20. Building Better Bone Strength with Rebekah Rotstein

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00:00:00 

Jen Milner 

Welcome to Bendy Bodies with the Hypermobility MD, where we explore the intersection of health and  hypermobility for dancers and other artistic athletes. This is co-host Jennifer Milner here today with Dr. Linda  Bluestein. Before we introduce today's special guests, please remember to subscribe to the bendy bodies podcast  and leave us a review. This really helps grow the audience and increase awareness about hypermobility and  associated disorders.  

00:00:41 

Jen Milner 

Today We have the great pleasure of speaking with Rebekah Rotstein industry leader in Pilates, bone health and  movement education. She's the creator of the medically endorsed buffed bones system with trained instructors in  more than 30 countries. She presents throughout the U S and internationally, and at conferences in the Pilates  industry and beyond including the international osteoporosis foundation worldwide conference. She pursued her  love of anatomy, training and Pilates at the Cain school in New York city under the tutelage of Kelly cane,  where she later joined the teacher training faculty. When she was diagnosed with osteoporosis at age 28, her  focus took on a new direction to share insights and options to those with low bone density and exercise  professionals, caring for them. Her work is in the field of osteoporosis and medical education. To invite her, to write an evidence-based continuing education paper on osteoporosis and exercise, which later encouraged her to  develop the buff bones exercise system for bone and joint health.  

00:01:40 

Jen Milner 

Rebekah serves as a long-standing ambassador for American bone health and worked as a partner of the U S  department of human and health services. She's a longstanding visiting instructor at the online studio Pilates,  any time Rebekah, welcome to bendy bodies. Thanks for having me. I'm excited to hear what you well, we are  so excited to have you right Linda. Oh yes. Super excited to chat with you. I should say also at the outset that  Rebekah and I are friends for about 15 years, maybe, probably more than that. Yes. I was one of Rebekah's  Pilates teacher trainers, so I trained Rebekah to be a Pilates teacher. We have been fortunate enough to be able  to stay friends through the years moving through. I'm so proud of what you have accomplished Rebekah. So  proud. I think it's actually, it's like 18 years now. Oh, thank you. I feel much better.  

00:02:41 

Jen Milner 

Wow, incredible. It is incredible. Rebekah, you have been a pre-professional dancer, you have hypermobility  and you had some serious injuries and were diagnosed at an incredibly early age with osteoporosis. So let's start  at the beginning. You're, you've got a wonky body, you get injured. So tell us about that.  

00:03:04 

Rebekah Rotstein 

The first time that I really realized that there was something going on was I was at Boston ballet school and I  was having a lot of problems with my Achilles. I went to the company doctor and I started seeing their physical  therapist. It can just continued onward from there. Same thing at San Francisco about the school. I kept going on  and discovering that these ankles were causing me a lot of problems and it was diagnosed as chronic Achilles  tendonitis, but, and that's why I quit. I learned later that it was far more than that. Now, from what I realize, it  really was a very different diagnosis than that, than what was given. That was really just the symptoms of it. It  all stems from the joint hypermobility throughout my body. I never thought of it that way because I never had  amazing extensions. I didn't have these incredible feet.  

00:04:02 

Rebekah Rotstein 

I just seemed to have pain, but it didn't seem that I didn't think I was hyper mobile. I just thought that I was had  more laxity than the average person, but looking back, there are so many signs going back even to beyond or  prior to that when I was an ice skater where you see pictures of me at three years old, and my ankles are totally  collapsing, inwards, gosh, with all the others who seem to have straight parallel feet and well aligned structures.  So this has been a lifelong thing. It's just, I didn't realize it at the time. So I ended up quitting. I, I got to the  point, I guess, where at North Carolina school of the arts, I was sitting out for most of class and only joining  rehearsal, essentially perform. I was, I, I decided I was about to quit when I was about to, consider this offer that  was happening where Fernando Honus was creating a new company down in Tampa or in Southern Florida.  

00:05:07 

Rebekah Rotstein 

I thought I would go that route, but then I just realized I'm just in so much pain and this is just I'm done. I  decided to quit dancing and I went to college instead. That took me on a very different route where I began  working in the sports medicine department and my college thinking I'd go to physical therapy school. I still was  surrounding myself by injuries. They just weren't my own. I thought that would be my path. I decided I just  needed to get away from the body a hundred percent and never deal with it. Again, it worked out really well. My  first, I'd say five years after I graduated college and I went to, I moved to New York. I wasn't working with  anything with the body, but I was seeing, one of the big dance medicine physicians there who dealt with the  Joffrey for my injuries.  

00:06:05 

Rebekah Rotstein 

He started doing injections, prolotherapy, which was extremely excruciatingly painful, but it turns out that was  coming from my sacroiliac instability. That was part of what was leading down to the discomfort and the pain  through my ankles. That was the first indication to me that there is some relationship where the symptoms are  not necessarily the source of the problem. 

00:06:34 

Jen Milner 

Yeah. That's, that's such a huge thing for you to learn. Hopefully some people learn it while they're still dancing.  But not everybody does, you know. A benefit of the injury process was that it introduced you to Pilates. Yes.  Started something that has, I think really, had an impact on the exercise world, with what you're doing. You  were always a very gifted Pilates teacher, I should know. I know that the diagnosis at age 28 of osteoporosis, it  absolutely reshaped your teaching and your focus. So, talk about how you got that diagnosis. Like what, why  were people even looking for that and what happened immediately afterwards?  

00:07:23 

Rebekah Rotstein 

Well, thanks to you actually, Jen, I, my interest in special populations that I'd already had from injuries led me  to teach the special populations like yourself curriculum. I should say, this led me to teach the special  populations curriculum like yourself at the Cain school. So I was already teaching about osteoporosis. So I had  some knowledge about it. I started taking some additional workshops just out of it at conferences. I was  interested in it. When I was diagnosed, I was shocked. The reason I even got a DEXA scan, a bone density scan  in the first place was because one of the workshops that I had attended had pointed out a staggering statistic for  me, at least at the time, the statistic was that 98% of your bone density is developed by the time you're 18 to 20.  The statistic varies a bit, but it's around that the majority of your bone density you develop in your teenage  years.  

00:08:23 

Rebekah Rotstein 

When I was dancing like many dancers, I had stopped menstruating. I had weighed very low amount. I weighed  82 pounds throughout my whole granted and only five feet tall, but still, I was very small and I'd only  menstruated for one of those teenage years. I knew from everything that I was learning, that I was at a  predisposition for osteoporosis. It ran in my family, both parents had it. I decided, let me just get a bone density  test to see as a baseline where I am now for once I hit menopause later. It just came back with very disturbing  and shocking results, which were that I already had osteoporosis according to that classification. So I, I got very  depressed. I got very upset, partly because I still identified as a dancer or at least you have your, you're never  going to not be a dancer in your mind, no matter what, no matter where your life takes you.  

00:09:27 

Rebekah Rotstein 

I identified so wholeheartedly with my body and it had so many ramifications from the idea that I would fracture  to the idea that from all that I had learned and studied already, I knew that I was going to have to completely  alter my Pilates repertoire and my personal practice, because I knew already what was contraindicated of  movements for osteoporosis and ability. Eventually I took action after I allowed myself to grieve as was needed.  At the time I started talking to physical therapists that I knew reached out to other physicians. I started just doing  my own research and finding out what I could do for myself. I visited an endocrinologist and that gave me a lot  of information that I think is critical for people still. Now that I think gets overlooked by the just simplistic or  oversimplified version of a diagnosis. You have it, you have to treat it.  

