August 2026
In our last letter, I wrote about the evolving understanding of women’s health and, in particular, the important role hormonal physiology can play in health, function, and quality of life.
This time, I want to take the next step in that conversation. Outside of hormone replacement therapy, what can women actually do?
Fortunately, there is a lot.
At the center of much of this is metabolic health. Hormonal changes throughout a woman’s life can directly influence metabolism, including how the body builds and maintains muscle and bone, uses energy, regulates blood sugar, and responds to exercise and recovery.
This is one of the reasons maintaining skeletal muscle becomes so important. Muscle does much more than allow us to move and be strong. It is one of the body’s most important metabolic organs, with profound influence on our health and function.
Strength needs to be progressively developed. That means gradually asking the body to tolerate greater loads and, yes, lifting heavier weights as we become capable of doing so. Many women remain hesitant to lift heavy because of a longstanding fear of becoming bulky or overly muscular. Unfortunately, that can keep them from developing and maintaining the very tissue that becomes increasingly important as they age.
But load is only part of the equation. How we move under that load matters too. Stability, movement quality, and control are not alternatives to lifting heavier. They help develop our capacity to progressively load the body well.
Nutrition matters just as much.
There is no single nutritional approach that fits every individual. Fundamentally, though, we cannot ask the body to adapt without providing the resources necessary to do so. That means adequate amounts of all three macronutrients, carbohydrates, fats, and protein, with particular attention to protein for building and maintaining muscle and bone. It also means eating enough to support the demands we place on our bodies.
For too long, much of the conversation around women’s nutrition has focused on restriction, calories, and body weight. We need to broaden that conversation to include strength, health, performance, and the nutrition required to support them.
And then there is recovery.
Sleep is critically important, but recovery is much broader than sleep alone. Stress, emotional well-being, and mental health influence how we recover, experience pain, and function. Work, family, relationships, caregiving, hormonal changes, and the many other stresses of daily life all contribute to the total load the body and mind must manage.
Recovery should not simply mean taking a day off from exercise. It means creating enough physical and mental space for the body to respond positively to the challenges we place upon it.
So, what can women actually do?
Strength training, appropriate nutrition, and adequate physical and mental recovery are not alternatives to hormone replacement therapy. When hormone therapy is appropriate, these things need to work alongside it. In fact, they are fundamental to metabolic health regardless of age, sex, or whether hormone therapy is part of the conversation at all.
We cannot prevent all of the physiological changes that occur throughout life, but we can significantly influence how our bodies respond to them. Building and maintaining muscle, supporting our bodies with appropriate nutrition, and giving proper consideration to physical and mental recovery provide a foundation for health that no medication can replace.
Our understanding of women’s health still has a long way to go. But we already know enough to recognize that women have meaningful ways to influence their health, function, and quality of life throughout every stage of life.
I find that incredibly encouraging.
Erik
July 2026
Lessons from My Most Puzzling Cases: A Reflection on Women’s Health
Looking back over the past two decades in orthopedic practice, some of the most puzzling cases I encountered involved women in their 40s and early 50s.
These women often presented with persistent tendon pain, muscle aches, joint pain, or injuries that simply did not fit the clinical picture. They were active, motivated, and doing all the right things, yet many were not responding to treatment the way I expected.
At the time, I was looking primarily for biomechanical explanations. Looking back now, I realize I had underestimated the profound influence that women’s hormonal physiology can have on the musculoskeletal system. It simply wasn’t something my education prepared me to recognize.
We now understand that the hormonal physiology of women influences far more than reproductive health. From adolescence and normal menstrual cycles, to pregnancy and the postpartum period, to perimenopause and menopause, hormonal physiology affects muscles, tendons, ligaments, bones, sleep, metabolism, cognition, pain, and recovery. The musculoskeletal system does not exist in isolation. It responds to this part of physiology just as much as it responds to exercise and injury.
Looking back, I think there were two reasons for that.
The first was the education itself. Looking back on my own training, women’s health, particularly the profound influence of hormonal physiology throughout a woman’s life, simply was not emphasized to the extent it should have been. That was not unique to my education. It reflected a broader gap in the entirety of medical education that is only now beginning to receive the attention it deserves.
The second was the results from the Women’s Health Initiative published in 2002. It was, in many ways, a landmark and highly informative study. Unfortunately, a misinterpretation of some of the data from the otherwise very informative report, produced decades of medically driven fear and, in many cases, flat out avoidance of hormone replacement therapy. Women were, and still are routinely told that estrogen would cause breast cancer, and many clinicians simply stopped the conversation.
