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Tag: ligaments

Mini Pause #90: How to Heal the Vibes

Posted on by stephanie-estima

Well, Bettys, after the Mini Pause about vibration training a couple weeks ago, you had questions. I absolutely love it when my inbox lights up after a Mini Pause because it tells me how much the topic resonated with you.

Two of you (and no joke – both were named Amy!) sent in questions about how I personally use my vibration plate and how to set the dials for midlife bodies with real-life challenges.

So, let's get into it. Vibration training isn't just a fancy washing machine. It's science-backed, joint-friendly, and surprisingly powerful for tendons, ligaments, bone health, and even the pelvic floor! (We haven't talked about the last one yet, so make sure you read to the end!)

WHY

Oooh the science of the shake.

Vibration training works because it taps into something called the tonic vibration reflex. Basically, that means you recruit muscle without needing heavy loads. This is certified gold when joints, tendons, or injuries limit your options. PMC

The strongest evidence shows vibration helps:

  • Ligament recovery after injury or surgery
  • Chronic tendon pain (patellar and Achilles tendinopathy)
  • Knee osteoarthritis – the #1 disability in older adults
  • Balance in older adults (fewer falls = fewer fractures)
  • Lymphatic health when paired with manual therapy PubMed

And for women in midlife? Add bone support, joint comfort, and pelvis floor activation to that list. Medical Journals

You'll generally see vibration therapy talked about in one of two ways:

Whole-Body Vibration (WBV): You stand or squat on a platform. Key things to note are going to be frequency (Hz), amplitude (mm), time (seconds/set, sets/session), and posture or position (knee angle, stance).

Local Vibrotherapy: A localized device that is going to deliver gentle mechanical signals to a specific body area (used in some lymphatic and pelvic-floor contexts).

For our purposes today, we're talking about the WBV vibration plate. I get into all my specific recommendations below.

HOW

For those of you asking how I use vibration, I've laid out my preferred methods below. I use my PowerPlate most often following a sprinting session as recovery for my tendons and ligaments. I set it at a moderate frequency (~30 Hz), and just stand there for 9 minutes while I shake it off.

I will also pair this with Kegels and pelvic floor exercises (see below!) during this time too. It's surprisingly very hard to do this!

Here's how I use vibration training myself, and how you can tailor it to your goals:

Ligament Injuries (like ACL or ankle sprains)
Vibration training is helpful for ligament injuries because the oscillations “wake up” fibroblasts (collagen-producing cells) to remodel along the correct lines of stress, helping the ligament to safely adapt to new loads.

  • Frequency: Start low (10-20 Hz) and progress toward 20-30 Hz as tolerated.
  • Position: Knees bent ~20-30°
  • Exercise: 6-8 sets x 60-90 seconds each. Rest 60-90 seconds in between sets.
  • Schedule: 3-5 x per week

Tendon Injuries (Patellar or Achilles Tendinopathy)
Dark Roast Bettys: Based on this RCT, pain and function improved similarly to heavy-slow resistance training, which is great if you are unable to train. If you can train, I would combine the two. PMC

Patellar Tendon

  • Frequency: ~30 Hz
  • Position: Static knee angle ~50°
  • Exercise: 10 sets x 60 seconds. Rest 60 seconds between sets.
  • Schedule: 3 x per week for 12 weeks

Achilles Tendon

  • Frequency: ~30 Hz
  • Position: Slight hip/knee flex with heels on the platform edge for a stretch.
  • Exercise: 6-10 sets x 45-60 seconds. Rest 45-60 seconds between sets.
  • Schedule: 3 x per week for 12 weeks
  • **Pro Tip: Pair this with progressive calf loading on non-vibration days for even better results.

Bone Health (Osteopenia/Osteoporosis Prevention and Support)
We can use the vibration plate to provide safe, frequent mechanical signals for bone remodelling.

Dark Roast Bettys: A 2023 meta-analysis favors higher frequency and cumulative dose at low magnitude; a 2021 RCT using ~10min/day reported microstructural benefits. I strongly believe that this needs to happen alongside training, and, of course, paired with protein, vitamin D, calcium, impact, and regular walking. PubMed

  • Frequency: ~30 Hz
  • Position: Standing
  • Exercise: 10 minutes per day
  • Schedule: Most days of the week

Knee Osteoarthritis
Don't give up on movement if your knees are stiff! The vibration plate can be used to reduce pain, improve mobility, and support strength.