00:10:31 

Rebekah Rotstein 

These are the ways you do it. I think there's a lot of gray area in there that is dismissed, unfortunately.  

00:10:40 

Jen Milner 

Okay. You started researching, you got first, you got sad, then you got angry and you started researching, right.  Trying to figure out what you were going to do. You chose to go see nutritionists, endocrinologists, you kind of  piece together, your own plan, right. Because as you said, options for treatment, right then weren't really, they  weren't really a lot of that gray area. They were more, as you said, here's what you have now. It's time to treat it.  I, my guess is that what they talked about as your treatment wasn't necessarily what you thought should be the  start and end of the conversation. Talk a little bit more about that.  

00:11:24 

Rebekah Rotstein 

In the medical world, treatment equates to medication, certainly in the osteoporosis world. The first thing I was told by the treating physician initially was all right, the bad news is you have osteoporosis. The good news is  there's medication that you can take pretty much sent me into us, complete sob story right there. The more I  looked up, okay, well, let me learn about the medications. Well, medications, certainly at the time, not a single  one had been tested on premenopausal women. I was in childbearing years, what are the ramifications and  possible side effects that could have that had been completely ignored? Let alone, the more I learned about  osteogenesis in bone resorption, metabolism of how your skeletal system works, it would the medications, the  predominant medications, except for one single medication and the ones that were had been recommended, all  suppress your bone turnover. In other words, what they do is they help bone breakdown, but it turns out as I  learned through getting blood and urine tests, I wasn't having a problem of bone breakdown.  

00:12:38 

Rebekah Rotstein 

The mechanism by which these medications would have treated me would not have been logical. They wouldn't  have actually treated what was going on. It turns out I had a vitamin D deficiency, which now everybody talks  about, but for, certainly in research papers, it was discussed, but clinically and definitely mainstream on blogs,  well, blogs probably didn't really exist, but you didn't hear about vitamin D deficiencies. I was able to get certain  blood markers and also urine tests to identify well, was there anything else underlying, was there something  going on with my endocrine system, which is very common for people okay. Check that was not it or X, that  was not the case. Were there any, was there celiac disease, like all of these other things that can be second  causes of secondary osteoporosis essentially. What we did identify, the only thing we really identified was that  had a vitamin D deficiency and that alone remineralizing my bones increased my bone density, but at the same  time, I think it's interesting to identify that I also changed my diet.  

00:13:56 

Rebekah Rotstein 

I also sought out the assistance of a trainer who is a colleague of both ours. Goodman had put me in touch with  Phil who became my long time trainer for Senate from probably what, 2005 until I moved away in 2019. I think  there was just the interesting part is that there is a number of other factors that have to be identified and rule out,  

ruled out on the course to treatment on the course to an identifying, plan and back then, and still, I think very  frequently, these other factors are not looked at and considered.  

00:14:43 

Linda Bluestein 

That's super interesting almost at the exact 2004. Sounds like about the same time that I got a of osteoporosis. I  was I'm older than you. I was older than 28 by a fair bit. But, I literally got a voicemail from my, it wasn't even  my doctor. It was the nurse they called, they left me a voicemail. You have osteoporosis, you can choose drug a  or drug B. And that is literally all they said. I had been asking him for years to test my vitamin D level because I  was aware of some of the research and things, not necessarily even for bone health, but for mood and pain,  because I already had pain at that point. And for sleep and stuff like that. So it's really fascinating to the  parallels. I totally agree with you that, and I think part of that is because of the healthcare system is so  dysfunctional and it's all about time and it's quicker to just say, you have this, you can do this or this.

00:15:43 

Rebekah Rotstein 

And it's still, unfortunately to this day I find it very myopic. I had gone with my mom to one of her physician  appointments probably about four years ago, I would say at this point. And she would, she has osteoporosis. She  had been on the bisphosphonate medications, which are the most commonly used to treat osteoporosis, actually,  it's changing now, but I should say not necessarily by phosphonates, but now anti-resorptive, which is a larger  classification of, stopping the bone breakdown essentially. My mom had said at the time, well, what about  exercise with me there? Her daughter who specializes in this and the doctor says to her point blank exercise,  won't help. I said, I had to pull myself back because this is to this day, very frequently stated, even though  there's actually much greater evidence than there was then. Even then there was more evidence than there had  been back in 2004 when I started investigating this.  

00:16:43 

Rebekah Rotstein 

The idea is, okay, you could say that there's a limited evidence, but to say that there's no evidence is a complete  fallacy. It's just interesting to see how even that has shifted in recent years, but still I can share with you some of  my challenges with the shortcomings, even of research and the approach though, in the medical world where we  

have so much of an emphasis on bone density. Yet there they've identified that there are more fractures that have  occurred in osteopenia, which is the precursor to osteoporosis than actual osteoporosis. In other words, more fractures occurring with a higher bone density. That points to some kind of shortcoming in our diagnoses, in our,  outlook on this condition.  

00:17:38 

Jen Milner 

That is so interesting. I, I see because you have hypermobility, I have hypermobility, Linda has hypermobile.  We all everybody's hyper mobile, right? All different. I'm somewhere on the EDS slash HSD spectrum,  depending on which labels you're looking at, and have fought with low vitamin D my whole life at one point cut  just a couple years ago, I switched doctors and she did a test and we had done the cup for a couple of years and  it was 12. Yes, one, two. I have seen with my hypermobile dancers are very prone to have low D everybody  talks about that now, which I'm so grateful for, but especially in my hypermobile dancers, I've seen without any  research to back it up, that they have a harder time maintaining that. I don't know, Linda, if it's, people with  people who are on the spectrum have a harder time absorbing minerals in general, have you seen anything like  that?  

00:18:36 

Linda Bluestein 

That's a good question. There are definitely gut issues that lead to, more difficulty with, absorbing definitely gut  function is impaired in a lot of people that are on the spectrum, which I think is a good way to think of it. Of  course, when you say on the spectrum, a lot of people think the autism spectrum, but now we're talking the  hypermobility spectrum. Yeah. Because of course, everything we talked about is hypermobility. So, so yes, I  think that's definitely the case. There's also some genetic markers that we can look at that have to do with  vitamin D incorporation and how well we work with vitamin D. There also could be genetic differences as well.  So, and that's of course, a very rapidly evolving field. It's a fascinating to look at, that pertains specifically to  snip testing, which is single nucleotide polymorphisms. Anyone that's had, like 23 and me, or some of those  things done, and then you can actually pay of extra money to have them look at some of these snips.  

00:19:37 

Linda Bluestein 

It's, there's a lot of great information. Stay tuned for a lot of that stuff. 

00:19:44 

Jen Milner 

Yes, absolutely. So, so you've got hypermobility, you have osteoporosis, you're young, they've told you start  taking drugs, and you are not finding at the time a lot of compelling research that says don't take drugs, do  exercise, right. Basically. What made you exercise? Like what was it, is that just because that's what you knew  and that's what you felt good doing? What made you seek Jeff out and start building that?  

