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Dr. Manu Mengi – Best Orthopedic Doctor in Mohali

Bone and Joint Health During Pregnancy - Expert Guide by Dr. Manu Mengi

Your Essential Guide to Bone & Joint Health During Pregnancy: From First Trimester to Delivery & Recovery.

Bone & Joint Health During Pregnancy: Expert Guide by Dr. Manu Mengi 

During pregnancy, your body undergoes remarkable changes in bone and joint health, with studies showing that 3 to 5 percent of bone mass can fluctuate throughout this journey. The hormone relaxin loosens your ligaments, while increased estrogen levels help build stronger bones.

However, these changes often bring challenges, especially during the second and third trimesters. Your expanding uterus shifts your centre of gravity, leading to lower back pain, while extra weight creates pressure on your knees and other joints. The good news is that your body becomes more efficient at absorbing calcium during pregnancy, specifically in the later months.

This comprehensive guide, reviewed by Dr. Manu Mengi (Leading Orthopedic Specialist in Mohali), covers everything you need to know about maintaining strong bones and healthy joints throughout your pregnancy. You’ll learn about essential nutrients, safe exercises, and practical strategies to manage common discomforts from your first trimester through recovery.

Understanding Bone and Joint Changes in Early Pregnancy

Your body begins preparing for your baby’s development from the moment of conception. The first trimester marks the beginning of significant bone and joint changes that will continue throughout your pregnancy journey.

How hormones affect your skeletal system

The early weeks of pregnancy trigger a cascade of hormonal changes that directly impact your skeletal system. By 8-12 weeks, you experience the first peak of relaxin, making this an especially vulnerable period for your joints and supporting ligaments. This hormone works by breaking down collagen in targeted tissues and replacing it with a modified form containing higher water content.

Relaxin isn’t working alone, though. Alongside progesterone, it increases connective tissue pliability and extensibility, resulting in reduced passive joint stability. This loosening process begins around 10 weeks of pregnancy, preparing your body for the eventual accommodation of your growing baby.

In contrast to these loosening effects, estrogen plays a protective role for your bones. High estrogen levels during pregnancy are beneficial for bone building, helping to counter some of the potential calcium loss. At the same time, your body begins producing parathyroid hormone-related protein (PTHrP), which increases from the first trimester until labor. This hormone works to suppress and replace regular parathyroid hormone, preventing hyperparathyroidism.

First signs of joint sensitivity

As these hormonal shifts occur, you might begin noticing subtle changes in how your body feels. Early pregnancy often brings minor joint sensitivity that many women dismiss as normal body aches. Nevertheless, the combination of ligament relaxation due to relaxin, postural shifts, and beginning weight changes can trigger initial discomfort.

You may first notice these changes when performing daily activities, as some joints begin losing their normal stability. At the microstructural level, bone biopsies suggest increased bone resorption occurs as early as 8-10 weeks of pregnancy, though this process typically normalizes by term.

Many women report slight discomfort in the pelvic region, particularly around the sacroiliac joints. Furthermore, the symphysis pubis experiences measurable changes, with the normal gap of 4-5 mm showing an average increase of 3 mm during pregnancy.

Preparing your body for changes ahead

The first trimester provides a critical window to prepare for the more pronounced joint challenges of later pregnancy. According to pregnancy fitness experts, this is an ideal time to learn proper pelvic bracing techniques that you’ll use throughout your pregnancy.

To protect your joints as they become more vulnerable:

  • Begin strengthening your deep core and pelvic floor muscles immediately
  • Perform cardio and strength exercises in a controlled manner to avoid hyperextending joints
  • Increase your calcium intake through food sources rather than supplements for better absorption
  • Be mindful of your posture as your center of gravity begins to shift

Although your joints are becoming more relaxed, the good news is that bone resorption appears to be regained through the addition of new trabeculae by late pregnancy. Additionally, your intestinal calcium absorption improves during early pregnancy to help meet your baby’s growing calcium requirements.

Consider speaking with your healthcare provider about appropriate prenatal exercises that can strengthen the muscles surrounding your joints. Consequently, this additional support becomes vital as your ligaments continue to loosen throughout pregnancy. With proper preparation now, you can significantly reduce discomfort in the coming months as your body continues its remarkable adaptation process.

Second Trimester: Managing Increasing Joint Pressure

As your pregnancy progresses into the second trimester, the subtle joint changes you experienced earlier become more pronounced. The growing weight of your baby, combined with hormonal shifts, creates new challenges for your skeletal system, particularly affecting your back, pelvis, and knees.

Why does back pain typically begin now?

Most pregnant women experience back pain starting in the second half of pregnancy. This timing isn’t random – it corresponds with several significant bodily changes. As your uterus expands, it puts pressure on the blood vessels and nerves in your pelvis and back, creating discomfort that wasn’t present before.

Moreover, your centre of gravity shifts noticeably during this period. Your body gradually begins to adjust posture and movement patterns, often without you even realising it. The pelvis also tilts forward as pregnancy progresses, creating a chain reaction through your spine.

Perhaps most importantly, the hormone relaxin continues its work, allowing ligaments supporting the spine to loosen. This increased flexibility, while essential for childbirth preparation, leads to greater instability and potential pain throughout your back.

The science behind pelvic expansion

The second trimester marks a critical period for pelvic joint changes. Your pelvis begins a measurable process of expansion, with both the anterior and posterior pelvic joints continually opening to accommodate your growing baby. This expansion is directly facilitated by relaxin, which helps your pelvic joints and ligaments relax.

From a biomechanical perspective, your pelvis serves a crucial function – transferring loads generated by body weight and gravity during daily activities. This function becomes even more vital now as your body weight increases substantially over a relatively short period.

Research shows that increased pelvic asymmetry during pregnancy is a risk factor for pregnancy-related sacroiliac joint pain. The relatively small and flat sacroiliac joint of women compared to men, combined with hormonal weakening of ligaments, often leads to sacroiliac joint instability.

Protecting your knees as weight increases

In the second trimester, more structural changes begin to affect your knees. The forward tilting pelvis realigns your center of gravity, subtly changing your posture and how exercise puts stress on your knees.

Increased weight puts direct pressure on your knees and may intensify any existing knee discomfort. Additionally, gaining water weight during this period can increase stiffness in your feet, hips, knees, and ankles.

To protect your knees:

  • Wear supportive, comfortable footwear with good arch support instead of high heels
  • Try core stability exercises like side planks, clam shells, and leg raises
  • Perform foot strengthening exercises such as toe-stands and foot arch lifts
  • Take time to rest, giving your joints regular breaks

Safe exercises for maintaining joint stability

Building off first trimester core strengthening, you can now add functional movements that support joint stability. Regular exercise during this period improves range of motion and keeps your joints flexible.

For optimal joint protection, focus on:

  1. Low-impact activities: Walking and swimming are gentler on your joints while still providing excellent conditioning.
  2. Core strengthening: The bird dog exercise increases stability, promotes a neutral spine, and alleviates low back pain. It improves posture while strengthening your core, hips, and back muscles.
  3. Lower body support: Squats strengthen your abdominal and leg muscles, helping prepare you for labour while reducing the risk of knee and ankle injuries.
  4. Pelvic stability: Standing pelvic tilts help alleviate back pain by relieving lower back stiffness and gently stretching back muscles.

If you experience joint discomfort, applying warm compresses to painful areas and wearing low-heeled, supportive shoes can provide significant relief. Likewise, avoid standing on one leg, and climb stairs one at a time to minimise pelvic stress.

Third Trimester: Navigating Peak Joint Stress

The final stretch of pregnancy brings the heaviest joint burden as your body reaches maximum physical adaptation. The third trimester introduces peak joint stress, with many women experiencing their most significant discomfort during these crucial weeks.

Why do joints hurt more in the final weeks?

The third trimester triggers relaxin’s second peak, creating even greater joint instability at precisely the time your body carries maximum weight. This hormonal surge increases the shearing forces at your pubic symphysis joint, often causing deeper discomfort than in previous months. First of all, your centre of gravity shifts dramatically as your baby grows, forcing your body to compensate through posture adjustments that put additional pressure on your lower back and hips.

Meanwhile, the extra pregnancy weight now places maximum strain on your joints. Your abdominal muscles, increasingly stretched to accommodate your growing uterus, weaken further, providing less support for your spine and contributing to joint discomfort. Above all, the continued loosening of ligaments supporting your pelvis reaches its peak effectiveness in preparation for childbirth.

Managing hip and sacroiliac pain

Wearing a belly band starting in mid-to-late third trimester provides critical support for your abdomen, notably relieving both lower back pain and sacroiliac joint discomfort. To protect vulnerable joints, avoid activities that place uneven weight distribution across your pelvis – no leaning on one leg, no hip jutting, and no crossing your legs when sitting.

For sacroiliac pain management:

  • Rest frequently to take the weight off your pelvis
  • Take smaller, slower steps when walking
  • Climb stairs one at a time to minimise pelvic stress
  • Change positions regularly to avoid prolonged sitting or standing

Wearing supportive footwear becomes increasingly important, as does using hot and cold therapy. Thereafter, consider physical therapy if pain persists, since strengthening your deep core and glutes often helps stabilise the sacroiliac joint.

Sleeping positions that reduce joint pressure

Left-side sleeping offers optimal circulation and reduces swelling, primarily benefiting women with high blood pressure or other complications. Place a pillow between your legs to improve alignment and decrease hip pressure. For lower back discomfort, try side sleeping with a pillow supporting both your legs and under your belly.