Dark Roast Bettys: Meta-analyses show vibration training and exercise improve pain and function more than exercise alone. Medical Journals Sweden

  • Frequency: 20-30 Hz
  • Position: Mini-squat holds (20-30°) and side-step holds.
  • Exercise: 5-10 sets x 45-60 seconds. Rest 45-60 seconds in between each set.
  • Schedule: 2-3 x per week

Pelvic Floor Training (Stress Incontinence and Strength)
No one wants to talk about it, but we need to work our pelvic floors. We can (and I do!) use the vibration plate to improve activation when traditional pelvic floor exercises are tough to feel. If the program below isn't hitting it for you, try it in a sumo squat stance or with your knees on the platform.

Dark Roast Bettys: WBV improved pelvic-floor strength and quality of life similarly to supervised PFMT at 4 weeks and 3-month follow-up. Use cues to co-contract the pelvic floor during sets. PMC+1

  • Frequency: Start at 30 Hz, then progress up to 40 Hz over time.
  • Position: Standing (or kneeling) kegels.
  • Exercise: 15-20 second hold x 15-20 reps. Rest 5-10 seconds in between each set. Follow with quick contractions of 2-second hold + 1-second release x 20-30 reps.
  • Schedule: 3 x per week
  • Pro Tip: Imagine you're gently pulling a blueberry up and into your vagina. Strange visual, I know, but it's incredibly effective.

General Dial Guide
A couple of notes to write down on a sticky note near your vibration plate:

  • Low (10-20 Hz) → circulation, early rehab
  • Moderate (20-35 Hz) → tendon and balance work
  • Higher (35-45 Hz) → advanced strength and balance
  • Knees always softly bent. Never locked.

Contraindications for Vibration Therapy:
It is GRAS (generally regarded as safe), but if you are pregnant, have a fresh fracture, severe disc disease, uncontrolled cardiovascular disease, epilepsy, bone tumors, or a major head injury, these would automatically preclude you from participating in vibration therapy. As with anything, you MUST clear any new activity with your primary healthcare provider before starting. PMC

NOW

If you've got a vibration plate collecting dust (or on your Black Friday list!), here's your homework:

  • Beginners: Stand quietly at 20-25 Hz for 5 minutes. Knees bent, breathing steady. See how you feel.
  • Intermediate: Add mini-squat holds or a tall kneel position.
  • Curious? Try one pelvic floor session on the platform. Trust me. You'll feel it.

Remember: vibration training isn't a replacement for progressive overload. Weights > plates, like I've said before. But for women in midlife, it's a smart complement – especially if you're managing joint pain, ligament injuries, or bone density issues.

So, are you shaking things up yet? If you've tried it, tell me how it felt. Blueberry cues and all!

 

Warmly,

Dr. Stephanie

WHAT I LOVE THIS WEEK

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🌟 Love these recommendations? Find more resources to support your health in midlife in my Health Toolkit!

1 Just Thrive ships worldwide. Code BETTER will work for all orders and first-time subscriptions. Terms and conditions may apply.

 

Mini Pause #89: PEACE & LOVE for your ligaments

Posted on by stephanie-estima

You asked for it: more on ligaments. My heart did a little pitter-patter when the response to my last Mini Pause was a resounding YES.

Most people overlook them, but I love ligaments. They're the unsung heroes that literally hold us together. While muscles are like a bouncy, eager puppy ready to play, your ligaments are more like the loyal family dog: slower to adapt, but dedicated to being there for you 24/7.

WHY

Ligaments connect bone to bone, stabilizing your joints like a seatbelt and giving your body that sixth sense of where it is in space (proprioception).

They don't get much blood flow, which means they heal and adapt slowly. Ligament injuries can take months, even years, to fully remodel. In midlife, with our lower estrogen causing slower collagen turnover, the process can be even longer.

Translation: We need to give these tissues extra care, patience, and respect.

HOW

Here's what the science says about taking care of your ligaments:

Progressive Loading, but Slowly

Deep breath. We need some patience with these ligaments of yours. We want to apply progressive tension over the course of months. Yes, “months” with an S.

