Kim Vopni (00:01.762)
Doctor Von der Wright, this has been a long time coming. I know that I've been a bit of a stalker and I'm really glad to have you here finally.
Dr Vonda Wright (00:07.751)
I'm so thankful for you. I'm so sorry.
Kim Vopni (00:11.63)
You have been busy. You have been busy. I think the very first time I messaged you was sort of as you were on your upward trajectory. And then you now have kind of taken over the world in a very positive way. And I am incredibly excited for this conversation. I love your work. Please tell people what you are, you walk onto stage waving a femur.
Dr Vonda Wright (00:27.921)
Thank you.
Dr Vonda Wright (00:32.677)
It's my steamer. don't have it here today, but look I do have. I have the rod we fix them with. god. I know. It's daunting, right?
Kim Vopni (00:38.208)
Okay, interesting. Okay. That and that looks really, you know, you you sometimes you want to know what's happening, but then other times you're like, just don't tell me what a hip replacement is, and yeah. Yeah. Yeah. Yeah. That is is yeah. Anyway, okay, so tell us what got you in, you're an orthopedic surgeon, what got you so passionately involved with bone health. Obviously, you chose a profession associated with that, but
Dr Vonda Wright (00:48.227)
Now this is the femur look what it does do you really want that? my god
Dr Vonda Wright (01:06.843)
Yeah.
Kim Vopni (01:08.034)
Who who are you? What do you do and why are you so passionate about this topic?
Dr Vonda Wright (01:11.367)
Absolutely. Well, number one, thank you. I was never avoiding you, but I'm so thankful to get to be in your presence at conferences and I love to hear you teach because the pelvic floor is skeletal friggin muscle. And that is all I do is skeletal muscle, bone, tendon, ligament, you know, the eight tissues in the skeletal system.
Kim Vopni (01:32.024)
Mm-hmm.
Dr Vonda Wright (01:37.486)
So I'm thankful for your work. So I am an orthopedic sports surgeon, meaning that I did all the orthopedic training and extra years in sports. And so I was one of the first hip arthroscopists in the country, which is adjacent, right adjacent to the pelvic floor. And many times pelvic pain, rectal pain, vague pain down there is not the hip.
Kim Vopni (01:54.157)
Mm-hmm.
Dr Vonda Wright (02:02.915)
I mean, we've had to be very specific to point with one finger where you think your pain is and totally not the hip, right? So our work is adjacent. my addition of women's health came in 2013 when, you know, I've always done orthopedics in elite sports. My research is all in musculoskeletal aging, but I read these data. In 2013, I read the data that women make 80 percent of all the health care decisions in this country for our
Kim Vopni (02:09.858)
Yeah.
Dr Vonda Wright (02:32.809)
and everyone we touch. And in talking to women, I knew for sure that we did not realize the power we had and that if we wanted to change the health of this country, then we have to change the health of the women. And so I added this third bubble to my Venn diagram of what I do and to really be concerned with the health, the whole health of a woman. So there is never very few times, even in my
orthopedic clinic where I happen to be sitting now, where someone will come in with a joint issue that we don't address her whole health, especially now that I'm so into this. So that's how I got to this place. But the reason, as you say, my messaging has skyrocketed because I've been basically, I'd like to claim that I've only been doing this a couple of years. I have literally been talking about this my whole career, but I believe that the public are,
are finally ready to listen to how aging can be powerful, how aging can be active. So now that's why this messaging and the, my call to action is, if you do nothing, I have seen your future in its frailty.
but we can step in front of this in the age with power. And that's what this book, Unbreakable, was about. This was the next step in, okay, now you're learning more about perimenopause and menopause. What do you do now? How do you design a future that you actually wanna live? And so it's really become, when I get like this, I instantaneously, my energy went up.
It's just because I can't help it. It's like this passion. Like I have been doing orthopedics so long that I am devastated. And you've probably been in places with me where I start to cry on stage because I'm describing yet another woman that I have to put this in. And it doesn't have to be that way. So, and one of the reasons...
Kim Vopni (04:33.624)
Mm-hmm. Mm-hmm.
Dr Vonda Wright (04:42.563)
that I appreciate your work so much is not only because you're a calm force in the universe and I like the way you teach. So many women are incontinent and 80%, is that the right data? Nobody talks about it. Even the athletes that we see box jumping in the Reebok, whatever the CrossFit games, holy cow.
You know, let's just say it, right? So I'm gonna say this on your podcast. When I don't train the way I train, even for a little while, my pelvic floor gets weak. And I have...
Kim Vopni (05:22.284)
And some people would say the opposite, say if they do train, like 'cause I watch how you train, some people would say, I can't do that because of my pelvic floor. But yeah, interesting. Yes.
Dr Vonda Wright (05:26.535)
No, the stronger I am, the less issue I ever have with urgency, frequency, frankincontinence. And I've only had one baby, plus menopause, whatever, right? So anyway.