If experiencing hip pain, adding a pillow underneath your hips helps improve alignment. Alternatively, if you find yourself on your back, try elevating your upper body at a 45-degree angle using pillows to prevent compression of the vena cava while taking pressure off your spine.

When to be concerned about severe pain

Contact Dr. Manu Mengi, Mohali’s Best Orthopedic Doctor, if joint pain intensifies, prevents normal daily activities, or leads to additional symptoms. Be particularly alert to unrelenting pain, deep, sharp sensations, or sudden inability to walk or get up. Importantly, rhythmic low back pain occurring every few minutes might indicate contractions, which sometimes present as back pain rather than abdominal cramping.

Even if pain seems manageable, mention any joint discomfort at your next appointment. Your provider can help develop strategies to decrease pain and potentially prevent it from worsening as you approach delivery.

Essential Nutrition for Bone Health Throughout Pregnancy

Proper nutrition plays a pivotal role in supporting your changing skeletal system throughout pregnancy. Your nutritional needs shift dramatically as your body works to maintain your bone health while building your baby’s developing skeleton.

Calcium requirements and absorption changes

During pregnancy, your daily calcium needs range from 1200-1500mg depending on your age. Remarkably, your body becomes more efficient at absorbing this vital mineral, with intestinal calcium absorption doubling as early as 12 weeks into pregnancy. This increased absorption appears to be your primary maternal adaptation to meet fetal calcium demands.

Your calcium absorption rate increases from 27% (non-pregnant) to 54% by the fifth or sixth month of pregnancy. This efficiency is crucial because, without adequate intake, your body will extract calcium from your own bones to supply your baby. Studies indicate that high maternal calcium intake positively affects bone mineral density in offspring even at age 16.

Beyond calcium: other minerals your bones need

Calcium doesn’t work alone. Research shows that magnesium and phosphorus also play essential roles in maternal and fetal bone development. Your magnesium needs increase during pregnancy to support proper muscle function and bone formation.

Vitamin D is equally important as it helps your body absorb calcium effectively. Adults need 10 micrograms (400 IU) daily, primarily obtained through sunlight exposure and diet. Without sufficient vitamin D, calcium absorption diminishes significantly – studies demonstrate that maternal vitamin D deficiency correlates with declining bone mineral density.

Foods that fight inflammation and joint pain

Incorporating anti-inflammatory foods can help manage pregnancy-related joint discomfort. Focus on consuming:

  • Fruits rich in antioxidants (blueberries, apples)
  • Leafy greens containing polyphenols and calcium
  • Nuts with protective compounds that fight inflammation
  • Fatty fish providing omega-3 fatty acids and vitamin D
  • Whole grains that help produce anti-inflammatory fatty acids

In fact, studies indicate that polyphenols in foods like coffee may provide additional anti-inflammatory benefits. Garlic, turmeric, and ginger contain potential anti-inflammatory properties that support joint health. Overall, maintaining a Mediterranean-style diet high in fruits, vegetables, and healthy fats offers the best approach for reducing inflammation while supporting optimal bone development.

Practical Daily Movements to Protect Your Joints

Daily movement patterns significantly impact how your joints respond to pregnancy’s changing demands. Small adjustments to your routine activities can make a substantial difference in preventing discomfort and protecting your skeletal system.

Proper sitting and standing postures

For sitting: Keep your back straight with shoulders pulled back, allowing your buttocks to touch the chair back. Place a small pregnancy pillow behind your lower back for added support. Maintain your knees and hips at a 90-degree angle with feet flat on the floor—never cross your legs. Take breaks every 30 minutes, as prolonged sitting increases joint strain.

For standing: Hold your head straight with chin in and shoulders back. Keep knees straight but not locked while maintaining weight balanced evenly on both feet. Avoid standing in the same position for extended periods; elevate one foot on a small stool when standing for longer durations, switching feet every 5-15 minutes to relieve pressure.

Safe lifting techniques when pregnant

First of all, avoid lifting objects heavier than 20 pounds during pregnancy. When lifting is necessary, stand with feet shoulder-width apart and bend at your knees—never at your waist. Keep your back straight while tightening your stomach and pelvic floor muscles before lifting. Hold objects close to your body with your arms bent, taking small steps as you move.

Core stability exercises for back protection

Strengthening your core muscles helps prevent back pain and improves stability. Try these exercises:

  • Pelvic tilts: While lying with knees bent, flatten your lower back against the floor to engage abdominals
  • Bird dog: From hands and knees position, extend opposite arm and leg while maintaining a stable core
  • Wall squats: With back against wall, slide down into a sitting position, engaging thighs and abdominals

Hold strengthening poses for 3-10 seconds, repeating 10-30 times. Remember to breathe out during exertion and in during relaxation.

Using supportive devices effectively

Supportive devices can significantly reduce joint stress. Consider wearing a belly band in later pregnancy to provide abdominal support and relieve lower back pressure. Importantly, research shows seven out of ten pregnant women are willing to change behaviors based on personalized recommendations from wearable monitoring devices.

Conclusion

Pregnancy brings remarkable changes to your bones and joints.

Pregnancy brings remarkable changes to your bones and joints, though understanding these shifts helps you navigate them successfully, for expert guidance, consult Dr. Manu Mengi, the Best Orthopedic Doctor in Mohali, at his clinic for personalised care. Book an appointment today!”. Your body becomes more efficient at absorbing nutrients while hormones prepare your skeletal system for childbirth. This natural wisdom of your body, paired with proper care, supports both your health and your baby’s development.

Maintaining strong bones and stable joints throughout pregnancy requires a balanced approach. Regular gentle exercise, especially activities like swimming and walking, strengthens supporting muscles without overtaxing your joints. Meanwhile, calcium-rich foods and anti-inflammatory nutrients provide essential building blocks for skeletal health.

Small daily adjustments make significant differences in joint comfort. Proper posture, careful movements, and supportive devices reduce unnecessary strain on your changing body. Remember that mild discomfort is normal, though sharp or persistent pain warrants a conversation with your healthcare provider.

After delivery, your joints gradually return to their pre-pregnancy state as hormone levels normalize. This recovery period deserves the same careful attention you gave your body during pregnancy. Stay patient with yourself and maintain the healthy habits you’ve developed – they’ll serve you well beyond pregnancy.

FAQs

Q1. How can I manage joint pain during pregnancy?

A1. To manage joint pain, engage in gentle exercises like swimming or walking, apply warm compresses or ice packs, get adequate rest, and wear supportive gear such as pregnancy belts and cushioned shoes. Also, maintain good posture and consider prenatal massage for relief.

Q2. Which trimester is typically the most challenging for joint health?

A2. The third trimester often presents the greatest challenges for joint health. As your baby grows, there’s increased pressure on your joints, particularly in your lower back, hips, and pelvis. The hormone relaxin peaks during this time, leading to greater joint instability.

Q3. What nutritional considerations are important for bone health during pregnancy?

A3. Focus on calcium-rich foods, as your body becomes more efficient at absorbing calcium during pregnancy. Include other essential minerals like magnesium and phosphorus, and ensure adequate vitamin D intake. Consume anti-inflammatory foods such as leafy greens, fatty fish, and whole grains to support joint health.

Q4. How should I modify my daily movements to protect my joints?

A4. Maintain proper posture when sitting and standing, taking regular breaks to move around. When lifting, bend at your knees, keep your back straight, and avoid heavy objects. Incorporate core stability exercises like pelvic tilts and wall squats to strengthen supporting muscles.

Q5. When should I be concerned about joint pain during pregnancy?

A5. While some discomfort is normal, contact your healthcare provider if you experience severe, persistent pain that interferes with daily activities or if you have sudden difficulty walking or getting up. Also, be aware that rhythmic low back pain could potentially indicate contractions.

For persistent pain, schedule a consultation at Dr. Manu Mengi’s Orthopaedic Clinic in Mohali for expert pregnancy joint care.

April 25, 2025 / by Manu
Osteoporosis Explained - The Silent Bone Thief Affecting Millions - Dr. Manu Mengi

Osteoporosis Explained: The Silent Bone Thief Affecting Millions

Someone experiences a bone fracture from osteoporosis every three seconds worldwide. This silent condition affects millions of people, yet we need to understand it better. More than half of Americans over 50 now live with osteoporosis or osteopenia.

The numbers paint a concerning picture. Osteoporosis affects one in three women after menopause, and nearly 200 million women worldwide face this condition post-menopause. Our bodies lose 1-3% of bone mass yearly after age 50 without proper medical care.

This complete guide will help you understand osteoporosis, spot early warning signs, and explore available treatment options. Your knowledge of this “silent bone thief” plays a significant role in maintaining an active, healthy life, whether you’re monitoring your bone health or helping a family member.

If you’re in Mohali, Chandigarh or nearby and seeking expert care, consider consulting Dr. Manu Mengi, one of the Best Orthopedic Doctors in Mohali. With years of experience, Dr. Manu Mengi specialises in diagnosing and treating bone-related conditions, including osteoporosis, at his renowned Ortho Clinic in Mohali.

What Is Osteoporosis: Understanding Bone Mineral Density

Bones are living tissue that constantly rebuild throughout our lives. Osteoporosis means “porous bone,” a condition that makes the bone’s internal framework so thin that even small impacts can cause fractures.

The silent nature of bone deterioration

Just like high blood pressure, osteoporosis shows no early warning signs. You won’t notice anything until a fracture happens, often from simple things like bumping into furniture or a small fall. Bone loss speeds up after age 50, and without medical help, both men and women lose 1-3% of their bone mass each year.

