We are at a current stage where sitting is the new smoking. There's two main types of back pain. One is acute back pain. One is chronic back pain.
If you're sitting for 8, 10, 12, 14, 16 hours a day and not doing anything for it, you are bound to come to me with that back pain. Muscle is the actual currency that you need in the bank balance of life. The moment you cross 30, your degeneration is going to start. The only way to stop that is...
Manan Bora is an orthopedic surgeon, content creator, physician and a sports doctor with 7 years of experience in the field. Where he educates people about body composition, muscle mass and how to keep your bones strong. This is our entire vertebral column. So we have the cervical vertebrae, which basically support your neck. You then have your mid-back, which is your thoracic vertebrae.
And then you have the lumbar vertebrae, which is mainly your lower back. We generally end up discussing neck. and lower back?
Because on today's What The Health podcast, Dr. Manandeep dives into correct body posture and the reasons behind shoulder, neck or chronic back pain issues and will also debunk myths about ergonomic chairs, beds and body posture belts. Peet sidi karo, aise mat betho. That doesn't hold true in 2024. Now you may ask why?
Because So just doing 10,000 steps is not enough? Walking isn't wrong, walking isn't bad. But is walking going to help you in anti-aging? Is walking going to help you in preserving your muscle mass? Probably not.
However, doing 10,000 steps a day along with is a game changer for your fitness journey. Hi! Welcome to Watchahead. Thank you so much.
Thank you so much for having me. Pleasure. Thank you. I'm so excited for this chat because I think wherever I go, whoever I speak to, every person I know around either has a back pain, neck pain or a shoulder pain. And people who are, let's say, a little older, probably knee pain.
So when I, I don't know what's happening. And I'm really looking forward to having an interesting chat with you to understand what is it that we are doing wrong and where are we going wrong? No, absolutely. Especially with... uh covid and the pandemic and the lockdown coming in uh our business has exponentially gone up because uh the kind of jobs that are there in today's day and age the kind of lifestyle that people have incorporated uh we're getting patients in their 20s 30s 40s compared to usually the degenerative orthopedic conditions that we used to see people in their 50s 60s and 70s uh but i'm really looking forward to this chat because If someone listens through this entire podcast, I'm going to be giving you information, tips and basically life hacks which will ensure you don't need to see an orthopedic specialist in your 20s, 30s and 40s.
So, to all the orthos watching this, I'm sorry because this may probably ruin our work and business. But if there is anyone who believes in the preventive side of health, it is me. And I really feel this information needs to be put out. So that people can take steps today to control their tomorrow rather than getting the issues and then coming to us. Absolutely.
I think let's start with this. Between 25 and 30 years, when a young person or girl comes to you and says that her neck is paining or her back is paining, what is the procedure you follow? What is your protocol to really help that guy and understand what is happening in his body?
So, see. Back pain is an extremely complex topic that technically one can speak on for 12 hours also. So it's not that easy that someone has come to me and is saying that he has back pain. What will we do?
There's a fixed protocol to follow 1, 2, 3. It's not that simple. To broadly give you an idea, there's two main types of back pain. One is acute back pain, one is chronic back pain.
Acute means suddenly something has happened due to which you have come to us with back pain. For example, you were in the gym. You were trying deadlift, suddenly you got a catch, you had a back pain injury.
Or while turning in bed while waking up in the morning, suddenly you got a catch, you had a back pain. Or you had a road accident, you had a fall. These are things which are acutely going to cause back pain, which are dealt with in a very separate way. Compared to chronic back pain, which is lasting for multiple weeks, multiple months.
And you then come saying... My back is still paining. I thought in a few days, he will get relief.
I tried hot water bag, I tried ice. Most people say I tried massage. Today, it's so easy to call a masseused home who gives you a deep tissue massage. It has become so famous.
So, there are a lot of things that people try out and then they come to us saying, I have back pain since a long time, what should I do now? So, they are dealt with in a completely different manner. As specialists, it's our duty to not just treat the symptom, but also identify the cause. Because for your back pain, it's very easy to give me medicine in 2 seconds.
That is happening left, right and center. People are giving pain medication. People are giving muscle relaxants.
People are taking it for 2-3 days, they are feeling better. They are living in a bubble thinking their problem is solved. And they are going about their life without addressing the root cause of the problem. So I truly believe that until you get to the bottom of the cause and treat the cause, you're just dealing the inevitable, which is a repeated episode of that back pain. So yes, it's a little dodgy that he's a doctor and he's saying you shouldn't take medicines.
When I know that in my community, people are prescribing medicines left, right and center. So call me unconventional, call me whatever you want. I am anti-pill popping unless it is absolutely indicated.
So. One message if anyone can take at least from the start of this podcast is stop popping medicines unless it is absolutely necessary. This is not a solution, it is a shortcut where you're fooling your body into thinking you are okay.
So coming back to your primary question, my entire focus, when a patient comes to me, completely depends on how I assess the patient, how I examine the patient. In some cases, we find certain examination findings, in which case it may warrant an X-ray or MRI scan to assess what the actual issue is. So an X-ray will usually tell us about the bony structure. It will usually tell us about the curvature of the spine.
But an MRI is the investigation of choice to tell me about the soft tissues. It tells me about the ligaments. It tells me about the tendons.
It tells me about the intervertebral disc. We have heard so much about slip disc. It tells me about the status of the disc. The disc also has certain material in it.
It tells me about the hydration of that material. This gives me an entire idea of what the entire back pathology is. And accordingly, we decide a treatment plan to actually treat the cause. That is the right way to go about it. Stop popping pills.
So, Dr. Manan, if we talk about only chronic in this, right? Because I am assuming that Unfortunately, more people are falling into the chronic bucket. And in chronic, when a young guy comes to you at 25-30, what are the most common causes? So for the 25-30 age group, all of it I will put towards lifestyle related issues. And also their work.
You won't believe we've started asking an occupational history for an orthopaedic patient. So to give you a little insight, when we are taught in medical school, There is something called history taking, where we ask questions to patients about their personal life to get an idea of what could have gone wrong. Usually, in orthopedics, history is not that elaborate because usually you come with, I have knee pain, I have shoulder pain, okay, how did it happen? You fell, you didn't fall, which sport did you play, knee twisting happened, dislocation happened to the shoulder, what happened?
And then you move on to examining the patient. That is usually the steps. So, usually, an orthopedic doctor is not used to asking 10 questions before getting to the point which is let me come on the examination bed and examine your issue. But because of COVID, the pandemic, the lockdown and all the jobs that have come from either work from home or desk related jobs just increasing.
