Are You Destroying Your Knees?
Why the fear of arthritis might be worse than running itself.

Episode Summary:
"Doc, I had to stop running. My knees are shot." If you've ever heard—or said—those words, this episode is for you. Today, Dr. Fred Bagares dismantles one of the most persistent myths in musculoskeletal medicine: that running ruins your knees. Spoiler: It doesn't. In fact, giving it up might be what’s really causing the damage.

We’ll explore real patient stories, misinterpreted imaging findings, misunderstood pain patterns, and the surprising science behind cartilage health. This one’s not just for runners—it’s for anyone who’s been scared into giving up movement they love.

Timestamps:

[00:00:00] – "My knees are shot." — The myth that won’t die
[00:01:00] – Call to action: If you find this show helpful, please subscribe
[00:02:00] – Sarah's story: When stopping running made things worse
[00:03:00] – Exam findings: Normal aging ≠ joint destruction
[00:04:00] – The science: Running may protect, not destroy cartilage
[00:05:00] – What really causes joint degeneration? (Hint: it's not the running)
[00:06:00] – Real culprits: Poor mechanics, inactivity, fear-based advice
[00:07:00] – Reframing arthritis: Normal, not necessarily pathological
[00:08:00] – Training smarter: Mechanics > mileage
[00:09:00] – Strength and shock absorption: Your cartilage's best friends
[00:10:00] – Strategic recovery: When rest builds resilience
[00:11:00] – Sarah’s comeback: 53 years old and running strong
[00:12:00] – The bigger danger: Fear of damage vs. real health loss

What if the bigger risk isn't running... but giving up on it too soon? Don’t let outdated beliefs rob you of strength, joy, or vitality. Movement is medicine. Cartilage is living tissue. And you don’t have to choose between your knees and your life.

If this episode challenged your assumptions, helped you reframe your rehab journey, or gave you a new lens for working with your patients—please subscribe. It’s free, takes a second, and helps this show reach more people who need to hear this message. And if you’re a runner struggling with pain, don’t wait. Book a clarity visit at www.fredbagares.com and let’s build a smarter path forward.

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Here's the humanized version with timestamps:

Ever heard this one? "Doc, can you fix my shoulder so I can get back to tearing it apart?"

That's exactly what Bugs asked me last month. He wasn't joking.

Bugs' a 43-year-old software guy who lives for Brazilian Jiu-Jitsu. Second shoulder injury in 18 months. Same story: did his PT, felt better, went right back to training five days a week, and... here we are again.

But here's the thing – Bugs didn't want rehab. He wanted permission to keep doing exactly what broke him in the first place.

Sound familiar?

This episode is about that messy space between wanting to get better and being terrified of changing who you are. Because for a lot of us, how we train isn't just what we do – it's who we are.

Timestamps: [00:00] The question that stopped me cold: "Can you fix my shoulder so I can get back to tearing it apart?" [01:00] Why most recurring injuries aren't really about the tissue [02:00] Meet Bugs: 43, software engineer, BJJ competitor, and repeat shoulder injury victim [03:00] The hard truth – most people don't want rehab, they want a reset button [04:00] When your sport becomes your identity (and why that's dangerous) [05:00] The shift: from surviving training to actually getting better at it [06:00] How Bugs learned to measure progress by how he felt, not how often he trained [07:00] Why volume and intensity are tools, not goals [08:00] My own wake-up call at 40 – when I had to choose between ego and longevity [09:00] The paradox of loving something that's slowly breaking you [10:00] Quality over quantity: what "training smart" actually looks like [11:00] Final thoughts: Let's stop fixing people just so they can break themselves again

The real question isn't "Can you fix me?" It's "What am I willing to change?"

If you've ever felt stuck between loving your sport and feeling like it's slowly destroying you, this one's for you.

Got your own "fix me so I can break myself again" story? I want to hear it. Seriously. Message me – I read every single one.

And if this hits home, share it with that friend who's always training through pain because they think recovery is for the weak.

Thanks for listening to Talking Rehab. Sometimes the strongest thing you can do is the smartest thing you can do.

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🎙️ Episode 65 – What is 5% Better?

Podcast: Talking Rehab with Dr. Fred Bagares
Length: ~13 minutes

Description:
When a patient tells you they're “only 5% better,” what do you do with that? For some, it sounds like failure. But for rehab clinicians, that 5% could be the spark that changes everything.