00:20:13 

Rebekah Rotstein 

Well, that's the thing that's interesting is that there was evidence to show that exercise can improve your bone  density. It's just for various reasons the medical community was hesitant to adapt it and to adopt it. I would say  the reasoning as far as I can tell is that it was limited in terms of, needing longitudinal studies. There was, there  was the famous Erlangen study, that had looked at this. There, there was research and I think it was compelling  research, but I think you needed more, you needed greater systematic reviews, you needed more men analysis,  to be able to make the case for it, but there definitely was evidence. I looked at that evidence and I said, well, of  course, and then also we already know from Wolff's law that bone's going to respond outside forces so that you  can strengthen bone by loading it. To me, it was a no brainer also just by the fact that I also was in the field and  something that I think is interesting, just going back to the history, my personal history that I think may have  been a savior for me with my hypermobility is that I had started ice skating when I was three.  

00:21:31 

Rebekah Rotstein 

Pretty much as soon as I could walk, I was ice skating. As you probably know, with ice skating, there's a lot of  load and force that's way more because you have velocity is haunted in addition to gravity and height, that you  get more impact going through your bones. I haven't, I have not looked at any research done on ice skaters, but I  do believe that helped my connective tissue system. The fact that I had so much force generated when I was  younger, prior to even dancing. I think that actually strengthened my joints more than I would have without that,  but I already knew all of these basic facts, just about weight bearing about resistance and impact, not to the extent that I then started studying, but these were already part of my life to begin with. I had not been very  intensely involved in progressive resistance, weight training.  

00:22:36 

Rebekah Rotstein 

High-intensity loading, as well as velocity training. I had worked out, but I had not been that diligent about it. I  had done some throughout my twenties, so I've gone to the gym, but I'd never had officially a trainer. That made  me think, all right, well, I'm going to take this next path.  

00:22:58 

Jen Milner 

Well, and I remember watching you as you went through the diagnosis, and then as you did your research, and  then, as you started working with Jeff, and I remember seeing a clear difference in you physically, as you seem  to take as you took on muscle, for sure, but you also inhabited your body in a different way and looked stronger,  looked more, I don't want to say aggressive, but assertive physically in your frame. I love that it did something  for you, but then you also thought that you wanted to take that and do something for other people and kind of  move that on. We know that it was your struggle through all of this, like your personal struggle that led you to  develop buffed bones. What made you feel like the world needs this program and I'm going.  

00:23:46 

Rebekah Rotstein 

To put it out there? I really didn't. That's the funny part. Yeah. Somebody else told me they did. I initially we  had just created this workshop for osteoporosis as I was doing all this research about it. I thought, wow, let me  share some of this information, which coincided at the same time as I was creating a workshop on  hypermobility. I was simultaneously researching the two very different diagnoses. At the time also, this was  when it was the benign joint hypermobility since, well, I guess it's the nine because it's not affecting protecting  my organs, but done that's true. Doesn't feel benign. Well, I was simultaneously looking at both pathologies, if  you will. I had created this workshop and at the, I guess probably about two years after I'd created the workshop,  I was invited by Haverly medical education to create a continuing education lesson and paper for exercise  professionals about osteoporosis.  

00:24:50 

Rebekah Rotstein 

They were building out this whole other arm for exercise professionals, in addition to their whole CME division  for nurses and physicians. I did a whole literature review, basically. That's how I started really delving into all  the literature that was there, looking at all the evidence that was out there. That's where I really started seeing  what was available and what was being stated about exercise. There, it was bountiful, despite what people were  thinking, there was plenty out there. Even if you look now, you'll see all sorts of citations in current literature  that references things prior to 2004, even prior to 2002, but it was a matter, I think of the word not spreading and  reaching ears that I think it needed to reach. Then, probably about a year or so afterwards after I'd done that, one  of my colleagues who'd taken my osteoporosis workshop said, why don't you put together a whole program that  is not just about all the science and the bone metabolism and about the medications and nutrition and movement,  but why don't you take the movement part and actually create a whole program for it? And at first I thought,  well, why does anybody need that? I said, I'm just giving them the tools to do it yourself.  

00:26:08 

Rebekah Rotstein 

It's like people actually want you to implement something. So that's how it came about. It became actually a  whole methodology in a system itself that follows these certain protocols that follows essentially my belief of  how you approach the body that comes essentially from my hyper mobile mind or my attitude toward the way I  treat my own body with hypermobility. That the way I, I worked with every single client. I took that approach  and put it into the system for bone health. And it works magically.  

00:26:46 

Jen Milner 

Who is your target audience for this? Is it people who've already been diagnosed with osteoporosis, people who  just want to get workout? Like where do the benefits come from, or for whom to the benefits come.

00:26:57 

Rebekah Rotstein 

It's really evolved actually much more than what my initial intention was. My intention initially was to help  people with osteoporosis to help people prevent osteoporosis. Also the part of the mission statement was to help  future generations and to spread the word about this epidemic that is growing and statistically, the numbers were  showing that future generations were going to take in have larger, experiences and greater experiences of  osteoporosis than already existed. I was looking at it from a pretty large standpoint, but the actual program, the  buff bone system itself was initially really just designed, targeting people that were early post-menopausal  women, who were far more capable of doing many different types of movements, getting up and down from the  ground and more capable than doing simple seated exercises with weights in their hands. And that's really all  that. There was, there was a huge gap that I felt a need to fill.  

00:28:09 

Rebekah Rotstein 

That was for these women who are, say forties to sixties that are, and now, things have changed. My mom is 74  and she's part of that. She still gets up and down from the ground. She's part of this demographic that can do  that. That is not elderly. That is not quote what you think of as this senior or fragile population. Yet these people  don't want to be doing boot camps. They don't have the same needs. They're not trying to flatten their stomach.  They need to be functional and they need to be strong, but we're doing them a disservice by saying, well, you  either can go and do burpees, or you can do your exercises where you sit down and you tap your toes. I realized  there's a huge population that is being underserved. Actually, even though age-wise chronologically, I didn't fit  into that. I did in terms of what my body needed to be doing.  

00:29:08 

Rebekah Rotstein 

I did, I created a system that felt good on my body. I was my Guinea pig to test it, but then I tested it on a  number of people and found that it served people very well and the results were getting were pretty outstanding.  It wasn't, it's become something it's not just osteoporosis. So it's safe for anybody with osteoporosis. It's, the  system is designed with bone loading approaches, and yet it also integrate so much more with, considerations of  fascia research and also how we can release restrictions in the body and then build it from there once you've  removed those restrictions. That then we build in the strength and how we bring in the mobility, the  coordination, the, a huge component that I don't talk about with the public is motor control. There's a law that is  built upon motor control in this, it just the general public, probably isn't as interested to hear about the  sequencing as it comes into play for that.  

00:30:14 

Rebekah Rotstein 

As a result, it's been great for people with osteoporosis or something with, for people, with osteoarthritis as well.  People with neck pain and people with shoulder pain, back pain, hip pain, and especially the hypermobile folks,  because what we're doing is we're releasing the areas where there's the fascial challenges, so we can restore the  gliding and then you start to change the sensation. We change the proprioceptive feedback, and then we bring it  all together. At the end is when we bring in some of the loading wit from outside forces and then the body  knows how to respond, and it really integrates it as a whole.  

00:30:57 

Jen Milner 

Your hypermobility did not feel like it was being challenged while you were starting to do your strength training  and everything, the work that you were doing actually felt good for your hypermobility and felt like it was  helping you kind of rein it in and get control over it. Is that what I'm hearing?  