We have started asking everyone, what is your occupation? What is your job? Nine times out of 10, the answer is IT professional.
To which my next question is, okay, how many hours per day do you spend on the desk? to which their answer is take a guess 18 12 to 18 yeah so it's around 14 to 15 hours because clearly companies are making these guys work their butts off and they don't have an option it's crazy because that's the job they've got now how do you expect your body to adapt to 12 to 16 hours a day on the desk okay and when you go back to our ancestors who never had these jobs They didn't spend this much time. Yeah.
Recently, I saw a very interesting video of a clip in 1930 people walking out of New York station. It's actually a clip that's gone viral online. It's a 30 second clip of at least 200 people going to and fro.
Not a single person's waist must be more than 34 inches. You have to see this video. Please YouTube this video and watch it, whoever hasn't.
And it just got me thinking that people in 1930, if 200 people walk out of a station and not a single one's waist is above 34, there were no diets at that point. There were no gyms at that point. There was no fancy information on different types of nutrition.
Meal substitutes, supplements, anything. And yet, I didn't see a single person who's obese in that video. And that just got me thinking that in the last 90 years, things have changed so much with the start of the entire food industry, packaged food industry, different types of jobs. It takes you 5 minutes today to order something that comes to your doorstep. You don't need to go to it.
There was a time people used to walk to railway stations to take a train or to a bus station to take a bus. Today you have RICs and various platforms that get a cab to your doorstep. And you have jobs which really force you to instead of physically work for your day-to-day earning, sit on a computer screen to give you your wage.
So can you imagine it stems from there that your lifestyle has changed to a point where of course you can't even think about it. Of course, you need to adapt and you need to do more than that. But if you're sitting for 8, 10, 12, 14, 16 hours a day and not doing anything for it either during that time, and we'll discuss that later, and during the other time in terms of exercise, you are bound to come to me with that back pain.
So I put it just to that. I think it's perfect time for me to share my story now. Sure.
I was working as a software engineer and hence I answered the IT profession answer so well, right? And then... My neck started to pain and it started to pain really bad like there came a position where I couldn't even hold my bag and I used to go to this physiotherapist. She asked me one very interesting question. She said, did you go to the gym?
Do you go to the gym? And then she smiled at me and she said, you know what Saloni, stop coming from tomorrow. And she said, start working out because till the time you will not run or do something, you just don't have muscles.
And then she put me on a BMI. machine and she said you know what how much fat you have to lose after looking at my weight i said how much she said you have to lose 10 kgs of fat and gain 10 kgs of muscles because your body has no muscles so how important manan is muscle you know i'm so glad you brought this up and i'm very impressed that you came across a professional who gave you this information because you'll be surprised as to the number of orthopedic surgeons physiotherapists and others treating musculoskeletal conditions who still aren't aware of all of this information and don't practice this because of alternate modalities available. To answer about muscle, I truly believe that muscle is the actual currency that you need in the bank balance of life. So you know, tomorrow, if someone asks me what my assets are, I'm going to answer by saying I have x, y, z, and currently 82% muscle mass.
That's the answer I give. Wow. So you Since we've come to the word muscle mass, let me explain how I know what this muscle mass is. Now you brought up BMI, which is frankly now an outdated method to calculate what your current physical health or fitness level is. Because what BMI does is it just takes your weight, it takes your height and it does a simple math formula to give you an answer whether you are in the normal BMI range or not.
So let's understand what body composition is, okay? Body composition is basically the amount of muscle, fat, bones and organ weight that is present in your body in percentage and kg form. So let's say you are 70 kgs, we need to assess how much of it is muscle and how much of it is fat. The only way for me to accurately do this is to make someone go through a DEXA scan.
A DEXA scan is a very simple 10 minute scan which is done at most radiologist centers. It has very low radiation and I would strongly recommend someone does it at least once in two years. And if you are really serious about your fitness and health journey, even once a year is okay.
The amount of radiation is very negligible. And it is the only accurate way to find out how much muscle you have, how much fat you have. Yes, you get a lot of these machines and different companies come out with these expensive machines that many commercial gyms buy and keep so that their members can use. They will have about 70 to 75% accuracy, but it's not ideal. if you want to do it once a year, then scan DEXA.
Now, the DEXA scan will tell me how much muscle you have and how much fat you have. Now, based on your otherwise height, your genetic status and all, we can determine what your weight should be. But there is a chance that someone's weight is actually in the normal category because they've probably been lean all their life.
Their parents have been lean all their life. And they are still extremely unhealthy because the amount of fat deposition in their body is high. You'll actually see people and this is a very common thing in the Indian setting, right?
Because generally the older Indian population sees the size of a person and says, Yaar, tu toh kitni patli hai. Tu toh kitna patla hai. Like, you know, you go for a wedding and people are wearing things and someone is like, Arey yaar, bada maintain kiya hai aapne aapne aapko.
Lekin maintain kiya hai may not mean the person is healthy or fit. So what you see with the naked eye is very different. You can be extremely thin, extremely lean and yet extremely unhealthy and unfit because you cannot see from outside what is the muscle distribution and fat distribution inside that person's body, which only a DEXA scan will tell you. Now, when you do a DEXA scan for men, generally to have above 75% muscle mass is considered healthy, which means You should not have more than 22-24% fat. Approximately less than that you should have.
Of course, if you want to be really fit, you need to have 16-17-18%. If you want to be an athlete, you should have 11-12-13% fat. And if you want to be a bodybuilder going for competitions where they sometimes use unhealthy means to get to those levels of body fat, then they aim for 7-8-9-10%, which is not something I would recommend or advise.
Now coming to women. Women, obviously because of their structure, they can afford to have a little more body fat percentage than men. But even they should restrict it below 30% ideally. So somewhere between 24 to 28% would be really good. So this means, by doing simple math, if you're a man, you need to have 75% muscle mass to be considered healthy.
If you're a woman, you need to have at least 70%. muscle mass to be considered healthy. Now, why is muscle important?
To come back to your original question, it's because as you age, we start losing muscle mass. It's just the way it is. Till you're 30, you are in the peak of your health in an orthopedic point of view.
The moment you cross 30, your degeneration is going to start. For women, it is 30. For men, it is 40. Again, Sorry, unfortunately, women have to bear the brunt here also. And in my entire orthopedic practice, it is women who are getting more conditions everywhere. It is just an unfair thing, but it is what it is.
So, peak bone density and muscle mass means at the age of 30, your bone strength will be at its peak, at its maximum. Your muscle mass will be at its peak and maximum from a natural point of view. from then the graph will only come down.
