Ep. 23: Clinton T. Rubin, PhD – Improving Bone Growth and Density with Mechanical Stimulation

00:00 – excerpt from the episode
01:17 – intro (listen to discover a little more about your host. Martin will tell you a new lesser-known fact about Dr. Maya)

01:57
Dr. Maya Novak:
Different types of vibration can be healing, but they can also be detrimental to your health. For the last 100 years or so, people have tried to hack fat loss in the abdomen and thighs and so in the early 1900’s, vibrating belt machines started popping up, and then they became really popular in the 50’s and 60’s, which some of our listeners might remember. But vibrations are not connected just to weight industry and losing fat -there’s a lot of research on how vibration can, for example, help heal bones as well. So this and more is the topic of today’s interview that I’m extremely excited about.
I’m joined by Dr. Clinton Rubin who is the most cited researcher in the area of vibration therapy. Dr. Rubin is a SUNY Distinguished Professor of Biomedical Engineering and Director of the Center for Biotechnology at Stony Brook University. His work is targeted towards understanding the cellular mechanisms responsible for the growth, healing, and homeostasis of musculoskeletal tissues such as bone, cartilage, tendon, ligament, and muscle, as well as the formation of adiposity. He has published over 200 peer-reviewed papers and 50 book chapters on the use of physical stimuli in controlling physiologic processes and the musculoskeletal system. Dr. Clinton holds 40 patents, with 20 pending, in the areas of wound repair, stem cell regulation, and treatment of bone disease. Clinton, I’m so honored to have you here. Welcome!

03:33
Dr. Clinton Rubin:
Maya thank you for inviting me. It's a pleasure to join you and it's a great honor to speak to your audience about the potential benefits and maybe even the consequences of vibration and the musculoskeletal system.

03:47
Dr. Maya Novak:
Yes, I cannot wait for us to dive into this topic, but before we do that, can we talk a bit about your background? You know, have you dreamt from a young age to be a professor and researcher, or how did you get into this field?

04:05
Dr. Clinton Rubin:
Well, it depends on how long you think your podcast actually is. It's a very, very long story. I think I had aspirations as a teenager, and pretending that I wanted to grow up to be an academic, that I wanted to be an architect was something I was very interested in. Structure and how things were put together and as I looked under the hood of these sort of challenges, I found that nobody did it better than Mother Nature. I looked at not only the fossil record but also in terms of real life. How mechanical challenges are dealt with by the living systems, in particular human systems. So I sort of took this early interest in architecture, structure and design, and sort of figured out that Mother Nature had a lot to teach us. Then I started looking at bone and how bone over millennia, the past hundreds of millions of years that bone’s been around, to how we deal with bone and bone loss as individuals. I found it very, very interesting and thought the mechanical signals would be a great way to understand bone failure, but also bone health.

05:19
Dr. Maya Novak:
Yes, so you know when we're talking about bones, I'm sure that some of our listeners are very well aware of how this bone formation and everything works. But can we lay some foundation in regard to understanding bone formation and how it is maintained through life? You know, bone quality and bone density. Can you talk a bit about this?

