physically possible, so slow that people mistake the adaptation for a choice. It wasn't a choice. It was the slow, quiet disappearance of capacity that nobody warned them to protect. They normalized all the changes and attributed them solely to aging. The narrowing is not inevitable!! Dammit... it's not ;-)! But it requires intention to resist because the body will not hold the capacity to do things you do not train, and the losses accumulate in silence until they don't.

Nobody comes into my office and says they've been losing ground for years. They come in for a knee or a shoulder. But when you ask the right questions, a different story emerges. They stopped hiking because it got too hard. They gave up tennis. They hesitate before the stairs they used to take without thinking. They've quietly rearranged their lives around what they can no longer do... and most of them didn't notice it happening. This is what I think of as the narrowing of people's lives. It's not a dramatic event. Instead, it's a gradual shrinking of what's physically possible, so slow that people mistake the adaptation for a choice. It wasn't a choice. It was the slow, quiet disappearance of capacity that nobody warned them to protect. They normalized all the changes and attributed them solely to aging. The narrowing is not inevitable!! Dammit... it's not ;-)! But it requires intention to resist because the body will not hold the capacity to do things you do not train, and the losses accumulate in silence until they don't.

76,768 views

The loss of quickness and power that comes with aging is profound. These quickness drills look simple... but they're very humbling. Try them ;-) See what I mean.

The loss of quickness and power that comes with aging is profound. These quickness drills look simple... but they're very humbling. Try them ;-) See what I mean.

72,507 views

Jumps should be a key element in any 50+ training regimen. Why? We lose power, balance, and quickness (and bone density) far faster than strength alone as we age. By 50, you’ve already lost a lot if you haven’t been training it. These jumps also help build bone density—1 in 3 women, and 1 in 5 men have osteoporosis. Many, many people need to be doing jumping variations. Try adding some complexity by slightly altering the jump's direction. I’m jumping forward and slightly to the right on the first one. These little changes challenge our neuromuscular system. I released a long post yesterday about neuromuscular training, which included ~8 videos of other exercises using my Enough, Better, and Optimal framework. Link to the article below.

Jumps should be a key element in any 50+ training regimen. Why? We lose power, balance, and quickness (and bone density) far faster than strength alone as we age. By 50, you’ve already lost a lot if you haven’t been training it. These jumps also help build bone density—1 in 3 women, and 1 in 5 men have osteoporosis. Many, many people need to be doing jumping variations. Try adding some complexity by slightly altering the jump's direction. I’m jumping forward and slightly to the right on the first one. These little changes challenge our neuromuscular system. I released a long post yesterday about neuromuscular training, which included ~8 videos of other exercises using my Enough, Better, and Optimal framework. Link to the article below.

34,512 views

No. It’s not golf training;-). But it will work for it. The world throws us challenges that require being able to develop and absorb load in rotation. We need to be able to handle that. We need to train rotation. This one trains thoracic rotation. You bend, lift, turn, and place in life often. Picking up a box, turning, and putting it on the counter. Moving mulch or things around the garden. Prepare for life’s challenges. Train rotation.

No. It’s not golf training;-). But it will work for it. The world throws us challenges that require being able to develop and absorb load in rotation. We need to be able to handle that. We need to train rotation. This one trains thoracic rotation. You bend, lift, turn, and place in life often. Picking up a box, turning, and putting it on the counter. Moving mulch or things around the garden. Prepare for life’s challenges. Train rotation.

28,493 views

Far too many do not train to move in different directions. One of the keys to maintaining balance and our ability to conquer the landscape is to train in directions other than straight ahead... You can land on both feet if need be... but work to being on one leg if possible.

Far too many do not train to move in different directions. One of the keys to maintaining balance and our ability to conquer the landscape is to train in directions other than straight ahead... You can land on both feet if need be... but work to being on one leg if possible.

61,897 views

Simple looking jump... but it trains many skills we lose as adults.

