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Tag: osteopenia

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

Just Thrive

Gut health affects literally everything. Your energy, sleep, mood, brain function, immune system, and even how well you absorb nutrients from food.

The one stat that will never not blow my mind: Up to 95% of your serotonin is actually made in your gut, not your brain.

Okay, great. You're taking probiotics, so you're good, right?

Yikes. Not so fast. Most probiotics are dead on arrival. They can't survive your stomach acid, which means they can't do their job.

I've switched to probiotics from Just Thrive because they're clinically proven to arrive 100% alive in your gut. Way, way, way more bang for your buck.

It's so hardy that the probiotics goodness survives coffee and even the blender, and it's good enough for the whole family.

If your gut's been giving you grief, or you just want to optimize your body with better digestion, less bloating, and steadier energy throughout the day, Just Thrive is worth a try.

Use code BETTER for 20% off.¹

LVLUP

Did anyone warn you that perimenopause would absolutely wreck your gut? No one told me!

If you're suddenly dealing with bloating, reflux, and random food sensitivities, I promise you: It's not all in your head.

As estrogen and progesterone decline, they directly impact gut motility, microbiome balance, and your gut barrier integrity.

A compromised gut lining wreaks havoc on your ability to absorb nutrients. It cranks up inflammation and worsens hormonal symptoms because you're not able to detoxify well.

I've been impressed with LVLUP Health's Ultimate GI Repair.

It's a clinical-grade formula with peptides like BPC-157 and GHK-Cu that actually repair the gut lining, plus larazotide to seal leaky gut, and tributyrin and zinc L-carnosine to calm inflammation.

This isn't your average gut supplement. It targets root causes, not just symptoms.

If perimenopause has your gut in chaos, use code DRSTEPHANIE for 15% off when you try LVLUP.

🌟 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 #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.

YES is my framework for optimal muscles, metabolism, meals, hormones and more in midlife. It's a deep dive into the protocols I use for myself and my clients.

Together, we'll explore how to build bone density and protect it for decades ahead, why your hormones, recovery, and metabolism need a seat at the table, and how to eat like you're building something (because you are!).

Oh, and we'll be doing a full session on the truth about cardio. Let's make sure you're doing what's most effective and not wasting your time.

YES makes you a mega-promise: No quick fixes. We're building a foundation that will carry you powerfully through midlife and beyond.

Sign up for the first live coaching session of YES, totally free here.

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.

The Pod 5 uses precision temperature control to keep my side of the bed icy-cool while keeping his side warm. When a hot flash hits, I can tap the app and instantly activate the emergency cooling. It often prevents the flare before it fully wakes me up.

Clinical data shows Pod 5 reduces hot flashes by 52%, but here's what it actually gave me:

  • One extra hour of quality sleep per night
  • Mornings where I actually feel like myself
  • My marriage. No joke.

For the first time in years, we're comfortably sleeping in the same bed all night long.

If hot flashes or night sweats are stealing your peace, this is the solution I trust.

Get $350 off and free 30-day returns on the Pod 5 Ultra with code DRSTEPHANIE.¹

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.

Okay, now here’s the really fun news. Until September 23, your code DRSTEPHANIE gets you exclusive access to Equip’s flash sale on Prime Protein and Prime Bars.

Your blood sugar, your gut, and your taste buds all got together and told me you’re going to love it.²

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!

With Incrediwear, better circulation is working behind the scenes. It's not magic – it's science. It's smart fabric technology supporting what your body already wants to do: heal and recover efficiently.

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.

 

Mini Pause #67: Natural Ways to Boost Bone Density

Posted on by stephanie-estima

TL; DR (Too Long; Didn't Read)

Maintaining bone density naturally becomes crucial as we age due to shifts in bone metabolism.

Osteopenia, the gradual loss of bone density, is a decades-long process that accelerates significantly during perimenopause and menopause, increasing the risk of osteoporosis.

Bones are dynamic tissues consisting of cortical (outer shell) and cancellous (inner, marrow-rich) bone, both of which change significantly with age.

Increasing bone density through strength training, plyometrics, walking, and adopting nutritional strategies is essential for maintaining overall health, regulating metabolism, and achieving optimal body composition.

WHY

Bone density naturally declines as we age because osteoclastic activity (bone breakdown) outpaces osteoblastic activity (bone formation). This process accelerates dramatically during perimenopause due to hormonal changes, particularly declining estrogen levels.

Estrogen supports bone density by inhibiting osteoclast activity (reducing bone breakdown) and promoting osteoblast activity (enhancing bone formation), thereby maintaining a balanced bone remodeling process.