In this episode of Talking Rehab, Dr. Fred Bagares unpacks the deeper meaning behind small gains, the psychology of progress, and how pain may not be the best marker for recovery. From subtle shifts to signs of momentum, he explores why tracking real-world wins—not just pain scores—might be the key to helping patients rebuild not just function, but identity.

⏱️ Timestamps + Episode Guide

[00:00:00] What is rehab? + Podcast intro
[00:01:00] The patient story: a limp, an injection, and a vague “5% better”
[00:02:00] What 5% really means in clinical decision-making
[00:03:00] Pain is noisy—why it's not always the best indicator of progress
[00:04:00] External influences on pain perception (sleep, stress, weather)
[00:05:00] Subtle signs of recovery: function, not just pain
[00:06:00] Rehab momentum: how sleep can signal real improvement
[00:07:00] Reframing recovery: repetition, trust, and invisible milestones
[00:08:00] 5% as a turning point, not a finish line
[00:09:00] Why great clinicians dig deeper into small wins
[00:10:00] Tracking the right metrics: ease, motion, movement by choice
[00:11:00] Coaching better reflection: "What felt easier this week?"
[00:12:00] Identity and recovery: why 5% might mean “I’m still in there”
[00:13:00] Wrap-up: honoring the small wins and building from them

🧠 Key Takeaway:
5% isn’t failure. It’s data. It’s a signal. It’s the start of a comeback.

💬 Question for You:
What would 10% better look like in your life?

🔁 If this episode resonated, please share it with a colleague or patient who’s struggling with slow progress. Let’s reframe recovery—one small win at a time.

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🎙️ Episode 64 – Nudging Our Patients

These aren’t just medical phrases—they’re nudges: subtle but powerful cues that steer decision-making long before our patients say “yes” or “no.”

In this short solo episode, Dr. Fred Bagares unpacks five common types of clinical nudges we hear (and use) every day in musculoskeletal care:

• Fear-based nudges
• Authority-based nudges
• Urgency-based nudges
• Fix-it framing
• Hopelessness language

🎧 Learn how these shortcuts shape the way patients interpret risk, autonomy, and what's really “on the table”—and why reclaiming our language is a step toward better shared decision-making.

⏱️ Timestamps

Time Topic
| 00:00 | Welcome + Podcast Purpose
| 00:00:40 | “She’s one fall away…” – Language with weight
| 00:01:00 | What is a nudge, anyway?
| 00:03:00 | 1. Fear-Based Nudges
| 00:04:00 | 2. Authority-Based Nudges
| 00:05:00 | 3. Urgency-Based Nudges
| 00:06:00 | 4. Fix-It Framing
| 00:07:30 | 5. Hopelessness Nudges
| 00:10:00 | Reframing language: clear ≠ coercive
| 00:12:30 | Why I started MSK Direct
| 00:14:00 | Reflection Questions + Substack plug
| 00:15:00 | Final thoughts + Thanks

#TalkRehab #DirectCare #SharedDecisionMaking #MSKCare #PhysicianVoices #OutOfNetwork #RehabilitationMedicine #HealthcareCommunication #MusculoskeletalHealth #ClinicalLanguage #PatientCenteredCare #PhysicianLeadership

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From Skeptic to Startup: How a Telemedicine Idea Survived—and Thrived—in a Broken System

In this reflective solo episode, Dr. Bagares shares the untold backstory behind his early adoption of telemedicine, the struggles of launching a cash-based virtual practice, and how he handled rejection from both peers and the healthcare system itself. A must-listen for anyone frustrated with traditional healthcare or curious about innovation in musculoskeletal care.

🎧 Topics include:

• The inefficiency of follow-ups and how email/telehealth filled a gap
• Navigating non-competes creatively
• Facing industry skepticism
• When COVID changed the rules overnight
• Lessons learned—and how they shaped MSK Direct

Whether you're a patient, provider, or healthcare entrepreneur, this origin story shows what's possible when you're willing to bet on a better way.