Kim Vopni (05:44.973)
Yep, yep. Yeah, I love that. The the stat that that I share a lot is forty six percent of women stop exercising because of their pelvic chloro dysfunction. And in this it was I can't remember the exact number, five thousand ish people. It was a lot of the younger generation. At the time when we're kind of you even past the t the technical peak bone mass, what is the peak the the period of time when our peak bone mass is?
Because we're coming to this and you're seeing the women way beyond the point where you know, not to say that it's too late to make change. We know that we can, but as to your point, we're waiting for these problems, we're waiting to screen, we're waiting for all this. So when is our peak bone mass and why does it decline? What contributes to us losing our bone mass?
Dr Vonda Wright (06:30.396)
Yeah.
Dr Vonda Wright (06:34.887)
So I love that you've asked me this question because bone health and osteoporosis is not an old lady disease. It presents as an old lady, but it begins in our teenage years. So the minute you go through puberty and your estrogen's rising and your growth plates are closing for women, you are laying down peak bone mass, 13, 14, 15, which tops out...
Many people, many papers believe late 20s by 30 definitely. So the higher the peak.
the better the start. But you know what I see, and there are data out of lots of universities, lots of my colleagues at big universities had the foresight. When I was a Division I doctor, I didn't do dexa scans on these girls. I would have now going back. But these doctors that do find bad bone density in very young women. And so now in my clinic, I do dexa scans on everybody who will let me, and I find 30, 40,
very young women with devastatingly low bone density because Kim.
they didn't build enough bone in their teenage years. Maybe because, let's give them the benefit of the doubt. We've had Title IX since 1972. Maybe they're just so athletic that they're burning so many calories that they skipped their periods for six to nine months. I did that, I was a dancer. At the time I'm like, yes, now I know that was devastating, right? Or maybe it's because we've raised everybody now as a digital native on their phones. They're not running around like,
Kim Vopni (08:05.08)
Mm-hmm, mm-hmm.
Kim Vopni (08:12.12)
Mm-hmm.
Dr Vonda Wright (08:14.541)
People used to go outside. Don't come back till it's dark or maybe Once again young girls are being taught that the skinniness is the only way to live and they're underfeeding and we're in relative energy Deficiency all the time and you don't lay down bone when you do that The other reason we don't lay but down enough bone when we're young is vaping Smoking has not is no longer in vogue by and large versus when we grew up when it was still a thing but they
Keeping is just as bad for bone. So those are all the reasons that young women may not lay down enough bone and peak around 30. So I call 35 to 45 the critical decade.
to let's get our health standards together. Let's get our habits together so that we're not catching up. Let's learn all the things. Let's eat enough food while we still have our hormones.
Kim Vopni (09:15.202)
Yeah. Yeah. The the piece about the the energy relative energy red red us, you know, whatever terminology, low energy, that is something that now in today's day, so it all of a sudden it w we went through this, you know, you and I are roughly the same age. We went through, you know, skinny is everybody needs to be skinny and thin and whatever. That's where we grew up. And then it became a
Dr Vonda Wright (09:23.505)
Reds.
Kim Vopni (09:42.381)
Change. And then all of a we came to the opposite where it was bot the body positivity movement. Then briefly, yes, but that has come to a very abrupt halt. And the other day you made a post about the skeletonization of women, which was highlighting this now. You see the the people we see in the media, you see very, very, very, very skeletal, very skinny, skinny people that is now being
Dr Vonda Wright (09:46.801)
Briefly, briefly, Kim.
Dr Vonda Wright (09:56.699)
right?
Kim Vopni (10:09.102)
And so all of a sudden body positivity is gone, and everybody who was in that movement is now thinner, and you we can we can the elephant in the room is GLPs. No shame in them. They're playing an incredible role for so many people, and there's so much evolution. So I I don't I don't mean to say this from a judgment perspective. However, we have implications from those medications we need to talk about specific to our muscle mass. So tell me a little bit about that.
Dr Vonda Wright (10:23.697)
Basically, it works.
Kim Vopni (10:37.176)
post that you made and what you were wanting to highlight there.
Dr Vonda Wright (10:40.123)
So the point of this post, which I generated a graphic, I described the skeletonization and the fact that it is not okay that when I look at a photograph of someone that I can identify all 206 bones by name, that is not normal. That is not okay with me. That I can see the joints of...
versus skeletal longevity, which is my entire mantra about the thing that's gonna make us frail is loss of muscle bone, tendon, ligament, cartilage, right? And that there's a difference.
And I was trying to point out that one leads to aging with power and frankly, freedom to get to do what we wanna do and the other one is gonna end you up in my OR. Because people don't realize that GLP-1's done well under supervision of people who actually care about your future can be life-saving.