Bones aren't just structural; they actively secrete hormones such as osteocalcin. This influences metabolism, insulin sensitivity, muscle function, and overall body composition.

WHAT

  • Cortical Bone: Dense outer shell providing structural support.

  • Cancellous Bone: Porous, spongy interior housing bone marrow, essential for metabolic and structural roles.

As we age, cancellous bone density decreases, making bones more susceptible to fractures.

Bone-derived hormones like osteocalcin regulate metabolism by enhancing insulin secretion and sensitivity, promoting glucose uptake by muscle tissue, increasing energy expenditure, and improving overall metabolic health and body composition.

Bones are the scaffolding of the body, but they are also active endocrine organs.

HOW

Practical ways to increase bone density naturally:

  • Strength Training: Increases mechanical load on bones, stimulating osteoblastic activity. Aim for consistent, progressive resistance exercises. 💪

  • Plyometrics (Jumping Exercises): Improves bone density through high-impact activities, encouraging stronger bone formation. Examples include jump squats, box jumps, jumping jacks, skipping rope, and squat jumps. I personally love to do plyos on a step (complete with my leg warmers and off-the-shoulder top). ‼️

  • Walking: Regular weight-bearing activity is gentle yet effective for maintaining and improving bone density. 👟

    • Try Magnesium Breakthrough and use code ESTIMA to get 10% off.

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    • Getting enough protein is easy with 8 flavors of grass-fed beef isolate goodness. Click HERE and use code BETTER to get 20% off.

  • Nutrition: Ensure adequate intake of magnesium, vitamin D, vitamin K2, and protein to support bone formation. 🦴

  • Sunlight Exposure: Enhances vitamin D synthesis, crucial for calcium absorption and bone health. ☀️

NOW

➡️ Choose one of the above that you are currently not doing and start integrating these bone-strengthening practices into your routine immediately.

➡️ Schedule regular strength and plyometric training sessions, daily walks, and supplements into your calendar or set reminders on your phone! This is one of my best tips for remembering to get all these little habits dialled in.

What I Recommend

TAME STRESS WITH THE RIGHT COLLAGEN

Stress does number on your body. Cortisol, the primary stress hormone, directly breaks down collagen, leading to deterioration of skin and connective tissue. Chronic stress not only accelerates collagen breakdown but also disrupts skin barrier function, leading to increased water loss and dryness. High stress elevates cortisol, promoting glycation, which causes collagen fibers to stiffen, resulting in skin wrinkles and dullness over time.

That's why you want a bioactive collagen that effectively counters the effects of stress!

  • Avoid Heat Degradation: High temperatures can break down collagen into less effective amino acids, reducing digestibility and bioavailability. Heat degradation creates cross-links within the collagen structure, making it more gelatin-like, less soluble, and harder for the body to absorb. This is why controlled low-heat processing, like Health Nag’s patented laser technology, preserves collagen’s full bioactivity and effectiveness.

  • Choose Hydrolyzed: Non-hydrolyzed collagen is ineffective because it’s too large to be absorbed. Hydrolyzed collagen is broken down into small peptides that cross the gut lining and are bioavailable to support collagen synthesis in skin, joints, and other tissues. Hydrolysis is key for any collagen to exert real benefits.

🍏 Health Nag’s collagen offers the most unique gel form I’ve seen on the market. And wow!—the delicious green apple flavor doesn’t disappoint. And just in time for spring and summer, Health Nag launched its bioactive collagen jelly in individual packets. Super convenient when you’re on the go or traveling! Learn more and try it HERE. Use code DRSTEPHANIE to save 10%.

KICK-START YOUR PERFORMANCE, ENERGY & FOCUS

I’ve been turning to ketones regularly in the morning before my workouts. Ketone-IQ gives me the fuel I need to power my favorite strength moves in the gym. Check out these mainstay benefits:

  • Appetite Control: Helps manage hunger by promoting a state of satiety. (Pro tip for my Bettys who find it hard to eat before early morning workouts.)

  • Energy & Focus: Provides a fast and steady energy source that crosses the blood-brain barrier. (I have the energy to focus on my workout and also maintain mental clarity to plan and think through my workday.)

  • Performance & Recovery: Enhances physical endurance and speeds up recovery by supporting mitochondrial function. (I don’t cut corners when it comes to recovery, but I do like the benefits of recovering more quickly and efficiently.

💥 Try Ketone-IQ (with or without caffeine) in several flavors: peach or green apple for me, please! Visit https://ketone.com/STEPHANIE to get 30% off your first subscription order. No code needed; discount automatically applied at checkout.

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