🕰️ Timestamps:

• [00:00:00] | 🎶 Intro & Welcome
• [00:00:20] | Why I started this podcast
• [00:00:50] | Two types of visits: new vs. follow-up
• [00:01:31] | Follow-up inefficiencies and the email solution
• [00:02:06] | Early thoughts on telemedicine (2013!)
• [00:03:18] | The non-compete challenge that pushed me toward virtual care
• [00:04:27] | Could an online orthopedic practice work?
• [00:05:39] | The inefficiencies of the traditional system
• [00:06:23] | How I performed virtual physical exams
• [00:07:00] | Why not everyone needs to be seen in person
• [00:08:00] | Waitlists, delays, and missed windows for care
• [00:08:55] | Presenting my model to skeptics (and being laughed at)
• [00:09:51] | Proving it works: walking exams and patient engagement
• [00:10:20] | The surgeon who tried to talk me out of it
• [00:11:02] | Launching anyway—cash pay, no insurance
• [00:11:59] | Building slowly… until COVID hit
• [00:12:45] | “You hit the jackpot!”… or did I?
• [00:13:57] | The collapse of my model (ironically due to insurance)
• [00:15:07] | COVID proves it can work
• [00:15:55] | Helping those who doubted me
• [00:16:21] | Patients I still care for today
• [00:17:04] | How this experience led to MSK Direct
• [00:17:43] | 🎧 Outro and invitation to connect

#TelemedicineJourney #DirectCareDoctor #MusculoskeletalMedicine #RehabRedefined #HealthcareInnovation #OriginStory #Physiatry #TalkingRehabPodcast 💡💬💻🦴💥

💬 Question for listeners:
Have you ever experienced a healthcare visit that felt like a waste of time? What do you wish was different?

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Are Our Tools Any Good?

Are our tools really the problem—or are we just not using them well?

In this thought-provoking episode, Dr. Fred Bagares, DO, takes a closer look at a recent study questioning the effectiveness of common spine injections like epidurals and facet blocks. While headlines suggest these tools are failing, Fred challenges the deeper issue: our mindset and misuse of short-term solutions in chronic care.

Drawing from over a decade of experience in musculoskeletal medicine, he unpacks the flaws in current research design, the burnout these studies provoke in physicians, and what truly leads to lasting recovery for patients in pain.

If you've ever wondered why spine care feels stuck—or how to bridge the gap between short-term relief and long-term function—this episode is for you.

🔑 What You'll Learn:

• Why injections are misunderstood in both research and real-world care
• The difference between tool failure and clinical failure
• How to help patients thrive between months 4–12, not just days 1–30
• The long-term value of coupling procedures with lifestyle changes

🩺 Ready for care that looks beyond the quick fix?
Visit mskdirectvb.com to work with Dr. Fred and get a personalized plan that moves you from pain to progress—one joint and tendon at a time.

Let me know if you'd like versions for Instagram, YouTube, or your newsletter too!

🗺️ Plan (Episode Breakdown):

[00:00:00] — Introduction
Dr. Fred opens by reflecting on the enduring challenges and evolving questions in musculoskeletal medicine.

[00:00:33] — New BMJ Study Sparks Debate
A recent study questions the efficacy of interventional spine procedures, igniting pushback from pain physicians.

[00:01:59] — The Real Worry: Insurance & Burnout
Research impacts reimbursement. Physicians feel pressure from both science and the system.

[00:03:20] — The Central Question
Are our tools truly failing—or are we failing to use them effectively?

[00:04:00] — Generational Gaps in Practice
Younger clinicians chase high-tech procedures; Dr. Fred prefers effective, simple tools that fit his population.

[00:05:53] — Short-Term Tools, Long-Term Goals
Injections are short-term tools—but they have a clear role when properly explained and integrated.

[00:06:57] — Unrealistic Expectations in Research
Comparing short-term treatments over long timelines leads to misleading conclusions.

[00:08:59] — Missing Piece in the Research
Why aren’t more studies looking at injections + therapy instead of one or the other?

[00:09:48] — Our Job is to Guide Through the Middle
Short-term tools should be the bridge to long-term solutions—like movement, nutrition, ergonomics, and lifestyle.

[00:10:58] — The Bigger Healthcare Cost Crisis
Spine care is expensive. And without deeper change, the system keeps cutting and blaming the wrong things.

[00:11:41] — New Tools, Same Problem
Fancier devices and techniques won’t fix the real issue: a lack of long-term follow-through.

[00:13:02] — A Lesson from Surgeons
Veteran clinicians succeed not because of new tools—but because they know how to choose and support the right patients.

[00:14:58] — Final Thought: The Real Question
It’s not whether the tools work—it’s whether we’re using them to their fullest potential, in service of long-term health.

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🎙 Episode 61 – Do Disc Herniations Go Away?