However, it is in your hands to ensure the rate at which that graph comes down is much slower than what it was intended to be by normal levels of degeneration and science for which building muscle is the only hack you need to avoid any muscular or bone and joint related chronic problem for which you will come and see me it is literally that simple and we'll get into how to build that muscle mass as we go on let's talk but people need to understand the only way you can do this is by lifting weights so when i ask people and when i ask people what do you think they say walking walking To which my response is, and I don't want people to think I'm anti-walking. My response to that is, walking is a function. Walking is not technically exercise.
Because tomorrow I will ask you, You exercise, you will say, My jaw muscles are moving. That does not work. You are speaking because it is something you need to do to go about your life on a day-to-day basis.
You are walking. because it is something you need to do to go about your life on a day-to-day basis. So just doing 10,000 steps is not enough?
Just doing 10,000 steps is not enough? is a statement that is true. However, doing 10,000 steps a day along with some form of actual strength training is a game changer for your fitness journey.
That is how I would put it. There is no way I sleep without hitting 10,000 steps per day. If you today remove my phone on my application which gives you data of my last six months, apart from a couple of days when I'm literally sick, there is no way I have missed this. I have actually purchased a walking pad, which I use for all my Google Meets.
So my entire team and everyone I work with knows that I take Google Meets while walking. I don't take Google Meets on a chair, on a desk, on a bed. So I have about two to three Google Meets a day for the startup that I run for my social media work.
I finish four and a half, five thousand steps during those Google Meets. I finish another four thousand during my strength training session. Because while everyone in the gym is on their phones between their sets or has gone to a bench and sat down with a bottle of water, I finish 100 steps between each set of my strength training. Very basic things.
I don't need to go on a 30-minute walk per day to hit 10,000 steps. So to coming back to the original point, walking isn't wrong, walking isn't bad. And I need everyone to walk because walking is really important to help boost your fitness journey. But is walking going to help you in anti-aging? Is walking going to help you in preserving your muscle mass?
Is walking going to actually help you in improving your bone density after you've hit that peak? Probably not. Which comes to the point that what is walking for?
Walking is for your heart. There is a reason cardio is called cardio. So when people say, do you work out? And they answer that, yes, I work out. My question is, define your workout.
Because walking is a kind of workout. Cardio is a kind of workout. Yoga is a kind of workout.
Zumba, Pilates, all of them are kinds of workouts. And I'm not against any particular kind of workout. But I need to come out there and tell people that there is no workout like strength training.
There is no workout. And I'm sorry people saying using your body weight is okay. And I know I may upset a lot of people who have built their services and businesses on how you can do home workouts with body weight.
But I'm sorry beyond a point, it is not okay. Because there is only so much you can use your body weight and do compared to using external weight. And fine, not everyone can use their body weight and do calisthenics and headstands and everything else which uses their entire body weight. And I think it is such a time consuming. Even with yoga, right?
Muscle building happens. But you have to reach such an advanced level to be able to really, you know, do that level of yoga that you get muscle building, right? For a beginner, I think you are absolutely...
makes sense to start doing strength training. And I have been quite open about this on social media and pissed off a lot of yogis who say, you think we don't help in muscle gain? I said, I'm not saying that.
I'm just saying that when someone goes to a gym or has significant weights at home, the external resistance that that weight provides just creates more muscle hypertrophy than you can. And I am not telling people not to do yoga. I'm not telling people to do not to do different kinds of workouts because today we've only discussed strength. There are so many more aspects to fitness like stability, mobility, flexibility, balance, proprioception.
These are all separate things that you need to work on. And I'm sure yoga helps you in that. I'm sure there are other kinds of workouts which also help you in that.
But if your primary goal is to build muscle, and if it is not after this podcast, I don't know what more I can do. You need to lift weights. It is as simple as that.
And it is only by lifting weights in your 20s, 30s, 40s and you don't have to end up stopping will your body thank you in your 50s, 60s and 70s. More so with women because post-menopause their bone density drops even more and they suffer from what is called osteoporosis. For those who don't know osteoporosis is weakness of your bones. Your bones become more fragile and are more prone to fractures.
The only way to stop that is not By coming to us at 65 and being forced to take medication to ensure you don't get fractures, it is to wake up when you are in your 20s. Why 20s? Teenagers. Wake up in your teens. Hit the gym.
Start lifting weights. Think long term. Everyone's watching finance content everywhere and learning the power of compounding. The same principle applies to body.
You're not going to see a difference. You went to the gym today, you're not going to see a difference tomorrow. Obviously, you're not going to see a difference.
You're not going to see a difference in 2 days, 3 days, 4 days, 5 days. Give it 3 months, look at yourself in the mirror. Of course, nutrition supporting that is a completely separate topic. You can't eat whatever you want and just say, I've worked out. See yourself in three months, six months.
Like start your SIPs on your applications and your mutual fund portfolio at the same time and start your gym membership at the same time. Just the way you'll see that grow, you'll see this grow. Yeah, in fact, Dr. Manan, I would like to add that I don't even think that going to gym or weight training or any of these workouts should be linked to weight loss or how you look.
I think one should just sort of... Because that's the trap that I fell in. I didn't feel the need... In my younger days too, you know, really work out because I was not overweight.
And when I started, I saw these fatter women around me who were more flexible than me, who could, you know, pull weights, do deadlifts way better than me. And I realized they are so much more fitter than the skinny me. You know, that's a very interesting point you brought up. And people think health and fitness are the same thing. So let me explain this.
Health is the absence of any physical... mental or emotional disease. Fitness is the ability of the body to do a certain physical task up to a certain particular extent.
You can be absolutely healthy and completely unfit. You can be absolutely unhealthy and yet be fit. They are not the same. They are absolutely not the same. And when you brought up that I want to go to the gym.
to look good? Or why should I lose weight? Just to look better? That's a very short term mindset and a short term goal to have. See, I don't mind people using that as a motivation to do it.
Keep the motivation you want. Dude, I'm getting married in 6 months, I want to be fitter. I'm not getting a match on the dating site. To improve those chances, I want to look better, so let me go to the gym.
Keep the motivation you want. that's totally okay. But that can't be your goal. Looking better aesthetically cannot be your goal. Looking better has to be a byproduct of a journey you have undertaken towards better health.
You need to understand and I'm again saying this being an orthopedic surgeon who is going to succeed professionally only when people don't follow this advice. You're getting the point here, right? I am my entire life's success and the The quality of school my child goes to depends on people not following this advice.