00:31:14 

Rebekah Rotstein 

Yes. Although I still had to do it my way essentially, and that was one of the beautiful things that Jeff and I  created together was this technique. To speak of hands-on work because I definitely needed the additional load  and I definitely needed the additional resistance. I mean, that made such a difference from my body, but for me  to do seated robes and lap poles where my shoulders not fully connected, I can feel it's not congruent it. I  wouldn't feel it. I felt nothing in my post to your adult ever until I worked with him and basically told him where  I needed his hands to give me the feedback so that I could get the joint congruent and I could get the joint stability, and then I could get the muscular activation where it needed to, but we did it that way. It still wasn't  enough for me.  

00:32:14 

Rebekah Rotstein 

W I guess my answer is that weight training has been a game changer for me, but still, Hey, the joints are so lax  that I still need the hands-on assistance. That makes the difference so that I can actually get the proper loading  forces and the proper activation where it needs to be.  

00:32:35 

Jen Milner 

That makes a lot of sense. Very, very interesting.  

00:32:40 

Linda Bluestein 

This is a great, concept because we talked about medications and the challenges with that. I think it's important  to remember that when it comes to writing a prescription, which is basically, when we give a plan to somebody,  we are giving them, we get, we're giving them a plan. We're writing a prescription for exercise in the general  sense is so much less useful than saying, this is a specific program that you can do. If we don't make it specific,  then people don't follow through. Even when we do make it specific, it's easier to pop a pill or, I mean, they  obviously it came up with things that you could have it once every, I think, year or whatever it is. I think that's  the other important thing that, when it comes to writing that prescription, there's vast differences in terms of, I  hate this word, but it compliance.  

00:33:29 

Linda Bluestein 

I think it's great for PR when people understand the. I think they're much more likely to actually do the how, and  for you under, you really understood it at a deeper level. You were really motivated to actually follow through  it, right. With, with the exercise and everything.  

00:33:48 

Rebekah Rotstein 

It's true. I hear you on the compliance term, but I think you're so right about that interestingly, when I had, when  I was in New York and my practice, I had a prominent sports medicine physician who would refer patients to  me and two interesting things about that. Every single one of them that was referred to me, what most, every  single one of them, the diagnosis was, there's nothing wrong with them. They just need to strengthen. Almost  every one of those people that I worked with that had came under those circumstances pass the beighton scoring.  Usually the situation was that there was hype, underlying hypermobility that was going on now, it's what were  really working with, getting them stronger, incorporating again, some of the strength training concepts, along  with Pilates and other movement modalities. The other thing that's interesting is that many of the people who  came to me were not compliant.  

00:34:49 

Rebekah Rotstein 

Even with that, when they were told by a physician that they had to come, it was the ones who actually stuck  around more often than not were the ones who had found me on their own, because it was their own volition. It  was their own determination, not being told by an outside source that this is something you need to do. They had  their own internal motivation that they were willing to do whatever they needed to do to get themselves out of  pain. Or for instance, if it's an osteoporosis scenario, it's at the people who are searching for me, find me through  a referral or through the internet, because they are so determined they are going to take charge of their health.  And that's really the biggest factor. I think, of that whole compliance idea. With my trainer, I would have him  help me stabilize the joint in order to produce force, because without that, I wouldn't get the forest production  directly through the joint in the way that I needed to.  

00:35:52 

Rebekah Rotstein 

If we start thinking about the path of mechanics here, it become, to me, it just becomes really evident that with  those who are hyper mobile, you're not going to have the exact same force, production, distribution, and  transmission through a joint as ideally you would with, the standard person or the standard patient. That to me  stands out as possibly the number one component. I also think, in terms of bone density, and therefore possibly with vulnerability to fracture. The other part that stands out to me is that there's the collagen makeup and that  actual component of what is comprising the bone, because most people always just think of bone as a skeleton,  or they think of it as hard and stiff and calcium forgetting about the collagenous component that gives it the  resiliency. That a strong bone is, I like to say that a strong bone is resilient.  

00:36:56 

Rebekah Rotstein 

It's not that I like to say a strong bone is resilience. I like to say that one of the goals that I'm having with both  bones is to make strong bodies that are resilient. It's not just that it's about strong bones, especially because with  buff bones, we're not getting, technically we're not getting enough loading force into the bones to truly make a  big impact on osteogenesis and in bone growth, right. And, and, changes in bone density. Although clinically  I've seen it, but technically we shouldn't really be it's that we're preparing the body to then go do the other  components of, high-intensity progressive resistance training, velocity. These other things that evidence has  shown on very high levels, even up at 85% of your one rep max, you can be increasing your bone density in  ways that they previously did not believe was possible. I, I, first of all, believed that buff bones is part of a  bigger system.  

00:37:53 

Rebekah Rotstein 

It's not everything, but at the same time, it's also the idea that you're loading the bones, but you're also having to  acknowledge that there is the chemical makeup and then there's the collagenous component. If there is a deficit  in, or some kind of a pyramid in the collagen, and people would say EDS, maybe with, hypermobility spectrum  

disorders, then that makes sense that also the collagen that's the component of the bone component or the bone  makeup might be altered as well. Perhaps that it responds differently in its genetic aspects or even in the  genotype. So I think that it makes total sense to me, but the one thing I also want to quote you on Linda is I was  listening to one of your past podcasts. You said something I love, which is that the exact label is not. You're  talking about hypermobility, disorders and spectrums, that the exact label is not as important as the symptoms of  that, because I think that's a big factor as well.  

00:39:04 

Rebekah Rotstein 

When we're talking about osteoporosis, people freak out that they've been diagnosed with osteoporosis. It's not  the same as being diagnosed with cancer. If you do nothing with cancer, then we know what can happen. I'm not  saying you shouldn't, you should just do nothing with osteoporosis, but osteoporosis is never a cause of death.  It's pneumonia or blood clots that it can lead to from a fracture, especially in the elderly, that if it is the  relationship to mortality. People in the healthcare system is so concerned about osteoporosis with the elderly  population, because of that relationship to mortality, because of blood clots or pneumonia after you fracture a rib  or a fracture, a hip and you're immobilized, but osteoporosis itself is not going to kill you. Many people live  very long healthy lives with osteoporosis and never even fracture. And, and there's also another component, which is that osteoporosis was originally supposed to be diagnosed the world health organization.  

00:40:15 

Rebekah Rotstein 

Let me rephrase that. Originally the world health organization created its classification of osteoporosis based on  low bone density, as well as changes in an inability of the bone to self repair itself. So changes in architecture.  For some reason, we're not looking at the secondary portion of that classification. We just look at low bone  density. As my original endocrinologist said to me, you are tiny. You are five feet tall and you weigh very little,  I certainly way more than 82 pounds now, but look at the size of your wrist. You're not going to have much  mass there you are automatically going to predisposed to having low bone mass because you have little bone  mass. I think we have to keep that in mind. I think that plays out for dancers certainly as well, that they're going  to be small bones. Ballet dancers are generally small boned, and they're going to probably be predisposed to a classification even of osteoporosis based on having low bone mass, that doesn't necessarily mean that they're  going to fracture.  

00:41:29 

Rebekah Rotstein 

I think that's an important thing that we all have to keep in mind for everybody that it has to be considered your  bone mass, but let's be careful with our labels as well. 