05:43
Dr. Clinton Rubin:
Sure I can, but let's look at it in terms of osteoporosis which many of us are interested in. In reality, whether you're a male or female, we peak our bone mass around the age of 30 or 35 and then the amount of bone loss overtakes the rate of bone formation. So our bone loss starts to exceed the amount of that bone that's laid down and we lose, both again, males and females lose about 2 to 3% of bone per decade. And then women following the menopause lose 2 to 3% of their bone per year. So there's a sort of an accelerated bone loss that women are faced with that men don't necessarily have to wrestle with, and the reason that you osteoporosis or bone loss becomes symptomatic. You can lose height. You can have vertebral fractures. You can break your femoral neck - these sorts of you know, tragic outcomes. They're sort of 80% - I would say it's an arguable poin - but 80% of the people who suffer from the disease are women rather than men, and that's really from my view for 3 reasons. One, the accelerated bone loss following the menopause, so women are losing bone more quickly, but women at that peak bone of around the age of 35 have less bone than men, so they're starting with less bone in this bank of structure. And then the reality also is that women live longer than men, so that when your bone quantity and quality is decreasing from the age of 40 to 50 to 60 etc., up to 90, the people who suffer the most fractures and really have to recover from them are women. But looking back to your question about the organization of bone. The world needs to stop picturing a bone as this dried out skeleton in the desert like a Georgia O'Keeffe painting. It's a very live, viable tissue. It's the only tissue in the body that heals without leaving a scar and it's this very intricate dance or symphony between the osteoclasts, the bone eating cells, and the osteoblasts, the bone forming cells. In an idealized world there's a balance between the remodelling, like bone repair where the osteoclasts eat out little spaces in the bone and they're closely followed by bone forming osteoblasts, so you end up with a net maintenance of tissue. But again, to go back to the challenges of osteoporosis, as we age this balance is lost and the osteoblasts aren't recruited as quickly and they don't form bone as well as they used to. So the osteoclasts start to really turn the balance towards loss. So from my view, the challenge is how to normalize or re-normalize that interaction between bone formation and bone resorption. How do we get the osteoblasts back in that symphony where everything is working out well.

09:17
Dr. Maya Novak:
Yes, so you know, when we are younger we are usually working out to look pretty, right? And then when we are talking about older age and when we're talking about bone loss, we have to talk about keeping this activity and working out just to keep our bones healthy - is that correct?

09:40
Dr. Clinton Rubin:
Right? So you know, mechanical loading of bone is how you can think of it in a generic term of exercise as bone loading. Because I don't think my aspiration is to look good on the beach in a bikini but I understand the point that when you're fifty, or sixty, or seventy, you're not 20 and 25 anymore. And what's happening there is that exercise which keeps you toned and fit when you're 20 and 25 doesn't quite work as well when you're 60 or 70. And that's a real challenge in the world of exercise and exercise physiology. Why is it that it doesn't work as well? Let me see if I can put it in context. We've already talked about osteoblasts - bone forming cells - and osteoclasts - bone eating cells. Let's talk about where these cells come from. They're stem cell progenitors where osteoblasts come from, cells in the bone marrow, that fatty tissue that some of us like to eat right at a barbecue, right? [chuckles]

10:48
Dr. Maya Novak:
[chuckles]