Simple looking jump... but it trains many skills we lose as adults.

17,248 views

Throw the damn ball like you mean it.

Throw the damn ball like you mean it.

17,793 views

LFG :-). Heavy day... I always wait for my achilles to bark... and it never does :-).

LFG :-). Heavy day... I always wait for my achilles to bark... and it never does :-).

19,165 views

One drill... many different necessary training adaptations. What does this one movement train? Power development- the jump- single leg Absorb force- landing Change in direction: Balance and coordination. Then another power move forward- both legs File it under anti-ageing drills

One drill... many different necessary training adaptations. What does this one movement train? Power development- the jump- single leg Absorb force- landing Change in direction: Balance and coordination. Then another power move forward- both legs File it under anti-ageing drills

17,610 views

Maintaining muscle mass, strength, and function as we age becomes critical to our independence and quality of life. Three terms often come up in this discussion: sarcopenia, dynapenia, and powerpenia. Understanding these concepts and their implications can reshape how we think about aging and exercise. Sarcopenia is the age-related loss of muscle mass and function. It is defined by smaller muscles and a diminished ability to perform physical tasks. Sarcopenia is linked to frailty, mobility issues, and an increased risk of falls. However, muscle mass alone is not the most reliable indicator of functional ability. Dynapenia focuses on the loss of muscle strength, independent of muscle size. Strength is essential for tasks like lifting objects or climbing stairs. While strength is a critical component of function, it doesn’t account for the speed or explosiveness required in many real-world activities. Powerpenia is the age-related decline in muscle power, which is strength applied with speed. Power is often overlooked, yet it’s crucial for activities like rising from a chair, catching yourself from a fall, or navigating uneven terrain. Power combines strength with speed, making it the most functionally relevant metric for daily life and mobility. A recent article in Frontiers in Physiology (PMID: 10961295) highlights the critical role of muscle power in preserving functional independence. Research shows that power is more predictive of mobility, balance, and fall prevention than strength or muscle size alone. This finding shifts the focus from simply building muscle to enhancing the quality and speed of movement. Training to improve power—such as explosive movements, plyometric exercises, or lifting lighter weights quickly—can profoundly affect aging populations. The ability to generate force rapidly can mean the difference between a fall and staying upright or between dependence and independence. Sarcopenia, dynapenia, and powerpenia represent interconnected challenges of aging. However, prioritizing muscle power offers a unique opportunity to address the most functionally relevant decline. While maintaining muscle mass and strength is important, integrating power-focused training into your routine may yield the greatest benefits for preserving mobility and preventing disability.

Maintaining muscle mass, strength, and function as we age becomes critical to our independence and quality of life. Three terms often come up in this discussion: sarcopenia, dynapenia, and powerpenia. Understanding these concepts and their implications can reshape how we think about aging and exercise. Sarcopenia is the age-related loss of muscle mass and function. It is defined by smaller muscles and a diminished ability to perform physical tasks. Sarcopenia is linked to frailty, mobility issues, and an increased risk of falls. However, muscle mass alone is not the most reliable indicator of functional ability. Dynapenia focuses on the loss of muscle strength, independent of muscle size. Strength is essential for tasks like lifting objects or climbing stairs. While strength is a critical component of function, it doesn’t account for the speed or explosiveness required in many real-world activities. Powerpenia is the age-related decline in muscle power, which is strength applied with speed. Power is often overlooked, yet it’s crucial for activities like rising from a chair, catching yourself from a fall, or navigating uneven terrain. Power combines strength with speed, making it the most functionally relevant metric for daily life and mobility. A recent article in Frontiers in Physiology (PMID: 10961295) highlights the critical role of muscle power in preserving functional independence. Research shows that power is more predictive of mobility, balance, and fall prevention than strength or muscle size alone. This finding shifts the focus from simply building muscle to enhancing the quality and speed of movement. Training to improve power—such as explosive movements, plyometric exercises, or lifting lighter weights quickly—can profoundly affect aging populations. The ability to generate force rapidly can mean the difference between a fall and staying upright or between dependence and independence. Sarcopenia, dynapenia, and powerpenia represent interconnected challenges of aging. However, prioritizing muscle power offers a unique opportunity to address the most functionally relevant decline. While maintaining muscle mass and strength is important, integrating power-focused training into your routine may yield the greatest benefits for preserving mobility and preventing disability.