Okay, let's be honest about it. And I am still saying that if you listen to what I'm saying here, you don't need to come to me. Exercise is medicine. 100%. You need to understand that exercise is medicine.
There are patients who come to me now and I tell them my prescription involves taking help of an exercise therapist because I don't consider myself to be a specialist in that. Kudos to whoever's a specialist in that. And I work with exercise therapists in my team.
I don't like to use the word physiotherapist unnecessarily because some people take the word physiotherapy with the idea that he's going to put me on those electrical modalities, which is something I'm not a very big fan of. So yes, sometimes in some cases where it's required, it's okay. But I like to use the word exercise therapist who are predominantly physiotherapists or sports scientists or after a particular point of help with an exercise therapist, a strength and conditioning specialist who puts my patients on an exercise program that actually addresses the root cause of the problem and solves it. Now moving on to that and you mentioned in your personal journey as well that your physiotherapist told you now go to the gym. So this has to be a natural trajectory of treatment.
where we assess your problem, we rule out any causes that require any intervention from our side, and we put you on an exercise program and get you into the habit forming of going to the gym. So my patients get an exercise prescription and I have had some of them talk about me negatively because they have thought, the doctor didn't give any medicine, if he doesn't give any medicine, how will we be fine? We went to other people, they gave 4 medicines and 2 supplements, so we thought we were consulted. And I'm trying to educate them and I've changed the way now that I counsel patients after hearing that, that I have to have this talk with them. I speak to each patient for 30 minutes now because they need to understand that what I am saying is not because I am foolish into not giving you more and more medications just to make you happier for the next three hours.
But I'm trying to sort out the next three years and the next 30 years of your life by changing the way you approach your life. You need to understand that exercise is medicine and it has to go to a... point where What do you do during your day?
Of course you go to sleep, of course you eat your food, of course you bathe, of course you brush your teeth, of course you exercise. Absolutely. It has to become a part of your routine. Most people will not go a day without bathing. Most people.
Especially in humid conditions that we live in. It's unlikely that those who have access to water and baths will go without bathing. How can you go about your day without exercising? Perfect.
It's that simple. Sounds perfect. So, Dr. Manan... We've understood exercise, we've understood importance of muscle and I think this was a fabulous start to really understand back, neck and shoulder. What else can a young person do other than exercising in terms of, I remember, you know, I mean my grandmother used to say this when we were kids that thik se betho, back straight rakho, right?
Importance of posture, especially because with the way we are on laptop and I think What a lot of us do is not even sit on the desk. Sometimes we are on the bed. Sometimes we are, you know, in absolutely wrong posture leading to such pain.
So can there be something around posture that we can learn from you? So I'm going to go out on a limb here and say something that's going to shock everyone, including you. And I'm pretty sure you're going to take away something yourself as well. In my opinion, and I only form opinions after significant... published literature and research trials are done which have been done over the last few years so this is not some alternate opinion just to sound unconventional a good posture is overrated i don't care about the noise around posture in the industry and i feel most of it has been created to put some form of fear into someone's mind that here are ways i can help you correct it i'm not saying that everything out there to improve a particular posture is bad but I'm saying it is in most cases unnecessary.
What I mean to say is that the latest research has proven that you can sit however you want, you can lie down in any way you want, you can sleep in any position you want and you can quote me on this and share this video with anyone in the future who tells you Peet sidi karo, aise mat baitho. That is outdated. That doesn't hold true in 2024. Now you may ask why?
Because obviously, sitting, sleeping and being in different positions changes the alignment of your spine and can cause issues for which you need to see an orthopedic doctor. To which the answer again is, the trick lies in not being in that position for long. So if anyone tells you, This is a correct posture. This is an incorrect posture.
Tell them this concept doesn't exist anymore. I will sit how I want. I will sleep how I want. I will lie down how I want.
I will do what I want, but I will not do it for long. And what is long? Long means you should ideally not be even in a single position for one hour, to which you will say, but Dr. Manan, how can I work in an 8, 10, 12 hour desk job? if you are telling me not to be in it for one hour. To which my response is start doing this today.
All you need to do is avoid your muscles becoming stiff by being in that one particular position for an hour or more. So all I'm asking you to do is work on your desk, sit for how many ever hours on the desk, even if it's 14 hours to that IT professional we discussed. Get up once every hour. Take a walk.
That's all I'm asking you to do it. Put a reminder on your phone, at the end of every 58 minutes, it should ring. You have to spend the next 2 minutes of that hour, going for a short 2 minute walk. Now what happens when you take a walk?
You end up extending your legs. Because obviously, you have been sitting in this position. So you end up extending your legs.
Your spine is in this particular position or this particular position. You have to get up, you end up extending your spine. Your neck is probably in this position. You end up extending and moving your neck. What I will also tell you to do is, since you're anyway going for a walk, why don't you just extend your fingers?
Because you have constantly been doing this. So just move your wrist joints, which also we get a lot of patients with wrist-related problems because they have constantly been doing this. Can you imagine the load that are there on the tendons of the wrist?
We have not even reached a stage of life where finger arthritis is going to become so common. We are still on knee and shoulder and hip arthritis because the entire cell phone industry has just technically been 15 years old. I cannot wait to become a 60 year old orthopedic surgeon and see, I mean I cannot wait as in I'm not excited about it, but I cannot wait to see what happens to people's fingers.
Our parents and grandparents haven't experienced this because they haven't spent 30 years of their life doing this. We have already spent 10 to 15 years of our life doing this and we are going to spend the next 30 to 40 years of our life also doing this. Can you imagine what's going to happen to this?
Our joints of our hands and fingers. So when you take that two-minute break, and I get my patients to do that 10 times a day, is just get up, take a one-two-minute walk, move your wrists, move your neck in all directions, maybe even do a quick shoulder rotation. This is going to ensure that your trapezius muscle, your shoulder muscles, your upper back and your lower back muscles as well as your legs they don't go into a stage of stiffness that over time causes chronic back pain and you walking into my clinic and getting treated and my child going to private school okay so this entire podcast is about making me poor i've understood that by now but as long as it brings value to people that's really important so that is my concept of posture where it stands today i don't care how you want to sit stand sleep once every hour get up from that position Even if it means just getting up, going to the washroom, coming back. And a bonus tip that I tell people is, when you get up for two minutes every hour, drink a glass of water.
I was just thinking that. You just end up hitting your water goals. People say, how do you drink 3-4 litres of water? You drink like this.
Just make it a routine. It actually becomes something you get used to. It's so simple, right?
