Why are some octogenarians competitive athletes, while others struggle to walk up the stairs? It isn’t luck, it’s orthopedic science. If you’re tired of doctors telling you that an injury will prevent you from playing the sports you enjoy, you’ll love the new book, Play Forever, by Dr. Kevin Stone. All great athletes get injured but only the best of them use those injuries to come back to their sport better, fitter, faster, and stronger than before. 

The book teaches how injuries can lead to a lifetime of high-performance fitness and athleticism. You’ll learn how the musculoskeletal system can be repaired through cutting-edge therapies then honed and strengthened through semi-annual fitness tests, you’ll learn about preseason education and training programs and regular in-season tune-ups. 

Everything in the book is backed by scientific studies and it will become your go-to health and fitness source, helping you play the sport you love to age 100 and beyond.

Hey Listeners, my name is Drew Appelbaum and I’m excited to be here today with Dr. Kevin Stone, author of Play Forever: How to Recover From Injury and Thrive. Kevin, thank you for joining us, welcome to The Author Hour Podcast.

Kevin Stone, MD: Thanks for having me.

Drew Appelbaum: Kevin, kick us off. Could you give us a brief rundown of your professional background?

Kevin Stone, MD: Sure. I’m an orthopedic surgeon in San Francisco and I divide my life between clinical practice and not-for-profit research. So that means I care for people with injured knees and shoulders and ankles, and I also run on a public nonprofit research foundation, focused on trying to figure out, can we push forward the science of healing, can we help people accelerate healing from injuries? 

Can we help treat, prevent and cure arthritis? Fundamentally, can I help people see their injury as an excuse to become fitter, faster, and stronger than they’ve been in years and hopefully so they can play forever or at least until the day they drop.

Drew Appelbaum: Why was now the time to write the stories in the book? Did you have a moment of inspiration? Did enough people tell you, you really need to write this down and spread the word? Was there an “aha moment?”

Kevin Stone, MD: You know, it’s almost all of the above. I have the privilege of caring for injured athletes of all ages. I find myself coaching more than treating in life because so much of recovery from injury is attitude and I found that if I could communicate that in writing, I might be able to help all those people who like to read and like to hear an audio version of a book and like to think about it in sort of a logical way.

The fun of writing a book and the work of writing a book is laying out your thoughts in a logical pattern so that people can understand what they go through when they get injured and how to use that experience to their benefit.

Don’t Let Injuries Prevent You From Achieving Optimum Performance, Regardless of Sport

Drew Appelbaum: Now, you’re clearly a professional in the subject; you’ve done a lot of research, you’ve seen a ton of patients, you’ve done a lot of coaching but while you were writing the book, maybe by digging deeper into some of the subjects or doing some research, did you come to any major breakthroughs or learnings on your writing journey?

Kevin Stone, MD: Yes, number one, writing is hard.

Drew Appelbaum: It sure is.

Kevin Stone, MD: Number two, that communicating ideas is sometimes hard too because each person is different and when you’re talking with them in an exam room or a training room, it’s one thing because they’re very receptive to that time of injury, nervous about the injury, excited about the recovery.

When you’re trying to write, though, when you’re trying to communicate these ideas in writing, it takes a logical flow of one idea leading to the next idea, leading to the next idea. One of the things I learned during writing this book was how important it is to synthesize those things down to really, not bite-sized, but ideas that people can take, engrain into their lifestyle, and then use.

Drew Appelbaum: Now, I want to dig into the book, and I’ll start my questioning just like you started the book, a few super basic questions but really key to understanding the book. To dig in, I’ll ask this question; what is the book about?

Kevin Stone, MD: The book is about the title, how to play forever. How do you both keep yourself healthy to avoid injuries, how do you recover if you have? How do you get treated if you have an injury with 21st-century care, utilizing all of what we’ve learned from our research and our pushing forward to the science of injury and recovery and treatment, and then how do you recover. How do you recover becoming again, as I love to say, becoming fitter, faster and stronger than you’ve been in years?

This book is about each of those things, preventing your injuries, getting them treated if they happen, and recovering from them. 

Drew Appelbaum: Who did you write this book for? Is this for young folks, old folks, athletes?