10:49
Dr. Clinton Rubin:
Nothing like some good bone marrow. But in your bone marrow are these cells called mesenchymal stem cells, mscs, and these mscs have the ability to grow up into many different types of cells. They can become satellite cells, they become muscle cells, or mscs can become bone cells – cartilage, ligament, tendon. They also can become fat. So let's think of that as one part of the equation. The other part of the equation: the osteoclasts, the bone eating cells, they come from hematopoietic stem cells. So mesenchymal and a hematopoietic stem cells are both living in your marrow and what happens as we age is the phenotype, or the makeup of your marrow changes. Just as we age your marrow ages. So what does your marrow look like when you're very young? 15 and younger it's very red. It's blood and gorge. There are lots of cells. There's lots of proliferation. Lots of turnover. Then we get into early adulthood. It becomes sort of yellowy and a little fattier, and as we age it becomes essentially a glob of fat. And as we become frail and elderly it becomes essentially gray and almost on the verge of dying, and along with the change of that tissue goes the change of the populations of cells within there. So again, back to a long-winded response to your fairly straightforward question. What does exercise do? Exercise signals all the cells in your body. Your physician is going to go off and tell you, “Well, to think more clearly, go out and run a mile.” Or to look thin on the beach and great in a bikini, make sure that you run and exercise and play tennis and all these sorts of things. But these mechanical signals are telling not only the resident cell population what to do, but the stem cells, the progenitors what to do. Then think of what happens as there are fewer and fewer of these stem cells in the marrow and they're less connected because the marrow is becoming fattier and fattier. As you exercise, even exercise intensely, signals that reach these stem cells are attenuated. So the stem cells, rather than becoming bone cells or osteoblasts, they start tending to become fat cells. So as we think as we age and we're worried about how we might look at the beach, we're not so worried about how our bone might look at the beach because God forbid we might end up seeing our bone by being crashed on by a wave. We're more worried about what our fat looks like as we age, there's more subcutaneous fat. But far worse, there's more fat within the visceral cavities. There's fat around our liver. Our kidneys. There's fat within our thoracic cavity, etc, etc. That's coming from these same stem cells in the bone marrow that, rather than becoming bone forming cells and protecting our musculoskeletal system. We're not driving them to become bone. We're allowing them to become fat. So we go to the beach and we see, “Oh, I got fat slogging over my swimsuit.” Now think of osteoporosis for a moment. Not so much as bone wasting and less and less bone in our femur, think of it as more and more fat. So what exercise can do is slow the decay of bone by slowing the formation of fat. So you are absolutely right that we need to exercise. All the people who are listening, if you take anything home from my conversation with Maya, remember that exercise is critical. Do not become a couch potato. But at the same time, it's really more the nature of the exercise that you do. That's really, really important, and let me put that in context.
We've talked about osteoporosis. We've talked about losing 3% of your bone per decade and then we've talked about for women in the menopause losing 3% of your bone per year. Astronauts who are the healthiest people on the planet, they go up into space and they're losing 3% of their bone per month, even though they're exercising. So why is it? How could that possibly be? We have to ask ourselves, what's different in space than being on the beach in Acapulco. Well, the difference is gravity. So all living systems on earth have grown up with one common feature. It's not the amount of light. It's not the temperature. It's not the nutrition. It's gravity. Gravity is the one common equalling factor for all living systems. So it shouldn't be a surprise to any of us that our cells have evolved to be sensitive to the pull of gravity and therefore the mechanical signals induced by gravity and exercise. So we can figure out how to put, not this large cloud of exercise into the system, but to go in and pick out the pieces that are most important to cells. That we think can trick cells into thinking that they are exercising and therefore slow down the formation of fat and stimulate the formation of bone. And that's really what our lab has been doing since I gave up being an architect and decided to study nature and listening to nature. What nature has told us is that mechanical signals, specifically exercise in general, is critically important. The other parallel to that is I'm guessing many of your listeners think, “Oh, I should get up and exercise each day.” Think about the other way around - that without exercise and becoming a couch potato you're enabling all of these systems that are responsive to mechanical signals to basically go to this default system of turning into fat. We as humans have grown up over the past thirty thousand or a million years, depending on your viewpoint, really being out, hunter gatherers, farming, etc. We've always been exposed to mechanical signals and our ancestors have not been sitting in front of the tv watching Netflix for 4 hours a day, allowing our body to basically become this sort of disenchanted physiologic system. So exercise. It's not so much a quest to go out and exercise. It's more the goal of don't stop exercising.

18:16
Dr. Maya Novak:
Yeah, so this tricking of the cells so that they don't become fat but they become bone cells... We're going to be talking about vibration and vibration therapy, of course, but because there may be some listeners who are now thinking, “Okay, now I have to go to the gym and I have to go there and I don't like it.” So what actually, according to your research or in your opinion, what counts as exercise that is helpful for our bodies?

18:50
Dr. Clinton Rubin:
Ah, well, that's another loaded question if I may say. But if I could put it in sort of a metaphor, if you're listening to this podcast right now and you're laying down, you should sit up. And if you're listening to it sitting you should stand. And if you're standing listening to this, you should walk. And if you're walking listening to this, you should jog. So every step up is an improvement. The bonus of this though is that you don't have to go out and play tennis against Venus Williams for 4 hours per day. Your cell systems are more like light switches than bank deposits, so that once you turn on the correct signal you get the benefit of the response. So a long story short - run to the bus stop. Don't walk to work. That intense stimulation is a very, very quick way to turn on that light switch and to get your cells listening. So yeah, I'm not going to talk any your listeners out of going to the gym because you know as much as we may hate going to the gym, we always feel better after we're done. And then we justify having a beer on the beach in our bikini thinking, “Wow! Well I look great, don’t I?” [laughs] And you really can enjoy that beer as well deserved. But you got to get off the couch and you have to do something.