It's so simple. And then you don't need to say walking is an exercise because you don't need to go on a 30-minute walk because two minutes ten times will also get you 2000 steps probably. So you don't even need to go on a separate walk each time. So can you imagine how many things we are achieving by a simple habit change that we can bring into our life and we are removing the entire concept of posture which I feel in today's day and age is extremely overrated. Are there any other hacks that we've missed discussing?
So when it comes to movement in general, there's one thing that I would like to talk about. Now this is called, because you mentioned one thing, you said that you know is 10 000 steps important okay uh and a lot of people feel that 10 000 steps is a lot and to get 10 000 steps you need to go on a significant walk what i need to tell people is there is something called neat neat stands for non-exercise activity thermogenesis which talks in detail of course that's a separate in-depth topic but it talks about the number of calories and the amount of activity that you do in a non-exercise part of your life. So while people think that going for a walk is only enough, while people think, I have done 10,000 steps today, I don't need to do anything else.
Or on the other extreme, you have people saying, I have done a half-hour yoga session, I have done a one-hour crossfit session, or I have done a one-hour gym, I don't need to do anything else. Please understand that you have 24 hours in the day, assuming you sleep about 7. which is usually what I hope people are sleeping. Sleep is a completely separate different topic which I hope 6 to 8 hours everyone is getting. You still have 16 to 17 hours a day in which you are awake.
And if you think 30 minutes of yoga or 1 hour of gym or 30 minutes of walk is enough. I'm sorry but it's not because like we understood now compared to the 1930 New York railway station video and the people I saw there who were doing physical labor. for their day's wage or they had to physically go for transport or they had to physically manage their food or they had to personally cook and clean their homes your neat is very very low all of us absolutely compared to them because we have help to do everything else we have someone or the other looking after something else of course for those people who are doing those things this is their job but you are not burning enough calories in the non-exercise stage So you need to understand that when you make simple changes in your lifestyle, it's going to impact yourself on a much larger scale. Now when I say simple changes, if your railway station is six minutes walk away and a rickshaw minimum wage gets you there, try leaving early and walk. I know sometimes weather and all is not helpful.
If your workplace is 10 minutes away and you're used to a car and driver, why not get a cycle and just bike to it? If you are on the second or third or fourth floor which is still manageable, why not take the stairs instead of the elevator? If you can take Google Meets while walking or phone calls while walking, why not do that?
If you want to spend good time with your spouse or partner and you usually pick a coffee shop, why not go for a walk? Why not make smarter decisions that improve your non-exercise activity thermogenesis, which over time lead to a significant calorie burn and help your fitness journey, which in turn results in more muscle mass, which in turn is the currency you need in your bank, which in turn helps you anti-age, which in turn helps you not having issues of the muscles, bones, joints or even your heart since we've established this cardio. It's that simple but still so difficult to follow.
Yeah, absolutely. You know, when you say it, it just sounds so simple. But we see very few people.
Very few people and which is why my kid will still go to private school. Because people will still come to me with problems. So I don't mind saying this out in the open.
But I know we've dragged that joke throughout the podcast. But it's usually the simple things that aren't interesting enough to follow. People still want, you write me four medicines.
And I want to be fit, I want to be healthy. There's a lot of research going on abroad for these weight loss pills. That has become the new thing we'll be talking about. Everyone wants a shortcut in life. And I think this just applies to life in general, right?
When it comes to hard work, when it comes to success, when it comes to income, when it comes to relationships. You have to take the long path. You have to put in the hours to reap the benefits. And the same thing applies for health.
Superb. Dr. Manan, is there anything around the spine? anatomy because I see this model here that a normal layman should know which will help them sort of understand or sort of be healthy or have a healthy spine and avoid back issues. Okay so I'm glad you've got this model here it's going to take me back to my medical school and training days.
So obviously this looks extremely complicated and there's too many things going on here but of course keeping our audience in mind I'll keep it really layman like as much as possible. So to give you an idea, this is our entire vertebral column and it's usually divided into three or five segments based on whether you consider the sacrum and the coccyx. So we have the cervical vertebrae which basically support your neck.
You then have your mid back which is your thoracic vertebrae and then you have the lumbar vertebrae which is mainly your lower back. We then have a sacrum bone over here followed by the tailbone, which is the coccyx. So this is the entire spinal column, as we call it.
Now, the reason why, and in this podcast as well, we've discussed mainly the neck and the lower back is because the neck pain due to our excessive hours, which we discussed either desk job or because we've got cell phones now, we are constantly in a neck flexed movement and we're not really strengthening our neck muscles. We get a lot of neck issues. Now, the reason why we don't get a lot of mid-back issues and because this is just the model of the back and not an entire skeleton is of course because we have a rib cage. Now because we have a rib cage, we have actual bones in the front that provide a lot of structure and stability to our mid-back which is why it's very uncommon to come with a thoracic vertebrae related problem or the discs of the thoracic vertebrae. That is your mid-back.
That is why we generally end up discussing neck and lower back. Because these are the patients we see in the clinic. But why do we see that?
Because we have your rib cage over there. Now, why lower back? Now, if you see a skeleton or you know in your own body that our ribs end over here.
We've got our tummy over here. We don't have a bony structure supporting us over here in our abdominal area. And that is where the lower back is. Which means all you've got is your abdominal muscles. Which is why?
If you go to an exercise therapist or a gym trainer who's really got a lot of good knowledge about the anatomy, most initial back pains you are put on a core strengthening exercise program. Now have you ever thought why do I need a strong core when I have back pain? Why are we not focusing only on my back muscles? It's because the stronger your core muscles are, That sort of stability will be provided to your entire lower back as well because your core muscles are all you've got over there compared to the ribs you've got over here.
No one has ever said put you on a chest muscle strengthening program. That's not even a thing. Of course, chest workouts are a completely separate thing for your fitness journey, but it's not really a rehab protocol that is given because your ribs are providing enough structure and stability. So your lower back is unfortunately exposed with only your abdominal muscles and going back to our conversation about Fat mass and fat distribution, more so in the Indian population, most of us generally have larger tummies, that's where we get fat deposition quite a bit, more so in males than women.
Women have a lot more fat around the hips and buttocks as well. But in Indian male population, belly fat is where predominantly fat deposition takes place. And then you put their lifestyle, their work hours and everything, it's a recipe for disaster. So that is why we see the lower back pain being significantly more. Now coming back to the anatomy, what you see over here, This is basically the spinous process.
This is the bump on the spine that you'll actually feel in leaner individuals with lesser back fat. You can actually feel the spine. That is this spinous process.