Kevin Stone, MD: I write it for my patients because I write it for all the people I get to see, injured athletes of all ages. My patients who are kids in high school and elementary school and my patients who are 70-year old’s, who still want to run centuries.

In between that whole range, I have athletes that were Weekend Warriors, athletes who are Olympic gold medalists and so, each of them I felt could benefit from the ideas that we could try to communicate of how we’ve been thinking about healing an injury and where the future is.

Drew Appelbaum: If you could explain this to us, what exactly does optimum performance mean to you?

Kevin Stone, MD: It means, really, achieving what your hopes are. If you’re going to go out for a run that day, it means, getting the most out of that run. If you’re competing, it means really performing at that level that you felt was your absolute peak performance. It means just not wasting time, it means not wasting energy. It means, hitting those wonderful feeling of, “Hey, I did it, I just – I performed well, I exercised well, I trained well, I delivered.”

Drew Appelbaum: When you were writing the book, was this mostly from your own experience from clients and people you coached or did you have to do a lot of outside research on some of these subjects?

Kevin Stone, MD: The research is going on all the time, every patient that I see often gets entered into a research program that we’re doing trying to understand the therapies and their outcomes. Fundamentally, I don’t believe that a doctor should do something to or put something in a patient that they don’t either already know the outcomes or aren’t trying to steady the outcomes.

To create this book, I’ve been learning all my career about what works for patients and what doesn’t work. My patients have taught me often by cheating on what we told them to do or not do. They’d push the envelope and we would learn, “Hey, you really can do that” and so it’s been a career full of research and development that leads to the writing of a book like this.

Drew Appelbaum: When you’re writing the book, is this more of a fitness routine for just your muscles or does your mind play a role in this, and does your overall mindset affect what you’re doing as well?

Kevin Stone. MD: Of course, and for sure, your mind controls your outcome. So, let me give you an example. A patient coming into surgery with a smile on their face, a really relaxed optimistic attitude, everything’s going to go great, everything does go great.

The patient dramatically influences the way the nurses care for them, the anesthesiologist, the surgeon, and the recovery room. That mindset of coming in with that smile, that relaxed feeling, that confidence in the team that the patient can exude, truly influences the performance of everyone around them.

That’s one example but there are so many other examples too as I counsel patients over the years. So many of the injuries that I see are mental injuries. It’s the skier thinking about his girlfriend or it’s the person going a little bit too fast. It’s the distracted by something, mental distraction, not having your head in the game at that moment so often leads to that sudden injury that occurs, it could have been avoided.

It happens in all sports and so we’re talking a lot about the mind to our patients, helping them avoid injuries. We’re talking to them a lot about how to perform and we talk to them about how to recover.

Keeping Injuries At Bay

Drew Appelbaum: It was really cool in the book that you actually called out some athletes that we all know, they were injured at some point and they came back stronger and these are people that – you know, normal people can look up to who overcome these major setbacks. Can you talk about a few that you mentioned in the book?

Kevin Stone, MD: Sure, I mean, you see so many people with so many moments of injury and then so many great recoveries. I think Tiger Woods is one we all know who had dramatic injuries and dramatic recoveries and then sometimes dramatic re-injuries from somewhat mental errors if you think about it. 

Just one little example but there are so many others. Almost every professional athlete, almost every great athlete gets hurt sometime during their career. The great ones use that injury as I say, to come back fitter, faster, stronger. So you can look at every athlete out there today and look at their experience and look back at their history and see their injury pattern and know that they were injured, and they recovered.

Drew Appelbaum: I like that you talk about how naturally, everyone’s train derails as you call it and maybe you just stop a fitness routine. Maybe you do get hurt, anything along those lines. What can folks do to sort of mitigate these derailments and get back on track?

Kevin Stone, MD: The first thing is to avoid them. As I mentioned, so many injuries occur from mental errors, just not being in the moment. Number two, training. Again, it’s a mind thing. If you watch someone train while on a Peloton, let’s say and watching TV or reading a book, that’s not training because they lose 50% of the training effect by not listening to their heart rate and feeling their sweat, noticing where their body is, noticing when the muscles are tired and then driving harder through that moment. That’s what training really is.