20:24
Dr. Maya Novak:
Yes, now let's talk about this vibration therapy and your research so tell us what is actually this slow vibration therapy.

20:33
Dr. Clinton Rubin:
Okay. Let me see if I can tell you how I got there, which might help. So as you can see, I'm pretty passionate about mechanical signals. I mean we all need things we're passionate about. I'm passionate about
mechanical signals and through nature I’ve learned how important mechanical signals are. To go back to someone like Venus Williams, a pro tennis player. There's a perfect example of the opposite of this of the astronaut. Professional tennis players have 30 to 35% more bone in their playing arm than the arm that throws the ball in the air. So that's telling you that the racket arm is sensing something about hitting the ball that's sending a signal to the bone and causing it to build up its quality and quantity. So a good question is what is it? Because Venus practices for 8 hours a day, or because she hits the ball so hard, or she hits it so fast. What our research has done is we tried to distil down from exercise to learn what's turning on these cells. That's sort of the quest of me as a basic scientist, and so what we found is that not only is an intense signal important, but they can only be given in short doses. Long doses of super intense activity can actually turn out to be bad for you. Think of football players and the percussive injuries to the brain - we have to be worried about that. But at the same time, what is it that we all as humans do most of the time is we stand around. We're not off playing tennis for 4 hours a day, we're standing for five or six hours per day and then we start to think, is standing important? And then think about the muscles. Antagonistic and synergistic muscles that help you stand up and help you balance and stay upright. Your muscles, in reality, when they're contracting they’re very inefficient motors. They're actually vibrating when they contract between 20 to 50 times per second, or 20 to 50 hertz, so when I pick up my coffee or later this afternoon when I pick up my beer, what's really happening is that my coffee cup is shaking very, very slightly. You can't see it but because it's an inefficient motor, as I am pulling the coffee cup to my mouth, my bone is being bombarded with these little tiny high frequency signals. Well, it also turns out to go to the beginning of our conversation. What happens to us as we age is that not only is there osteoporosis and symptomatic bone loss. There's osteopenia, the process of bone wasting and getting osteoporosis. There's also sarcopenia, muscle wasting. So as we age not only are we losing bone, we're losing muscle. And it turns out that we're losing specific components of our muscle. We're not just losing muscle mass or missing losing muscle fiber types or muscle quality. These postural muscles that hold us up, this 20 to 50 Hz vibration that's bombarding our bones, they're the first muscle fiber types to disappear. So if you stick with me for a second, if you're willing to give me a little poetic license. What I think is that these 20 to 50 hertz really, really small vibrations that are the predominant mechanical signal that your bone sees that as we age it begins to disappear. So the reason that even if we're exercising when we're 60 or 70 our bone isn't responding as well is because remember, our marrow is changed and there aren't as many stem cells to become bone forming cells, but also the nature of the mechanical signal itself has changed. It's less of this 20 to 50 hertz signal. So how we got into low intensity vibration is a long 30 year story that brings us to this point of saying, “Wow, maybe if we just put that low intensity signal that used to be muscle vibrating, if we put that back into the system, maybe we can trick an aging system or an inactive system into thinking that it's still out playing tennis with Venus Williams.” So the point of standing on this sort of bathroom scale or pizza box that puts out this barely perceptible mechanical signal is not that we're silly enough to think that vibration is going to build up our bone. But rather that vibration represents a surrogate for muscle contractibility or what's called the power spectrum of muscle contraction. We put it back into the system. Maybe we can trick the cells into thinking that they’re in a very, very active system.

26:05
Dr. Maya Novak:
Well, Clinton, I have to say that listening to you was a bit of an emotional roller coaster for me. We started off by discussing how bone marrow is producing different cells, which led to the realization that exercise is crucial. Then you started talking about how, as we get older, we are losing these vibrations. So I was like, “OK, is there any solution to this issue?” That was the rollercoaster.
We moved on to discussing a potential solution: these low-vibrational plates that we could stand on. But let me ask you this, because roughly two decades ago, vibrational plates became very popular in gyms and many people were jumping onto them and praising their effects. But I read read some research suggesting that these plates might not be as beneficial as they seem. So before more people start jumping onto them, can we discuss if these plates are really a great thing, or if it’s better to avoid them?