27,372 views

Orthopedic surgeons' work involves a lot of load in rotation. Rotational and lateral training is often absent except for athletes. Aside from the benefits to all adults in terms of protecting ourselves from the balance issues and falls accompanying aging, working on lateral movement alone or in combination with rotation is vital to building our resilience for a long day in the OR.

Orthopedic surgeons' work involves a lot of load in rotation. Rotational and lateral training is often absent except for athletes. Aside from the benefits to all adults in terms of protecting ourselves from the balance issues and falls accompanying aging, working on lateral movement alone or in combination with rotation is vital to building our resilience for a long day in the OR.

14,980 views

Deep squats … Balance and isos And some explosive work. Well. Not so explosive 😂 Fear the downsides of not doing these more than the fear of injury from doing these

Deep squats … Balance and isos And some explosive work. Well. Not so explosive 😂 Fear the downsides of not doing these more than the fear of injury from doing these

19,287 views

My workouts have changed a lot over the last few years. We lose power and balance far faster and more dramatically than muscle mass alone. I like to start with isos to warm up. Then some power blocks… and some “balance” work- even if it’s horizontal

My workouts have changed a lot over the last few years. We lose power and balance far faster and more dramatically than muscle mass alone. I like to start with isos to warm up. Then some power blocks… and some “balance” work- even if it’s horizontal

11,924 views

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We have the script all wrong. Why falls are a common cause of death…
0:40
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We have the script all wrong. Why falls are a common cause of death…

Howard Luks MD

527,973 views • 2 years ago

Orthopedic surgery office based decision making isn’t easy …
2:31
hjluks's profile picture

Orthopedic surgery office based decision making isn’t easy …

Howard Luks MD

331,027 views • 2 years ago

The Most Dangerous Phrase in Midlife Fitness: “I Used To…” “I used to run faster.” “I used to lift heavier.” “I used to train every day.” I hear this constantly. In the office. In the gym. From people who still care deeply about being capable… yet are often injured. I always ask patients what sports they play. Not uncommonly, they’ll answer football or basketball. I’ll ask when they last did it… the answer is universally— in college or high school. Then a spark woke them up, and they tried to get back to the things they did 20-30 years ago. While that’s not impossible, it requires a far different approach. The problem isn’t remembering the past. It’s training as if the past is the standard you still have to meet. When training is anchored to past ability, the focus shifts away from adaptation and toward proving something. Over time, that almost always leads to frustration, injury, disengagement, and a visit to my office. Midlife isn’t about reclaiming an earlier version of yourself. That version lived in a different body, with different recovery capacity, different stress, and different biology. What you have now is a different body. Not a broken one. Not an inferior one. Just different. But one that is still able to adapt and achieve. The people who age well in sport and in life understand this sooner rather than later. They stop chasing intenisty volume for its own sake. They become more selective about intensity and focus on consistency. They leave room for recovery. They care less about what a workout looks like and more about what it allows them to do tomorrow. They aren’t lowering standards. They’re changing the rules… they’re adapting. For the longest time, I didn’t do this. I was working out in my late 50s as I did in my 20s… and I was often hurt or aching enough that the next day was a bust. The question stops being, “Can I still do what I used to do?” It becomes, “What do I need to do now to stay strong, capable, and independent ten years from today?” That shift isn’t quitting. It’s about choosing healthspan… and adapting to what the passage of time demands. —Howard
0:39
hjluks's profile picture

