Howard Luks is an orthopaedic surgeon with almost 30 years in the operating theatre, and he spends a remarkable amount of his time telling people they do not need one. In this conversation we work through the joints that bring most people into a clinic, knees, shoulders, Achilles tendons and ankles, and try to separate what a scan is actually telling you from what it is being used to justify.
Most of us have been trained to read an MRI report as a verdict. A tear is a tear, and a tear needs fixing. Howard’s argument, built on three decades of clinical experience alongside the sham-surgery and physiotherapy-controlled trials that sit behind it, is that our language has raced well ahead of the biology. A great deal of what shows up on imaging is age-appropriate, painless, and shared by the people sitting either side of you. The harder and more useful question is which findings genuinely explain your pain, and what you can do to change the biology that produced them in the first place.
What We Cover
- Why “tear” may be the most damaging word in a radiology report, and what Howard would put in its place
- What the sham surgery trials actually showed for meniscus tears, rotator cuffs, labral tears and bone spur removal
- Why two surgeons can look at the same scan and give you two different answers, and how surgeons are paid
- What the phrase “bone on bone” does to a person’s behaviour, and why X-ray findings so often fail to match symptoms
- The role metabolic health plays in whether pain settles, and in how well you heal if you do end up having surgery
- Why tendons do not want rest, and what loading them properly actually looks like
- Where Howard lands on cortisone, PRP, stem cells and peptides such as BPC-157 and TB-500
- The training most people put off until it is too late: plyometrics, balance, power and quickness in your 50s and beyond
What I appreciated most here is how carefully Howard chooses his words. He is treating the person in front of him rather than the image on the screen, and he keeps coming back to what that person wants to be able to keep doing. That seems like the right place to start.
To connect with Howard Luks, read his writing on Substack or find him on X and Instagram.
- Most Patients Don’t Actually Need Surgery (00:00)
- What Sham Surgery Reveals About Joint Pain (03:50)
- When Surgery Helps And Who Profits From It (07:32)
- What AI And MRI Reports Get Wrong (13:47)
- Prehab, Healing And Normal MRI Findings (17:38)
- The Word “Tear” Is Making Pain Worse (21:56)
- Rotator Cuff Tears: Rehab Beats Rest (27:56)
- MRI Decisions, Tendinopathy And Returning To Sport (34:25)
- Knee Arthritis X-Rays And Bone On Bone (41:57)
- Exercise Or Knee Replacement: How To Decide (45:53)
- Cortisone, Hyaluronic Acid And PRP Compared (50:19)
- Regenerative Medicine Has Outrun The Research (55:12)
- BPC-157 And TB-500: A Surgeon’s Warning (59:24)
- Does Every ACL Tear Need Surgery? (01:03:31)
- Why Ankle Ligaments Heal But ACLs Don’t (01:07:03)
- Ice And NSAIDs Can Slow Healing (01:12:04)
- Train Power And Balance To Prevent Falls (01:17:17)
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More about Dr Howard Luks
Howard Luks, MD, is a board-certified orthopaedic surgeon with nearly 30 years of clinical experience and a longtime focus on helping people remain active, strong, and capable as they age. He is an athlete, author of Longevity…Simplified, and writer of Built to Move, Born to Heal, where he translates the science of exercise, musculoskeletal health, and longevity into practical guidance for navigating midlife and beyond. Most importantly, he is the proud father of three awesome kids and believes that staying healthy and capable is ultimately about being able to keep doing the things, and being with the people, we care about most.