Start with isometric holds, then move into heavy-slow resistance, followed by eccentrics, and only later into plyometrics, deceleration, and balance drills.

This stepwise approach tells your fibroblasts (the cells that rebuild collagen) how to lay down stronger fibers along the right lines of stress. Ligaments will remodel along lines of stress of the movement, not necessarily along the original architecture of the ligament, so form and slow progression are key.

Bad movement pattern habits can accelerate injury risk and take years to unlearn and relearn.

Nutrition

Collagen is not the be-all-and-end-all for muscle protein synthesis, but there's good data supporting collagen supplementation for ligament health.

I know, I know. Every online fitfluencer wants to tell you that collagen is garbage, and in the context of muscle, there is an argument to be made that it's not worth your money.

But stay with me. Studies show an increase in circulating markers of collagen synthesis in human ligaments when we ingest ~15 g of gelatin (or collagen peptides) plus vitamin C 30-60 minutes before short bouts of loading. PMC This is undeniably helpful while training, rehabbing an injury, or preventing an injury.

So, its an and/both approach. It's wise to supplement with both protein that will upregulate muscle synthesis AND collagen to support ligaments.

Post-Injury

Okay, so you got injured. You went for a PR right after a PR. Or your coffee hit just right one morning, so you jumped right into track sprints, and now your knee feels wonky. Been there, done that, got the rehab notes to prove it.

First off, let me just exhale a giant ARGUHHGHHHHHH of frustration with you. It is SO annoying to feel like you're being punished for doing something positive for your body. I don't want you to get discouraged. Let's put together a plan to get you back to business.

Remodeling and coming back stronger is going to look something like this:

A few days of inflammation. Then a few weeks of proliferation. Then, a few months to a year (or more) of remodeling and maturation. PMC+1

PEACE & LOVE, not RICE

You've heard about Rest, Ice, Compression, and Elevation for injuries, but the British Journal of Sports Medicine has a new acronym for you:

Protection, Elevation, Avoid Anti-Inflammants, Compression, Education (PEACE) followed by Load, Optimism, Vascularization (cardio), and Exercise (LOVE).

In PEACE, we want to protect the joint and compress it.

To ease discomfort, I'll often wrap the injured joint or compress it to manage swelling. I love the knee compression sleeve from Incrediwear, and I use it pretty regularly post-sprinting as a preventative measure. It'll work well if you're acutely injured as well.

In LOVE, we want to nix old ways of thinking and actually load the ligament as soon as possible. British Journal of Sports Medicine

You can do this by starting with isometrics, then slowly moving to load-bearing exercises and eccentrics, and eventually gently resuming higher-impact activities.

The Midlife Caveat

For women in midlife like us Bettys, estrogen matters and will most certainly impact your healing time.

Higher estrogen can reduce ligament stiffness and alter collagen turnover. Our knee laxity fluctuates across the cycle, and therefore, so does risk. (I wrote about this in The Betty Body.)

In perimenopause and menopause, lower estrogen will impair collagen turnover and healing, making the months monthier and the years yearsier. It just takes longer to heal without the anabolic influence of estrogen.

This is why I will die on the hill of technique. Your ego is your enemy in the gym and on the track. I will absolutely insist that you develop neuromuscular control and year-round strength and balance. Frontiers+1

NOW

The overarching principle of PEACE & LOVE is to protect the ligament, compress it, and return to activity as soon as possible.

The following is an example of how I might structure this for rehabbing a ligamentous injury. This is for demonstrative purposes only on how I might progress through a program:

  • Angle-Specific Isometrics
    30-45 second holds x 3-5 sets x 3-5x/wk initially

    Start these as soon as possible and do them at positions that lightly tension the target ligament. It's good for pain modulation and early load tolerance. If available, I would do these on a vibration plate.

  • Heavy-Slow Resistance (HSR)
    6-8 controlled reps x 3-5 sets x 2-3x/week; ~3-5 seconds down, 1-2 seconds up

    These exercises will build tendon-muscle unit capacity and apply a steady collagen stimulus across joint angles.

  • Eccentrics
    8-12 slow reps x 3-4 sets x 2-3x/week

    Do these exercises to improve strain tolerance and control. I would also incorporate vibration plate training with these eccentrics.