00:41:42 

Linda Bluestein 

That that makes sense. And, and if you found a difference in how people that are hypermobile progress through  the buff bones course, or how they respond to exercise as compared to people that are not hypermobile? 

00:41:55 

Rebekah Rotstein 

It's a really interesting question. I have not done enough of a clinical analysis to identify, but I would like to, I  can tell you that. Well, I think they actually respond differently. So here's the thing. I think that those who are  hypermobile respond well, because the we're talking about usually women who are post-menopausal, who are  coming to our classes or who are coming to me as clients, because of osteoporosis, not always, I have some  

premenopausal, but if we look at that subset, then I would say, we generally know that with hypermobility, most  people tend to become stiffer as they get older. So, especially as the beighton scoring has shifted that, at certain  ages, it lowers with their scoring. I think it's at four is the number of their scoring after age 50 and five is, the  number of joints that have to be classified prior to that people are getting stiffer.  

00:42:58 

Rebekah Rotstein 

As they're getting stiffer. They're also having more of the fascial restrictions and the tightening that is occurring,  also trigger points and such. I think that the release work that occurs early on in the program, benefits them and  the motor control benefits them. That then when they add the load on later and they're doing more full body  integration, it makes sense in their bodies, not necessarily in their heads cerebrally, but their bodies radically are  saying, Ooh, okay, wait, I'm getting this, I'm starting to congeal. I would say that those who are not hyper  mobile are still benefiting from the stretch components and the fascial release work that they're having issues  with regardless, because they're just stiff and tight. I don't know that I'd say there's that much of a difference,  because I do find that both benefit from it, but maybe it's they benefit in different ways.  

00:44:00 

Linda Bluestein 

Okay. So, so how did you discover also things like nutrition and other forms of intervention? how did you find  experts to help you with that? Because we know that exercise is a hugely important component, but there's other  factors that are important as well in terms of treating, for bone health.  

00:44:20 

Rebekah Rotstein 

Well, the answer is that I'm still in the process. I've worked with various nutritionists and I have, I've also had  colleagues in the field that I've referred to. It can be an interesting topic though, because that is one also that is  constantly shifting and constantly changing. The discussion about vitamin K now is now the new vitamin D and  then we've talked about that and I'm fascinated with vitamin K and yet I also don't talk about it much myself  because people like my father who was on Coumadin for much of his life, it would have been totally  contraindicated for. Never without it's a, it's out of my scope and B I'm not doing a full medical, intake to be  qualified, to tell people, whether they should be taking certain vitamins or not. I do find it challenging because  sometimes people come back to me after I've referred them to a, a nutritionist where they appreciate what the  person said, or they don't appreciate what the person said, or they don't like the path that person took them on, or  maybe it was that they had to go into so many supplements.  

00:45:44 

Rebekah Rotstein 

It's, it's I find it to be a really tricky road, partly because there's different beliefs as well. So, and some of those  beliefs are evidence-based and some of them are not evidence-based and I don't, I'm not always so thrilled with  it. Some of the things that I see that are evidence-based because I feel that they do overlook other components,  but then the ones that are less evidence-based you want to be careful of what you're aligning yourself with, but  

at the same time, there's there are things that seem to have some evidence, but it's not enough to warrant,  physicians backing it or certain standard physicians backing what they're saying. It, in some ways it parallels  what I find in the exercise world that sometimes, maybe you're just ahead of the curve, right. Maybe it's for, as a  movement professional, the reason that there's no evidence is that it just hasn't been shown yet, but at the same  time, you don't want to be a whack job. 

00:46:47 

Rebekah Rotstein 

You want to be out there reporting stuff that is valid. I find it to really, it's a really tough balance.  

00:46:54 

Linda Bluestein 

Yeah, definitely. It's funny, I didn't even make the association until you just were answering this question  between something that was happening in our household recently, my husband had a stress fracture and nobody  had advised him about vitamin D or any other. I mean, they just said don't they put them on crutches and he had  some complications with that. And, yeah. So, and no one had discussed diet or anything again, that's time  consuming and yeah, you're right. It's, it's challenging. Are you an early adapter or are you a late or are you  somewhere in the middle? And to me it's all about the risk. So you're right. For someone like your dad who was  on Coumadin, then obviously eating a lot of dark leafy greens, which are high in the K vitamins, is dangerous  because then you're going to, negate the effects of the Coumadin. Otherwise a lot of the nutritional type advice,  is stuff that you can be an earlier adopter on because the risks are less.  

00:47:55 

Linda Bluestein 

It can be really challenging to find somebody that has the expertise and can provide that additional information  because I really do feel like no matter how great, the pill or supplement is that, you still need a good quality diet.  It's not going to make up completely for, a poor diet or other things like smoking. Right. We, I mean, in terms of  bone health, smoking is definitely not something that's social. Which of course dancers, at least, I don't know. I,  I know the other day I tried to look for a more recent study and I couldn't find one. I don't know if either of you  two ladies know anything about more recent statistics with smoking and dancers. It used to be, I know a really  common thing because of weight probably, but, is that still the case do think, or is that something that's really  shifted?  

00:48:53 

Jen Milner 

I don't see it as much now and I'm work mostly with pre-professionals, but even with the professionals I work  with, then of them smoke and they don't talk about that. I encounter a few dancers who smoke. I know one male  dancer who smokes and he works as a freelance dancer. I've actually heard a few of his dance partners say, Oh,  he smokes and they can kind of tell. And, and I think that it's changed. I think the it's become more of a stigma  than, a stimulant. I know when I was dancing, there were so many dancers that said, my lunch is a tab and a  cigarette. Both of which are not good for bone density. Right. That was just kind of the way it was, but I think  it's a lot different now. Hopefully everybody listening knows you shouldn't smoke right. For so many different  reasons, but for the purposes of this conversation, you shouldn't smoke because of bone density issues.  

00:49:50 

Jen Milner 

Right. So, right.  

00:49:53 

Linda Bluestein 

Sorry that I digress. I got off on the stress fracture thing, which of course is not, that's just bone health in  general. As you pointed out, Rebekah, very early on, the bone with, I think so many people think of bone as  being static and it's not right. It's how fast are we building bone? And how fast are we breaking down bone?  Because just like every other tissue in our body, we're constantly growing cells and destroying cells. It's a  question of the balance of those two. And, well, but,  

00:50:28 

Jen Milner 

The digression about, stress fracture is actually I think really germane to the conversation because so many of  my dancers get stress fractures, or they get stress reactions in their feet and then their shins. We have to talk  through what's causing this, right. Look at the exercises they're doing or not doing, but then it's also a great time  to say, have you been to your doctor, say to the parents, have you, has your kid ever had blood work done? Have  you looked at vitamin D and it let's examine your diet and the dancers who, commit to a healthier diet and  commit to, trying to use nutrition as well. We'll see, hopefully that they don't get more stress fractures and also  recover faster than if someone just said, Hey, here's a boot sit in that for six weeks and don't do anything else.So just like osteoporosis dancers deal with stress fractures and the way that you deal with it will greatly affect the  outcome, right? Just like with osteoporosis, if you sit on the couch, you will have different results than if you  start moving and try to do a system like buffer bones.  

00:51:30 

Jen Milner 

If dancers sit on a couch while their stress fracture, they will have different results than if they move with a  doctor supervision and look at their nutrition.  