How healthy bones maintain strength

Our skeleton stays strong through a careful balance of bone building and breakdown. Until we turn 30, our bodies build more bone than they lose. Special cells called osteoclasts and osteoblasts work together to keep our bones dense and healthy.

The daily cycle includes:

      • Small amounts of bone mineral get removed (resorption)

      • New mineral gets added to keep bones strong

      • Bones keep rebuilding to repair and strengthen their structure

    Hormones are vital to this process, especially estrogen, which affects bone cells through specific proteins called estrogen receptor alpha. Calcium and vitamin D work as a team – calcium builds the bone’s main structure while vitamin D helps our gut absorb it.

    The tipping point: When bone loss exceeds formation

    After 35, things start to change – bones break down faster than the body can rebuild them. This happens for several reasons:
    Building new bone takes three months, but breaking it down only needs 10-13 days. This means more remodeling activity leads to bone loss. As we age, minerals slowly leave the cortical layer and bone cavity, which causes ongoing loss of trabecular bone.

    Women face bigger challenges during menopause. Their bones deteriorate 3.5% faster each year after 50. This happens because their bodies make less estrogen, which used to help keep their bones strong.

    Age makes everything more complex. Our stem cells become less able to turn into bone-forming cells, and instead create fat tissue. These changes, along with shifts in growth factors throughout the body, create a gap between bone breakdown and formation.

    Recognising Osteoporosis Symptoms Before It’s Too Late

    People usually find out they have osteoporosis after a fracture happens, but their bodies send warning signals much earlier. Recognising these warning signs can substantially help prevent serious bone deterioration.

    Early warning signs most people miss

    Your body often signals when bone health starts declining, even before fractures occur. Decreased grip strength directly relates to lower bone mineral density. Receding gums can point to bone loss in the jaw, but people rarely notice this symptom.

    The first fracture: How osteoporosis shows itself

    That first fracture is a vital turning point – about half the people who have one osteoporotic fracture will end up with another. The numbers are even more concerning for women. One in four women who get a new spine fracture will face another within just a year.

    These fractures usually happen from:

        • Simple falls from standing height

        • Everyday activities like bending or lifting

        • Strong coughs or sneezes can sometimes cause them

      Height loss and postural changes

      Height reduction stands out as one of the most reliable signs of bone loss. Healthcare providers worry when they see a decrease of 2 cm (¾ inch) or more, as this might mean spine fractures. Losing 6 cm (2½ inches) since young adulthood strongly points to vertebral fractures.

      The changes happen slowly:

          1. Height loss starts around age 40

          1. Loss speeds up substantially in the 70s

          1. Multiple vertebral fractures make these changes more obvious

        Pain patterns and mobility issues

        Pain demonstrates different patterns based on where fractures occur and how severe they are. Vertebral compression fractures show three distinct pain patterns:

            • Midline paravertebral pain

            • Diffuse paravertebral discomfort

            • Remote lumbosacral pain

          Pain tends to spread more and move toward the front as vertebral body height decreases. Note that 66% of spine fractures happen without any pain. This makes regular height measurements crucial for catching problems early.

          Mobility problems can be substantial. Simple tasks like walking short distances or carrying shopping bags become challenging. Long-term structural changes often lead to chronic pain, causing:

              • Limited movement in daily activities

              • Problems with balance and coordination

              • Higher fall risks

              • Trouble using public transportation

            Hip fractures create the most severe mobility challenges. About 40% of survivors can’t walk by themselves, and 60% still need help even after a year of recovery. This loss of independence changes everything about daily life, often requiring major lifestyle adjustments or family members’ help.

            Risk Factors That Accelerate Bone Loss

            Knowing what puts our bones at risk helps us protect our bone health better. Our bones lose density due to factors we can’t change, like biology, and choices we can control in our daily lives.

            Age and gender considerations

            People over 50 face higher risks of osteoporosis. Women worldwide are four times more likely to get osteoporosis than men their age. Men who get osteoporotic fractures often face worse outcomes. Their death rates hit 22.8% compared to 19.5% for women in the first year after breaking a hip.

            Hormonal changes in women and men

            Hormone levels make a big difference in bone density. Women’s bone mass drops faster after menopause because their bodies make less estrogen. Women who go through early menopause between 40-45 years face higher chances of weak bones and fractures.

            Low testosterone makes men’s bones weaker. Research shows 66% of older men in nursing homes who broke their hips had low testosterone. Both outer and inner bone layers weaken when testosterone drops, as bone breakdown speeds up while new bone formation slows.

            Family history and genetic predisposition

            Genes cause 50-85% of osteoporosis risk in women after menopause. Scientists have found several gene variants that matter:

                • Estrogen receptor genes (ESR1, ESR2)

                • Major histocompatibility complex gene (MHC)

                • WNT16 gene polymorphisms

              These genes affect bone density and how likely bones break. Your risk goes up if your family members, especially your mother, had osteoporosis or broken bones.

              Medical conditions that compromise bone health

              Many health issues can speed up bone loss:

                  • Endocrine disorders (hyperthyroidism, hyperparathyroidism)

                  • Gastrointestinal diseases (celiac disease, inflammatory bowel disease)

                  • Autoimmune conditions (rheumatoid arthritis, systemic lupus erythematosus)

                  • Type 1 diabetes mellitus

                  • Chronic kidney disease

                Lifestyle factors affecting bone density

                Daily habits shape bone health directly. Too much alcohol stops bone-building cells from working well. Smoking cuts blood flow to bones and slows down new bone cell growth.

                What you eat matters a lot. Too much salt raises your chances of osteoporosis because it makes your body lose calcium through urine. Drinking lots of soda, especially cola, weakens bones due to its high phosphoric acid.

                Staying active makes a big difference – lifestyle choices affect 20-40% of adult bone mass. Long periods without movement or staying in bed can make bones lose minerals quickly.

                Diagnosis: From Blood Tests to DEXA Scans

                Early detection of osteoporosis through proper diagnostic tests helps prevent serious fractures. Doctors use several advanced tools to review bone health and decide the right treatment approach.

                Getting a Medical Review

                Medicare pays for bone density screening for women over 65 and men over 70. Notwithstanding that, you might need testing earlier if you have:

                    • A fracture from a minor fall after age 50

                    • Sudden back pain or height loss you can notice

                    • Medical conditions that make bones weaker

                    • Osteoporosis running in your family

                  Bone mass drops faster within four to five years after estrogen levels go down during menopause, making regular screening vital. Doctors suggest starting bone density tests at age 50 if you have risk factors.

                  T-scores and Bone Density Tests Explained

                  The Dual-energy X-ray Absorptiometry (DXA) scan remains the best way to measure bone density. This painless test uses low-dose X-rays to check bone mineral content, focusing mainly on your hip and spine.

                  DXA scans give T-scores that show how your bone density matches up to a healthy young adult:

                      • Normal: T-score of -1.0 or higher

                      • Osteopenia (low bone mass): T-score between -1.0 and -2.5

                      • Osteoporosis: T-score of -2.5 or lower

                    Each standard deviation shows about 10-12% difference in bone mass. A T-score of -1 means your bone density is roughly 10% below average. A -2.5 score indicates 25-30% less bone mass than a typical young adult.

                    Other Ways to Test Bone Health

                    While DXA leads the way in diagnosis, doctors use several other methods to check bone health:
                    Quantitative Computed Tomography (QCT) gives 3D bone density measurements and looks at the spongy bone inside vertebrae. This method works great for detailed spine analysis.

                    Biomechanical Computed Tomography (BCT) looks at existing CT scans to estimate bone strength through engineering tests. Doctors can use routine medical scans to check fracture risk this way.

                    Radiofrequency Echographic Multi Spectrometry (REMS) measures hip and spine bone density without radiation. This portable technology lets doctors test in different locations.

                    Doctors usually add detailed blood work to:

                        • Check how well your kidneys work

                        • Look at parathyroid gland activity

                        • Test mineral levels needed for strong bones

                        • Watch the effects of cortisone therapy

                      After diagnosis, your medical team calculates your risk of major osteoporotic fractures over the next 10 years using the FRAX calculator. Treatment usually starts right away if you have a 20% or higher chance of major fractures or at least 3% risk of hip fracture.

                      Comprehensive Treatment Options for Osteoporosis

                      Managing osteoporosis needs an all-encompassing approach. Doctors combine medications, supplements, and physical therapy to strengthen bones and prevent fractures. Modern medicine has many treatment options that doctors can tailor to each patient’s needs and risk factors.

                      First-line medications and how they work

                      Bisphosphonates remain the top choice to treat osteoporosis. These medications work well to slow bone deterioration and maintain bone density. Doctors commonly prescribe alendronate, risedronate, ibandronate, and zoledronic acid. Patients can take these in different forms, from daily pills to yearly infusions.

                      Denosumab and other advanced treatments

                      Some patients can’t handle bisphosphonates or don’t respond well enough to them. Denosumab gives these patients a powerful option. This fully human monoclonal antibody blocks RANKL to slow bone loss. Studies show that using denosumab for 36 months reduces hip, nonvertebral, and vertebral fracture risks by a lot. It also improves bone mineral density in the lumbar spine by 9.2% and total hip by 6%.

                      Supplements for osteoporosis management

                      Calcium and vitamin D are the foundations of supplement therapy. People over 50 should get 1,200 mg of calcium each day. Vitamin D needs go up with age – those over 50 need 800-1,000 international units daily. Magnesium plays a key role too. Studies show that 40% of postmenopausal women with osteoporosis have low magnesium levels.