The Most Dangerous Phrase in Midlife Fitness: “I Used To…” “I used to run faster.” “I used to lift heavier.” “I used to train every day.” I hear this constantly. In the office. In the gym. From people who still care deeply about being capable… yet are often injured. I always ask patients what sports they play. Not uncommonly, they’ll answer football or basketball. I’ll ask when they last did it… the answer is universally— in college or high school. Then a spark woke them up, and they tried to get back to the things they did 20-30 years ago. While that’s not impossible, it requires a far different approach. The problem isn’t remembering the past. It’s training as if the past is the standard you still have to meet. When training is anchored to past ability, the focus shifts away from adaptation and toward proving something. Over time, that almost always leads to frustration, injury, disengagement, and a visit to my office. Midlife isn’t about reclaiming an earlier version of yourself. That version lived in a different body, with different recovery capacity, different stress, and different biology. What you have now is a different body. Not a broken one. Not an inferior one. Just different. But one that is still able to adapt and achieve. The people who age well in sport and in life understand this sooner rather than later. They stop chasing intenisty volume for its own sake. They become more selective about intensity and focus on consistency. They leave room for recovery. They care less about what a workout looks like and more about what it allows them to do tomorrow. They aren’t lowering standards. They’re changing the rules… they’re adapting. For the longest time, I didn’t do this. I was working out in my late 50s as I did in my 20s… and I was often hurt or aching enough that the next day was a bust. The question stops being, “Can I still do what I used to do?” It becomes, “What do I need to do now to stay strong, capable, and independent ten years from today?” That shift isn’t quitting. It’s about choosing healthspan… and adapting to what the passage of time demands. —Howard

Howard Luks MD

70,380 views • 5 months ago

And alongside the loss of quickness is the loss of power. Learn to absorb force- the landing-- and produce the force-- the jump. The change of direction is key- we lose these spatial abilities, too. Yes... I miss a few- so what... that's what training is all about.
0:23
hjluks's profile picture

And alongside the loss of quickness is the loss of power. Learn to absorb force- the landing-- and produce the force-- the jump. The change of direction is key- we lose these spatial abilities, too. Yes... I miss a few- so what... that's what training is all about.

Howard Luks MD

49,300 views • 5 months ago

Workout cheat codes I know at 60 that I wish I knew at 25: Consistency beats intensity. One hard week won’t change your life. Thirty years of steady effort will. Strength is the fountain of youth. Muscle protects joints, maintains metabolism, is the largest glucose sink, and slows aging far more than I realized. Most of your muscle is in your legs... train them! Power fades first—train it. Jump, sprint, throw, push explosively. Even in small doses, it keeps you athletic. Sleep is training. Recovery is the multiplier. Ignore it, and every gain is short-lived. Pain is feedback, not failure. Learn the difference between “working hard” and “breaking down.” Mobility is freedom. Hips, shoulders, ankles—guard them like gold. Once lost, everything else shrinks. Chasing numbers is a trap. Longevity comes from movement you can sustain, not personal records that wreck you. Small wins compound. 10 minutes a day is better than 0. Forever beats temporary. Fuel matters. Protein isn’t just for bodybuilders—it’s protection against frailty. Don’t fear carbs. Just don't overeat and never reward yourself with food. Enough is the goal. Train to live fully, not to prove something. Life's physical stressors occur in rotation; Train it!
0:33
hjluks's profile picture