Done well to me means body composition before you start. So you know what we're made of, how much muscle, how much, if you can get a DEXA scan, how much bone, how much visceral fat. A diet that will probably be in calorie deficit, but not protein deficit, right? Because you can still maintain muscle with enough protein.
even if the calories, studies have been done, these are well studied. And resistance training to build or maintain muscle.
Dr Vonda Wright (12:23.257)
We know that you can still recompose your body and lose the weight you want, lose the fat you want without sacrificing your muscle when done well. But what happens when skeletal becomes the goal, and the reason I was raging about it, or not really raging, I was so sad, Kim, I'm so sad, because for the brief time that...
Kim Vopni (12:45.006)
Mm-hmm.
Dr Vonda Wright (12:50.011)
We were body positive, like Iona Mahler, the rugby player, right? Strong bodies come in all sizes, right? My size, your size, her size. I thought that the residents that I trained might be out of a job, right? That's never gonna happen now. We're gonna have two more generations of frail women breaking bones.
Kim Vopni (12:58.606)
Mm-hmm.
Dr Vonda Wright (13:16.583)
So when I say the skeletonization, I am just trying desperately to make people aware that the visual that people are trying to achieve is actually gonna kill them due to frailty. And the stat for that is more people die after hip fracture than of any kind of cancer and heart disease, 30 % in one year, right? So.
Kim Vopni (13:30.912)
Mm-hmm. Mm-hmm.
Dr Vonda Wright (13:44.548)
I think that we get to be healthy. I think we get to be lean. I know there are no shortcuts to that. It's possible to be healthy and lean without being skeletal.
Kim Vopni (14:01.73)
Yep. Yep. In I I don't it was a podcast, I don't remember where I heard it, but I've heard you say it multiple times in in your talks that you you you're in the E the hospital, there you go to the ER, there's a woman on the bed and she has broken her hip and she is lying in a pool of urine because she is incontinent. And my my kind of mantra and and passionate promotion is that this
Dr Vonda Wright (14:23.804)
Yeah.
Kim Vopni (14:30.646)
loss of skeletal mass as we're aging, whether whether you're using a GLP or not, despite that, we're losing muscle. We are usually underproteined. We're not doing as much resistance training. Sometimes it's because of the pelvic floor, but also sometimes that is all well, not sometimes always that is influencing the pelvic floor as well. So if it's not the reason why you're not doing those things, it may be the reason why you end up falling and breaking your hip and ending up incontinent where they're your your your patient. What is the
Dr Vonda Wright (14:34.492)
Yeah.
Kim Vopni (15:00.546)
Like how often do you see incontinence as part of hip people who need hip replacements, people who have hip fractures, people who have hip osteoarthritis?
Dr Vonda Wright (15:13.905)
I am sitting here trying to remember the last time I had a little old lady with a hip fracture who was not laying in a pile of her own urine. Or two things, she's either laying in a wet bed because the nurses just can't keep up, it's a constant flow, or they're constantly changing the pads under her, or...
Kim Vopni (15:32.472)
Mm-hmm. Mm-hmm.
Dr Vonda Wright (15:39.696)
She's laying in a dry bed because she's got one of those little wiki sticks like a hot dog between her legs. I forget the brand, but it's blue, it looks like a hot dog. put it, it's like an external suction device. Or people are just like, she can't lay here in her urine because she's got a fresh hip incision. Let's put a Foley in her and get an indwelling Foley and then colonize her bladder, right?
Kim Vopni (15:45.528)
Mm-hmm.
Dr Vonda Wright (16:05.871)
I'm trying to remember the last time I had a dry bed on a woman because she didn't have an appliance attached to her and I frankly can't. Yeah, because, I mean, a simple orthopod explanation, right? So.
Kim Vopni (16:14.018)
Yeah.
Dr Vonda Wright (16:23.649)
Many of these older women have had multiple children, and we don't talk about this now. I'm definitely sure that nobody told them about their prolapse, their incontinence, their pelvic floor, and they definitely didn't have pelvic floor therapy before they had babies, which my daughters are now. Miracle of miracles, amazing. Train your pelvis to have a baby. So they never had any of that, and then...
Kim Vopni (16:41.166)
Mm-hmm.
Dr Vonda Wright (16:50.469)
The 80 year olds were offered hormones and then they were taken away. Like, okay, take them away. So then their skeletal muscle, the 60 year old, the 65 year old baby boomers got screwed. Can I say that on the podcast? They're the generation that never got hormones and they are mad. They are mad. Yeah, so there's so many reasons they're laying there in incontinence or they're at home in continent.
Kim Vopni (17:02.06)
Yep. Absolutely. You can say whatever like.
Kim Vopni (17:17.505)
Mm-hmm.
Dr Vonda Wright (17:19.159)
or with a frank UTI because of this constant, and they get dizzy and fall down and break their hip. Very few times do people break and then fall. It does happen because the bones are so fragile, but usually they slip and fall and then break.
Kim Vopni (17:23.501)
Or the
Yes, exactly. Yeah.