Fortunately, medicine continues to evolve. As our understanding has grown, so has our ability to care for women throughout every stage of life. We are asking better questions, conducting better research, and having better conversations. We also have a much better understanding of the role that appropriately prescribed hormone therapy, including testosterone when clinically indicated, can play in helping many women maintain and improve their health, function, and quality of life.
One of the privileges of practicing medicine over many years is recognizing that our understanding continues to evolve. The best care evolves with it.
Women deserve conversations that reflect what we know today, not what we believed twenty years ago. They deserve accurate information, thoughtful guidance, and every opportunity to maintain and improve their health, strength, independence, and quality of life.
I find that to be progress worth embracing.
Erik
May 2026
I started playing soccer when I was five years old, and the game never really let me go.
For decades, it was a central part of my life, from youth leagues to college, to professional environments and beyond. I was still competing into my early 50s, often sharing the field with players young enough to be my kids.
I stopped playing last year at the age of 51. Not because of a major injury, and not because the love for the game was gone. My body simply told me it was time. It had in a sense, told me that I had met my physical quota for soccer play.
And I can honestly say without regret or remorse, that I will happily take this ending.
Nearly 50 years in the game, across every level I could find. The game never broke me, not physically and not emotionally. I was able to walk away on my own terms. That is exactly what I want for today’s young athletes.
Last month, I wrote about the current challenges in youth sports, overuse injuries, early specialization, year-round play and the pressure that can quietly take the joy out of the game, or worse, take the player from its game. The response from our community was meaningful and confirmed something important. Parents are paying attention, and they want better for their kids.
This month, I want to focus on the other side of that conversation. Not just what is going wrong, but what getting it right actually looks like.
Looking back, what protected me was not talent or luck. It was the environment.
I had great coaches who emphasized more than technical skills like passing and shooting. They taught teamwork, work ethic, leadership, communication, and commitment.
At home, my father helped me learn how to manage my anger, how to handle frustration, control my temper, and stay focused under pressure. He taught me how to visualize calm and focus, how to navigate frustration with myself, coaches and teammates, and how to turn those things into strengths during practice and play.
Just as importantly, my parents modeled the right kind of support. They were not yelling at referees or coaches. They created space for the game to be something I owned. They also encouraged variety. My younger sister and I engaged in multiple sports, and activities throughout the year. There was no pressure to specialize early or play year round. That balance and variety mattered more than I realized at the time. These influences were not complicated, but they were consistent. They made all the difference.
What we are seeing more often today is not a lack of care, but a shift in the system. Families are being led to believe that more is always better, that earlier, more frequent, and more specialized participation leads to success.
But the body and mind of a young athlete tell a different story.
The good news is that we already know what works. The research is very clear. Athletes who develop broadly, rest adequately, and build strength progressively are not only healthier, they generally perform better and to higher levels over a greater period of time.
More importantly, they are more likely to carry a positive relationship with sport into adulthood.
And that is the real goal.
Not just the trophies, the highlight videos, the college scholarships, or even the pro contracts. We want a lifetime where the game doesn’t break us or end for us, we want one where it benefits us in one form or another.
That is the outcome worth aiming for.
Erik
March 2026
Youth Sports Reality Check: Playing the Long Game
Youth sports in the United States have grown dramatically over the past two decades—but in many ways, youth athletes are paying the price.
What was once primarily about play, development, and teamwork has increasingly become a high-pressure, profit focused industry built on year-round play, travel teams, tournaments, and early specialization.
The result is that we are asking young bodies—and young minds—to operate like professionals long before they are ready.
Overuse injuries that once appeared mostly in collegiate and pro athletes—stress reactions, tendon injuries, growth plate problems, UCL injuries (Tommy John surgery) and ACL tears—are now showing up in middle school and early high school athletes. Injuries like these used to occur almost exclusively in older, higher-level athletes. They were rarely—if ever—seen in youth sports.
And the cost isn’t only physical.
Way too many young athletes are also carrying significant psychological pressure. Families are regularly told that early specialization, travel teams, and constant competition are necessary to reach college or even professional levels. This is false, but those expectations are quietly turning childhood sports into something closer to a job.
For many kids, that pressure leads to burnout, anxiety, and a loss of the joy that drew them to sports in the first place. For others, the story ends with a serious injury that suddenly removes the identity they’ve built around their sport. When that happens, the emotional impact can be just as significant as the physical one.
The reality is that the vast majority of young athletes will never play professionally, and only a small percentage will compete in college athletics. That doesn’t make youth sports less important—it simply means their purpose should be broader.