Workout cheat codes I know at 60 that I wish I knew at 25: Consistency beats intensity. One hard week won’t change your life. Thirty years of steady effort will. Strength is the fountain of youth. Muscle protects joints, maintains metabolism, is the largest glucose sink, and slows aging far more than I realized. Most of your muscle is in your legs... train them! Power fades first—train it. Jump, sprint, throw, push explosively. Even in small doses, it keeps you athletic. Sleep is training. Recovery is the multiplier. Ignore it, and every gain is short-lived. Pain is feedback, not failure. Learn the difference between “working hard” and “breaking down.” Mobility is freedom. Hips, shoulders, ankles—guard them like gold. Once lost, everything else shrinks. Chasing numbers is a trap. Longevity comes from movement you can sustain, not personal records that wreck you. Small wins compound. 10 minutes a day is better than 0. Forever beats temporary. Fuel matters. Protein isn’t just for bodybuilders—it’s protection against frailty. Don’t fear carbs. Just don't overeat and never reward yourself with food. Enough is the goal. Train to live fully, not to prove something. Life's physical stressors occur in rotation; Train it!

Howard Luks MD

41,339 views • 4 months ago

What does your warm-up look like? Every time in the gym or on the trail. This is mine. I might look goofy on the trail... but this gets the relevant systems warmed up.
0:47
hjluks's profile picture

What does your warm-up look like? Every time in the gym or on the trail. This is mine. I might look goofy on the trail... but this gets the relevant systems warmed up.

Howard Luks MD

17,481 views • 2 months ago

Tendon pain and “rest” I’m tired of seeing runners in a boot for AT 🤦‍♂️ This will piss off some too, all good. Let’s have a conversation.
2:08
hjluks's profile picture

Tendon pain and “rest” I’m tired of seeing runners in a boot for AT 🤦‍♂️ This will piss off some too, all good. Let’s have a conversation.

Howard Luks MD

47,294 views • 1 year ago

Do you really expect your MRI result to say "normal"?
1:48
hjluks's profile picture

Do you really expect your MRI result to say "normal"?

Howard Luks MD

48,502 views • 1 year ago

Lots of folks here say the average 50 yr old should squat their bodyweight and do 5 pull ups. Thats our bubble’s objective. Well. Most 50 year olds can’t. And they won’t even try. But… There are better objective tests for the average person in their 50s to see if they’re at risk for sarcopenia- or the pathological loss of muscle mass and strength.
1:39
hjluks's profile picture

Lots of folks here say the average 50 yr old should squat their bodyweight and do 5 pull ups. Thats our bubble’s objective. Well. Most 50 year olds can’t. And they won’t even try. But… There are better objective tests for the average person in their 50s to see if they’re at risk for sarcopenia- or the pathological loss of muscle mass and strength.

Howard Luks MD

33,808 views • 1 year ago

Creating content for large audiences is hard... I like to frame advice for how to exercise into 3 buckets. Enough Better Optimal yes... You can argue semantics about 'optimal,' etc., with me all day long. But keep in mind... most people out there are doing nothing. We need to help them move the needle. They're afraid to start... they're worried... they have a ton of questions... this is my lived experience in the office over decades. This was one of many topics in an awesome podcast recorded with Alan Couzens and Iñaki de la Parra today -- you'll need to wait to hear about the other 10 topics ;-).
4:10
hjluks's profile picture

Creating content for large audiences is hard... I like to frame advice for how to exercise into 3 buckets. Enough Better Optimal yes... You can argue semantics about 'optimal,' etc., with me all day long. But keep in mind... most people out there are doing nothing. We need to help them move the needle. They're afraid to start... they're worried... they have a ton of questions... this is my lived experience in the office over decades. This was one of many topics in an awesome podcast recorded with Alan Couzens and Iñaki de la Parra today -- you'll need to wait to hear about the other 10 topics ;-).

Howard Luks MD

11,499 views • 4 months ago

There were far too many runners in the office this week with arthritis-related questions... or some who have been told to stop running elsewhere... so... this.
3:45
hjluks's profile picture

There were far too many runners in the office this week with arthritis-related questions... or some who have been told to stop running elsewhere... so... this.

Howard Luks MD

24,328 views • 1 year ago

Surgeons who have done the same procedure thousands of times look calm and collected. That’s their experience showing … they’re still actively looking out for any unusual. We might be humming a tune, but we’ll react in seconds to anything that’s off.
2:42
hjluks's profile picture

Surgeons who have done the same procedure thousands of times look calm and collected. That’s their experience showing … they’re still actively looking out for any unusual. We might be humming a tune, but we’ll react in seconds to anything that’s off.