Kim Vopni (17:41.944)
Yep. Yep. And when you look at the research, it is one of the contributing incontinence is a risk factor for falls in the general population, not just the elderly population. And you know, we look at
Dr Vonda Wright (17:48.913)
That's it. Yes.
Dr Vonda Wright (17:55.238)
Yes, I didn't know that about younger women because there's plenty of 50 year olds out there who are on continent. Unfortunately, yeah, plenty of them.
Kim Vopni (18:00.512)
Yeah. yeah. Yes. And to your point, the you know, my my mom's generation, I she was in the women's health initiative era where she was on hormones but then felt bad for it, then was taken away and kind of back and forth on it. And you just they just didn't talk about it. You didn't talk about it at all. And there isn't w the information that we have now. And thankfully I do see pelvic health trending as I do see women's health in general and bone health and all the other things trending now and more people are talking about it, which is great.
Dr Vonda Wright (18:24.071)
Yes, you did.
Kim Vopni (18:29.998)
that being said, the people listening to this podcast most likely are not in the, I'm in my perfect area to build my bone. They're usually in the post-menopause where they may even have an osteopenia. somebody's told they have osteopenia or they like bone loss, or now maybe they have an osteoporosis diagnosis. What are the reasons why we are losing bone? And what is it about menopause that accelerates that? And then I'll follow up with what to do about it.
Dr Vonda Wright (18:52.997)
Mm-hmm.
Dr Vonda Wright (18:58.927)
So let's talk for two and a half seconds about bone biology. Like how do we build bone? How does it actually work? Well, there are multiple types of cells. I'm looking around for a bone. I'm in my office. You would think I would have a nice bone to show you. Within the hard structure of bone, the reality is we...
Kim Vopni (19:03.629)
Mm.
Dr Vonda Wright (19:21.127)
replace our bone every 10 years. It is a constant remodeling. So we have these cells, I always do this with this hand, the osteoclast.
Resorb bone, they create an acidic environment, they resorb bone because our bone, one of the job of bones, one of the many jobs of bones is to be the storehouse of the minerals that the rest of your body needs. Like calcium, what do need it for? Well, every chemical muscle contraction in your entire life, you need calcium. So we take it from our bones. Well, coming beside the osteoclast is the osteoblast who fills up the holes and remodels the bone. That's how the eating
in the building, we remodel our bone every 10 years. This is a very tightly controlled environment. One of the reasons that this environment becomes unbalanced with the osteoclasts taking more bone than the osteoplasts can build.
is because of estrogen. Estrogen helps control the crazy osteoclast. I've animated osteoclasts in my mind. They're insane. Everything's trying to control this constant biting of bone and estrogens. So what happens in perimenopause is we lose control of the osteoclast.
Well, what happens in perimenopause, right? It's a chaos of hormones, your body's desperately trying to maintain estrogen levels, and they're dropping. So that's one thing. But something that I am fascinated with, and I wrote a sub stack about it, and I'm gonna talk about it on the other channels, is the role of FSH. So as estrogen is declining, the brain perceives it, and it starts pumping out high levels of follicle stimulating hormone, whose job is
Dr Vonda Wright (21:08.861)
to help the ovary mature a follicle and make estrogen. So the brain's pumping this out. And that's one of the ways we diagnose or we say, you're in menopause now, look at your FSH, it's off the charts. There is a role of FSH in bone health. And it's thought that the higher your FSH,
the less bone you're making. So it's a double whammy, even in one little system. Estrogen's not controlling it, FSH is off the charts. So this is happening in perimenopause until menopause, average age 52 variable, unless it's surgical and we could talk about that.
you have no more or very little estrogen being made. So the osteoclasts are going crazy, FSH is permanently high, and bones are always at a deficit. So that's how it works, the biology, and why we need to do everything in the proverbial toolbox to halt the progression of this. And it's not one thing, it's many things. Yeah.
Kim Vopni (22:16.62)
Yeah. Yeah. So the the many I guess like let's go carry on that tangent. What are the many things we the we let's say somebody's listening and they say, well, I wasn't an athlete, I wasn't active, I du I I reached my peanut bo bo peak bone mass, however, but maybe it wasn't the most optimal. Now I'm postmenopause. you know, regardless of whether you're postmenopause or not, what are the essential things for building bone?
Dr Vonda Wright (22:41.628)
Yeah.