Youth sports should help kids build confidence, resilience, friendships, and a lifelong love of movement. So keeping kids IN sports is essential. It simply needs to be healthy as well.
Parents and coaches can help create healthier environments by focusing on a few key principles:
- Encourage participation in multiple sports, especially before high school
- Allow for real off-seasons and recovery periods
- Focus on skill development and movement quality rather than constant competition
- Keep long-term health and enjoyment ahead of short-term wins
Because the real success of youth sports isn’t measured in trophies or scholarships. It’s measured in whether young athletes can grow, thrive, and still love the game years down the road. And most importantly, it’s measured in their success as adults in our world.
Erik
November 2025
Hello friends,
As the year begins to wind down, November invites us to pause, not just for the holidays, but for something deeper and more personal. For me it’s a season that brings both gratitude and perspective: a time to recognize what we’ve been carrying, how far we’ve come, and what it means to care for ourselves and each other as the days grow shorter and schedules fill up.
It also marks a moment of reflection for us at Waterland Performance as we prepare to celebrate our 6th Anniversary of December 1. I’m truly grateful for the incredible team that brings our mission to life each day, and for the patients, clients, families, and community members who’ve trusted us along the way. You are the reason this space feels more like a home than a clinic or gym.
At Waterland Performance, we see this month as a powerful reminder that health isn’t a one-time goal, it’s an ongoing relationship with our minds, bodies, families, and community. Whether you’re managing chronic conditions, supporting someone you love, or simply trying to stay well through the seasons of life, we’re here to help you stay grounded, connected, supported and most of all, healthy.
Thank you for being part of the Waterland Performance family, and for allowing us to be part of yours.
Warmly,
Erik Waterland, DPT
September 2025
A Season of Awareness: September & October Health Highlights and Whole-Family Wellness
As we shift into September and October, I always notice a certain energy in the air—a season of change that’s both grounding and reflective. Maybe it’s the rhythm of school routines picking up again, or the way the days begin to feel more crisp and focused. Either way, this time of year always reminds me how interconnected our health really is—not just within ourselves, but with one another and our community environment.
At Waterland Performance, we believe deeply in caring for the whole person—mind, body, and spirit—and that belief extends to every member of your family. But just as importantly, we believe in building and supporting a connected, thriving community. The health awareness events recognized this season are more than calendar observances to us. They represent real people and real stories—often ones we see, support, and walk alongside every day.
From mental health challenges to chronic pain, from injury recovery to aging well, from kids navigating diagnoses to loved ones facing cancer—these causes touch all of us. And that’s why we’re sharing this overview of September and October’s health awareness highlights—not just to inform, but to help all of us stay more connected, proactive, and compassionate.
Because healing isn’t just about individual progress—it’s about knowing that we’re part of something bigger, something supported, something shared.
We’re here for you through every season of change—and this one is no different.
Warmly,
Erik
June 2025
Hello friends,
As a kid, I had a fierce competitive streak, especially when it came to soccer. I was hot headed, quick to lose my temper, frustrated by mistakes, losses, or anything that didn’t go well. After games, especially losses, I often left the field angry and unable to see anything beyond the moment.
But my dad had a way of helping me shift that lens.
He never tried to suppress the emotion or offer hollow encouragement. Instead, he helped me slow down, reflect, visualize and begin to ask better questions: What can I learn from this? How could I train more thoughtfully? What’s within my control to improve? Without ever saying it outright, he was teaching me how to become solution-oriented, but also how to respect the process, how to respect and embrace my emotions. He showed me that growth doesn’t come from quick fixes or blind optimism, but from honest reflection paired with thoughtful, deliberate action.
But perhaps more importantly, he modeled what it means to live with integrity. He treated people with respect, regardless of their background or standing. He stood up for what was right, even when it wasn’t easy. And he consistently encouraged me to use everything I had: my skills, my emotions, my experience, my intelligence, and even my entitlements not for self-gain, but in defense and service of others.
That mindset: calm, principled, and compassionate shaped more than just how I approached sports. It laid the foundation for how I approach my work in medicine. Helping people isn’t just about solving problems; it’s about understanding their circumstances, listening with care, and acting with both clarity and empathy.
This month especially, I’m reminded of how those quiet, steady lessons molded not only my character, but my commitment to the kind of work I do. And I remain deeply grateful for his guidance, his example, and the values that continue to shape me today.
Thanks Pop.