00:51:38 

Rebekah Rotstein 

Well, there's two parts that are really interesting about that is that the stress fracture actually stress fracture could  actually be a sign growth outside the dancer population. When somebody pre-menopausal gets a fracture, that  seems unusual, maybe a stress fracture, but also just any kind of fracture. Like somebody that I know that  skiing, she was skiing and she fell and she fractured her arm. The doctor wisely said, what, let's do a DEXA.  Let's do a bone density scan. Sure enough, it came back as osteoporosis. It wasn't the first of the fractures that  she had. The other interesting thing that you mentioned, Jen, and I think is something that Linda as a physician  would be intriguing for you, is that how often have we had let's maybe outside of the dancer population, how  often have we had clients who have experienced a fracture from something, and let's not talk about, well, maybe  it could even be the spine, but let's say you fracture in your equal or a wrist, right.  

00:52:47 

Rebekah Rotstein 

Being the third, most common site for post-menopausal women due to osteoporosis. They're told by their  physician while you're supposed to not do any exercise for six to eight weeks. I'm like, well, what does your  wrist have to do with all the ankle work that we're doing? That's going to help you with this piecemeal approach.  The reason I say different for dancers is that as a dancer, this idea that you have to bedrest bedridden or inactive  for six to eight weeks is hell. You might keep it as, so know your clients that are dancers are probably much  more eager to say, Jen, well, give me something. I can do that in my non dancer, population. It's trying to  convince them that no, you really should have this conversation with your physician to ask them that this isn't  your ticket to, activity. Are there things that, can we get permission to do some other things?  

00:53:54 

Linda Bluestein 

Right? And the difference between what we provide in terms of written instructions and versus verbal and how  clear we are and what people actually can recall, because it's also possible that the doctor didn't say do nothing  for six weeks, but they interpreted it that way because that's what they want to hear, or because the physician  didn't say, well, because your wrist is broken, you need to have that immobilized, but you still can do a whole  bunch of other things, including walking and so I just, that came to mind as you were talking about that.  Speaking of seeing a doctor, Rebekah, if you're working with someone and maybe they came to you  independently, as you mentioned, they didn't come to you because a doctor suggested that they come to you, but  you're working with them independently. And, you're thinking maybe they should see a physician or somebody  about their bone density issues. At what point do you encourage them to do that?  

00:54:55 

Rebekah Rotstein 

Well, the reason they've come to me further bones though, would, well, let's put it this way. The reason that  somebody would have come to me for their bones was because they got a diagnosis and they lived, they would have gotten the diagnosis is because they saw the doctor. Okay. They would have come to me because of the  medical side to begin with. I still, even in those cases, I still always tell them, all right, you got this diagnosis,  but one of the first things you do well, the first question they always ask me is, should I take medication? The  first thing I always tell them is that I'm not going to give you answer on that. The second thing I then tell them is  in order to make a decision on that, which is a decision between you and your family and your doctor, you need  to get more information.  

00:55:47 

Rebekah Rotstein 

I tell them that they want them to see an endocrinologist or a rheumatologist so that they can get the proper  blood workup and identify. There any other underlying cause do you have a thyroid disorder? Are you hyper  parathyroid? Perhaps I had a client where that was the case. She went and got her parathyroid tested, and it turned out it was hyperactive, which was leading to unusual bone breakdown because that's what regulates the  osteoclast activity. By that she was able to control her osteoporosis by controlling the parathyroid. It was  actually a really wonderful thing that she discovered some other underlying condition. That often is the case  with osteoporosis too, that it's really just an indicator of something else that is going on, that erroneously with  the, and you're having this homeostatic effect in the body because there's no else that's not functioning properly.  Well, that's just not the case.  

00:56:49 

Rebekah Rotstein 

Sometimes it's just idiopathic osteoporosis where we just don't know why this is happening. That's sometimes  the case for younger people as well. Even now, after all this discussion, it makes me wonder, well, that whole  idiopathic thing, maybe there's something going on with the connective tissue disorder that we thought it's just  

unknown origin, but there is something that is there. I do send, clients or a patient referrals right back to another  specialist to at least rule out any other conditions that might be the class of unusual bone breakdown, and then  take it from there.  

00:57:30 

Jen Milner 

Okay. So, sorry. Let me follow up with that. If you were still doing a private practice because you have, you're  still a Pilates teacher and you work with some non, osteoporosis clients, is there a client that you might work  with, that wasn't sent from a doctor or a friend that you run into of your mother's or something like that? What  are some things that might lead you to tell someone like that, an old friend from dance school, Hey, maybe you  should go get your bone density checked out.  

00:58:00 

Rebekah Rotstein 

Definitely. A couple of things, the signs and symptoms, including if they have, well, first of all, if they've  experienced one or more fractures and what we call a fragility fracture, meaning a fracture that is not because  you were standing on a chair, changing a light bulb and fell off, but a fracture that has occurred from standing  height or from a seated height, that should not be occurring in normal, healthy bone. If you've had one or more  fragility fractures, if, you have lost height and, if there is a clear sign of kyphosis or, excess curvature  roundedness in the spine, sometimes so as symptom could have of say a fracture of her tibial fracture of the  spine could be pain, but that can be so misinterpreted because the pain could be from anything, but also  likewise, that loss of height could be from just degenerative disc disease as when they get older.  

00:59:06 

Rebekah Rotstein 

But, certainly the, if somebody has lost height, if they ha if they are a certain age, if they have, experienced any  fractures to begin with, that's, a deal breaker for me to say, you should go get your DEXA checked. Again, I'm  talking about not just a stress fracture in the foot, although that could be it, but also if they've, if they fell and  fractured and ankle, or if they fell a fractured their wrist. I would say also, the guidelines, the medical guidelines  have shifted considerably in the last decade as well from saying over 65 women over 65 should be getting a  DEXA to then starting to depending it's altered, on different guidelines. Some have stated, well, if you have had  a DEXA and it's fine, then you do not need to get another one for 10 years. The question becomes, well, 10  years, it's a really long time.  

01:00:11 

Rebekah Rotstein 

At what point, what age did you get the first DEXA because you lose, five to 7% to up to 20% of your bone  mass in the first five to seven years after menopause. So, I also look at that when I'm talking to somebody, all  right, well, what is their age right now? Are they in that large bone loss period immediately after menopause? Or  are they far out where it's probably leveled off where they're probably not losing so much in such a dramatic  fashion? So I do tell people to get a DEXA though, if they've experienced a fracture and I, I am a proponent of  the Dexis. Some people are not, I do believe in at least having a baseline measurement because when people  come to me and they are showing me one single DEXA, I'm like, okay, well, that's fine. I don't know if the  reason your bone density is low is because it's just low to begin with.  

01:01:09 

Rebekah Rotstein 

What's really helpful. It now if I have to, I can compare one to another. Now I can see, are you low or are you low? And you're dropping from the last time you hide your DEXA. So I'm a proponent of it. An advocate of it to  at least have some kind of measurement and have a baseline. Not it's not the end all be all. And I also use the  FRAX score. I have them use the FRAX score, which is another measurement. It's an algorithm basically that  was developed by the, I think the university of Sheffield in the UK, where it looks at all these different factors  from your age, your bone density, or your last T score, DEXA from your hip, secondary osteoporosis history of  smoking history of glucocorticosteroids. Like you're on prednisone at some point, especially those with Crohn's  or colitis and alcohol units per day.  