                      The role of physical therapy and rehabilitation

                      Physical therapy helps prevent and manage osteoporosis through targeted exercises. A complete program has:

                          • Resistance training to improve bone and muscle strength

                          • Weight-bearing activities to improve bone density

                          • Balance exercises to reduce fall risk

                          • Posture training to prevent fractures

                        Studies confirm that regular physical therapy can improve balance by 54% and reduce bone loss markers by 23%.

                        Surgical interventions for fracture management

                        Severe fractures need surgery. Vertebral fractures can be treated with minimally invasive procedures like vertebroplasty or kyphoplasty. Doctors inject bone cement through the vertebral pedicle using local anesthesia.

                        Hip fractures usually need more extensive surgery. Options include:

                            • Metal screw implantation for stable fixation

                            • Hemiarthroplasty to replace femoral head and neck

                            • Complete hip replacement for severe cases

                          Surgery success rates stay high, but recovery times vary a lot. Most patients need 6-12 months of rehabilitation. Even after a year, 40% of hip fracture survivors need help walking. That’s why post-surgical care focuses on early movement and complete rehabilitation to help patients regain independence and avoid future fractures.

                          Conclusion

                          Knowledge about osteoporosis strengthens our ability to protect bone health before substantial damage occurs. This silent condition affects millions worldwide, yet medical advances bring hope through treatment options and management strategies.

                          Proactive care and constant alertness will protect bone health. Bone density screenings after age 50 help detect loss early. The right combination of medication, supplements, and targeted physical therapy can substantially lower fracture risks while preserving independence.

                          Detailed care makes osteoporosis management successful. Healthcare providers’ guidance with first-line medications like bisphosphonates or advanced treatments such as denosumab will give a treatment plan that works for individual needs. Note that bone health impacts every part of our daily lives. Today’s actions protect our mobility and independence for tomorrow.

                          If you’re in Mohali or Chandigarh or nearby and looking for expert care, visit Dr. Manu Mengi, the Best Orthopedic Doctor in Mohali, at his Ortho Clinic in Mohali. With his expertise and state-of-the-art facilities, Dr. Mengi provides comprehensive care for osteoporosis and other bone-related conditions.

                          FAQs

                          Q1. What are the early signs of osteoporosis?

                          A1. Early signs of osteoporosis can be subtle and often go unnoticed. They may include weakening grip strength, receding gums, and a gradual loss of height. However, many people don’t realise they have osteoporosis until they experience a fracture from a minor fall or everyday activity.

                          Q2. How is osteoporosis diagnosed?

                          A2. Osteoporosis is primarily diagnosed using a Dual-energy X-ray Absorptiometry (DXA) scan, which measures bone mineral density. This painless procedure focuses on the hip and spine. Blood tests may also be conducted to check mineral levels and assess overall bone health. Your doctor may use the results to calculate your risk of future fractures.

                          Q3. What are the most effective treatments for osteoporosis?

                          A3. The most effective treatments for osteoporosis typically include a combination of medication, supplements, and lifestyle changes. Bisphosphonates are often the first-line medication prescribed. For those who can’t tolerate bisphosphonates, alternatives like denosumab may be used. Calcium and vitamin D supplements, along with targeted physical therapy, also play crucial roles in managing the condition.

                          Q4. Can osteoporosis be prevented?

                          A4. While some risk factors for osteoporosis can’t be changed, there are steps you can take to prevent or slow bone loss. These include maintaining a healthy diet rich in calcium and vitamin D, engaging in regular weight-bearing and resistance exercises, avoiding smoking and excessive alcohol consumption, and getting regular bone density screenings, especially after age 50.

                          Q5. How does osteoporosis affect daily life?

                          A5. Osteoporosis can significantly impact daily life, particularly if fractures occur. It may lead to chronic pain, reduced mobility, and difficulties with everyday activities like walking or carrying items. In severe cases, it can result in a loss of independence. However, with proper management and treatment, many people with osteoporosis can maintain their quality of life and reduce the risk of fractures.

                          March 18, 2025 / by Manu
                          Why Your Shoulder Joint Pain Won't Go Away - Expert Guide to Relief - Dr. Manu Mengi

                          Why Your Shoulder Joint Pain Won’t Go Away: Expert Guide to Relief.

                          Seven out of ten people experience shoulder joint pain during their lifetime. This makes it one of the most common musculoskeletal issues doctors treat today. The shoulder provides our body’s greatest range of motion, yet it remains the joint most prone to dislocation. These issues can lead to painful conditions that might last months or years.

                          Many patients come to me with persistent shoulder pain after trying various home remedies without success. The pain doesn’t always stem from the shoulder joint itself. Other conditions might be the reason why it happens, and these require professional medical evaluation. The recovery journey varies significantly – a frozen shoulder needs 6-9 months to heal, while rotator cuff injuries from repeated movements present their own challenges.

                          This detailed piece will help you understand your persistent shoulder pain. You’ll discover important warning signs and learn proven methods that bring lasting relief. The information here will guide you through specific steps to treat and prevent shoulder problems, whether you struggle with stiffness, sharp pain, or reduced movement.

                          Why Shoulder Pain Becomes Chronic

                          Pain that lasts beyond six months becomes chronic shoulder pain. You need to know how acute pain turns chronic to find the right treatment options.

                          Common reasons for persistent pain

                          Your shoulder’s complex structure makes it prone to long-term problems. Being the most mobile joint in your body, it needs many tendons, muscles, and ligaments to work together. Here are the conditions that often cause lasting pain:

                          Rotator cuff problems top the list and make up about 10% of all ongoing shoulder cases. These start with swelling that can turn into partial or complete tears without proper treatment.

                          People over 50 often develop arthritis, especially osteoarthritis. The pain gets worse as time passes, and people start moving their shoulders less. This limited movement stiffens the joint’s soft tissues.

                          Frozen shoulder, known medically as adhesive capsulitis, shows up in about 6% of chronic shoulder pain cases. This condition links strongly to health issues like diabetes and thyroid problems.

                          Hidden causes most people miss

                          Many factors behind chronic shoulder pain go unnoticed. Neck problems can show up as shoulder pain. If you feel tingling in your hand along with shoulder pain, neck issues might be the real cause.

                          The way you sleep affects your shoulder health. Sleeping on a painful shoulder can make rotator cuff tears worse. Deep, achy pain at night often points to severe glenohumeral osteoarthritis or rotator cuff tears.

                          What you do at work and play matters too. Contact sports or weightlifting might lead to joint instability or acromioclavicular osteoarthritis. Working with your arms above your head raises your risk of rotator cuff problems.

                          Role of daily habits in pain cycles

                          Bad daily habits make shoulder pain worse. Poor posture at your desk puts extra stress on rotator cuff muscles. Your computer screen should be at eye level while you keep your shoulders relaxed and back supported.

                          Staying still too long can make things worse. Working without breaks tightens muscles and reduces flexibility. Taking breaks to move every 30 minutes helps prevent stiffness and keeps joints mobile.

                          Reaching overhead brings special risks. Lifting heavy things above shoulder height strains your muscles and tendons too much. You can reduce strain by keeping items you use often at shoulder level.

                          Managing stress helps your shoulders more than you might think. People often hold tension in their shoulders during stressful times. This constant muscle tension feeds into ongoing pain cycles.

                          Age affects your shoulder health, especially after 60. Shoulder tissues naturally wear down as you get older. This breakdown makes your joint more likely to develop chronic conditions and heal slower.

                          Knowing these factors helps create better treatment plans. Quick action prevents chronic conditions from developing. But if shoulder pain stays despite home treatment, you must see a Best Should Pain Specialist in Mohali to avoid bigger problems.

                          Signs Your Shoulder Pain Needs Attention

                          Spotting warning signs of serious shoulder problems early can save you from long-term complications. My years of treating shoulder conditions have taught me which symptoms just need immediate medical care.

                          Red flags to watch for

                          Your shoulder’s sudden changes in appearance or function might signal serious problems. A deformed or misshapen shoulder joint points to possible dislocation or severe injury. Any noticeable swelling, redness, or unusual warmth around the shoulder area should be checked.

                          Restricted mobility is a vital warning sign. You might notice these signs at first:

                            • You can’t lift your arm above your head

                            • Simple daily tasks become difficult

                            • Your strength gets worse over time

                          Ongoing stiffness with grinding, clicking, or popping sounds in your shoulder joint suggests potential cartilage damage. On top of that, lasting numbness or tingling down your arm could mean nerve compression.

                          Shoulder pain that disrupts sleep needs attention. You might struggle to find a comfortable position to sleep, as any shoulder movement causes pain. Putting a pillow under the affected arm’s elbow might help temporarily.

                          When to see a doctor immediately

                          Some symptoms call for urgent medical care. Call emergency services right away if you experience:

                            • Sharp, sudden shoulder pain with chest tightness

                            • Dizziness with shoulder discomfort

                            • Shortness of breath with shoulder pain

                            • Pain spreading from chest to left jaw, arm, or neck

                          These signs could mean you’re having a heart attack instead of a shoulder problem.

                          Get immediate medical help after an injury if your shoulder looks:

                            • Severely swollen

                            • Badly bruised

                            • Bleeding

                            • Obviously deformed

                          See your healthcare provider within 24-48 hours if you notice:

                            • Fever with shoulder pain

                            • Severe pain even without movement

                            • Growing weakness in the arm

                            • Shoulder pain that lasts beyond 2-4 weeks despite home care

                          You might need to see an Orthopedic Specialist in Mohali if you have:

                            • A loose or unstable shoulder joint

                            • Reduced strength affecting daily tasks

                            • Limited range of motion

                          Without doubt, early treatment prevents bigger problems. Even though mild shoulder pain might get better with rest and home care, ignoring ongoing symptoms often creates complications.