27:27
Dr. Clinton Rubin:
Yeah, thanks Maya, that's a really critical question and it comes back to the old saying, at least in America, of an Apple a day keeps the doctor away kind of thing. That doesn't mean that forty apples a day won't make you sick, right? So it is a bit like the good old fairy tale of Goldilocks right? That too much of a good thing can be bad for you. You know the bed's too hard or the porridge is too hot or whatever. So remember what we are trying to do in our lab is first, do no harm. So we want to make sure the vibration signals that we deliver are safe and then we worry about whether they're effective. So it turns out in just getting back to your question, that you don't need to believe me, that there's an international standards organization that tries to keep us safe from x-rays, or from toxins in in food, or from insecticides, or from vibrations in the workplace. But we think of vibrations where we already mentioned percussive injuries to the brain of American football players, or soccer players banging their heads against balls that it's now believed it's not so much a single insult. It's a lifetime accumulation of these percussive injuries that causes basically damage to the brain and so ISO, International Standards Organization, your listeners can look it up because they don't believe me - look up ISO 2631 you could just Google it. It's a world advisory for thresholds for human exposure to vibration and the reason they came up with this is people who suffer from low back pain and in particularly in occupational exposure; truck drivers, helicopter pilots, there're people who work in meat factories that are holding handheld saws and then get white finger disease.. Exposure to vibration can create hearing loss or blurred vision. So this ISO 2631 creates an algorithm that gives the frequency cycles per second and the intensity. How big the acceleration is usually deemed in terms of g-force. Earth's gravitational field is one g, so ISO gives you this algorithm that for a given frequency, for a given g force, how much exposure is safe for you and me, healthy adults. Exposure in the workplace and the signals that we give are 0.4g, so 40% of earth's gravitational field, at 30 cycles per second for 10 minutes per day is our typical clinical trial. And we could talk about those later if you're interested or the things we do in cells. But just for clarity's sake, 0.4g 30 hertz, 30 vibrations per second and 10 minutes per day, ISO 2631 considers this safe for between 4 to 8 hours exposure per day. Nobody's going to stand on our plate for 8 hours a day, at least I hope not. Have better things to do - go to the beach, have a beer in your bikini, perfect, but stand on the plate first. ISO 2631 considers this safe for 4 to 8 hours per day. We're fine, we're doing no harm and in all the clinical trials we've done, from the frail elderly down to kids with Duchenne muscular dystrophy or cerebral palsy, we've never had to report a serious adverse event. Now the devices that you're referring to in the gym... “Oh, I just listened to Maya and Clint talk about vibration and I see this device over here in the gym. I'm going to go stand on it.” These devices at the low setting - things like Power Plate or Galileo at the low setting deliver 8 g's. 8 times Earth's gravitational field. I don't care if you're Usain Bolt running a hundred meter dash, the g force that you're subjecting your body to for that hundred meter dash against Usain Bolt is around three g’s. Fighter pilots are blacking out, they're falling unconscious at around 8 to 9 g. Our system is not prepared to deal with this. So ISO is telling you that at eight g at the low setting at this gym device, or at the high setting at 15 g, 15 times earth's gravitational field - do not do this. It’s like go out to your garage and jump off your garage 30 times a second - nobody probably thinks that's good for you. ISO does not even come up with an algorithm, so their briefest exposure they give is 10 seconds. And these devices you run into in the gym are not even considered safe for 10 seconds per day. Let me just say again, I think we started off by saying if you take home anything from this communication, it’s to go out and exercise. And now that you're a few minutes into this and you have the patience to continue listening to me, the second thing I would say is, do not stand on these devices! The reason - I and I'll use Power Plates’ own advice to you - and that is to bend your knees when you stand on these devices. There's a real reason for that because if you stood upright and your skeleton works as this perfect transmitter of mechanical signals, it's shaking your head like it's a paint shaker in the in the hardware store and it's shaking your brain like you're banging a football 40 times a second. Not so good for anyone. They say to bend your knees, but Newton taught us that you can't fool physics. So if you're delivering ten g at the bottom of your feet, and that Power Plate tells you to bend your knees, because they only want 1 g to reach your head, those 9 g have to go somewhere. They're going to your knees and they're evaporating. This energy is evaporating as heat in your knees. You could get off your 10 minute exposure at the gym and say, “Gee, I feel great,” but that's all going into the bad bank of your physiology where this stuff accumulates and one year, ten years, whatever, it's going to come back to haunt you. As either brain disease, low back pain, disc problems or femoral neck fractures. And again, it's not just me. Go to ISO 2631, look at PubMed, the world access to health information, and look up safety of vibration and you'll see huge amounts of information that tell you healthy people need to limit their exposure to vibration. Injured people or the frail and elderly need to avoid it completely. So this intense vibration in these devices in the gym... trust me, these manufacturers do nothing but yell at me about this because I spend half of my scientific life saying how great vibration is, and the other half of my scientific life saying how horrible vibration is. So you know, it's just the cross I bear I guess, so be careful.