Number one, this always surprises people. I insist that we mobilize our mindset. If we think that aging is an inevitable decline and there's nothing we can do about it, then why are we gonna try? We're gonna grind through this hard time in our life. Listen, research has been done that shows that what we believe about aging directly impacts how we age. So number one, let's mobilize our mindset. Number two, we have to become completely literate about what's happening to us.
right now, whether it's the biology of menopause, the biology of bone, whether it's what actually is happening to my body? Can you please go get some lab tests? Can you please search out a DEXA scan, which will tell you your bone density or in the United States it's not as easy, in Europe and Australia it's more easy to get a REM scan, which tells you about bone quality because bone is not only has mineral
but it has the ability to bend slightly. And we actually need to know both, even though most of the literature talks about bone density, but you can't know until you know. So I think I've already said, I get decks of scans on everybody. So I had a 44 year old that I take care of.
people come to me for menopause care, a musculoskeletal-based menopause care, and she lived in another state and I sent her home, I said, go make your doctor get you a DEXA scan.
Dr Vonda Wright (24:16.185)
and the doctor because they just weren't, I'm not a one of bash doctors, but it's not in their mind. We were never taught. what insurance companies don't pay for DEXA scans until we're 65 when it's too friggin' late. So she went, he said, you're too young, you don't need it, you're so healthy. No, she insisted, she got it, and she's osteoporotic because maybe it's one of those things we talked about before when she was young.
But about 40 % of bone density is genetic. So if your mother shrank, there's a good chance you're gonna shrink due to osteoporosis. So become completely literate. Mindset, literacy, hormone optimization. You get to choose whether you optimize your estrogen progesterone and testosterone, but I insist that you do it based on facts, not fear.
Kim Vopni (24:54.638)
Mm.
Dr Vonda Wright (25:10.343)
It is not okay just to cop to the, oh my God, it causes cancer. Does it, really? Do we know that? No. The WHO has been largely refuted and subsequent research has shown that...
Kim Vopni (25:17.805)
Mm-hmm.
Dr Vonda Wright (25:27.111)
For most people, most of the time, estrogen benefits outweigh the risks, and yet it's still your decision, but you must make it based on facts. Hormone optimization, number four, if you have 30 minutes a day and can't fit in any extra time, you must go build some muscle and...
Kim Vopni (25:37.356)
Mm-hmm.
Dr Vonda Wright (25:47.324)
Bless your hearts, if you're trying to build endurance, then do five pounds 30 times. But if you really wanna build muscle, it takes heavier loads for fewer reps. Next, I think number five, we need to add jumping. The way the bone, the osteoblasts are stimulated to lay down more bone is because when you jump up and down, either from a standing or from an eight inch step, which is about all it takes,
Believe it or not, there's these little cells in your bone that are encased in bone, but they're connected by these little channels called canaliculi. When you jump, the fluid in those channels changes, and the miracle of your bone is that it changes the biomechanical signal to a chemical signal to the osteoblast that says, Vonda, the crazy woman is jumping up and down, you better build some bone in her, right?
So it's easy, 20 jumps a day, 10 in the morning before your coffee, 10 at night. It doesn't take any extra time. So that's jumping. Nutrition. Maybe we're at number seven now, nutrition. Bonus 50 % protein. You need a protein forward diet. You need calcium in your diet.
Not many of us anymore are fans of calcium pills, and yet that is consistently what I hear. Get your calcium from your diet. It's a little harder if you're not a dairy person, but you can take lactate. But it is not hard to get 1200 milligrams of calcium in a diet if...
In two thirds cup of Greek yogurt, get 300, right? You just have to be mindful. Now, none of us are perfect. I'm not perfect, I eat pretty well, but sometimes we need augmentation with things like magnesium. I'm a big fan of everybody taking magnesium for bones and other reasons.
Dr Vonda Wright (27:52.156)
Vitamin D, because most of us are not in the sun to make enough vitamin D, and bones need that to absorb the calcium from our diets. You know, there are some collagens like four to bone that have some data, not randomized control trials really, but the best data we have in women's health.
that shows that that's helpful for building bone. you know what, there are supplements, I have one that puts hydroxyapatite, it's a scaffolding of the bone. And more natural forms of calcium, like we get from red algae than we get from just atoms, for instance. So protein for nutrition, nutrition augmentation if we need it. And those are all the tools. And it doesn't...
Kim Vopni (28:38.348)
Mm-hmm. And the foundation and the fundamentals. Yeah.
Dr Vonda Wright (28:41.179)
Those are fundamentals, right? And the good news is that all those things I have listed, for the most part, are also good for your muscle and for your brains. mean, it's all those things. You know, we get all systems in one with those bone building things.
Kim Vopni (28:50.53)
Yeah. And your brain yeah, and heart.
Kim Vopni (28:59.382)
Yeah. When it comes to jumping, I've often thought of the footwear somebody has on, the the floor or the surface they're landing on, and also how they're landing. Are they landing flat foot on their heel, on their toe? Does that make a difference from a stimulation of the bone perspective?
Dr Vonda Wright (29:11.002)
and it's good.
