Pain | Episode 66 | with Dr Ashish Babhulkar

Pain | Episode 66 | with Dr Ashish Babhulkar

Author Name:Uncondition Yourself with Namita Thapar

Youtube Channel Url:https://www.youtube.com/@UnconditionYourself

Youtube Video URL:https://www.youtube.com/watch?v=Cm63e3rjnWc



Transcript:
(00:00) Then doctor had tennis elbow. He went he got his elbow surgery done. He did the damn nothing. And then they did shoulder mage and he found that they had a tear and a cyst there >> and then he got fixed and then he got better. >> Also the steroid injection that you wanted to give on the shoulder when should that be taken and when is only physio good enough? >> I'm the chairman of the society against steroid injection.
(00:21) What happens is some patients come in late. Their pain tolerance is very poor. The disease is severe. My physios will come to me and say that they're just not cooperating. they cannot do the physio that's when I'll give the steroid >> so that they able to do the physio >> correct the pain paradox is people get pain they stop doing activity that's a disaster >> using painkillers to kill pain is like throwing water on the fire you've dowsed it but it's still there so as is our practice you know I never give painkillers the IT band syndrome is a
(00:49) very common runner's problem >> because they're running too far ahead maybe 10 maybe 20k maybe 42k [music] and the hips are weak so the whole load is taken by the IT band and it's a very common affliction amongst runners. Every kilo that you put on when you're climbing the stairs, you have 3 to 5 kg extra. >> Ah, >> so when I'm climbing stairs, I'm putting 200 to 250 kg on that leg.
(01:11) That knee is not designed for that. >> At some point, it's going to >> it will Ashish, I'm so excited that we're having this podcast because we've been talking about it for so long. >> It's a pleasure. I wouldn't miss this and that's why I scrubbed out the whole day just for you because it was important to do this and we've been discussing and talking about this >> and doc I want to start with a topic we discuss very often which is pain and what are the most common conditions of pain that patients come to you with >> apart from my practice if you look at
(01:38) pain um knee pain back pain and shoulder pain >> they're the most common all pervading and if you look at across everybody everybody's had backachche everybody's had neck pain and it's all pervading and then we don't take it too seriously ly until such time that it becomes unbearable and that's when that's the nature of India and then they come in at the last stage and then we start treating it but pain itself is not only disabling it affects your sleep it affects your mentation but it has some long-term connotations and then people just stop
(02:09) doing things just because somebody bent over and got a sciatica they just stop bending over >> or they go to golf and they get a pain they stop playing golf or something like that so that's why pain can have long-term connotation But pain is not pain. There are so many layers to that pain. So you have to unpeel every layer like an onion and then find out what this pain.
(02:31) Let's go one by one. Let's start with the shoulder because I know you're like the shoulder specialist. So we start with your favorite part pain. >> Let's start with that. What are the most common conditions? Of course, frozen shoulder that you're treating me for. Let's start with that and then move into different types of shoulder pain.
(02:45) >> Yes. Amongst all the gamut of shoulder problems, the frozen shoulder is the most common. It's very embarrassing. But if you ask all the shoulder specialists across the world, why do you get frozen shoulder? Nobody knows because there's no one cause for that. You can develop a tear. You can develop an injury and that can explain.
(03:05) Frozen shoulder is one of those maladies which just affects extremely disabling >> and before I get on to the uh granular details. If you look at literature and my past seniors and everybody, oh ignore frozen shoulder, it'll self relocate. I've heard that a lot better. Common thing my boss used to say in a year's time it all self relocates.
(03:25) And then we went deeper down and did some lot of study. Once you go down the rabbit hole, you realize frozen shoulder the pain settles down after one year. The strength doesn't come back >> and the strength remains. And so the whole idea throughout my practice is restoration of function. M >> everybody's practicing resolution of pain.
(03:44) So you're giving painkillers, you're giving acupuncture, you're giving needling, you're giving heat and therapy. So that can take down the pain. It can't restore the function and then the whole thing improves at such glacial pace that you finally get over get used to it and that is not right. >> Yes. >> So for all the physios that my team does, >> I tell him we must have a very finite outcome measure.
