13/02/2026
Have We Been Looking in the Wrong Place?
I’ve been a surgeon for over 25 years, and the longer I practice, the less I’m interested in structure — and the more I’m drawn to physiology... the entire person sitting before me.
I don’t ignore the structure… but I weigh the findings differently.
Early in my career, I obsessed over images. MRIs, X-rays, cartilage wear, meniscus tears — the structure told the story, or so I thought.
But experience humbles you. It teaches you that what shows up on a scan often matters far less than what’s happening in the body that scan belongs to.
Many cases of adult joint/tendon pain are just another manifestation of metabolic disease. It's true. The inflammation from your fatty liver, insulin resistance, diabetes, etc. It all plays a role in how much pain you're currently having.
Most of my patients are metabolically “sub-optimal”. And that has made me care less about what’s torn, worn, or frayed — and far more about inflammation, insulin resistance, central adiposity, elevated uric acid, and being under-muscled.
Again, I don’t ignore the structural changes… I see their contribution to the plan differently.
Lean muscle, central adiposity, systemic inflammation, mitochondrial health — these are the quiet variables that determine how someone feels, heals, adapts, and recovers.
Structure breaks down when our foundational physiology fails. Tendons degenerate when uric acid/ insulin, glucose and inflammation stays high. Cartilage thins when inflammation rises. Bone weakens when load is absent.
As surgeons, we were trained to fix anatomy. But biology is where the leverage is. Improve the chemistry, improve the outcome!! Remember that's one.
I still look at the images — but I look through them now. Because behind many joints that hurt is a system that’s out of balance.
