In the past, I might be harsher in jumping down someone’s throat if I heard too much ‘armchair doctoring.’ But being on guard around these conversations is a costly time sink.Physical Therapist Helping Patient Bend Their Knee Lately, I’m more mild-mannered and just let people think what they want about pain and injury.

But, and this is important when someone has a stage and an audience such as the JRE does, misinformation can travel much faster and have a far more negative effect on those it touches than idle chatter on the mat between two training partners who share knee pain.

If you’ve already read my initial Facebook post, scroll past the following section to the next part of the breakdown. If you haven’t, below is the exchange that made it clear that I should interject some natural medicine into the conversation:

In a Facebook message:

“Hey, Carlos, what are your thoughts regarding using a reverse hypermachine for back/disk issues?”

My answer went like this:

”It’s no prob at all. It is generally wise to strength-train your posterior chain, hamstrings, glutes, and back extensors. That piece of equipment is an excellent way to do it.”

Until now, I’d not heard the episode in full, but when I did…LOL. I just realized you probably heard this from the Joe Rogan/Danaher podcast, didn’t you?
Almost every gym has this equipment (the reverse hyper), but that doesn’t mean it’s the best piece or move to strengthen your posterior chain.

Here was the portion of the show that my training partner was referring to:

Episode Timer: 1:11:25 (D: Danaher, R: Rogan)

D: “I’ve developed a strong need for ibuprofen all of my life.”

R: “I have a machine I have to show you. It’s called a reverse hyper; have you ever heard of it? It’s a life changer.”

D: “Yeah, I’ve heard of it…” I can’t use one now because I have a hip replacement, and when you go up, it puts extreme shearing force on a hip replacement. I can do it with body weight, but I can’t do it with a weight.”

This exchange is typical of how people with pain share information. Person 1 is talking about pain. Person 2 commiserates and offers up some solutions. This is perfectly well-meaning, but the nature of pain and how we get out of pain is so far from a one-size-fits-all approach that this advice is almost meaningless. Making a blanket statement about a single piece of equipment, a single nutrition program, or a single exercise and how it will “change your life” is ridiculous. There is no cure-all. There is no BEST single anything. The best movers use a combination of approaches in their exercise, training, and nutrition programs to elicit their best results. Beware anyone who tells you they have found the single greatest answer to everyone’s problems because you can be sure they are wrong.

As I’d told my training partner, back to this example, the reverse hypermachine is excellent, but is it what he needs?

Are there easier-to-do options that are BETTER than the reverse hyper? Of course! There are dozens of moves that I’d recommend that would be better than the reverse hyper and that do not require this piece of equipment. Not to mention that literally every box gym ever opened has had this piece since 1960. Why would it be any more useful now than it ever has been? Silliness.

Another important thing to note is that this machine, and the movement of hip extension by itself (loaded or not), does NOT cause any issue with the shearing of a hip replacement or any part of the hip itself. I say this so folks with hip pain don’t assume they cannot perform these movements. They are very safe and helpful for strengthening the glutes, hamstrings, and posterior chain.

Danaher could have said, “Because of my specific hip replacement surgery, the surgeon didn’t want me performing any excessive hip extension past neutral.” Furthermore, suppose you read the current literature on the precautions we follow after hip replacement surgery. In that case, the anterior approach is much stronger than we’d known in the past, and the hip ligaments are highly unlikely to be disturbed by this motion. John Danaher is probably missing out on much of the good that can come from some work into hip extension.

I’m sure that when Joe Rogan exclaimed how excellent this piece was, it gave my friend a shot in the arm of hope. Otherwise, he wouldn’t have messaged me for validation. If Rogan had said that “this exercise I do has been helpful for the kind of weakness or pain that I had” and that “maybe it would be helpful for you too,” he’d have been more correct but might not have created any call to action.

Here are other portions of the episode where some clarification might help:

Episode Timer: 1:12:04 (D: Danaher, R: Rogan)

D: “Things didn’t become critical until my early 40s when, as the result of walking with a limp, my left hip started to become bone on bone. So the problems doubled…”

D: Needed to defer treatment/surgery due to fight schedules D: “Delayed the hip operation as long as I could. I was able to work effectively…”,  “…the best I could with my hip problems and, of course, the original leg (knee) problems.” “… at some point, it got to a point where literally if I walked down a NYC block, I’d have to stop … and wait for my hip to stop hurting. It became impossible to work with. I ended up getting a full hip replacement.

R: “So, that’s when they shear off the top of your hip, and they screw a bolt down in there with a new hip. … And how does it feel now?”

D: “Pain-free, which is a wonderful thing for me. Like any fake hip, it won’t be as strong as your real hip.”

This is where I would have loved to hear more about Danaher’s case, and I wished he’d reiterated this kind of disability. Many of us are so quick to consult a surgeon for pain and then have to weigh treatment options; some surgeons of which are quick to recommend surgery even when, for the most part, we are ambulatory and can train and live without too much trouble. Danaher here describes some pretty crippling disability before he made the call to have his hip replaced. This is the best possible situation. It sounds backward, but as for long-term results, you want to hold off on these surgeries as late as possible. Once you go in, there’s no getting things back to “standard issue,” and new pain and restrictions start adding up.