We feel that people lose about 50% of that benefit of training if they’re watching TV or reading a book while doing their workout. That is the first part about training but so much more, there are so many other ways of optimizing their output in sport and from nutrition to mindset to preparation to coaching, these are things we’re trying to help people with and it is not just for the professional athlete. 

My patient who comes in and their goal is to walk through the mall without pain has perfectly reasonable goals that we can help them with especially if they can set their mind to saying, “I’d really like to come back better than I was before.” 

Drew Appelbaum: You’re actually talking about this, which is pretty funny, does being fit actually prevent you from getting injured and some folks will argue, “Hey, you’ll never tear your ACL by sitting on the couch and eating Cheetos.” 

Kevin Stone, MD: There’s an interesting range. The fundamental answer is yes, being fit helps you in so many ways because it is not— the definition of fitness has about 10 basic characteristics to it but one of the most important characteristics of it is mobility, so flexibility and the ability to move your arms and your joints and your legs through a full range of motion. It’s an important part of fitness. 

Other things— balance, coordination, accuracy, strength— these are all components of fitness as well. However, that said, our most fit athletes still get hurt. If we look at our downhill skiers, no one has stronger quads and musculature than they do and yet that one little snow snake can catch their ski edge and they can go off the course and be terribly hurt. So that’s true in so many sports where the strongest of football players still get hurt. 

Being fit is important but understanding the 10 aspects of fitness and working on all of them is what keeps injuries at bay. 

Drew Appelbaum: You go into supplements a bit in the book, which I think is a pretty gray zone for a lot of people. We walk into a GNC and are not really sure what to do and there is just an overwhelming variety of things. Is there anything out there that you could suggest or that actually makes us “healthier”?

Kevin Stone, MD: The first thing with the supplements is, what are you supplementing? Hopefully, you are supplementing a great diet and so a great diet to us these days means a diet more loaded towards lean protein than carbohydrate and fat. If people are choosing their foods wisely in lean protein; there are fishes, there is pork, there are lean meats that are low in fat and tremendously high in protein and caloric intake in a positive way. 

If people have a well-oriented diet tuned to their exercise level, meaning what goes out goes in, so balancing that amount of exercise each day with the amount of caloric intake makes a huge difference. Additionally, using water as their primary beverage. So if people would reach for a glass of water before they would reach for an alcoholic drink or before they reach for a— lift up the fork, they will hydrate themselves with water, which will decrease their portions when they eat and optimize their caloric intake and decrease the sugar content of so many of the beverages that they might otherwise choose. 

On top of that you could then look at, what are the supplements that make a difference? From an orthopedics’ point of view, only glucosamine and chondroitin sulfate have solid data about making people’s joints feel less stiff. All the other supplements including vitamin D and calcium and things that we all hear about have really quite mixed data on whether or not they have a meaningful benefit to someone who is healthy. 

If someone is osteoporotic, if they have deficiencies in one aspect or another of their diet, or if they’re on diets that are vegan or otherwise difficult to create a well-rounded dietary caloric intake of everything they need, then they may need to choose specific supplements to make up for the missing components. 

Drew Appelbaum: Right. 

Kevin Stone, MD: However, in general, you’re far better off optimizing your food balance and your water intake and saving your pennies from the GNC store.

Utilize Modern Techniques, Preparation, and Care to Play Forever

Drew Appelbaum: You also do some medical myth-busting where you break down commonly held beliefs, which you believe may do more harm than good. Can you name a few of those and maybe break one down for us? 

Kevin Stone, MD: Sure, so let us start with cartilage. Cartilage is that wonderful white shiny surface that covers the ends of bones and all joints. If you crack open your chicken wing, that white shiny surface, that’s articular cartilage. When you get arthritis, it’s wearing that articulate cartilage down to the bone and it used to be thought— and it still is thought in many places— that you can’t regrow that cartilage but in fact, you can, and we’ve been doing that now both in the lab and within people’s own knees, re-growing their damaged articular cartilage. 