(04:06) M >> so unlike all the other practices for physiootherapy as you know my patient will come to me only for 2 weeks nobody comes more than that if I can't move the needle in 2 weeks >> I can't move it in 3 months >> so that critical 2 weeks initially getting physio is very important >> you must have we say 50% but even 30 40% better >> in terms of pain in terms of movement but most critical the metric is strength so if you can change the strength in two weeks then the patient is trained they can do it at home and this applies to
(04:37) every little problem that you have. You've got headache, you've got backachche, you're taking therapy, you're taking physio, you're taking massage. >> In two weeks time, if you have substantially better, 30, 40, 50%, it's working. Please pursue. >> But someone like me who literally came to you 5 months after my frozen shoulder, what damage is it doing? Because people should know the price you pay by ignoring it for 5 months and not curing it or going in the first two weeks.
(05:02) >> So, two things. The later you come, the longer it takes to restore. Number one. >> Number two, there's muscle wasting. >> And at my age, perhaps not your age, once the muscles have gone down, they don't restore back to normal. They can, but it requires huge effort. >> I'm facing that. Exactly. >> That is very important.
(05:19) That's why you want to nip it in the bud. Plus, you lose sleep, you get stressed out. The stress hormones are going up. Those who are diabetic will have spikes of sugar raising. >> Oh, really? >> Yeah. Yeah. and frozen shoulder amongst the whole cohort of frozen shoulder patients more than half are diabetic. >> Oh, so the correlation could the diabetes be causing the frozen shoulder? >> They have the worst frozen shoulder.
(05:41) All the other patients who are non-diabetic I will tell them that I'll get you better in a finite period of time say 6 weeks 8 weeks but diabetics can go on forever and that's hold true for all diabetic surgeries cataracts and every surgery. So the healing process is enormously slow. Same glacial pace. It takes time because that's the nature of the beast.
(06:01) >> So diabetes have to be very conscious and they should treat their sugars levels, lifestyle, obesity, everything. So you have to tick all those boxes in them. That's very important. >> It's a full approach. Also the steroid injection that you wanted to give on the shoulder when when should that be taken and when is only physio good enough? Just a little bit on that.
(06:20) >> So Namita that's a very important point. >> Yeah. So on the face of it, if you ask me, I'm the chairman of the society against terror injection. >> Really? >> It's true because that's again resolution of pain. It's not that I don't give it. So let me correct that. I don't want this to go home that I never ever give it.
(06:36) >> But it's very few and far in between. >> I'd rather do the rehab. My physio team is superb. >> And if they can restore this in 40 50% without a steroid, I think there's a bigger bang for the buck that you get on that. What happens is some patients come in late, their pain tolerance is very poor, the disease is severe.
(06:57) My physios will come to me and say that they're just not cooperating, they cannot do the physio. That's when I'll give the steroid >> so that they able to do the physio. >> Correct. >> So most doctors would give a stero like a short-term band-aid fix which is not happy because they don't have to do any exercise. There's no sweat.
(07:15) It's done. But that steroid lasts for four to 6 weeks. >> Yeah. and the pain goes down after 6 weeks is back again. >> Absolutely. >> So if I'm giving a steroid injection, it's a means to get the physio done and that is very important. So if you are going for a steroid injection and you're non-diabetic, please go ahead.
(07:33) There's nothing wrong with that. But use that time interval to kick in do all the best so that you can move the need. >> Bottom line, there's no shortcut to physio and using that to build back the stress >> 100%. Number one, but it's also important here to highlight that which other patient should never take a steroid injection.
(07:48) If your sugars are too high, >> okay, >> if you're running fever, >> please don't. >> And there's no emergency that you need to take that. Let everything settle down because the steroids will shoot up the blood sugar can create havoc with the HBO C and those who are labile uncontrolled will be a problem. So there's it's not mandatory to take a steroid injection at all.
(08:06) >> Understood. That's a good good point. >> What where did the steroid injection come from? It came from when players were in the middle of a match and they got a sore shoulder. They were given a stero shot. They could play back. >> But that's a million dollar question. He's >> getting his match fees.
(08:21) The match has to be won. There's a country's repetition at stake. But >> quickly physio extrapolated that that this is a magic quick fix. >> So people and patients are not in that hurry. There's no finite time that they have to play a match. They have to go and do something. So >> that's I'm really glad because a very big myths that we busted here.