01:02:10 

Rebekah Rotstein 

I was just doing this with a client the other day, going through it with her so that she could ask her doctor about  it. Who wants her to go on medication? I was like, that's your, but talk to your doctor about the FRAX because it  gives you a 10 year probability fracture risk. Well, guess what's missing from this algorithm. Have you ever  exercised, do you have an exercise history? Right. To me, there's, again, a fault in the system because I really  have a lot of trouble believing that your dancer, or your say your patient or client who is now 60 years old, but  either a was a professional dancer or just was an avid mover and did quite a bit of movement training throughout  her life and has excellent balance, has the exact same fracture risk of the other patient who has been sedentary.  

01:03:10 

Rebekah Rotstein 

Most of her life who's balance testing or any kind of balance assessment would come up very poorly. Do you  really, do they have exact same probability of fracture? Well, according to this algorithm, yes, they do again,  interesting in our system. I think it is very interesting a tangent, but there are so many different things that I  think can be considered. It's also comes into play with the work that you do, Jen, specifically with your training,  whether they are a dancer or not that even if they have osteoporosis, that balance training and all the  proprioceptive work will difference in their fall reduction. I mean, evidence totally shows that. Evidence also  shows that if you fall less, you are less likely to fracture a fracture, less likely to fracture. Isn't that the goal of all  of this to begin with.  

01:04:14 

Linda Bluestein 

And, Rebekah, we know that you've presented to, doctors and hospitals around the world. How has the medical  community reacted in general to your approach and how have you pulled together so much research to inform  your system? 

01:04:33 

Rebekah Rotstein 

I'll start with the last one, which is, I mean, the, that initial literature review back in, I think it was 2008, really  the Genesis of everything for above bones. I just, I look at it and I update our instructor training manual every  year as well with the latest research studies that, I should mention that we have an instructor training program, a  certification for exercise professionals. I update that, yearly with the latest research. I, I look at it as well, just to  see, obviously there's limitations to how much you can constantly see everything that's coming out, but in terms  of the medical world, it's an interesting one because I think there are some in the medical world who really don't  care, because what they're looking at is just purely the evidence that is out there. There is out there, especially in  the last five years.  

01:05:34 

Rebekah Rotstein 

There's a growing body of evidence on high-intensity progressive resistance training, especially and adding in  some impact as well. That is having some really promising results. Either they don't want to see it, or they do  acknowledge it and they do encourage that. The challenge becomes so many in that same population also have  arthritis. They get concerned about how are we going to do heavy loading for people that already have pain in  their joints? Isn't it going to add more compression? And part of the answer to that is, well, it depends on how  

you do it. That's where buffaloes comes in is that we really prepared the bones and the joints to be smart so that  you can move in a smart, intense, intelligent fashion that you can get those extra forces in so that the body does  know how to absorb and transmit. The other answer is that sometimes physicians will say, well, actually we love  this idea, right? They're not concerned about it. 

01:06:41 

Rebekah Rotstein 

So it just, I think it depends. I remember I was presenting at, an international osteoporosis conference, once and  I was presenting a latest research for what was going on with exercise. There was a, a physician who was  moderating this who really questioned what I was saying. I'm saying, this is not my beliefs. I'm telling you what  the research is showing right now. This is who was, sometimes you have the physicians questioning it because it  just doesn't seem possible. Sometimes you have physicians who are embracing it, but are still going to say yes,  but you need medication. I think maybe there are some physicians that might say, well, we will, we'll be able to  hold off. I know that my mom's physician has honored her request in the last couple of years to hold off one of  the McCain medications so that she can see what the weight training will do.  

01:07:40 

Rebekah Rotstein 

In fact, the weight training did increase her bone density. Now granted that was prior to COVID and her having  COVID and all the gyms closing down right now. I actually do think this is, a frightening time for the  osteoporosis well with COVID because don't go, we're active in going to gyms are no longer doing that and  know why I've been trying to bring in more and created the online studio in the meantime, so that people have  an option of something they can do at home. I'd say it just depends on the physicians and that's why I am so  happy to know physicians such as yourself, one who come from a background of movement. This is one of the  things that I've, that has really become very clear to me in past couple of years, that the greatest advocates that  I'm going to have for this work are physicians who understand personally, the importance of movement and  exercise for themselves.  

01:08:42 

Rebekah Rotstein 

I realized that I can talk until I'm blue in the face to a physician who I can think of plenty that I think are  wonderful human beings, but the idea of actually going to a gym or the idea of taking a movement class would  make them laugh. They like their sedentary lifestyle, and that's fine, but that's not going to be my advocate  because they don't believe it for themselves. Why would they possibly advocate that for their patients? So the,  my Alliance is going to be with physicians who believe in movement because they understand it and they  embrace it themselves, or maybe they haven't, but they've seen the effects that it can have on their wife or their  husband or their parent. That becomes the game changer that makes them a convert to the gospel that the three  of us are trying to spread.  

01:09:43 

Linda Bluestein 

And that's the ironic thing. If you could take all the benefits of exercise and put them into a pill, it would be the  best selling pill ever, but, yeah, it's, it is very interesting. There is data actually in osteoarthritis as well, that  muscle strengthening improves pain and improves function. It makes sense, excuse me, it can be challenging to  figure out what kind of exercises that person can do, but the muscle protects the joint. It's not like you have to  choose, you don't choose either or right. It's so it is kind of ironic. But, as Jen and I have figured out, we just  keep converting the easier to convert and, the people who are going to be at the very tail end, we w we don't  worry about them quite yet.  

01:10:34 

Jen Milner 

I'm always surprised at how many of our conversations, how many of our podcasts come back to the basics of  nutrition and exercise and sleep. I remember it was Dr. Roy, I think, right. We were talking to our neurologist.  Talking about how to heal the brain holistically and she listed out these three things. Those three things, she was  like, these are the three non-negotiables I work on, and they were get better sleep, clean up your gut, like watch  what you eat and how you exercise, or how you diet like, heal that and get exercise. I mean, every single person  that we talked to, every expert in field, one of those three things at least is talked about as this is what you got to  do. It feels so silly that we keep saying this over and over again, diet, exercise, and sleep. And, I mean, that's  what it is.  

01:11:31 

Rebekah Rotstein 

This is I've been doing a lot of thinking lately this year about hurdles. I got everybody. One of the things that  comes to me exactly about what you're referring to is how can we change the mindset? How do we change this paradigm so that it's not a, well, I have to change my diet. I have to get more exercise. That's been part of what  I've been working on with the bites program that I have, how it's just a five minute, a day subscription. What is  the least amount of time to let you realize it's not something you have to do that actually brushing your teeth.  Doesn't just keep your cavities away. Brushing your teeth actually makes your breath smell better, right? Like  minutes, a day of exercise. Doesn't just make you adhere to what you're supposed to do from your doctor to,  keep your joints, mobile.  

01:12:37 

Rebekah Rotstein 

It's that, wow. I actually feel better! Wow, my attitude is more positive. Well, I can actually more easily tackle  the, every other component of my life when I've done this. How could we possibly do that with everything  changing all of these, the, this triad of sleep movement and food nutrition to things that are more joyous. It's  like, Oh, no, I don't have to cook my own meal now.  