Those arthritic surfaces sometimes can be replaced with what we call a biologic knee replacement, re-growing the cartilage and replacing the meniscus cartilage and restoring the knee back to having tissue. The old days of, “Hey, you’ve got a worn-out knee and you have to have a knee replacement”, artificial knee replacement, have been replaced with, “Hey, you have a worn-out knee, it might be that only part of it is worn out and we can either regrow part of the cartilage, replace the meniscus or if it needs a bionic solution, a partial knee can often be done.”

About 80% of the world have been told they need a knee replacement actually don’t, there are other options for them. That is the one big myth. Another good big myth that we hear so often is that water doesn’t matter. Water really does matter, drinking water during the day hydrates all of your tissues. All of our brains work better when they’re better hydrated, every tissue in the body works better and so most of us tend to be relatively dehydrated during the day. 

We’ve slept all night, we’ve been mouth breathing, drink coffee in the morning and don’t hydrate enough with water and if you do, you can decrease your caloric intake, optimize your weight and feel better all the same time. Those are two good ones right off the top. 

Drew Appelbaum: Now, you also go into so much detail in the book and injuries in all parts of the body and ankle and your ACL injuries— you just talked about knee replacements— really the whole body gamut, if you will, and then in the back of the book, just super interesting, you dive into the top five reasons to avoid space travel and I thought that was really fun. Maybe you could tell us a little bit about that and maybe why that came up?

Kevin Stone, MD: Because of all of our efforts these days to save the planet earth, to diminish pollution, to decrease climate change and global warming, so much of the money is being spent to send people to other planets thinking that we could habitat there or that be an alternative to earth when all that money should be spent in my view on preserving the earth that we live on. So what I do is choose to explain why people will never be living on another planet. 

The reasons are huge. Space travel and planetary habitation is perfect and important for robots. It is terrible for humans. As soon as you leave the gravitational pull of Earth, the low gravity states do wreckage to all of your systems. The astronauts who come back have brain atrophy, have problems with eyes, have all kinds of other issues that go on, bone density loss, muscle density loss and that’s just from spending a short time in space. 

Additionally, the radiation dose that all astronauts are exposed to, and anybody trying to live on another planet would be exposed to, is just so high that there is very little chance that people would ever be able to procreate. A baby trying to be born on another planet with low gravity and high radiation would be extremely unlikely to make it to full term and so a trip to another planet is most likely a one-way trip. 

You would be living indoors all your life, and think about how good you feel when you get outside and smell some fresh air and have some lovely sunshine on your skin, you’d never be able to do that again in life. So, the psychological damage is the same kind of damage that we see from people who are imprisoned with no access to sport and life and fresh air and good food. 

The conditions for living on another planet are so harsh and so unlikely to be productive for people, that we’re better off spending that money, sending robots there for sure for exploration, but spend all the rest of the money understanding the oceans around us and the planet that we live on. 

Drew Appelbaum: What impact do you hope the book will have on readers and are there any immediate steps that you hope a reader will take either by starting the book or after finishing the book? 

Kevin Stone, MD: Yes, I hope people will realize that there is a way to play forever. That if you take care of yourself, if you treat the injuries that we all get along the way with modern techniques, that if you use all of what we’re learning around stem cell science— around growth factors, around tissue replacement, around training— if you’ll come away from this book and realize that you can be active all your life, your life quality will be so much better if you are. But it just takes some planning and some preparation and some care. 

Drew Appelbaum: Well, Kevin, as I mentioned, we just touched on the surface of the book here but I want to say that just writing a book where you’re helping people better themselves and just be healthier and more fit in their day-to-day and that’s no small feat, so congratulations on finishing and publishing your book.

Kevin Stone, MD: Thanks so much, and thanks for having me to have a chat with you about it.

Drew Appelbaum: Kevin, this has been a pleasure and I’m excited for people to check out the book. Everyone, the book is called, Play Forever, and you could find it on Amazon. Kevin, besides checking out the book, is there anywhere else where people can connect with you? 

Kevin Stone, MD: Sure, we’re here at the Stone Clinic in San Francisco and that’s stoneclinic.com and our research is posted at stoneresearch.org. 

Drew Appelbaum: Well, Kevin, thank you so much for coming on the show today and best of luck with your new book. 

Kevin Stone, MD: Thanks so much.