Erik Waterland, DPT
May 2025
Hello friends,
Some of my earliest and most vivid memories are of Saturday mornings, sitting quietly and listening to my mom, Michelle, while she made her post-op calls. As a nurse with a Friday surgery schedule, she spent every Saturday morning checking in on each and every one of her patients, asking how they were feeling, answering questions, listening intently and providing whatever they needed over the phone. I was fascinated by the care and compassion she conveyed over the phone. Even as a child, I could feel how much those conversations mattered. Without ever meaning to, she was grooming me and my sister for this kind of work, for a way of practicing medicine that prioritized presence, empathy, and follow-through.
That early exposure shaped not only my professional values, but the very heart of Waterland Performance. As we celebrate Mother’s Day this May, we’re reminded again of the deep need to care for the women who so often care for everyone else. From pregnancy to postpartum recovery, to perimenopause, women face powerful physiological transitions that are still under-discussed, under-supported, and frequently misunderstood in mainstream care.
Too often, these stages are brushed aside as something to “get through.” Women are told, or even gaslit to believe that what they’re experiencing is simply “normal,” and that struggling is just part of the deal. But we know that women deserve so much more. They deserve to be educated about their own health, to have access to informed support, and to feel strong in their bodies at every stage of life. Fitness and physical therapy are key not just to recovery, but to long-term confidence, functionally, and well-being. Whether it’s prenatal strength training, postpartum care, or thoughtful movement strategies through hormonal shifts, our team is committed to walking with women through every step of that journey.
This month, we celebrate mothers and all women, who carry so much give so deeply, and so very often receive too little in return. We see you. We are here for you. And we are proud to continue the kind of work that my mother quietly modeled for me each and every Saturday morning, with compassion, commitment, and care that is unwavering. Thanks Mom.
Erik Waterland, DPT
February 2026
Hello friends,
February is Heart Health Awareness month, and just because it’s nearly done doesn’t mean there’s not still time to reflect on the vital role our cardiovascular system plays in overall health, longevity, and performance. The heart is more than just an organ – it’s the engine that powers every movement, fuels endurance, and supports recovery. Whether you are training for peak performance or simply aiming to maintain a healthy, active lifestyle, prioritizing heart health is essential.
A holistic approach to cardiovascular well-being goes beyond exercise alone. While consistent movement – whether through endurance work, interval training, or active recovery – is key, heart health is also deeply influenced by nutrition, stress management, and quality sleep. Proper hydration, balanced meals rich in heart supporting nutrients, and restorative sleep all contribute to optimal function. Likewise, stress management techniques, such as mindfulness or breathwork, can help regulate heart rate variability and improve overall resilience.
Dr. Peter Attia, MD, a leading expert in longevity and performance medicine, emphasizes the importance of cardiovascular fitness as a key predictor of long-term health. His research highlights that VO2 max – a measure of the body’s ability to use oxygen efficiently – is one of the strongest indicators of longevity. In fact, individuals with high cardiorespiratory fitness have a significantly lower risk of all-cause mortality, making aerobic conditioning not just a performance booster but a critical factor in disease prevention. He advocates for a well-rounded approach that includes both low and high-intensity training intervals to build peak cardiovascular capacity.
Taking care of your heart isn’t just about improving endurance – it’s about sustaining long-term health and vitality. Stay tuned for more expert insights and practical steps to keep performing your best.
Erik Waterland, DPT
December 2024
Hello friends,
As the season shifts and we move into this time of year filled with both reflection and preparation, I wanted to take a moment and reconnect with all of you.
I am Erik Waterland, and on behalf of myself and the entire Waterland Performance team, I’m thrilled to reintroduce our newsletter. It’s been a while since we used this space to reach out to you and I couldn’t be more excited to get back to regularly sharing with you. This newsletter is a reflection of our commitment to providing the highest quality care and education – not just during your visits to the clinic but also in the resources and support we share with our community.
In each installment, you can expect thoughtful content tailored to your health and wellness journey. We’ll bring you expert advice, tips to stay active and pain-free, updates on exciting happenings at the clinic and with our provider, as well as spotlights on local events and initiatives that promote happiness and healthy living right here in our area. Our goal is to make this newsletter not just informative but also something you look forward to reading – always relevant, never overwhelming.
Above all, I want to emphasize that this is a two-way street. My team and I deeply value the trust you place in us, and we’re always here for open communication. Whether you have questions about your care, suggestions for what you’d like to see in these newsletters, or just want to reach out to share information that benefits our neighbors, we’d love to hear from you. Together, we can grow a strong, and supportive community focused on health and wellness. Thank you for being an integral part of what makes Waterland Performance so special. We’re honored to be on this journey with you and excited for what lies ahead!
Erik Waterland, DPT