Dr Vonda Wright (29:20.059)
Yeah, so there are studies that have been done on force plates that help us understand how much is walking, how much is running, how many times body weight is walking, running. I do retreats and at the retreats that we did, we made all the women jump up and down on a force plate. And even in the really thick, sold, like crazy walking shoes, they still generated four times body weight by landing hard. Now,
I don't know the data like dirt versus asphalt or I don't really know that that data has been done, but we know that you can generate four times body weight off an eight inch step, which is the height of the step of your house. And you can also generate it by jumping straight up and down and landing like you're mad.
Kim Vopni (29:54.605)
Mm-hmm.
Kim Vopni (30:01.934)
Mm-hmm.
Kim Vopni (30:05.783)
Mm-hmm.
Kim Vopni (30:12.43)
Mm-hmm.
Dr Vonda Wright (30:13.433)
Many women write me, however, number one, they haven't jumped in years and it scares them. Well, that's real. So don't start jumping high. Just drop your heels and then start with a two inch stepperobics box and stomp up the stairs. Just get over the mindset that you're going to break. Women are so not fragile. mean, think about what we do. I mean, our purses are heavier than four times body weight sometimes.
Kim Vopni (30:18.392)
Mm-hmm.
Kim Vopni (30:24.376)
Mm.
Kim Vopni (30:33.91)
Mm-hmm. Yeah.
Dr Vonda Wright (30:41.903)
I yeah, I would like to dispel the myth that women are fragile. Yes. So anyway, so.
Kim Vopni (30:46.818)
Yeah. Yeah.
If somebody was to land more on their toes to sort of soften the load, will there still be impact to the bone? And also the, you know, how straight or st I don't want to say you're not landing on a completely stiff leg, but you could land with more of a bent knee, which is gonna help from a pelvic floor perspective manage that load a little better, but will you still get some benefit to the bone?
Dr Vonda Wright (30:55.644)
Yeah.
Dr Vonda Wright (31:09.703)
It's best to, all the studies are done with landing hard on your heel like you're mad with a stiffer knee. That being said, part of my professional sports doctor job, I've taken care of three professional ballet companies. And those dancers are taught to land softly without a sound, but they have thick, hard bone cortices from jumping. So.
Kim Vopni (31:33.006)
Mm.
Dr Vonda Wright (31:39.141)
Do I want you to land softly like a dancer with no sound? Not actually, no, don't do that. But you still will impact the bones.
Kim Vopni (31:48.931)
Yeah. Yeah. magnesium. I just want to touch upon that quickly. Is there a form of magnesium? 'Cause there's many different forms. Is there a form that is better from a bone health perspective?
Dr Vonda Wright (32:01.063)
You know what, I don't know that answer directly. Usually I suggest not magnesium citrate, which is what we use in the hospital to move people's bowels. But magnesium is the primary element paired with L-3-anine or glycinate because of those two molecules effect on calming the brain. Because it's the magnesium, the primary element that the bone wants, the other two are accessory to the bone.
Kim Vopni (32:07.629)
Mm-hmm.
Kim Vopni (32:27.874)
Yeah. Yeah. I wanna kind of wrap up now from a a surgical perspective with hip replacements. So there are people who have I was just with a friend of mine. She is the same age as me, mid fifties. She struggled with osteoarthritis for years and had two hip replacements within three months of one another and changed her life and she got back to movement and everything is great.
Dr Vonda Wright (32:46.907)
Mm-hmm.
Kim Vopni (32:54.014)
She did not have any pelvic floor issues going in. she has not had any coming out. She had a lateral approach. I know there are different approaches. Posterior is the one that historically will will influence and cut through the the musculature, one of which being the obturator part of the pelvic floor. And that can sometimes use said
I believe some people don't even reattach it. So what is it about the different approaches that can influence the pelvic floor? and even what is it about hip challenges, hip arthrosteophilis? The reason somebody might need a hip replacement, what is it about that that can also influence the pelvic floor?
Dr Vonda Wright (33:35.876)
So as I think through that question, if you consider that, if this is the femur, if this is the hip, right, that the cup, the acetabulum, it's a cup, is in the pelvis, and the pelvic floor sits over here and comes around the back of it, and the femur sits into the cup, and in the back, back here,
You have all your external rotators coming up and attaching in the back, right? In the posterior approach where someone is laying on their side and the incision is actually behind, if this is the front of the femur, the incision is actually behind the femur, it's an easy approach. It takes like one and a half seconds. You know why? Because we make the skin incision, we make the fascial incision. They're the external rotators in all their glory. They sit there.
They sit there like that, it's beautiful. Just like the anatomy books. It's lice. The tendons are taken down and these little muscles just retract and there's the capsule. And then you open the capsule, you put in the cup, you put in the femur. Maybe, maybe surgeons now are putting them back, but the tendons are this big. I can't remember seeing them put back or if they were put back.
Kim Vopni (34:29.496)
Yeah. Yeah.