Podcast: The Talking Rehab Podcast
Host: Dr. Fred Bagares, DO
Location: Virginia Beach, VA

Back pain can stop you in your tracks—sometimes literally. In this episode, Dr. Fred Bagares explores the often alarming diagnosis of disc herniation. Whether you've had an MRI that showed a large herniation or woke up one morning unable to move, the big question remains: Do disc herniations actually go away?

You’ll learn about the anatomy of disc injuries, why symptoms don’t always match the imaging, and how healing often happens even when things look scary on paper. Dr. Bagares also shares the clinical signs he watches for, conservative treatment approaches, and how to avoid unnecessary surgery.

⏱ Timestamps:

• [00:00] – Introduction to rehab and the episode's purpose
• [00:33] – Why back pain is so frightening and disorienting
• [01:34] – Focus of the episode: Do disc herniations go away?
• [02:00] – Three common ways disc herniations present
• [02:51] – Pain patterns: radiating pain, leg symptoms, and “the pop”
• [03:26] – Anatomy of a disc (jelly donut analogy) and what goes wrong
• [04:16] – When disc herniations affect nerves and cause radiculopathy
• [04:46] – Classic clinical sign: patients who prefer to stand
• [05:26] – Why sitting often worsens symptoms
• [06:01] – Typical treatments: PT, injections, massage, traction
• [06:44] – Can a disc herniation resolve on its own? (Yes – and here’s how)
• [07:38] – Improvement doesn't always mean the disc is gone
• [08:56] – Is treatment shrinking the herniation? (Not necessarily)
• [10:00] – What actually happens as the disc resorbs (bulge vs. blowout)
• [10:45] – The real role of treatment: symptom control while nature heals
• [11:26] – The risks of inactivity: joint issues, blood sugar, muscle loss
• [12:19] – Timeline matters: when is conservative care likely to work?
• [13:44] – When symptoms persist beyond 6 months, surgery may be considered
• [14:30] – The paradox: large herniations are more likely to heal
• [15:28] – Final thoughts: be patient, stay hopeful, stay informed

🗣 Call to Action:

If you're dealing with back pain or were recently diagnosed with a disc herniation, don't panic—get informed. Follow Dr. Fred Bagares on Instagram and Facebook (@drfredbagares), and subscribe to The Talking Rehab Podcast for more expert insights on musculoskeletal medicine.

Let this episode empower you with realistic expectations, practical advice, and hope for healing.

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🎙 Talking Rehab Podcast – Episode 60: "The $2,000 Hip Pain: Why Systemic Solutions Matter"

In this episode, I walk you through a real case involving a 10-year-old boy with hip pain. What started as a simple clinical concern quickly turned into a reflection on the inefficiencies of our healthcare system. I share what it’s like navigating specialty referrals, high deductibles, and trying to advocate for timely, affordable care—while practicing in a direct care model.

If you’ve ever wondered what “value-based care” looks like in the real world, or how something as basic as getting an x-ray can spiral into a $2,000 hospital visit, this episode is for you.

🕒 Timestamps for Key Moments:

• [00:00] – Why I started the podcast and what rehab means to me
• [01:00] – Busting the myth: direct care isn’t just for the wealthy
• [02:00] – The clinical case: a 10-year-old with progressive hip pain
• [03:00] – Ultrasound findings and the red flags every clinician should know
• [04:30] – Top differential diagnoses: SCFE, LCPD, and transient synovitis
• [05:30] – Calling the pediatric orthopedist: the reality of gatekeeping and systems barriers
• [07:00] – “Send them to the ER” – the most costly, inefficient route
• [10:00] – My alternative: working around the system to avoid unnecessary costs
• [11:00] – What this experience says about our healthcare priorities
• [12:00] – A call for new care models: direct orthopedic care and transparent pricing
• [13:00] – Is ultrasound underutilized in pediatric ortho triage?
• [14:00] – A message to medical students: question what you've been taught
• [15:00] – Final thoughts and a call to rethink what "value" really means in care

🎯 Whether you're a provider, a parent, or a med student, this story is a glimpse into the decisions we’re forced to make when systems get in the way of solutions.

🔗 Follow me on Instagram, Facebook, LinkedIn, and YouTube @drfredbagares
📍 Explore more via Linktree

👉 If this story resonated with you, subscribe, leave a review, and share the episode. Let’s continue reimagining better care—together.

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