Now similarly, there's a lot of other anatomy that can cause issues. We also have the facet joints which you see over here. These are facet joints, very important for certain movements of the spine.
So a lot of people get inflammation around these facet joints which again need different forms of treatment. You also have your intervertebral disc. So, all these are our vertebrae.
These are the vertebrae bodies. And between them, this gel-like layer you see, that is the intervertebral disc. It is supposed to maintain a certain amount of height. This is its height and thickness.
Because it contains fluid and gel that is required for various spinal movements and to absorb all the shocks and the mechanical movements that we go through. So when we hear slip disc. Correct. Yeah. So when that fluid gets dehydrated and gets dried up or it escapes the area it's supposed to be within, as you see in this model, if you see this red color protrusion, this is what we call a disc bulge or the disc has actually come out.
Or in layman's term, your disc has slipped. And why is this significant? Because everything that is yellow are our nerves. So when we have this disc bulging, there is a chance that it compresses what we call in medical language a traversing or an exiting nerve root. You can have symptoms in your lower back and all throughout your legs going up to your toes because all these nerves end up going and supplying the muscles in the lower half of your body, which is what sciatica is.
So you are compressing this nerve. Hence, we have patients coming to us with problems like. tingling sensation i have numbness now remember when you started you said you had radiating pain down your right arm it's the same thing happening at the cervical level you have cervical discs you have nerve roots over here and you are getting a little bit of inflammation of the nerve root or an irritation of the nerve root in the form of a compression that is causing these radiating symptoms so that is exactly what sciatica is but of course there are a lot more things that happen not every back pain is a sciatic back pain What we can't see in this model are all the interspinous ligaments that also exist.
We can't see in this model are all the superficial and deep back muscles. So you can have a lot of spasms, a lot of stiffness, a lot of strains of these ligaments that can also cause back pain, which is why I said right at the start that when someone walks into my clinic, it's my duty to do tests and maybe an investigation to find the cause. If I don't know the cause, how do I create a treatment plan for you?
What is the shortcut that I can do? Take a 4-day medicine. Is that solving your problem?
It's probably not. Understanding this anatomy and realizing what the problem is, giving a tailor-made program to someone is the right way of addressing the root cause of the problem. And that is something they'll thank you in the long term for.
Now, it's a separate thing whether if your intentions are not to give them the long-term thing so that they keep coming back to you every two months. That's not ideally how an ethical medical practitioner should function. Your job is to not only treat their current problem, but put them on a lifelong path of preventive medicine or preventive orthopedics where they get relief with your advice after understanding the problem, where they take the help of an exercise therapist to go on a structured rehab protocol and they move on to a strength and conditioning specialist or a fitness specialist to incorporate exercise and workout and weightlifting as part of their life and that's when you come... complete your job as an orthopedic surgeon at three months, six months when they're like, doc, I go to the gym every day. And this is how I am now.
And I'm like, you're never going to come back to me. I'm never going to send my kid to private school. Okay, last time I said this.
But no, so that is the understanding of the anatomy and how it would help. And then when you come down, sacrum predominantly doesn't usually cause issues. Yes, these are your hip bones and the sacrum.
attaches to the hip bone in what we call a sacroiliac joint. Sometimes we have this SI joint inflammation and pathologies which we treat separately. But what I want to discuss here is the tailbone. Because that is something that irritates a lot of people. So you have the tailbone right over here.
And that is the one that takes the maximum pressure and load when you sit. And the tailbone also has a lot of surrounding tissues and ligaments that get inflamed. Leading to a condition called coccygodinia. Which is pain of the tailbone. Which again has to be diagnosed.
And it is sometimes, it's not a serious problem. It's an irritating problem. Because it's difficult to treat.
Because a lot of its treatment requires modifications that may involve the way a person sits, which is something you can't really tell someone not to do, which is why it continuously gets inflamed. And we sometimes struggle treating this problem and we have to go on trying different treatment protocols, whether it's exercise therapy in some cases, an injection straight into the coccyx, sometimes long-term, you know, ice and heat therapy. some sort of medication that can help control it and in most cases we do recommend an air pillow you know so you sit on this ring which means you're sitting on something but that component has a donut shaped hole so you're not applying that pressure and you're allowing that inflammation to settle over time that is something what we try and we get good results but in some cases patients do end up requiring an injection to reduce the inflammation locally injection into the coccyx In some cases, we end up blocking the nerve that supplies the pain to that area so that your brain doesn't perceive the pain at all. That is what we call a ganglion impar block.
It's a procedure we do, which is done to just remove that sensation so you're just happier after that. However, nerves have a regenerating potential and after 6 months, 12 months, 18 months, it may come back. So again, the lifelong tip would be, fine.
If the pain is so much that you can't even exercise, can't even do anything, we have to intervene and help you. That's what we exist for. But the long-term theme is, start exercising, change your lifestyle, don't sit for long hours, and over time, it won't come back.
If you don't follow all of that, all these interventions after 6 months, 12 months, it starts coming back. So that's an overview of the spine and I hope we have a better understanding of it now. Dr. Manan, when it comes to low back, right, and tailbone pain, are there any hacks which are other than... of what we have discussed in this entire chat, right?
Is there anything specific that one can do for a healthier lower back? Healthier lower back in general is something I would say. For tailbone, there's nothing really much you can do. So frankly, I am 31 years old and I have never had any form of neck or back pain.
I don't want to jinx it. But anyway, I've never had any form of neck or back pain in my life. I've had multiple injuries and fractures because of my sports history. That's a different thing.
But I've not really had any other issue. And I just look at myself as a, you know, a sample in terms of what I have done in the past. Which frankly is the simple things.
When we go back to the same thing again and again, there really isn't any hack. If you're doing a nice four to five times a week gym protocol that focuses on different muscles in your posterior chain, right from... You know, a simple face pull exercise that is going to work my scapular muscles and my trapezius muscles to ensure I don't get neck or shoulder pain, to an entire lat pulldown that is going to work these muscles as well, to some rows in the gym that are going to work my mid-back, and to some basic deadlifts or back hyperextensions that are going to work my lower back, the chances of this happening is significantly lower.
Yes, if your abdominal fat is significantly higher, you're loading your lower back that much more so obviously it goes without saying you need to be in a healthy body range or your dexa scan should be normal and overall if you work on these things it's unlikely and the last thing of course if you're going to sit for long anyway we've established all these problems are there so the key to lower back pain relief or lower back pain prevention is still the same work your back and core muscles exercise is medicine superb so dr manan you this entire industry of ergonomic stuff right uh getting a really good mattress an expensive pillow which is in a certain shape uh or even chairs uh what is your viewpoint on this and who should people really invest in some of these things appropriately to avoid back and neck issues okay uh slightly controversial topic and i'm going to do my best to answer it um are they useless no you Are they absolutely necessary and you must invest in them if you can't afford them? No. What phone do I use?