Howard Luks MD

16,419 views • 1 year ago

Orthopedic surgeons' work involves a lot of load in rotation. Rotational and lateral training is often absent except for athletes. Aside from the benefits to all adults in terms of protecting ourselves from the balance issues and falls accompanying aging, working on lateral movement alone or in combination with rotation is vital to building our resilience for a long day in the OR.
0:15
hjluks's profile picture

Orthopedic surgeons' work involves a lot of load in rotation. Rotational and lateral training is often absent except for athletes. Aside from the benefits to all adults in terms of protecting ourselves from the balance issues and falls accompanying aging, working on lateral movement alone or in combination with rotation is vital to building our resilience for a long day in the OR.

Howard Luks MD

14,980 views • 1 year ago

You’re not too old. You’re not too broken. And you’re not too far gone. I’m turning 62 in 2 weeks. I post videos of myself training, but not to impress anyone. I’m not chasing likes. I’m not trying to prove I’m elite. And I’m not pretending everyone should be able to do what I do. There was a time, like for many of you, when I struggled to find time to train at all. Three young kids. A demanding job. Little balance. Fitness wasn’t even on the back burner—it was off the stove entirely. But it came back. With work. With consistency. With a mindset shift. I don’t post because I think you should do exactly what I do. I post because I want to show you what’s possible. Because we lose what we don’t train. Because we assume age means decline. Because we assume the risk is too high. And because we assume—somewhere deep down that it’s too late. But it’s not. You may not aim to lift a certain weight or hit a specific number. But you can move better. You can get stronger. You can build resilience. And you can surprise yourself. This isn’t about showing off. It’s about showing up... to see what’s possible for you.
0:49
hjluks's profile picture

You’re not too old. You’re not too broken. And you’re not too far gone. I’m turning 62 in 2 weeks. I post videos of myself training, but not to impress anyone. I’m not chasing likes. I’m not trying to prove I’m elite. And I’m not pretending everyone should be able to do what I do. There was a time, like for many of you, when I struggled to find time to train at all. Three young kids. A demanding job. Little balance. Fitness wasn’t even on the back burner—it was off the stove entirely. But it came back. With work. With consistency. With a mindset shift. I don’t post because I think you should do exactly what I do. I post because I want to show you what’s possible. Because we lose what we don’t train. Because we assume age means decline. Because we assume the risk is too high. And because we assume—somewhere deep down that it’s too late. But it’s not. You may not aim to lift a certain weight or hit a specific number. But you can move better. You can get stronger. You can build resilience. And you can surprise yourself. This isn’t about showing off. It’s about showing up... to see what’s possible for you.

Howard Luks MD

13,397 views • 1 year ago

Muscle… it’s not about how it looks on you.
1:30
hjluks's profile picture

Muscle… it’s not about how it looks on you.

Howard Luks MD

16,415 views • 1 year ago

A short video...
0:55
hjluks's profile picture

A short video...

Howard Luks MD

15,618 views • 1 year ago

GLP1 medications and osteoarthritis. They are making a difference
2:12
hjluks's profile picture

GLP1 medications and osteoarthritis. They are making a difference

Howard Luks MD

12,864 views • 1 year ago

My workouts have changed a lot over the last few years. We lose power and balance far faster and more dramatically than muscle mass alone. I like to start with isos to warm up. Then some power blocks… and some “balance” work- even if it’s horizontal
0:15
hjluks's profile picture

My workouts have changed a lot over the last few years. We lose power and balance far faster and more dramatically than muscle mass alone. I like to start with isos to warm up. Then some power blocks… and some “balance” work- even if it’s horizontal

Howard Luks MD

11,924 views • 1 year ago

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