                          Athletes and active people should watch out for:

                            • Sudden popping feelings during activity

                            • Immediate weakness after hearing a “pop”

                            • Problems doing usual training movements

                          These symptoms often mean rotator cuff injuries that need quick medical evaluation.

                          Older adults should pay attention to gradual changes in how their shoulder works. Pain that steadily gets worse, especially during rest, might show arthritis getting worse. Quick medical help for early diagnosis can slow down the disease.

                          Note that mild shoulder discomfort can turn into long-term problems without proper care. Trust your gut – if something doesn’t feel right with your shoulder, getting professional medical advice ensures you get the right diagnosis and treatment.

                          Common Mistakes Making Your Pain Worse

                          Simple mistakes in daily activities can make shoulder joint pain worse. What starts as minor discomfort becomes a lasting problem. Learning about these common errors helps you avoid strain and recover faster.

                          Incorrect sleeping positions

                          Your sleep posture affects shoulder health. Putting pressure on an affected shoulder all night can tear muscles or cause dislocation. The pressure also blocks natural healing that happens while you rest.

                          To protect your shoulder while sleeping:

                            • Put a supportive pillow under your arm when lying on your back

                            • Use pillows between your knees to keep proper alignment

                            • Learn to sleep on your good side

                          Sleep position matters even more with conditions like rotator cuff tears. Yes, it is worth noting that night pain often points to severe glenohumeral osteoarthritis or rotator cuff damage.

                          Poor workout form

                          Bad technique and pushing too hard cause most shoulder injuries from exercise. Heavy gym workouts put stress on shoulder joints, muscles, and tendons.

                          The worst workout mistakes include:

                            1. Lifting weights beyond your strength level

                            1. Not taking enough rest between sets

                            1. Using wrong form, especially during bench presses and overhead movements

                          Overhead lifting brings special risks because repeated motion can strain tendons and cause tendinitis. Continuing these movements while in pain might tear your rotator cuff.

                          Bad posture habits at work

                          Long periods of poor posture at your desk strain your shoulders. Slouching makes your shoulders round forward and puts too much pressure on rotator cuff muscles.

                          Bad posture affects everything in shoulder function:

                            • Shoulder blade positioning

                            • Muscle efficiency

                            • Joint space availability

                            • Arm movement patterns

                          Simple changes can make a big difference. Keep your computer screen at eye level. Your chair height should let your feet rest flat on the floor. These adjustments reduce neck and shoulder strain while supporting good alignment.

                          Your workplace setup needs special attention. Sitting too long without breaks causes muscle tension and stiff joints. Taking short walks every 30 minutes helps keep joints mobile and prevents stiffness.

                          Most people who work at desks develop rounded shoulders from leaning forward. This tightens chest muscles and weakens the upper back. The imbalance adds stress to shoulder joints, which makes lifting or reaching painful.

                          Looking down at screens pushes extra weight onto neck and shoulder muscles. This position tires muscles and might squeeze nerves.

                          A rounded upper back changes how your body distributes weight. Your shoulder muscles work harder to make up for it. This compensation pattern creates lasting tension and pain.

                          Muscle imbalances often cause poor posture. Building strength in specific muscles helps pull shoulders back where they belong. Regular stretching of tight chest and neck muscles lets shoulders stay in better positions.

                          Note that posture isn’t just about exercise—it’s about daily habits. Small, steady improvements prevent damage better than occasional big corrections. Moving often and staying aware of your body position helps build better posture habits.

                          Modern Treatment Options Explained

                          Medical science provides many innovative ways to treat ongoing shoulder pain. Advanced therapies and technology-driven solutions give us better understanding to create a working treatment plan.

                          Latest medical therapies

                          Physical therapy remains essential in shoulder rehabilitation. We focused on strengthening exercises and improved mobility. Quick relief from inflammation comes from corticosteroid injections, though doctors limit these to four shots per year.

                          Hyaluronic acid injections mark a breakthrough in joint treatment. This natural lubricant can relieve pain for up to two years when injected into the shoulder. PRP therapy also employs the patient’s blood components to boost natural healing.

                          Some severe cases need different solutions when standard treatments don’t work. Doctors insert subacromial balloon spacers through arthroscopic techniques to stabilize joints with severe rotator cuff tears. Reverse shoulder replacement surgery changes joint mechanics so other muscles can compensate for damaged areas.

                          Alternative treatment approaches

                          Acupuncture has become a proven non-pharmaceutical option. Practitioners place thin needles at specific body points for 15-40 minutes. TENS therapy delivers mild electrical currents through skin electrodes to manage pain among other treatments.

                          Regenerative medicine shows promising alternatives:

                            • Stem cell therapy targets underlying tissue damage

                            • Mesenchymal stem cells promote natural healing

                            • Growth factors reduce inflammation

                          Hydrodilatation helps stretch tight tissues and improve mobility by injecting sterile water into the joint capsule. Shoulder manipulation under anesthesia breaks up restrictive scar tissue, but patients need careful selection.

                          Technology-based solutions

                          Better diagnostic tools have improved treatment precision. Advanced imaging technologies include:

                            • MRI with contrast

                            • Ultrasound elastography

                            • 3D motion analysis

                            • Dynamic ultrasound

                          Wearable devices play a vital role in rehabilitation. These tools track heart rate variability, sleep patterns, and shoulder movement ranges. Smart apparel with sensors monitors compensatory movements during therapy sessions.

                          Computer-guided treatments have made surgical precision better. Surgeons use three-dimensional printing to create exact models of patient’s shoulders for meticulous procedure planning. Complex cases needing customized implants benefit most from this technology.

                          Mobile health applications support ongoing treatment by syncing exercise programs with calendars and sending daily reminders. This technology helps patients stick to their prescribed rehabilitation routines.

                          IMUs provide detailed movement tracking. These small devices attach to the body and analyze shoulder mechanics during activities. Therapists use this data to adjust treatment plans based on measured results.

                          Virtual reality systems make rehabilitation exercises more effective. Patients participate in therapeutic movements through immersive environments and get live feedback. These systems show good results but need professional supervision.

                          GPS devices help with surgical navigation, especially during reverse shoulder arthroplasty procedures. AI algorithms analyze movement patterns to help make smarter decisions about daily activities.

                          Daily Habits That Speed Up Recovery

                          The right daily habits can speed up your shoulder recovery dramatically. Research and clinical experience show that specific lifestyle changes make a substantial difference in how quickly you heal and reduce pain.

                          Proper posture techniques

                          Your rotator cuff muscles strain excessively when you maintain poor posture. Here’s how to arrange your body properly throughout the day:

                            • Position your head directly over your shoulders

                            • Pull your shoulders back while engaging your abdomen

                            • Give your lower back proper support during long sitting periods

                          Your workplace setup plays a vital role in shoulder health. The computer monitor should sit at eye level, and your chair must provide good back support. Quick breaks every 30 minutes prevent stiff muscles and keep your joints flexible.

                          Shoulder blade squeezes provide immediate relief if you work at a desk. You can stand or sit comfortably. Pull your shoulders down and back, then hold this position for 3-5 seconds. Do this exercise 30 times, 3-4 times daily to release tension and improve your posture.

                          Gentle movement practices

                          Exercise is essential for shoulder recovery, but your approach matters substantially. A well-laid-out conditioning program should last 4-6 weeks under medical supervision. You should maintain these exercises 2-3 days weekly afterward to protect your shoulder’s long-term health.

                          Start any movement routine with these basics:

                            • A 5-10 minute warm-up with low-impact activities

                            • Pay attention to your body – exercises shouldn’t hurt

                            • Work on increasing your range of motion gradually

                          T-Y-I movement sequences strengthen vital rotator cuff muscles effectively. Stand with your back against a wall, then move your arms into T, Y, and I shapes while keeping your shoulder blades in contact. Do 5-10 repetitions, and keep movements below shoulder level.

                          Standing wall push-ups provide another gentle strengthening option. Put your palms on the wall at shoulder height and do 10-15 repetitions twice daily to build arm and shoulder strength gradually. This exercise maintains mobility without putting too much stress on healing tissues.

                          Stress management for pain relief

                          Psychological stress shows up as physical tension in your shoulders. Your body enters fight-or-flight mode under stress, which tenses muscles, especially in your neck and shoulders. Long periods of stress can lead to chronic muscle tension and might contribute to frozen shoulder development.

                          These stress management techniques work well:

                          Deep breathing exercises trigger your parasympathetic nervous system and help relax tense shoulder muscles. Regular outdoor activities like walking or cycling boost blood circulation and lower stress levels. Mindfulness practices help you learn about how stress affects your body and manage tension better.

                          Sleep quality affects your recovery substantially. Here’s how to get optimal rest:

                            • Choose a pillow that supports proper neck alignment

                            • Put a pillow between your arms when sleeping on your side

                            • Keep your sleep and wake times consistent

                          These habits need patience and consistency. Physical therapy research shows that simple stretches 2-3 days weekly maintain muscle flexibility and reduce pain. Moving remains important even when you feel discomfort since complete stillness can stiffen muscles and shorten tissue.

                          Note that shoulder conditioning needs professional guidance. Regular visits with healthcare providers ensure your exercises match your condition and recovery stage. Focus on activities that maintain strength and range of motion without causing extra strain.