35:16
Dr. Maya Novak:
Yes, thank you for explaining that, because I do remember the first time when I saw this type of platform in the gym. You were saying to please don't stand on it, but if you are then bend your knees. But I can tell you that I do remember I was observing a personal trainer with a client and they were not just doing squats on this platform. The client was also doing pushups. So you know, it's not just that people are standing - people are doing all sorts of stuff on these platforms because they are supposed to be so good. So you talked a bit about what can happen down the road. So if a person right now is using this and nothing is actually happening physically, do we know approximately how long does it take? Is this years or can if also compromise some people's health if the yonly use it a few times?

36:18
Dr. Clinton Rubin:
I've been contacted by people around the world showing that a single interaction with these devices is enough to cause irreversible back pain or disc rupture. There's stuff in the literature with people reporting detached retinas.

36:40
Dr. Maya Novak:
We'll continue in just a moment. I wanted to quickly jump in for two things. First, thank you for tuning in. And second, I’m sure you have at least one friend, colleague, or family member who would very much appreciate this episode. So share it with them and help us spread the word. Now let’s continue…
37:01
Dr. Clinton Rubin:
I am confident your listeners are bright, well-educated people. I'm going to tell your listeners here and now that you would be foolish to stand on these devices. Even if there is some subtle benefit to them, and I'm not sure that I know there is, we have to put in this equation of first, do no harm, and the risk of true harm. Not only your musculoskeletal system - your visual, your auditory ,your sensory, your cognitive system is over the top at risk. So I think that my colleagues that are building these devices would turn around and say for example, ISO 2631 which I've mentioned a couple of times, “We’ll pay it no heed because,” and they would be correct in stating that, “it's an advisory for exposure to vibration in the workplace if you're a train conductor or if you're a ferry pilot or a truck driver.” They're absolutely right. “And therefore because you're doing this voluntarily in the gym, it doesn't apply to you.” That to me is just insanity. That's like saying, “If you want to see if you have the correct shoe size you could put on your shoes and expose it to an X-ray to take a film, because it's not a medical procedure.” Well X-rays are dangerous. That's why they took x-rays out of shoes stores to see how well your shoes fit. So don't be foolish. You know I'm not here to sell a device. It is true that I have many patents around this. I formed many companies around this and I'm a great believer in it. My wife uses the device every day and she doesn't believe a single thing I say. A lot of people have benefited from this. I'm very proud of that. It's the reason I do what I do, but make sure that when you're putting yourself at risk that it's worth the risk. I think subjecting yourself to high intensity vibration is asking for either acute or chronic accumulated damage to too many systems, and do not do it.

39:18
Dr. Maya Novak:
Okay, and for those listeners who are interested in the platform that you are talking very highly of, we're going to put the link in the show notes so they can look into potentially purchasing it. But what we are saying right now is don't go to the gym and stand on these platforms that are vibrating and think that they are doing something really good for you and for your health, right?