(08:38) Now let's go on to another form of pain. Right? You have this whole tennis elbow, trigger, thumb and all these fancy words. Can we touch upon that? >> So that's another part of the mythbuster thing that we should go on. So this is very important. We developed this accidentally >> 2007 when we were treating our patients on shoulder.
(08:55) They came back and said that tennis elbow start getting better. >> Now we realized that there's nothing wrong with tennis elbow has nothing to do with the elbow. >> Oh really? What? Can you just remind me what is tennis elbow? So tennis elbow is the pain on outer side of the elbow because the wrist extensors have gone sore.
(09:11) It has nothing to do with tennis players. Very rarely do we get tennis players with tennis elbow. But >> golfers elbows is inside [clears throat] pain and tennis elbows outside the elbow pain. >> And it's because this is the victim. This is the culprit because the shoulder has been weak. >> Now let me take you on an anecdote. We used to call it the tendulkar syndrome.
(09:28) >> Oh why? because tender had tennis elbow and for lot of time it didn't get better and this was around 2007 if I'm not mistaken and we were discussing this with another >> therapist and surgeon in Mumbai that will get better you think have you treated these patients before and what happens is because it's a elbow problem they'll go ahead he went he got his elbow surgery done it did a damn nothing and then they did shoulder mage and found that they had a tear and a cyst there >> and then he got fixed and then he got
(09:55) better >> so that was an expensive way of find out that >> tennis elbow has to do with shoulder but we've been practicing that for a long time now so the last tennis elba I operated was 2007 since then the team has been so good so that's why you fix the root cause first and then once the shoulder is stronger there >> you don't need to go through the operation because you're fixing the shoulder >> there is no steroid injection there's no operation for tennis elbow >> so because your shoulder is weak and this muscle is weak
(10:22) >> the wrist extensor tends to compensate and that's why you get >> the trigger finger is also So similar because if I have a 10 kg weight, I'm lifting 10 kg. >> The bigger joint will lift 7 kg. The middle joint will lift 2 kg. The small joint will lift 1 kg. But because the shoulder's been weak and unnoticed, >> the wrist ends up lifting 5 kg and the shoulder lifts up only 3 kg.
(10:45) >> Ah, so that's why >> the wrist is not designed for that. And so because just because there's pain there doesn't mean the pathology is there. But nine out of 10 times the patient says I have this pain, they will treat that. So even in the trigger finger you got to fix the shoulder >> first and most otherwise they tend to be recurrent phenomena.
(11:04) People keep taking injections there. So deer veins the trigger finger the tennis elbows. So this is very important. This is called as proximal inadequacy leading to >> proximal inadequacy >> leading to distal decompensation. There's a >> what does distal decomposition mean? >> The distal joints are compensated for proximal weakness and they are failing.
(11:21) There's no logic. It's like the roof is leaking >> and you're painting the roof. when it start leaking somewhere else, you'd rather go upstairs, take out the water and then this you fix the problem. >> Absolutely. So, we spoke about the tennis elbow and then the trigger finger.
(11:36) Is there anything else that is also connected to this distal decomposition where the shoulder is a culprit? >> Honestly, um the entire body works like that >> because it's a force couple system. Force couple is the engineering term. We call it the balance couple. But they're equal and opposite forces. So your frozen shoulder happened because your internal rotators were too strong.
(11:53) Your external rotators were very weak. So we're largely working on your external rotators to try and restore that balance. >> Whenever that balance is off, the dominant muscles will take. So the whole body tends to go into a fetal position. Yes. >> Because the flexors are way too strong. We hardly ever work out on the extensors.
(12:10) If you look at your gym, your trainers basically going to do your pecs and decks and biceps. All these are flexes. Very rarely do people work on their extensors >> and the other movement opposite. >> It's very important that you do your training equitably even on the leg side. Your ankle sprains, your knee pain, your runners IT band. >> That's a good segue into that part of the body.
(12:31) Let's start with ankle, knee, and the >> the IT band syndrome is a very common runner's problem >> because they're running too far ahead maybe 10, maybe 20k, maybe 42k, and the hips are weak. So the whole load is taken by the IT band which is a very big shape. >> This is called the IT band. >> It band >> and it's a very common affliction amongst runners and they keep focusing on stretching and they think that's going to solve the problem but if you can make the hips stronger runners need very strong hips >> like the rotator cuff the hip muscle the
(13:00) abductor of the hip is the rotator cuff of the leg. >> So this latest fashion or it's a good thing the trend of marathons um it's a very important message for the runners to focus on hip strength. Most runners will spend time cutting 30 kilometers a week, 40 km a week and that's just one repetitive exercise.