Dr Vonda Wright (34:54.433)
One stitch was put through the tendon and it was sewn to some fascial layer so that they're laying there like that. And who knows, who even knows if those stitches hold because for sure we walk hip patients the same day. So if I were repairing a tendon around a knee or in a foot,
It takes a month for the bone to send out Sharpies fibers and grab the tendon and heal it. We would protect that. Let's say the posterior approach, some nice surgeon is putting those back, are they even staying? So that leaves the whole posterior portion wide open and flapping in the breeze. So that's the posterior approach. No wonder it affects the pelvic floor.
The lateral approach is made directly over the lateral side. We spread through the skin, through the IT band and around the posterior portion of the femur, but then we elevate all that off. So it's up here like a flap of tissue. And we sew back the main incision.
Kim Vopni (36:07.362)
Mm.
Dr Vonda Wright (36:13.263)
So it's less damaging to the external rotators.
There has to be consequences to the pelvic floor because of the adjacency. And so I'll talk about what happens when muscles feel pain. But the anterior approach, we love it because it cuts through no muscle.
Kim Vopni (36:38.316)
Mm.
Dr Vonda Wright (36:39.139)
Once you're through skin, you go through intermuscular planes, right? You just spread the muscle and you're directly down on the capsule. And that's why it's so good for athletes is because we're cutting no muscle. That being said, let's talk about the role of pain and adjacent inflammation on muscle. When a hip feels pain, whether it's due to osteoarthritis or...
an injury, IT band, the body's not stupid. The body will shut down adjacent muscles. So if we're talking about the knee and you tear your ACL, what happens within one week is your quad atrophies by about 20 to 30%, visually atrophies in one week. That's not because the ACL is attached to the quads, that's because of the adjacent pain, swelling, it shuts down the quads.
Kim Vopni (37:26.85)
Wow.
Dr Vonda Wright (37:39.098)
So if you've got, now back to the hip, if you've got arthritis in your hip and you are grinding along for years and you're in pain and inflammation, it is no wonder that your glute atrophies and stops firing. Well, the pelvic floor is right next to the glutes. You have to know that they're atrophying. It would be an interesting study to stick a...
Kim Vopni (38:00.268)
Best friends with the glutes, yep.
Dr Vonda Wright (38:08.601)
I don't know how you would do this, an EMG on those muscles to see if they're even firing anymore, and at what degree of arthritis. the other thing we see is when the glute medius in arthritis a lot, the glute medius stops firing or frankly tears and detaches. That's when you see that lurching gait, called a Trendelenburg gait. It's lurching like
Kim Vopni (38:11.81)
Mm-hmm, mm-hmm, mm-hmm, mhm, mhm.
Dr Vonda Wright (38:37.083)
the Adams family guy. Like that. If the biggest muscles in the body are lurching, what's the little pelvic floor doing? So, stands to reason to me.
Kim Vopni (38:38.604)
Yeah.
Kim Vopni (38:48.706)
Yeah. Yeah.
Kim Vopni (38:53.786)
I I guess I wanna the final thing I just want to have highlighted is the study you did naming musculoskeletal syndrome of menopause. This, what led you to that study? I've also had Dr. Wittenstein on the podcast as well, who I know was part of that with you. Tell us a little bit about what brought you to that study, what was found, what what what do you want people to know about?
Dr Vonda Wright (39:06.151)
Yeah.
Yeah.
Kim Vopni (39:23.064)
That and why it's so important.
Dr Vonda Wright (39:25.287)
So you know what, I've been a surgeon since 1999 and I think that in listening to people, I had always heard the same things. I'm falling apart. I think I'm going crazy because people tell me nothing's wrong with me. And number three,
I have a very high pain tolerance and I didn't wanna come in today, which now breaks my heart. But as I was going through my practice and started experiencing perimenopause myself, I'm like, my God.
We have been missing so much of this because I myself had such horrible arthralgia, which is the total body inflammation due to loss of estrogen, which I think is many times misnamed as fibromyalgia. I mean, there's a whole study of fibromyalgia, but I don't think that all fibromyalgia is fibromyalgia. I think it is missed musculoskeletal syndrome of menopause. So as I started listening better,
because I finally understood in a real sensory way what women were talking about.
Kim Vopni (40:38.754)
Mm-hmm.
Kim Vopni (40:42.861)
Mm-hmm.
Dr Vonda Wright (40:43.687)
I dug deep, I went into the literature, I started pulling up what we knew. Oh my God, Kim, we have known about this arthralgia for a very long time. We have known about the arthritis of menopause for 100 years, 1925. 1925, nothing's been done about it. We have known about the relationship of estrogen to bone for 86 years, right? It goes on and on and on.
Kim Vopni (41:00.45)
Wow. Wow.
Dr Vonda Wright (41:13.681)
reading all this literature and nobody had been put it together because in the discussion section it would always be like, this seems to happen in women in their midlife. I wonder why that is. I I don't know. What's the common experience? We lose our estrogen. I thought, well, what would happen if a woman came to me and said, or most orthopods, my body hurts, my shoulder hurts, my knees hurt, my right hip hurts and I...
