Mike Smith PT, DPT

PT, DPT, CSCS

[Mike Smith PT, DPT @MichaelScott729]

@mitch_fretton I’m struggling with the fact VAR was allowed to review a no-call on the field. That violates their current rules, no? Should void the whole situation

[Dan Lorenz @kcrehabguy]

Insane. What are we doing? 160 pitches in an 11 year old!

https://t.co/p9sDofhnzl

[Mike Smith PT, DPT @MichaelScott729]

@mnemeth0960 @benlikessport Man we see what we want to see. Philly fans everywhere in shock at the lack of offensive fouls called on the Celtics

[Mike Smith PT, DPT @MichaelScott729]

@asdfjkmark @AntSanPhilly lol

[Mike Smith PT, DPT @MichaelScott729]

@draapaah @NHLFlyers @FlyersTCenter Let’s goooooo!

[Howard Luks MD @hjluks]

I’ve been an orthopedic surgeon for nearly 30 years, and a few patterns have become impossible to ignore. One is that many musculoskeletal problems in adults aren’t sudden injuries. They’re the moment when declining capacity and awful metabolic health finally reveals itself.

Over the decades your strength fades, muscle mass declines, as your aerobic capacity tanks. Tendons and connective tissues lose substance, stiffness, and resilience. For years the body compensated... quietly. Then one day a knee hurts during a run to get the train, or shoulder aches reaching overhead, or a back tightens lifting something simple.

At that point the story usually becomes more about structural damage. An MRI gets ordered. Welcome to high-tech, low-medicine. And the MRI almost always finds something. A meniscus tear. A rotator cuff tear. A disc bulge. Why? Because by midlife these findings are extremely common — even in people with no pain at all. If you have a tear in one shoulder, image the other shoulder... you probably have the same tear there. But I digress.

Once the scan appears, the narrative changes. The image becomes the diagnosis. Now the patient believes something is broken, and the focus often shifts to fixing what the MRI shows.

What often gets lost in this is the reason the symptoms appeared in the first place. Many so-called “atraumatic” orthopedic complaints are not purely mechanical failures. They are the moment when reduced strength, declining tissue capacity, and sometimes broader metabolic health issues finally reach a tipping point. Our tissues change over the decades... get over it.

In other words, the MRI didn’t create the problem. Well... it sort of did in this scenario. But all the MRI showed was something that was already there.... because of your age, lifestyle, health and so on.

The real driver of symptoms is often loss of physiologic reserve. Less muscle. Less tendon or aerobic resilience. Less tolerance for load, etc.

Once the MRI enters the picture, the risk becomes overtreatment. This is probably the number one reason people have surgery. When in many cases the most powerful intervention was never the scan or the procedure.

It was rebuilding capacity.

Strong muscles stabilize joints. Aerobic fitness improves metabolic health and tissue perfusion. Gradual loading restores tolerance.

But people often don't take PT seriously prior to surgery. They often take PT very seriously afterwards. Therefore, PT is probably the reason you feel better, despite the surgery.

The irony is that the treatment many people ultimately need is the same thing that might have prevented the problem in the first place.

Staying strong. Staying active. Maintaining the reserve that protects our joints/tendons/muscles/abilities as we age.

[Mike Smith PT, DPT @MichaelScott729]

@NFL_DovKleiman

[Mike Smith PT, DPT @MichaelScott729]

@ScottFish24 Pierce vs Parker Washington vs Egbuka

[Mike Smith PT, DPT @MichaelScott729]

@Espngreeny No the officiating is a joke if they can’t see the late start. The play is fine. Call the false start on the Packers 4th down play too. Do better Greeny

[Mike Smith PT, DPT @MichaelScott729]

@Rate_the_Refs If this is PI then every single play in tight coverage has to be called. This is as good a coverage as you can ask for from a CB

[Mike Smith PT, DPT @MichaelScott729]

@PFF_Nicky What a stupid take. That’s what the defense gave him. We’ve already seen he can throw the ball down the field so what is the argument here??

[Mike Smith PT, DPT @MichaelScott729]

@AlZeidenfeld @jwindheim *He* didn’t but the process screws over players who are more deserving based on their performance for the entire first half of the season..

[Mike Smith PT, DPT @MichaelScott729]

@stoolpresidente @NickMensio Don’t disagree but it’s funny because if it was so automatic, every team would have the success the Eagles have. That’s not the case though.

[Mike Smith PT, DPT @MichaelScott729]

@NickMensio If everyone could do it, they would.

[Mike Smith PT, DPT @MichaelScott729]

@NickMensio Hahaha stop it

[Mike Smith PT, DPT @MichaelScott729]

@MatthewBerryTMR LOL you are such a whiner

[Mike Smith PT, DPT @MichaelScott729]

@SharpFootball What are you talking about?

[Mike Smith PT, DPT @MichaelScott729]

@SharpFootball Lots of missed calls on Carter so…

[Mike Smith PT, DPT @MichaelScott729]

@TrustTheClimb @thedanidennis Rent free bro 🤫

[Dan @danmurrays]

Timeless wisdom from Warren Buffett.