39:43
Dr. Clinton Rubin:
But let me put the device that we've developed and is now available worldwide and again, I'm proud of it. I'm proud of a conflict of interest. I'm proud to see my science translate into medicine. I mean, it’s wonderful. It's why do what I do. But remember if you have severe osteoporosis at least in the US, there are FDA approved drugs for the treatment of osteoporosis. Ironically, even though these drugs are out there, if you're a female with a low T score and your physician by reflex prescribed you with an anabolic. I understand that because that's what the physician community is trained to do. But a lot of very intelligent people also know that to take a drug for twenty or thirty years to prevent a disease is not something our culture is really ready to deal with. They want other strategies to protect their musculoskeletal system. So 50% of women that are prescribed these drugs never fill the prescription and the remaining 50% that do fill them, 50% of those never refill them. They're looking for other ways. So people who contact me, the first thing I tell them is to coordinate a discussion with their family and their physician to make sure that the strategy they're going to pursue is right for them and their musculoskeletal health etc. But if their family and their physician decides that they want to try something like low intensity vibration in addition to choosing your parents with good genes, eating correctly, exercise, having a beer at the beach because we all need our rewards - if in addition to that you want to try to see if vibration works.. Or for that matter you're in such a state like some of our most successful trials have been with cohorts of kids or adults that have been unable to exercise because of the conditions, the injuries or the disease the yare suffering with - this goes back to don't be a couch potato. Figure some way to send mechanical information to your musculoskeletal system in that case. Give it a try because we have a lot of evidence of success and success not only with the outcomes that those of us that may have osteoporosis might be worried about - improving bone density or improving bone quality - but going back to the beginnings of our discussion. And showing that mesenchymal stem cells proliferate in the marrow. They're driven towards bone cells and away from fat. So we have basic science biology up to clinical outcomes that say there's enough reason at least for me to believe that low intensity vibration is relevant. Again, I appreciate your interest in me and my work and I appreciate your audience's interest in what I have to say and our conversation. I'm not here to sell you a device. I'm here to ensure that your listeners go out and exercise and value the key nature of mechanical signals to all of our systems, including our Immune system, including our cognitive system, and if you want to try low intensity vibration, I say go for it.

43:14
Dr. Maya Novak:
Yes, absolutely. Now you talked about osteoporosis and osteopenia. But let me ask you, this low vibration therapy. How is this connected to fracture healing. Is it beneficial? Or maybe you know someone right now, a listener may be having trouble with bone formation or bone healing. Their fracture is not healing correctly. Is this something that could help them? Have you done any research in that regard and can you talk a bit about this?

43:49
Dr. Clinton Rubin:
Yeah, I could try and I'll give you sort of a look back over my right shoulder to some of the things I've done in the past. I've been interested in mechanical signals for a very, very long time and those in your audience that have a fracture, maybe have a cast or immobilization, or maybe have an intertrabecular rod to stabilize the fracture. It is stabilizing fracture, which is key right? You want the cast or the pin or the plate to stabilize the fracture. But what that's doing is it's basically suppressing or attenuating delivering mechanical signals to the injured site. Now remember the stages of fracture healing. There's the inflammatory response, the hematoma with the blood clot. And all these sort of immune cells coming in and the platelets and the aggregation. There's the remodeling phase, the repair phase and the remodeling phase, these are all phases that are also important to building up bones. So there is a parallel to this. But when I say looking over my shoulder where I started in translating the science that we do to... at the clinic we used low intensity ultrasound rather than low intensity vibration. So there's something called a Safe Device - Sonic Accelerator Fracture Healing System. Made by a company called Exogen which I've found. I think it's now worldwide and it's good. One of the first FDA approved devices for the acceleration of fresh fracture healing. It shows that if you have a fracture it can speed up the process of healing. Now that's all fine and good and if somebody has a delayed or a non-union fracture, they might speak to their orthopaedic surgeon about considering an Exogen’s device. I have absolutely nothing to do with the company. There's no conflict now. Been removed from them for 20 years or so, and they're a wonderful device. But standing on the device, there's a group in Hong Kong that had shown that women with e femoral neck fracture that’s been stabilized by something called ephemeral nail, that by standing on a device that's delivering 0.3 g at 30 hertz for 10 minutes a day, it actually augments and not only accelerates the healing of fracture. So the bridging of cortical bone. It augments it. The amount of callus that's laid down increases. We've shown this in animal studies. We've never had the courage to do it in humans, but colleagues in Hong Kong have shown that these mechanical signals going back to the very nature of cells from the beginning of time being responsive to mechanical signals, your fracture callus increases. And your orthopaedic surgeon will tell you of course, if you have a total knee replacement or total hip replacement, your orthopaedic surgeon will want you up and ambulatory as much as you can tolerate the pain. They want you active. Why? Because they want the bone to grow into the implant. They don't want the fibrous tissue or the fat to start. They want the bone to grow. Do you need the mechanical signals? Just like the astronaut, just like the couch potato. Just like the total hip replacement. You need mechanical signals.