01:13:16 

Linda Bluestein 

It's all in the attitude, for sure. For sure. So, Rebekah, we definitely know that, as were just saying, for sure  exercise and ideally some kind of, program where you are getting really informed advice and really being able  to do the proper type of exercise to help you achieve the goal that you are looking to achieve, what is really ideal  for everyone? Is there any point at which you encourage a person not to exercise? No.  

01:13:55 

Rebekah Rotstein 

I feel because two things, how was it? Do you notice that I always have two things. I can't answer succinctly. I  feel that part of it is that we, I like to use the sometimes exercise, but just sometimes movement because  sometimes exercise is misconstrued even by the medical community, when they're saying, Oh, you just had  surgery. You're not allowed to exercise as were saying for such and such number of weeks. Well, sure you had  surgery, but maybe you can just breathe and maybe you can just move your arm. Maybe you're doing like a  sematic type of movement, or you're doing some level that is not affecting the area of concern. Even just the  movement, I would say, no, there's not really an instance now, certain types of exercise, certain types of  movement. Absolutely. There are times that I say it's not appropriate, but there's all I really do believe there's  always something that somebody can do.  

01:14:58 

Rebekah Rotstein 

Just as were saying before, it goes back into that mindset and it goes back into the idea of self-efficacy that if  you are told that you're not allowed to do anything, I know from my experience, that has been some of the worst  times for me emotionally, when I was told, Oh, you on a very restricted diet, you cannot eat blah, blah. Because  we're trying to assess certain things with a health situation, or when I've been told even just the initial diagnosis  of osteoporosis, you are not to bend your back anymore. Great. That feels awesome. The idea of being told that  of things, just not to do things I think creates a very negative cyclical pattern and negative mindset, very  dangerous. I always feel that there is something that somebody can do. I can't think of any scenario where I say,  because even if you're just doing finger exercises here, you can see, my fingers.  

01:16:10 

Rebekah Rotstein 

Oh, look at that. Always. There's always something that you can do and how we define it as exercise or  movement might be, but there's always something that you can do now, do I say that you should just do any  exercise? No, that there's very specific things. There specific things that we shouldn't do based on what might be  happening in our bodies at certain times, but that's all the more reason to do the 568,000 other things that you  can do.  

01:16:44 

Linda Bluestein 

Right. I love the movement as opposed to exercise concept, because if we want to be able to move, then we need  to move. Right. So, but I think we often don't think of it in those terms. We've covered so many great and  interesting things, and this has been really educational for sure, for me. There anything else that we didn't ask  you that you wanted to be sure to cover?  

01:17:10

Rebekah Rotstein 

Something that I think is interesting is the discussion of instability that comes up a lot in the movement world,  and this might not be relevant for everything here, but the movement in Pilates world especially has become  very focused on this term stability. And we want to help stability. We want to fight instability when really the  majority of the population doesn't need to worry about stability and instability of a joint in your population, in  your world. That is a huge focus personally, that's part of your world for, let's say, not as a huge focus, but I  think we need in the movement world to stop talking about focused on joint stability. I used to talk about it all  the time too, and worries about instability because all we're doing is creating more fear when most people really  don't have to worry about that. They need to move more focus more on mobility.  

01:18:22 

Rebekah Rotstein 

Even in our, maybe even in your hyper mobile world, we can still talk about where are you find your mobility  from that it's just not in your keel junctions, or it's not just hanging out on that. Why ligaments? Where are you  going to it from a different part so that we work in this integrated fashion, I've become really indoctrinated if  you will, into the world of biotensegrity and the idea of how the body is a self-sustaining structure that is  inherently stable unto itself, absence, let's say of maybe Ehlers-Danlos syndrome, hypermobile, conditional, and  that when we move and we work in a way that leverages the biotensegrity of the body, that takes on the natural  compression and tension components that are inherently there and allows the body to work as a systematic unit  where one part affects the other part that inherent stability is automatically found.  

01:79:39 

Rebekah Rotstein 

We can start moving away from worrying about stability or instability, again, absent from the population that  you're focused on, where there is very valid concerns about joint instability, but how do we stabilize certain  areas, but through movement and how do we embrace all of that to move away from some of the fear based  discussion of movement that I know was a very big part of my life for a long time.  

01:80:13 

Linda Bluestein 

Oh, fantastic. Can you let us know, where can people best find you and learn more about what you're doing?  

01:80:23 

Rebekah Rotstein 

My website is, the name of the brand is Buffalo bones, and the website is buff-bones.com. I also have a product  or a, an online studio that you can find through there if you search, but we have to make it clear it's called  revive. And, but you can also find that if you search there on the website, when you're looking for the classes,  and you can also just find this by, on Instagram, as well as Facebook. Got buffed bones is the name on  Instagram and on Facebook, it is just buff bones. And, the buff bites that five minute day subscription is also  find-able through there.  

01:81:19 

Linda Bluestein 

Fabulous. We will also have links to all of that on the website as well. 

01:81:26 

Rebekah Rotstein 

I should mention also, sorry, I forgot also I have my own work that I do that is separate from Buffalo bones.  That is just my integrated movement and emphasis on bio tensegrity and such, is on my personal Instagram  called Rebekah Rotstein. I actually do the things that might be also more of interest to the dancer population  through there, because I also teach a class every Tuesday that is for dancers and movement professionals.  

01:82:01 

Linda Bluestein 

Very good. Great, well, we'll have to point everyone in the right direction, but we will do that through the show  notes and the website. People can check all of that out. So well, fabulous. Well, it's been so great chatting with  you today, Rebekah, and, you all have been listening to bendy bodies with the hypermobility MD today. We've  

been speaking with Rebekah Rothstein creator of the medically endorsed buffed bone system, industry leader in  Pilates, bone health and movement education. It's been so great to chat with you, Rebekah, thank you so much  for taking the time to talk to us and share your knowledge. 

01:82:38 

Rebekah Rotstein 

Thank you both for inviting me to speak with you. Also just for all that you're doing for the world of dance and  the world of hyper mobile populations and for bendy bodies, I wish that, I had 20 years ago.  

01:83:00 

Linda Bluestein 

That's, that's part of why we're doing this. We wish that we had us back 20 years, so we're trying.  

01:83:21 

Linda Bluestein 

Thank you for joining us for this episode of bendy bodies with hypermobility MD, where we explore the  intersection of health and hypermobility for dancers and other artistic athletes. Please leave us a review on your  favorite podcast player. Remember to subscribe so you won't miss future episodes. Be sure to subscribe to the  bendy bodies, YouTube channel as well. Thank you for helping us spread the word about hypermobility at  associated conditions. Visit our website, www.bendybodies.org. For more information, for a limited time, you  could win an autographed copy of the popular textbook disjointed navigating the diagnosis and management of  hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorders just by sharing what you love  about the bendy bodies podcast on Instagram, tag us at bendy underscore bodies and on Facebook at Bendy  bodies podcast. The thoughts and opinions expressed on this podcast are solely of the co-hosts and their guests.  They do not necessarily represent the views and opinions of any organization. The thoughts and opinions do not  constitute medical advice and should not be used in any legal capacity whatsoever. This podcast is intended for  general education only and does not constitute medical advice. Your own individual situation may vary, do not  make any changes without first seeking your own individual care from your physician. We'll catch you next  time on the bendy bodies podcast.