(13:18) So you're doing only one set of muscles. >> The whole thing about force couple is that you want to invest more in strengthening less running. >> As a runner, I run less. I do a lot more training. I do a lot more strengthening >> that reduces your injuries. Others if you look and ask any runner who's worth a sword, all of them have had injuries because of this.
(13:36) They are overdoing the stuff. You want to be in that >> we're emphasizing on one and not on the other especially the strength part. What about the knees? >> So knees are the most common joints to be affected. Um most of the problem is middle age. Most of the problem is overweight >> all the pressure on the knees when you're walking >> denial.
(13:54) The two biggest problems if you see everybody knows that the knee is weak and you need to do exercise and you don't want to squat and sit. >> The chair >> is the single most culprit and it is said that sitting is the new smoking. It is absolutely true. We are not designed to sit and if you sit then you're just going to weaken the critical muscles the functional muscles go weak and and people is sitting the whole day >> with the office culture >> office culture IT professionals doctors everybody in my consulting there are four chambers I'm the guy who's running
(14:22) up and down in four chambers my fellows are sitting down it should have been the other way around as I'm the boss but I don't like to so I'm walking up and down because I don't like to sit because it's the whole day you sit the whole day you're gone because reversing that is going to be very difficult.
(14:38) And the other thing is our indulgent habits. Food has become so attractive that we've forgotten the basics of what food we need to do. We eating food that is more attractive that is more buttery and sugary and so moment you put on weight then it's a problem. Reducing that weight is a big challenge >> and that's what's damaging your knee.
(15:00) So every kilo that you put on when you're climbing the stairs, you're 3 to 5 kg extra. >> Ah. >> So if I'm disproportionate 70 kg burden that you carry. >> Exactly. So when I'm climbing stairs, I'm putting 200 to 250 kg on that leg. That knee is not designed for that. >> At some point is going to >> it will. So >> I've been okay.
(15:19) I've been like this for years. So every year you put on 45 kg, the body is designed to accommodate that. 3 years later it's 30 kg extra. It's too late. >> Absolutely. So those are key issues for me is remain fit, stay slim, do exercise and don't sit. >> If you can do this, I don't think you would ever >> have knee issues.
(15:37) You're talking about another like just like you said food and obesity is a big uh issue these days. The other very big issue is constantly being on your phone, right? And we're constantly looking down and constantly on our phones. What's that doing to your neck and upper back and your posture in general? And how does that lead to a lot of pain as So I'll translate English into English saying that what's a posture problem.
(15:57) >> Yeah. >> So posture is the biggest problem. Moment you're sat down your main posture muscle and postural muscles fitting much faster than your biceps, quads, hip muscles as they're designed to keep you erect as such. >> The worst problem is most of the time you're bend down looking into your keyboard, looking into your phone, looking into your tablet or doing that simple.
(16:21) Moment a neck flexes you try that you flex 15 30° most of our heads weigh about four and a half to 5 kg >> you flex even 30° everything goes for a toss and your shoulders come together your back arches go for a toss >> but just put your head back automatically your shoulder braces your tummy tucks in and you get the best posture but we don't tend to work this is not a functional position we are now keyed in every little activity that we do we are like this hunching >> and 4 hours together.
(16:50) I don't mind you do it for 10 minutes and come back. So if you're more like this 20 minutes and you are like this 5 minutes, >> it will not you know cross that threshold. >> But we are doing this all the time and so we losing. >> So what is posture? Posture is about keeping your neck on the center of your spine, keeping your shoulders braced up and allowing the weight transfer to go down the spine.
(17:11) The spine is designed to distribute weight equitably. >> Excuse me. What happens is most of us in our busy schedule are like this and are like this and are like this and it's become fashionable now. Everything has gone wrong. >> You want to look like the hustler. >> Yeah, that's it. >> It's glorified. >> It's glorified and it's look like he's a busy man. He's multitasking.
(17:32) But so that's why. So there's a 30second 3030 rule. Every 30 minutes just get up, stand up, >> stretch a little, just do those rotations, take a 30-cond walk and come back. >> Oh, and interesting. >> Doing a purposeless walk is very difficult. So, I said just go drink water and come back >> because we're not drinking enough water as well. So, you're serving two.