47:21
Dr. Maya Novak:
This is great news and you know, Clinton, I would love to talk to you longer. But I know that I have to let you go because you have other things to do. Perhaps in the future we can do another interview for all of my follow-up questions and questions that listeners will also have, so if you are open to that I would love for another opportunity. But before I let you go, I have one fun question that is out of the box. And that is, if you were stuck on a desert island with an injury - any kind of injury - and you could bring only one thing to help you heal amazingly... Well, what would that be and why?

48:03
Dr. Clinton Rubin:
So, I assume that that means I can't bring a case of beer because if I'm now on the beach on a desert island I got to be on a beach and I like the thought of it being summer and being on a beach. I mean, I don’t know, if your boundary conditions would allow it I'd probably bring a satellite phone and call a helicopter. That's what I would do, but I would probably figure out a way to keep mobilized and keep exercising. You know I know that the people listening to your podcast are curious about how to stay healthy, how to recovery from injury, and I cannot emphasize enough to you the importance of staying mobile and staying as active as you can be. Whether you're an elite athlete at the age of 25 or whether you're 90 and swimming laps. It's key to keep moving, to keep exercising and in answer to your question about a follow up interview. Only if it was on the beach with a beer and I would be happy to. [laughs]

49:09
Dr. Maya Novak:
[laughs] Let's do this on the beach. You know, you're gonna be drinking beer, I'm gonna be drinking coconut water and we're gonna do this one more time.

49:17
Dr. Clinton Rubin:
Perfect I look forward to it. [chuckles]

49:21
Dr. Maya Novak:
Now for those who would love to learn more about your work. What is the best thing for them to do, where to search for your work?

49:30
Dr. Clinton Rubin:
Well, I would start by listening to your interview. I think that's a valuable start of information. Regarding the device that I'm inferring to but not trying to sell - if people wanted to look for more information about it, as you point out, it's low intensity vibration, L I Vm and the device is called Marodyne LiV. It's a bit of a mouthful but the reason for Marodyne is marrow, because we've talked about marrow, and dyne which is a small unit of force. So in one of my few clever moments I was trying to connect marrow to a small unit of force and there came Marodyne. So if your listeners, if they're curious, if they search for Marodyne and Rubin and they'll come up with more information than they care to, really.

50:29
Dr. Maya Novak:
And we're gonna put the link in the show notes. So it's gonna be very easy to find that. So thank you so much Clinton, that was an amazing interview and I learned a lot of new stuff today. Thank you.

50:43
Dr. Clinton Rubin:
Thank you Maya! Thank you again. It's been a great pleasure. Thank you so much and enjoy the beach. See you later, bye bye.

50:50
Dr. Maya Novak:
Thank you for tuning into today’s episode with Dr. Clinton Rubin. If you haven’t done it yet, subscribe to The Mindful Injury Recovery Talks on whatever platform you’re using to tune in. Of course, also remember to share this episode with your loved ones and help them out. To access show notes, links, transcript, and video of today’s talk go to mayanovak.com/podcast and click on episode 23.
And to learn more about The Mindful Injury Recovery Method visit my website mayanovak.com and find my book Heal Beyond Expectations on Amazon. Until next time – keep evolving, blooming, and healing.