The other issue that should be clarified is Rogan’s apparent misunderstanding of how hip or joint replacements go. “Shearing off the hip” and “screwing a bolt down there.” Surgeons work hard to preserve as much native bone as possible. The impression that the hip is “ripped apart” or roughly treated is not an accurate visual. Also, the “rod” that he is referring to is placed into the femur in such a way as to provide a solid fixation and is by itself not a sensitive part of the femur. It can be cemented (or glued) or partially screwed into place. The majority of the trauma in this surgery is to surrounding soft tissues and will also subside given time and good mobility work and rehab.

Yes. Orthopedic surgery is far from gentle. But, to use the language that Joe used to describe how surgery is performed does nothing but add fear and anxiety for someone who might be in that decision-making process. This will increase your pain and for no real reason. It’s called nocebo, the phenomenon of increasing someone’s pain or fear without actually doing anything! 

Look, if you need a hip replacement, know that techniques for doing so are constantly improving, and each new change is about reducing pain and improving mobility when the patient is back on their feet, in most cases, the very next day. I was glad, but not surprised, that Danaher reported being pain-free after his procedure.

Episode Timer: 1:13:38 (D: Danaher, R: Rogan)

D: “The only problem was that shortly after the hip replacement, the knee finally collapsed after 30 years of problems. So I’m going to have to get a knee replacement on the same leg.

R: audible gasp, or something

D: “Knee replacement is much more tricky… There’s not as much bone mass to work with. Generally, there’s not a lot of longevity with replacements because there’s much more movement in the knee than there is in the hip; There’s less bone to affix to…

D: “I’m 50 years old. Generally, you’d want a replacement that would outlive you. I’m probably going to have to get a second knee replacement when I get older to replace this first which is not ideal but I’m probably going to have to do it.”

R: “Who knows what crazy technology they will have down the line.”

D: “I hope they give me a superhero leg.”

I want to point out one thing here that wasn’t explained above. It’s the idea that technology will someday be at a level where we can have superhero parts. The human body and all of its tissues are fricking amazing. Our ability to heal, deal with stresses, train… We genuinely are all superheroes when it comes to healing. We also can slow or speed our healing.

That said, given the average lifespan of a human and the average lifespan of a prosthetic hip or knee, there are few situations when a replaced joint will outlive a person. Second joint replacements, called revisions, are a widespread practice. Materials sciences are constantly improving. We can add a few years to the life of certain parts of these devices, but it’s not likely we will ever have a one-and-done solution to these joint replacement issues. If you need a joint replaced and surgery can give you 10-15 years of pain-free movement (the average life span of the knee and hip replacement parts up til now), then you will take it. The need for another surgery down the line will cost you another 2-3 months of recovery and then give you another 10-15 years. This is simple math that almost anyone in pain would gamble on. This is also why “holding off as long as you can” is critical. Careful thought should be given to lifestyle changes that can improve tissue healing or resilience.

Episode Timer: 1:16:43 (D: Danaher, R: Rogan)

D: “After the hip replacement, I could only (teach) verbally. I would point with a stick, and they would do the moves for me. There are days when I can barely walk. On those days… I’ll have the students demonstrate for me when needed. I do what I can on the days that I teach.”

R: “It is quite fascinating that a guy who has catastrophic injuries of his leg is one who is known for being an innovator in crushing people’s legs. You were joking around about that being a kind of revenge.”

D: “It’s my revenge against the world. If God took away my leg I’ll take away everybody else’s. There’s something ironic about that.”

This last exchange of the bad armchair doctor section is an excellent example of how people can continue to thrive and coach, given significant pain and a neat surgical history. You do what you must to continue. You don’t make excuses. If you need to make adjustments, then you make them. You DON’T curl up into a ball and quit.

I wanted to point this out to those who might think their life has to change significantly after a joint replacement. It doesn’t.

Dr. Carlos J Berio, PT, DPT, MS, CSCS, CMTPT

Dr. Berio is a licensed Doctor of Physical Therapy, Certified Strength and Conditioning Specialist, and a Certified Myofascial Trigger Point Therapist. In addition, he holds a Master’s Degree in Clinical Exercise Physiology. He has treated high school, collegiate, recreational, and professional athletes of various sports including baseball, softball, football, hockey, tennis, swimming, golf, and martial arts. His experience as a collegiate and semi-professional athlete and a professional baseball coach make him a sought-after resource among elite-level athletes on the field and in the training room. The concept of ‘all the way well’ in his work as a physical therapist and fitness professional continues to drive Dr. Berio to be the best movement specialist there is.

Carlos remains active in several sports and is an avid agility training, powerlifting, and adventure race runner. He is an advocate for his patients, clients, and his fellow PT colleagues. He can be reached at [email protected].