  • Plyometrics & Deceleration

    Once foundational strength and balance are solid, start adding in hops, land-and-stick, and cutting mechanics. Gradually increase the speed and directional variability.

  • Balance and Proprioception

    Start adding in single-leg stance progressions, with eyes open or closed. I'd likely incorporate vibration plate training here, too.

  • Movement Quality

    Focus on tracking knees over toes, hitting soft landings (triple flexion), and maintaining trunk/hip control. Mobility training becomes super important here.

  • Nutrition

    Supplement with gelatin/collagen + vitamin C 30-60 min pre-load, and make sure your total daily protein intake is 1.6-2.2 g/kg of body weight to support remodeling. PMC

I've kind of been itching to talk more about arthritides like osteoarthritis, rheumatoid arthritis, and psoriatic arthritis. How about you? What should we get geeky about next?

 

 

Sending you PEACE & LOVE,

Dr. Stephanie

WHAT I LOVE THIS WEEK

My Secret to Maintaining Skin Health As I Age

Read more about the role of maintaining the skin barrier as we age. 

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References:

01 Zonari, A., et al. Journal of Cosmetic Dermatology, 2025

02 Zonari, A., et al., npj Aging, 2023


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Electrolytes Are Essential for Midlife Women

Electrolyte imbalance is a common but overlooked issue during midlife. As estrogen declines, our bodies struggle to retain sodium, potassium, and magnesium, leaving us depleted despite drinking plenty of water.

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🌟 Love these recommendations? Find more resources to support your health in midlife in my Health Toolkit!

1 OneSkin ships to all addresses in Canada, Australia, New Zealand, and the United Kingdom. They also ship to Austria, Belgium, Bulgaria, Republic of Cyprus, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain (unable to ship to the Canary Islands and Balearic Islands) and Sweden. For shipments outside of the US, we ship DDP (with duties paid). Shipping duties and taxes are all included in the final price you see at checkout. Code DRSTEPHANIE works for new and repeat customers on orders over $50. Terms and conditions may apply.

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Mini Pause #88: Can vibration protect your bones and tendons?

Posted on by stephanie-estima

Have you ever seen those vibrating platforms tucked away in the corner of the gym? It might look gimmicky, but I promise it's not a shakeweight situation. Research shows that whole-body vibration (WBV) is actually a goldmine for your tendons, ligaments, and bones.

I had one in my clinic for years, and it was a staple in rehab and prehab. I still use it every day.

It is right for you? Hop in my Jeep, keep your arms and legs inside the vehicle at all times, and please do not feed the animals any of your emergency granola.

We're going on a nerd safari!

WHY

Midlife comes with a few big realities:

  • Tendons heal slower
  • Joints feel stiffer
  • Bones aren't as forgiving as they used to be
  • Injuries take longer to recover
  • Bone density is a group project, and you're stuck doing all the work

I hate to be the one to bring you all this delightful news, but I love you too much to keep the truth from you.

WBV (remember: whole-body vibration) is a gentle wake-up call to your tissues. It's a way to stimulate healing and repair without pound-pound-pounding on your poor joints.

For women in midlife navigating perimenopause and menopause, this can be a game-changer.

HOW

Here's the science of how WBV works:

  • Tendons and Ligaments:
    Vibration creates micro-stretching at the cellular level, stimulating fibroblasts (cells that make connective tissue) to make more collagen (the scaffolding of these tissues). It also boosts nitric oxide (NO), which helps improve blood flow to areas that rarely get it. Over time, tendons actually stiffen in a good way, making them stronger and more resilient.
  • Bones:
    WBV acts like mini-impact training. Vibrations activate bone-building cells (osteoblasts), improve fluid flow through bone canals (for my dark roast Bettys, if you want to go down the rabbit hole of the lacunar-canalicular system, that is what I'm referencing), and even suppress the cells responsible for breaking done bone. It's like sneaking in bone density training without jumping, sprinting, or lifting heavy. But psst… don't stop lifting heavy!
  • Balance and Neuromuscular Control:
    WBV triggers rapid muscle contractions, sharpening your stability. More balance means fewer falls, which translates to fewer fractures. Even if you're not tippy right now, it's smart to get on top of it before your tippy years hit.