In 15 minutes that insurance allows us to talk to you, it is too many problems to solve. So I thought we have got to give this a nomenclature so that when a 46 or a 52 or a whatever age woman goes in, she can say, I am a 46 year old midlife woman, my estrogen is leaving, I think I have the musculoskeletal syndrome of menopause. It gives us all, whether we're clinicians or whether we're
individual woman, words to use, because I think words matter. Words matter.
Kim Vopni (42:17.282)
Yeah. Yeah.
Dr Vonda Wright (42:20.231)
And I know that we were right because this paper, which is a good paper, it's a review paper. It is not Nobel Laureate God's gift to the world paper, but it has been downloaded almost 550,000 times. put it, I know. To put it in perspective, Nobel Laureate papers are downloaded 100,000 times. And most research is never read by anybody except the researchers who publish it. This tells me that the need in the world
Kim Vopni (42:25.378)
Mm.
Kim Vopni (42:35.618)
Wow, amazing.
Kim Vopni (42:41.804)
Wow.
Dr Vonda Wright (42:50.235)
so great and women are hungry for information.
Kim Vopni (42:54.284)
Yeah. I'll have a link to that. That's really, really cool. I just remembered one thing I wanted to add two things actually. Testosterone and bone. Is testosterone helpful for bone?
Dr Vonda Wright (42:57.243)
Thank you.
Dr Vonda Wright (43:01.999)
Uh-huh. Less helpful, it helps control the osteoclast. What it's really been helpful finding is that things like after hip replacement, there is less need for assist devices, probably because of its influence on helping to stabilize the musculature of the core, right? So.
Kim Vopni (43:13.922)
Mm-hmm.
Mm-hmm.
Dr Vonda Wright (43:24.325)
We need more studies on that. I'd rather somebody take estrogen. If we're choosing, take your estrogen. Yeah. Yeah.
Kim Vopni (43:30.008)
Sure. Yeah. And then the final thing, really truly final question. you s I have s I have witnessed many people who you would consider they're very flexible, they're yoga people, they're they're very bendy. And a lot of them end up having hip replacements. And you there's there's a thought of, well, I don't want to stretch too much because it's gonna be problematic. It could be problematic. But
Is what is the role of mobility? So we've talked about resistance training, we talked about impact. What about mobility in specific? I'm talking from the hip perspective.
Dr Vonda Wright (44:03.943)
Mobility is critical in all parts of midlife health, right? So my framework is, I use a little framework called FACE, flexibility and mobility, joint range of motion, aerobics, carrying a load, which is weightlifting, and equilibrium and balance. But flexibility, if we allow our soft tissues to get really tight,
Kim Vopni (44:09.965)
Mm-hmm.
Dr Vonda Wright (44:31.075)
If you have arthritis and you're losing your joint space, your soft tissues will get tight. But if we do not pay attention to our mobility and allow our soft tissues to get tight, it stands to reason it increases the pressure across the joint. That being said, tight soft tissue around the joint, whether it's the anterior capsule, your iliopsoas, your hip flexor, or your glutes, changes your very motion patterns.
Kim Vopni (44:33.87)
Mm-hmm.
Dr Vonda Wright (45:00.859)
which begets injury, right? If you're walking with a stiff hip, you're gonna pull on your spine, right? So our bodies work best in full fluid range of motion. Can you be too flexible? Well,
You can be very flexible, but without a connective tissue disease like Eiler's Danlos, I haven't seen too flexibility be problematic. It's when your soft tissues will not support your joint and they become unstable that I see the issue with my patients. And even in those patients, I keep them in physical therapy forever to try to get some stability by using muscles. Yeah.
Kim Vopni (45:25.762)
Yeah. Yeah.
Kim Vopni (45:35.63)
Mm-hmm.
Kim Vopni (45:40.214)
Mm-hmm.
Kim Vopni (45:44.312)
Yeah. Where can people find your amazing book, Unbreakable? I recommend that to my community all the time. Where can they find you potentially work with you in person, find your website, all the things?
Dr Vonda Wright (45:56.141)
So my website is drvonda Wright.com so you can find me there. My book is on Amazon and every bookseller.
And I'm on Instagram every single day. It's my primary social media, although Facebook, it goes to Facebook. So if you want today's thoughts, like what my lunch is, it's there. you want the complete, know, what do I do now? Unbreakable has really become a workbook for midlife women, and I'm thankful for that. But it's all at drbondaright.com.
Kim Vopni (46:15.564)
Yeah.
Kim Vopni (46:32.558)
Amazing. Thank you so much. I will have everything in the show notes so people can find you in your book. Your wisdom is amazing and the work you're doing to spread the word about this is I I I every time I see you come on the stage with your femur, it just brings me so much joy. So thank you for all the work that you're doing.
Dr Vonda Wright (46:45.511)
business.
Thank you so much for having me.