                          Building a Long-term Pain Management Plan

                          A structured approach that combines medical guidance and personal commitment will help you manage shoulder pain successfully. Research shows that 90% of patients respond positively to detailed conservative management plans.

                          Creating your daily routine

                          A consistent daily routine builds the foundation of effective shoulder rehabilitation. Physical therapy studies show that doing exercises 2-3 days each week helps maintain strength and flexibility. Here are the significant components:

                          Morning routine:

                            • Start with gentle stretches to reduce stiffness

                            • Apply ice or heat therapy based on your condition

                            • Take prescribed medications at scheduled times

                          Your posture and ergonomics matter throughout the day. Research highlights that early treatment prevents chronic conditions. Regular movement breaks help you avoid static positions that lead to muscle tension.

                          The core team of physical therapists suggest weekly visits for 4-6 weeks. This schedule leads to noticeable improvements in shoulder function. These sessions focus on strengthening exercises and mobility improvements tailored to your needs.

                          Setting realistic recovery goals

                          Physical therapists and patients who set goals together see better rehabilitation results. Studies show that patients who expect positive outcomes from physical therapy show better results at four weeks and six months.

                          These factors matter when you set recovery targets:

                            • Time-based progression: Recovery needs 4-6 weeks of dedicated conditioning

                            • Activity modifications: Adjust daily tasks to prevent strain

                            • Sleep quality improvement: Address night discomfort with proper positioning

                            • Stress management integration: Include relaxation techniques

                          Research confirms that meaningful goals boost patient participation. Set functional objectives that relate to your daily activities. To name just one example, instead of targeting general “pain reduction,” want to achieve specific goals like “comfortably reaching overhead cabinets.”

                          Physiotherapist-led programs show success rates of 65-80%. All the same, recovery timelines change based on individual factors. People over 60 heal more slowly.

                          Track your progress regularly. Document improvements in:

                            • Range of motion

                            • Pain levels during specific activities

                            • Sleep quality

                            • Daily function capabilities

                          Note that shoulder rehabilitation needs patience. Studies show that even minor shoulder injuries might need eight weeks or longer to heal properly. Live communication with healthcare providers helps adjust treatment strategies based on progress.

                          These proven strategies will give a better outcome:

                            • Schedule exercises during specific times daily

                            • Monitor progress through a symptom diary

                            • Modify activities based on pain levels

                            • Maintain regular check-ins with healthcare providers

                          Research shows that worrying too much about symptoms or imaging findings can slow recovery. Focus on achievable milestones and celebrate small victories during your healing trip. Successful rehabilitation combines proper medical guidance with dedicated personal effort.

                          Conclusion

                          Shoulder pain can feel overwhelming. Understanding why it happens makes treatment easier to manage. Dr. Manu Mengi’s clinical experience shows patients get lasting relief with structured rehab plans and smart lifestyle changes.

                          Getting better requires several essential steps. Look out for warning signs that need immediate medical care. Poor posture and bad sleeping habits often make shoulder problems worse. Physical therapy and advanced medical procedures are great ways to get better, depending on your condition.

                          Your daily habits determine whether relief is temporary or permanent. Simple things help – good desk posture, gentle exercises, and lower stress levels affect healing by a lot. Most patients improve noticeably within 4-6 weeks if they follow professional advice consistently.

                          Begin your Shoulder Pain Treatment in Mohali today to stop minor issues from becoming chronic problems. Listen to your body’s signals and get professional help when needed. Stay committed to your recovery plan. Your shoulder’s health affects your quality of life directly. Taking care of it now helps you avoid complications later.

                          FAQs

                          Q1. How long should I wait before seeking medical help for persistent shoulder pain?

                          A1. If your shoulder pain doesn’t improve after two weeks of home care, it’s advisable to consult a healthcare professional. Persistent pain could indicate an underlying condition that requires proper diagnosis and treatment.

                          Q2. What are some effective non-surgical treatments for shoulder joint pain?

                          A2. Non-surgical treatments for shoulder pain include physical therapy exercises, proper posture techniques, application of ice or heat, and medications to manage pain and inflammation. In some cases, corticosteroid injections or alternative therapies like acupuncture may be recommended.

                          Q3. Can poor sleeping positions contribute to chronic shoulder pain?

                          A3. Yes, incorrect sleeping positions can exacerbate shoulder pain. Sleeping on the affected shoulder or without proper support can lead to increased discomfort and hinder the healing process. Using supportive pillows and training yourself to sleep in a neutral position can help alleviate pain.

                          Q4. How does stress affect shoulder pain, and what can I do about it?

                          A4. Stress can cause muscle tension, particularly in the neck and shoulder region, potentially worsening existing shoulder pain. Incorporating stress management techniques such as deep breathing exercises, regular physical activity, and mindfulness practices can help reduce tension and improve overall shoulder health.

                          Q5. What role does posture play in shoulder pain recovery?

                          A.5. Proper posture is crucial for shoulder pain recovery. Poor posture, especially during prolonged periods of sitting or computer use, can strain shoulder muscles and contribute to chronic pain. Maintaining good posture, taking regular breaks, and performing posture-correcting exercises can significantly aid in the healing process and prevent future issues.

                          March 8, 2025 / by Manu
                          How to Avoid Running Injuries - Expert Tips from Dr. Manu Mengi for Pain-Free Training

                          How to Avoid Running Injuries: Expert Tips from Dr. Manu Mengi for Pain-Free Training

                          The numbers are shocking – 90% of long-distance runners get hurt at least once every year. I’ve seen this firsthand in my medical practice, as an Orthopedic Doctor in Mohali. Running is great for your health, but injury risk remains one of the most important concerns for runners at all levels.

                          My experience treating running injuries shows that most problems come from things we can predict and prevent. Runners often push too hard too fast and go beyond the 10% weekly mileage increase rule. Poor running form and not enough rest time between runs are also common triggers.

                          Let me share some proven ways to stay injury-free. We’ll look at everything from running form and choosing the right shoes to smart training plans. This piece will help you build an eco-friendly running routine that works, whether you’re getting ready for your first 5K or training for a marathon.

                          Understanding Your Body’s Warning Signs

                          Your body sends warning signals that can prevent a minor discomfort from becoming a serious running injury. One in three recreational runners will face a running-related injury in their lifetime. Understanding your body’s signals is a vital part of prevention.

                          Common pain signals to watch for

                          Running with sharp, stabbing pain points to an acute injury in your muscles or joints. Throbbing or pulsating sensations, especially when you have warmth or redness, signal inflammation. These warning signals need your attention:

                          • Sharp pain while running or walking
                          • Persistent aching that gets worse during activity
                          • Joint swelling or visible bruising
                          • Pain that makes weight-bearing difficult

                          When to stop running

                          Pain during running can lead to severe injuries if you ignore it. You should stop running if pain lasts beyond 10-14 days or returns after rest. It also makes sense to end your run right away if you feel localized pain that gets worse as you move.

                          Difference between soreness and injury

                          Only when we are willing to understand the difference between normal muscle soreness and injury can we train safely. Delayed onset muscle soreness (DOMS) shows up 24-48 hours after exercise and feels better with movement. This type of discomfort signals that your muscles are getting stronger.

                          In stark comparison to this, injury pain follows different patterns. It usually starts during exercise or within 24 hours of activity. Unlike soreness, injury pain tends to:

                          • Disrupt your sleep
                          • Get worse with continued activity
                          • Target specific areas rather than general muscle groups
                          • Last beyond 3-5 days

                          Medical attention becomes necessary if you notice consistent pain in a muscle or joint that rest doesn’t improve. Three out of four running-related injuries affect the lower leg, with most impact on the knee, ankle, shin, and foot. Dr. Manu Mengi, one of the Best Orthopedic Doctors in Mohali, can help assess and treat these injuries effectively.

                          Building a Strong Foundation

                          Strength training is the life-blood of injury prevention for runners. A strong core and balanced muscles prepare your body for the repeated impact of running.

                          Simple strength exercises for runners

                          We focused on compound exercises that target multiple muscle groups at once. Single-leg exercises need special attention since running involves alternating one-legged movements. A well-laid-out strength routine done twice weekly can reduce ankle injury rates by 36%.

                          The most effective exercises include:

                          • Single-leg deadlifts for hip stability
                          • Walking lunges for stride improvement
                          • Step-ups for leg power
                          • Glute bridges for hip strength
                          • Bodyweight squats for overall leg strength

                          Core stability workouts

                          Your core covers everything from your shoulders to your hips, not just your abs. A complete core routine should target all these areas. A strong core helps transmit force through your legs during the launch phase and absorbs impact during landing.

                          Planks, side planks, and bridges are the most beneficial core exercises for runners. These movements target your external obliques, lower back, and top of the glutes – areas where distance athletes often feel tired. You should do these exercises right after your runs until your muscles feel fatigued rather than counting specific repetitions.

                          Balance training essentials

                          Balance training is a vital component for injury prevention. Research shows that balance exercises alone can reduce anterior cruciate ligament injuries in male runners. Single-leg holds, lateral bounds, and reverse lunges to knee drives are vital balance exercises.

                          Balance training helps your body maintain proper form during running and prevents excessive motion from your foot up to your torso. You should do balance exercises 2-3 times weekly for the best results. Start with simple movements like single-leg stands and progress to more challenging exercises as your stability improves.

                          Note that strength and balance exercises should support your running, not hinder it. Start with bodyweight exercises before adding resistance and focus on proper form rather than speed.

                          Smart Training Progression

                          Training progression is the life-blood of injury prevention in running. The way you increase your running volume can determine if you’ll see steady improvement or face painful setbacks.