In my clinic, I used a plate to help rehab Achilles or patellar tendinopathies, rotator cuff injuries, chronic ankle or knee sprains, and osteoarthritis with joint stiffness.

Aside from acute injury, the women who will benefit most from WBV are those with tendon pain, osteopenia, osteoporosis, joint pain, or anyone who can't yet tolerate high-impact training.

NOW

So, should you and your girlfriends all Secret Santa vibration plates to one another this year?

I'm a big proponent of a vibration plate, and I use my Power Plate every day. In my weekly training, I am doing a lot of high-impact activities like sprinting and weight lifting, so vibration helps prevent injuries and improve tissue tolerance.

The connective tissue and bone benefits overlap because the same signals of mechanical load, nitric oxide release, IGF-1, and collagen synthesis are shared across tissues. WBV is like giving your musculoskeletal system a gentle “shake” that wakes up repair pathways without over-stressing them.

Now, WBV is not a replacement for progressive overload (weights > plates). But it's an incredible add-on or bridge. Here's how I'd recommend using it:

  • Use it during rehab if your tendons, ligaments, or joints aren't ready for a heavy load yet.
  • Layer it into your bone-health strategy if you're at risk of osteoporosis.
  • Add it as a primer to improve circulation, healing, and balance before lifting or sprinting.

It's like a little love note to your muscles, tendons, and bones that says, “I see you. I'm taking care of you. I want you with me for the long haul.”

I'm curious. Have you ever tried standing on a vibration platform? Did it feel like a helpful tool, or just like a fancy washing machine?

 

Shake it up, baby.

Dr. Stephanie

 

P.S. Have you saved your spot for the first session of my YES coaching program? I'm offering the first live coaching session completely free, and when you sign up, you'll unlock a special discount code for the rest of the program.

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WHAT I LOVE THIS WEEK

The Sleep Technology That Ended My “Sleep Divorce”

Read my full story about the way this affected my marriage.

For two years, hot flashes kept me and my husband in separate bedrooms. I tried every trick in the book. Cooling pillows, fans, even ice packs. But nothing worked consistently until I started using Eight Sleep's Pod 5 with Hot Flash Mode. I'm not exaggerating when I say it changed everything.

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Sweet dreams, Betty!


The Protein That Actually Tastes Like Food (Not Powder)

Why do most protein powders taste like chalky disappointment? I've tried countless brands that promise “great flavor” that are actually barely edible.

The only protein powder you’ll find in my kitchen is Equip’s Prime Protein.

It's a 100% grass-fed beef isolate with the same nutrient profile as 4 ounces of steak. I’m talking about protein, collagen, and micronutrients that support joint health and recovery. The beef source means better amino acid absorption compared to plant proteins and none of the dairy allergens that can trigger gut issues.

I blend Prime into my morning smoothies, mix it into my protein oats, and bake with it all the time. The chocolate flavor makes incredible protein muffins that taste like dessert. It even passed the taste test with my kids.

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The Recovery Secret That's Been Hiding in Plain Sight

There's a product that has come out of the woodwork and completely, unexpectedly revolutionized my post-workout routine.

It's Incrediwear's bamboo charcoal-infused gear, and I'm not messing around when I say it has flipped my recovery on its head.

After aggressive pickleball sessions or sprint intervals, my knees used to ache for days. Now, I slip on their knee sleeve immediately after training and that lingering soreness is dramatically reduced.

The science is fascinating. The bamboo charcoal fibers increase blood flow at the cellular level without compression. You're getting faster healing, reduced inflammation, and you don't have to worry about feeling squeezed like a sausage.

Their socks have become a non-negotiable for travel and recovery days to keep my circulation flowing naturally. I'm not above wearing them to bed, either!

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Try Incrediwear with code DrSteph20 for 20% off. Your joints will thank you!³

🌟 Love these recommendations? Find more resources to support your health in midlife in my Health Toolkit!

1 Ships to US, Canada, UK, Mexico, EU, and Australia Terms and conditions may apply.

2 Ships worldwide. Code valid on first-time orders or first subscriptions (unless a special sale is running). Terms and conditions may apply.

³ Ships internationally. Terms and conditions may apply.