I use a phone with great technology because it has certain features that I feel will help me. Does this mean a cheaper phone does not exist and I can't use one? No, of course I can.
Because I can afford one and I have used it and it suits me, it's a good idea. That's the explanation I can give. Do I use probably one of the best quality chairs that are there as my consultation chair? Yes, I do.
Do I sleep on an really... Expensive mattress compared to what India sleeps on? Yes, I do.
Do I feel everyone else out there should? Probably not. The point is that if you follow everything that I've spoken about today, you probably don't need them.
But if you can afford them, they will put you in a particular position that you should be in that does you no harm. Does this mean you can't sit on the chair that you're currently sitting on? Does this mean you can't sleep on the mattress that you're currently using? Does this mean you can't rest your head on the pillow that you're currently using?
There's nothing like that. Please go ahead and continue. Yes, if you are having significant neck or back pain that we have identified as specialists and ruled out every other cause, one of which could be poor mattress, poor pillow. We may ask you to change it.
How does one identify? How do I know a good mattress versus a bad mattress for back? So the rule is it should neither be too soft nor be too hard.
You should not be uncomfortable when you rest on it in terms of, ouch, this is hard. But you should not sink in it like the most ideal hotel bed, which is great for you for a couple of days because you want that relaxation but probably not ideal on a day-to-day basis so neither too soft neither too hard firm is a good way to go about it now when it comes to pillow it's slightly different because some people based on the curvature of their cervical spine based on which height they prefer and the softness they prefer i feel the pillow there is no golden standard so in case you've decided to invest in a pillow and it's not that expensive you Please go out and try four kinds and rest your head on it. See what suits you and pick that.
Because if it suits you, that is more important than ideal or not ideal or orthopedic pillow or someone has recommended pillow. There is nothing like that. No one has recommended any particular type of pillow.
So pillow is an extremely subjective choice. And it could be a reason you are having persistent neck pain. Because we do have a lot of people who come into us.
with a little lower back pain or neck pain. And when we ask a history, there's nothing else. And they're like, did you go stay somewhere for 10-15 days?
Or did you change your mattress? Did you change your pillow? The answer is yes.
So that's when you know it's definitely something that is causing an issue. So it's then worthy of change. If your life is going fine without neck pain or back pain, do you need to spend more money and get them? The answer is no.
But if you want to upgrade, it's not useless. It's definitely greater technology. I have 100% enjoyed sleeping deeper on the bed that I'm currently using than before. So for me to say that it's useless is absolutely wrong. Does it mean you need to break the bank to afford it?
Probably not. Similarly with chair, yes, you get great chairs which have different forms of curvature, which mimic the curvature of this spine over here, so that it doesn't put your spine in an uncomfortable position. But we have established already in this podcast that no position is uncomfortable if you move it enough. So yes, if you want to use the best chair possible, go ahead and use it. It's not going to be of any negative impact to you.
But do you need to use it if you are otherwise working out, if you are getting up for two minutes once an hour? Probably don't. Fair.
Let's move to shoes, right? And especially people who walk, run, how do we really get the right footwear? And I have seen this, especially with the slightly older people, that they start to face knee pain. if their shoe is not appropriate.
Is that true? Is shoe, you know, important? And how does one who's going through pain issues identify the right foot?
Got it. So if you're going through pain issues, I would still say it's probably difficult for you yourself to identify the shoe is the culprit. So once again, getting assessed and understanding why the pain is there or how we need to treat the pain is a completely separate thing.
Okay, so people with knee pain, is probably a completely separate thing because you already have the knee pain. So it's not like changing the shoe may magically take away the knee pain. We may still need to assess the knee pain and see what the cause is and treat it accordingly. But for people generally who are into walking and running, footwear technology has... really evolved leaps and bounds and you have all major players and brands today making specific walking shoes specific running shoes uh what i'd like to say is investing in a good pair of shoes is far more important than the pillows and chairs and beds that we discussed we do see a lot of people having a lot of issues due to improper footwear but it's not just the footwear it's the surface the footwear is on as well so while you feel that i may buy a particular pair of shoes it's also the interface between the footwear and the ground that you're working out on.
So it's about whether you're running on concrete, whether you're running on grass, whether you're running on beach, whether you're running on treadmill. It's a completely separate thing also rather than just oh I took footwear. Again you may say let's not go deep into the science.
Tell us what is the actionable advice. The actionable advice would be to definitely invest your money in a good pair of walking or running shoes based on what you do. And training shoes are completely different for gymming.
And stay true to those. Don't try to use a walking shoe for training or a training shoe for running. Because they have completely different structures.
The way the heel is cushioned, the way the midfoot technology is there, the way the toe box is aligned, the amount of cushioning that is there throughout, the way the arch is, this goes into the depth of every brand shoes and I love reading up about this. But to keep it simple, ensure... You take the exact category that you need and every brand today has a separate menu for running shoe, walking shoe, training shoe.
You even nowadays get cross-functional training shoes separate. That is something I would definitely recommend you can go into and then based on your budget decide what brands you want to take. But definitely something important because it can lead to ankle, foot and knee pains. Got it.
So Dr. Manan, I have received some questions that people have sent in. to ask you. So I'm going to go ahead and start asking. Sure. I want to work out but I have heard exercises like deadlift can cause a lot of back injuries.
Is that true? It is true but that's not a reason to not work out. Now there's two ways you can go about it. Personally, I have seen so many people with deadlift related injuries that I don't deadlift myself but I have an extremely strong lower back. So that's one way to go about it.
You can have an extremely strong lower back and go about your back workouts without deadlifting. Some may say that's a very conservative approach and we shouldn't tell people not to deadlift, to which you can use the second one which is take proper guidance, get a personal trainer, learn the exact form and technique. The issues will happen only if you don't follow the right technique.
Most people look at random videos online, try to go deadlift themselves, come to us with injuries. So these are your two options. Hello doctor, I have been sleeping on the floor since childhood as I find it more comfortable than bed.
Now I am 48 years old and I am having a little back pain problem. Should I sleep on the bed or can I continue as before? So again going back to our conversation, it shouldn't be neither too hard nor too soft. Of course, when we are younger as with different parts of our body, our body can take a lot of crap compared to when we grow older.