                          Weekly mileage increases

                          The traditional 10% rule provides a starting point for mileage progression. This guideline suggests never increasing weekly mileage by more than 10%, but research shows a more nuanced approach works better. We focused on your current fitness level and running experience to plan increases.

                          These proven strategies help you progress responsibly:

                          • Stay at new mileage for 3-4 weeks before next increase
                          • Lower intensity when building volume
                          • Begin at 50% of your target mileage, then increase gradually
                          • Watch your body’s response to each increase

                          Elite runners often follow a “3 weeks up, 1 week down” approach for mileage progression. This method lets your body adapt to increased training loads and prevents burnout. Some runners need recovery weeks every three weeks, while others can go five weeks between down periods.

                          Rest and recovery periods

                          Sleep and proper nutrition are vital parts of adapting to increased training loads. You need at least two days of rest per week when building mileage, with three days being ideal.

                          Your body needs time to adapt positively to training stresses. Watch for these warning signs that show you need more recovery:

                          • Fatigue that lasts seven or more days
                          • Performance drops despite consistent training
                          • Changes in sleep patterns or appetite
                          • Unusual muscle soreness that doesn’t improve

                          Plan “down weeks” where you cut mileage by 30-50% every fourth week. Avoid increasing both volume and intensity at once since this mix often causes overuse injuries. Runners who increase mileage faster face a higher injury risk compared to those who progress gradually.

                          Physical rest isn’t the only factor – mental recovery matters just as much. Active recovery through gentle walking or swimming can help maintain fitness while your body rebuilds.

                          Proper Running Form Basics

                          The right running form helps prevent injuries and makes you more efficient. Studies show that runners who use proper mechanics use up to 13% less energy.

                          Foot strike patterns

                          Runners use three main foot strike patterns: rearfoot strike (RFS), midfoot strike (MFS), and forefoot strike (FFS). Data shows that 81% of marathon runners land on their heels. Notwithstanding that, each runner’s ideal foot strike pattern depends on their unique biomechanics and goals.

                          Landing on your midfoot or forefoot usually puts less stress on your joints. You should focus on landing with your foot directly under your hip. Reaching forward increases your risk of injury, so your foot needs to hit the ground beneath your center of gravity. This creates a smooth flow into your next stride.

                          Body alignment

                          Good alignment builds from the ground up. Stand tall with a slight forward lean from your ankles, not your waist. This position helps you use your core and lets gravity pull you forward naturally. Keep your head level and look ahead instead of down at your feet. This helps maintain proper spine alignment and reduces neck tension.

                          Arm movement

                          Your arms are vital power generators when you run. Research proves that the right arm swing saves 3-13% of energy. Here’s what you need to know:

                          • Keep elbows bent at about 90 degrees
                          • Move from your shoulders
                          • Don’t let arms cross your body’s center
                          • Keep hands loose like you’re holding a delicate potato chip

                          Running cadence tips

                          Your cadence or stride rate substantially affects running efficiency. Most casual runners stay between 150-170 steps per minute (spm), while elite athletes often hit 180 spm. Higher cadence usually means less ground contact time and lower injury risk.

                          Start improving your cadence by finding your current rate. Then add 5-10% gradually. To cite an instance, see how a 160 spm runner might aim for 168 spm first. Practice this new rhythm on a treadmill where you can keep a steady pace.

                          Note that the best running form comes from regular practice and proper training. Research shows that most running injuries come from three things: heel striking, overstriding, and wrong cadence. You can lower your injury risk by working on these elements while keeping proper form.

                          Choosing the Right Gear

                          The right running footwear is crucial to prevent injuries. My experience as a doctor shows that good shoe choices can substantially reduce common running problems.

                          Running shoe selection guide

                          You need shoes that fit perfectly right from the start – no breaking-in needed. Leave a thumb’s width of space between your longest toe and the shoe end. Your feet get bigger during runs, so try shoes later in the day when your feet are naturally swollen.

                          Different running styles need different shoes. Here are the main things to look at:

                          • Running surface – Roads need more cushioning, while trails need better grip and ankle support
                          • Foot mechanics – Neutral shoes work for most runners, but specific gait patterns might need extra support
                          • Cushioning preference – You can pick anything from maximum cushioning to minimal ground feel

                          Runners with pronated feet do best with motion control shoes – studies show they have a 45% lower injury risk compared to standard shoes. The evidence suggests occasional runners do better with low-drop shoes, while regular runners should use conventional drop heights.

                          Modern running shoes now come with various cushioning technologies. Soft midsoles cut down impact forces, and thick midsoles absorb shock better. The thicker cushioning might reduce your ground feel though.

                          When to replace shoes

                          Regular runners typically get 400 to 500 miles from their shoes – about 3-4 months of use. You’ll know it’s time for new shoes when:

                          Look out for these signs:

                          • Compressed or worn midsoles and outsoles
                          • New aches in your feet, legs, knees, hips, or back
                          • Obvious heel damage or worn soles
                          • The midsole doesn’t bounce back when you press it with your thumb

                          Studies show running shoes keep about 80% of their shock absorption after 150 miles, dropping to 70% at 500 miles. Today’s foam materials last longer than older ones, but lightweight race shoes might wear out faster.

                          Using two pairs of shoes helps them last longer. This lets the cushioning recover between runs and helps prevent injuries. Save these shoes just for running – casual wear adds unnecessary miles.

                          Conclusion

                          My experience as a Best Ortho Doctor in Mohali shows that running injuries aren’t inevitable – you can prevent most of them. You can reduce your risk of injury by a lot when you pay attention to warning signs, do regular strength training, and progress at the right pace.

                          A mix of different approaches helps prevent injuries effectively. Your best defense against common running problems comes from core stability exercises, proper running form, and the right shoes. On top of that, when you listen to your body’s signals, you can spot potential risks before they turn into serious issues.

                          Runners who stick to these guidelines usually train more consistently. The trip to injury-free running needs time and patience, but pain-free training makes every preventive step worth it. These strategies can show positive results in just a few weeks if you start today.

                          Smart choices about training progression, recovery time, and equipment will help you succeed in running. Don’t push through pain or ignore early warning signs – take charge of preventing injuries instead. This change in thinking can reshape your running experience from constant setbacks to steady progress.

                          February 20, 2025 / by Manu
                          The-Hidden-Truth-How-Obesity-Affects-Your-Orthopedic-Health-dr-manu-mengi

                          The Hidden Truth: How Obesity Affects Your Orthopedic Health

                          Obesity poses a major threat to orthopedic health worldwide. By 2030, half of all Americans will likely be obese. The situation is already serious, with one-third of North Americans dealing with obesity that puts their joints and bones at risk.

                          Your knee joints face tremendous strain from excess weight. Every extra kilogram adds four to six kilogram of pressure on your knees. Someone carrying 25 extra kgs puts an additional 100 to 150 kgs of pressure on their knees with each step. This explains why obese people need knee replacement surgery 20 times more often than those at healthy weights.

                          This piece examines the vital link between obesity and orthopedic health. It shows how extra weight affects your joints, spine, and overall musculoskeletal system. A modest 6 -8 kgs weight loss can slow down knee osteoarthritis progression by 50%. You’ll also learn about specific challenges that obesity creates for orthopedic treatments and surgeries.

                          The Biomechanical Impact of Obesity on Your Skeletal System

                          Body weight affects how your skeletal system works by a lot. Extra weight creates unique challenges for your joints and bones that can affect your overall orthopedic health.

                          Understanding load distribution in weight-bearing joints

                          Extra weight puts substantial pressure on your joints. A single pound of body weight adds four to six pounds of pressure on your knee joints. This extra force changes how your joints handle daily movements. Your chances of needing a knee replacement become 20 times higher than people who maintain a healthy weight.

                          Obesity changes the mechanical stress patterns in your joints. Research shows that it alters knee joint reactions and increases muscle activations during walking. Your joints must work harder to stay stable, especially during the first and second peak loading moments of each step.

                          Impact on spine alignment and posture

                          Extra weight drastically changes your spine’s natural alignment. Carrying additional weight around your abdomen causes:

                          • Forward displacement of your center of gravity
                          • Increased lumbar lordosis (curve in lower back)
                          • Greater stress on spinal structures

                          Your body adjusts its posture to compensate for these changes. Research reveals that obesity creates higher thoracic kyphosis (upper back curve) and limits spinal mobility. These postural changes often result in chronic back pain and reduced physical function.

                          Effects on joint cartilage and bone density

                          Obesity and bone density share a complex relationship. Extra weight can stimulate bone formation through mechanical loading. However, too much loading might harm your bones. Your joint cartilage faces special challenges because obesity increases contact stress in hip joints.

                          The effects go beyond mechanical stress. Your body’s inflammatory responses to obesity can change bone metabolism. Research indicates that obesity might increase bone mass at first. Yet over time, it can reduce bone quality. This intricate relationship between weight and bone health shows why healthy weight maintenance matters for long-term orthopedic health.

                          How Obesity Triggers Orthopedic Complications

                          Obesity causes complex biological changes in your body beyond just mechanical stress. These changes trigger a series of effects that can harm your bone and joint health in many ways.

                          Metabolic changes affecting bone health

                          Obesity alters your body’s metabolic processes substantially. Studies show that it creates a lasting, mild inflammatory condition that changes how your bones grow and repair themselves. Your fat tissue plays an active role in many disease processes and affects your insulin sensitivity and blood pressure.

                          Inflammatory responses in joints

                          Your joints face unique challenges from obesity-related inflammation. Studies show that people with obesity have higher levels of inflammatory markers that directly affect joint health:

                          • Higher levels of TNF-α and IL-6 in adipose tissue
                          • Increased C-reactive protein levels
                          • Elevated inflammatory cytokines

                          These changes cause your joints to become more inflamed. Research shows that 34% of people with obesity develop osteoarthritis, while 22% experience low back pain.

                          Impact on muscle strength and function

                          Obesity changes how your muscles work. Research proves that it affects your skeletal muscle’s ability to contract, which reduces mobility. This creates a difficult cycle where limited movement leads to more weight gain.

                          The effects on your muscle quality raise serious concerns. Research shows that obesity causes:

                          • Less muscle strength compared to body mass
                          • Disrupted muscle activation patterns
                          • Limited ability to perform daily tasks

                          Your muscle strength and obesity share a complex relationship. Research shows that 92% of middle-aged and older adults with obesity have poor muscle quality. This muscle function decline affects your daily life and makes you more likely to develop orthopedic problems.

                          Common Orthopedic Conditions in Obese Individuals

                          Extra weight can put you at risk of several orthopedic conditions that affect your daily life. Let’s look at specific problems you might face and how they affect your everyday activities.

                          Joint-specific problems and manifestations

                          Extra weight creates substantial challenges for your joints. Research shows you’re 8.5 times more likely to need knee replacement surgery if you have obesity compared to people with normal weight. This risk jumps to 18.7 times with higher BMI levels and reaches 32.7 times if you have severe obesity.

                          You might experience these common joint-related conditions:

                          • Osteoarthritis in weight-bearing joints
                          • Increased risk of joint space narrowing
                          • Higher chances of component loosening in joint replacements
                          • Greater possibility of hardware failure

                          Spine-related issues and complications

                          Obesity creates unique challenges for your spine’s health. Studies show that it contributes to disk degeneration and raises your risk of developing operative spine pathology. The research has found:

                          • A 60% higher chance of cervical spine degeneration
                          • 212% increased risk of thoracic spine problems
                          • 156% greater likelihood of lumbar spine issues

                          Soft tissue disorders and injuries

                          Extra weight affects your body’s soft tissues through increased stress and inflammatory responses. Studies show you have a higher risk of developing various soft tissue conditions. These include:

                          • Rotator cuff tendonitis and shoulder impingement
                          • Plantar fasciitis and Achilles tendonitis
                          • Posterior tibial tendon dysfunction
                          • Carpal tunnel syndrome

                          You also face a higher risk of skin and soft tissue infections. Research shows you’re 1.76 times more likely to develop surgical site infections if you have obesity. Weight management plays a vital role in preventing these complications and protecting your orthopedic health.

                          Surgical Considerations and Risks

                          Extra weight creates unique challenges in orthopedic surgery preparation. A clear picture of risks and challenges at each stage of your surgical trip helps you make better decisions about your treatment.

                          Pre-operative challenges in obese patients

                          Your medical team must assess several critical factors before surgery. Studies show that patients with a body mass index (BMI) above 40 face higher risks of serious complications during and after surgery. Your pre-operative assessment looks at:

                          • Cardiovascular health evaluation
                          • Respiratory function testing
                          • Sleep apnea screening
                          • Diabetes management
                          • Nutritional status assessment

                          Sleep apnea affects between 40% and 90% of obese individuals, so your surgical team needs extra precautions with anesthesia management.

                          Complications during orthopedic surgery

                          Extra body weight makes the technical aspects of surgery more challenging. Research shows obesity leads to longer operative times because of:

                          • Complex surgical exposure
                          • Increased anesthesia requirements
                          • Technical difficulties in accessing surgical sites
                          • Extended fluoroscopy time requirements

                          Modern surgical techniques have improved, but obesity still increases surgical site infection risk by 1.76 times. Your surgical team will use specific protocols to minimize these risks.

                          Post-operative recovery challenges

                          Recovery after surgery needs special attention. Studies show obese patients often face:

                          • Longer hospital stays than non-obese patients
                          • Higher chances of needing rehabilitation center care
                          • Increased risk of wound healing complications

                          Higher BMI levels increase post-operative complication risks. To cite an instance, research shows morbidly obese patients have higher risks of readmission, reoperation, and superficial infection. These statistics should motivate you to work with your healthcare team to optimize your pre-operative condition.

                          Your surgical team might suggest specific measures to boost your recovery:

                          • Early mobilization protocols
                          • Specialized wound care management
                          • Customized pain management strategies
                          • Regular monitoring of vital signs

                          Your healthcare providers will assess if benefits outweigh risks in your case before surgery. They might suggest alternative treatments or weight management strategies to improve your surgical outcomes.

                          Modern Treatment Approaches for Obese Patients

                          Modern medicine provides many ways to boost your orthopedic health while managing excess weight. State-of-the-art surgical methods and detailed rehabilitation programs can help you get better results.

                          Latest surgical techniques and innovations

                          Surgical methods have changed to meet the specific needs of patients with extra weight. Many institutions now support specialized programs for patients with higher BMI that focus on optimization rather than exclusion. Your surgical team may use:

                          • Advanced imaging techniques for precise implant positioning
                          • Specialized instruments designed for deeper tissue access
                          • Custom surgical protocols to reduce infection risk

                          Your success largely depends on preparation before surgery. Studies show that losing just 5% of your body weight can create meaningful improvements in your metabolic profile.

                          Non-surgical treatment options

                          Outpatient rehabilitation programs are a great way to get help with obesity-related orthopedic conditions. Research shows these programs can boost your muscle strength and self-confidence effectively. Your treatment plan might include:

                          1. Medical weight management
                          2. Nutritional counseling
                          3. Metabolic optimization
                          4. Lifestyle modifications
                          5. Well-laid-out exercise programs
                          6. Dietary adjustments
                          7. Behavioral support

                          Research indicates that detailed outpatient programs lasting 3-18 months deliver the best results to improve functional performance. These programs combine aerobic and strengthening exercises (2-3 days per week) with caloric restriction.

                          Rehabilitation strategies for better outcomes

                          Your rehabilitation experience needs a well-planned approach. The most effective programs combine multiple elements to address both weight management and joint health. Research supports that successful rehabilitation should include:

                          • Aerobic exercises
                          • Low-impact activities
                          • Aquatic exercises
                          • Stationary cycling
                          • Resistance training
                          • Muscle strengthening
                          • Joint stability exercises
                          • Functional movement patterns
                          • Flexibility work
                          • Joint mobility exercises
                          • Stretching routines
                          • Range of motion activities

                          You might notice improvements in your daily activities shortly after starting your program. Studies show that programs with both aerobic and resistance exercises, plus proper nutrition, can substantially improve your physical function.

                          Your healthcare team will create a tailored plan for you. This detailed approach helps build lifestyle patterns that can improve and maintain your physical function throughout your life. You’ll start with strengthening exercises that don’t worsen your joint pain, such as upper body workouts that avoid stress on problematic knee or hip joints.

                          Many patients have found success through these modern treatment methods. Your experience toward better orthopedic health might include several of these strategies, specifically tailored to your needs and goals. Consistent effort and following your prescribed treatment plan often lead to successful outcomes.

                          Conclusion

                          The link between obesity and orthopedic health helps you make smart choices about your well-being. Your joints face less pressure with each pound you lose. Good weight management also cuts down your risk of serious orthopedic conditions.

                          Weight management and orthopedic health work hand in hand. Your joints, spine, and muscles get better even with modest weight loss. When you drop 10% of your body weight, your knee pain can go down by 50%. This also substantially reduces your chances of needing joint replacement surgery.

                          The path to better health combines proper medical guidance, regular exercise, and lifestyle changes. Your orthopedic health trip may have its ups and downs, but modern treatments offer many paths to improvement. Small, steady steps toward a healthy weight create lasting benefits for your body’s musculoskeletal system.

                          Better orthopedic health takes dedication and patience. Talk to your healthcare provider about weight management strategies today. Focus on achievable goals that protect your joints and boost your quality of life.

                          FAQs

                          Q1. How does obesity impact joint health?

                          A1. Obesity significantly increases pressure on weight-bearing joints, particularly the knees. Each extra kilogram of body weight can add four to six kgs of pressure on knee joints, leading to a higher risk of osteoarthritis and the need for joint replacement surgeries.

                          Q2. Can weight loss improve orthopedic health?

                          A2. Yes, weight loss can significantly improve orthopedic health. Even a modest 10% reduction in body weight can reduce knee pain by 50% and lower the risk of needing joint replacement surgery. Weight loss also helps decrease inflammation and improves overall joint function.

                          Q3. What are the common orthopedic conditions associated with obesity?

                          A3. Common orthopedic conditions in obese individuals include osteoarthritis in weight-bearing joints, increased risk of spine-related issues (such as disk degeneration), and soft tissue disorders like rotator cuff tendonitis and plantar fasciitis.

                          Q4. Are there increased risks for obese patients undergoing orthopedic surgery?

                          A4. Yes, obese patients face higher risks during orthopedic surgery. These include longer operative times, increased anesthesia requirements, higher chances of surgical site infections, and more challenging post-operative recovery. Patients with a BMI above 40 are more likely to experience serious complications.

                          Q5. What modern treatment approaches are available for obese patients with orthopedic issues?

                          A5. Modern treatment approaches for obese patients with orthopedic issues include advanced surgical techniques, specialised instruments for deeper tissue access, comprehensive outpatient rehabilitation programs, medical weight management, and personalised exercise regimens combining aerobic and resistance training with proper nutrition guidance.

                          January 18, 2025 / by Manu