So if you didn't have back pain just by sleeping on the fourth... If you didn't have back pain just by sleeping on the floor throughout, doesn't mean you can't start at that point. You may need to consider getting a mattress or a gadda and sleep on that. Having said that, if you don't have pain and you're sleeping on the floor, you don't really need to change. If it's working for you, it's okay.
Hello, doctor. My age is 16. I'm currently preparing for NDA. I found out a few months ago that my feet are flat.
Do I need a surgery to solve this? So this is... There are a lot of surgeons who are recommending flat feet surgery. I would say strongly stay away from this.
Having flat feet isn't the end of the world. There are a lot of athletes who have flat feet and they are accomplishing a lot of things. So if it's not bothering you, if you can manage with exercise therapy for flat feet, if you can manage with...
Some orthotic or sole support or footwear that suits you because a lot of shoe brands also have footwear that supports flat feet. That is the right way to go about it. Stay away from surgery as much as possible.
Only if it's affecting your life to an extent by which your livelihood depends on it, can you consider it. I am 22 years old. I have knee pain during sports.
What should I do? The ideal thing would be to stop. Because there are chances that you are going through a new pathology that can become worse if you continue. So the immediate action would be stop, get assessed.
Let's reach a diagnosis, find out what the cause is and take it from there. Because overdoing it at this stage... may lead to more damage and you may have to go through treatments that you would not otherwise have needed had you come in sooner. I have a fundamental question and I'm interrupting. When should one use ice as a solution and hot water?
I always have this confusion that when to use ice pack and when hot water pack. So ice is always for an acute injury. So if you have sprained your ankle, If you have just woken up on the wrong side of the bed like they say and you have a neck catch or a lower back catch, it is most likely due to inflammation.
So when you have inflammation in a particular area, you apply that ice to take away that inflammation, take away that swelling. So what happens is vasoconstriction. Means the amount of blood going to that area will be reduced. and fluids will move back to other pouches, causing a decrease in inflammation. When you have a chronic problem, that I have pain in my knees since 6 months, I have pain in my waist since 6 weeks, apply a hot bag, because that causes vasodilatation, which is increased blood supply in that area, which promotes really good growth factors and cells going in that area, causing more healing.
So that's when you use heat. So for simple, acute... Accidents, emergencies, ice. For chronic problems, heat. Understood.
I'm 35 years old and I've developed low back pain after two deliveries. What is the solution for me now? Okay, so once again, and this is very common with tailbone pain during and after pregnancy also.
What happens is that due to the hormonal fluctuations, there is a lot of relaxation of the ligaments. and the structures around the lower back and tailbone to allow the body to be a little more flexible to help with delivery this is a natural process unfortunately because of this a lot of people get lower back and tailbone pain and we see a lot of women postpartum come to us with these issues we actually see a lot of pregnant women with tailbone pain as well and becomes a little difficult because obviously the exercises are limited due to third trimester pregnancy you We can't really inject a steroid to decrease the inflammation. So anyway, in postpartum, once again, it's about identifying and going through an exercise program and starting weightlifting and ensuring that this pain doesn't happen again. Again, the root cause is this.
Let's find out why it's happening. So get assessed and start moving. There is no reason to stop. I am anti-stopping people from movement when they are in pain.
Unless, of course, there's a significant finding on an MRI that means don't move like the knee pain condition we discussed. But otherwise, I promote movement and you should as well. I am an inspiring cricketer.
I want to know that some athletes have injuries that are so severe that their career ends. Why is that the case? Why do fit athletes with a good support team of doctors sometimes fail to recover? How do I avoid this? Okay.
See, athletes are very different. And I am a sports and exercise medicine specialist who treats athletes at different levels. Their demands from life are very different. For example, if they are having knee pain versus you are having knee pain as either a recreational athlete or someone who barely plays sport, I have to treat them very separately.
That guy goes in the MRI machine within two hours because I need to know the answer because he needs to play his next match as soon as possible. Which means his treatment protocol, his exercise protocol is running on your 2x of your YouTube video compared to 1x that most people are watching it on. So there are times when we have to cut some corners.
There are times when athletes need to be playing the next match at 60, 70, 80% fitness. Because I have so much pressure from the coach, sometimes from the parents, sometimes from the team management. You're seeing what's going on with franchisee sports and the amount of money that is invested. You need your star player back in the game. So they are not going through the ideal protocol that they need to, which is intervention, exercise therapies, strength and conditioning, fitness and return to play.
These are the stages of a comeback, which sometimes they don't get because they can't afford it. So you can't compare your journey to theirs because they may have to cut those corners and they may end up harming their body at times, getting re-injured at times, career-threatening injury at times. Whereas you, as a regular patient, get the liberty of going through that because whether you go back into the gym or your... badminton court or your football turf two weeks from now four weeks from now it's not altering the way your life progresses so they're completely different situations makes sense hey doctor my name is rohan i have had poor posture since childhood and i'm considering purchasing a posture correction belt does it truly correct body posture and how long do i need to wear you want to answer this for me i will skip this we don't need to answer this rohan you have your answer if you listen to this podcast you don't absolute marketing gimmick absolute shortcut Please stay away from any device that claims to correct your posture. The only thing you need is to get up, move your butt and enter the gym.
I am 24 years old. A few weeks ago, I started experiencing a mysterious problem. When I go to bed and lie down in the straight position, I can't keep my leg completely straight.
What should I do? So, if you can't straighten your leg and you have what we call is a fixed... flexion deformity, which means you're lying down on the bed and your one knee is like this and your other is forcefully like this. It means you may have torn the meniscus of your knee, which is the shock absorber of your knee, which is obstructing this straightening movement.
You urgently need to seek orthopedic help. In most cases, an MRI will be asked from you to reach a diagnosis. That is not a joke.
So definitely need to get checked. That's it. Thank you so much, Dr. Manan.
This chat. That was fabulous. I think this is going to be so useful no matter what the age. I hope younger people are watching this and going to start working towards building their currency.
Absolutely absolutely and just one thing before we end I just want to tell people that in the 1950s and 60s smoking was considered cool. People didn't know what happens if you smoke. They really didn't. It was such a norm.
We are at a current stage where sitting is the new smoking. We'll wake up in 2050 and 2060 and that time people coming on such podcasts will say I can't believe 50 years ago people were sitting so much like what is wrong with people and right now it seems so normal to us. So please take that as the take-home message just don't sit.
And disclaimer we did cut and did a stand-up. Absolutely that needs to come in the intro or outro please figure that out. Thank you. Awesome thank you so much for having me.