(17:54) >> That's a very very very important. >> So, put in alarm 30 40 minutes, get up, just walk in. Your muscles are toned up. You will not lose the pressure. Most of you all think when you start in office you're starting like this erect very fresh lot of energy by the evening you are slouch like this loss of energy don't feel like working and because the moment you lose posture you're losing your energy level you're consuming too much muscles >> right >> if you stand erect >> then only your tendo actually is working
(18:25) so you're conserving lot of energy because the body is designed like that >> that you don't have to expend any muscle strength to hold because it's designed But there are people with chronic like I hunch a lot. Even when I walk, I hunch. I tend to hunch. I constantly have an upper neck and a shoulder pain.
(18:41) Again, for that strength exercises, flexibility is very important. Posture correction is >> on the PSRP that you're doing the P shoulder rehab program. >> Part of it is posture correction. >> Correct. >> Because that's very critical. >> We address the muscles that are not being addressed and counterbalance the and fix the muscle imbalance very quickly. That's important.
(19:01) Since you've touched neck pain, neck pain is again very omniresent everywhere >> and we think neck pain is brought to s most patient 99% will come and tell me and they'll say I have cervical spondosis and they're like a 30-year-old girl who's coming and say I have cvical spondylosis you can't >> very common and wearing that band.
(19:18) >> Yeah. So spondylosis means degenerated >> which means that you ought to be 60 70 for you to wear down that time. >> A lot of neck pain emanates from the shoulder >> because your shoulder is weak but you've got to do all the task over it. >> The neck trapezius muscle will spoil everything >> and that gets overactive and that causes all that strain here and that's why they're doing this or they're doing this that medial of the scapula pain.
(19:44) That's it. What happens because they're saying neck pain, everybody's addressing the neck. If you can just go and check the shoulder and find out that their external rotators and the supraspin rotator cuff is weak and you strengthen the neck >> that could be connected to your neck pain too. >> Exactly. The neck pain just dissolves.
(19:58) So on the 10th or 12th day of physio, they will say that neck pain is gone because you just find well how important is your mattress and pillow. >> So ergonomics is a science which was marketed brilliantly. I'd rather invest in fitness and if you're fit you could sleep anywhere even on the bus stand and but >> as you get older don't you need like a certain type of mattress and pillow it doesn't matter >> it really doesn't matter >> so don't think that there is a defined ar what works for you namita not work for me your posture is different my
(20:29) posture is different the style is different so when they tell you that this is the ergonomic chair >> I don't like those tall if you've seen my clinic I have very short chairs I don't have that executive chair because that pushes me into >> a poor posture. So I like a low one which is supporting my back but I don't like support above the air cuz I can then keep and lean back and stay like that.
(20:49) >> Correct. >> So whatever works whatever floatboard is good for you as long as keeping you in the correct posture. >> So I don't think there's a one quick fix for everybody that this mattress is a posture matter. It's a good selling point. People will buy >> like marketing to an artist. >> It is and so were magnetic beds.
(21:04) >> Absolutely. There's something called magnetic beds. >> I didn't even know that >> big hustle >> really. and they were swelling like hot cakes >> and it came down like a roof. Nobody benefited. It was a MLM multi level and now it's gone. >> It's just gone. >> So let's move on to seiatica because so many people I know are getting sciatica pain slip disc in the gym.
(21:25) >> What's causing that again and how do we deal with it? >> So again uh a multi- origin >> um seiatica means one of your biggest nerves in your body is gets pinched somewhere at L5 and S1. It's a sharp pain but not all red pain is sciatica. Backachche is very common. >> Before we go down to the proper lactic uh bandwagon, it's important to turn give you the red flags that if your sciatica is going all the way down to the toesh >> if it is sharp shooting and present at rest, >> right? >> And is associated with tingling
(21:59) numbness, it's a big red flag. Just get up and go and see a back specialist. >> What is it a red flag about? like >> the fact that the nerve is getting pinched big time, you're losing muscle strength, it could be progressive. >> So that needs immediate attention. >> People typically don't go and show a specialist >> because you've got painkillers, you're killing the pain.
(22:19) So those are the extreme patients that we need to know about. Most of your pain which is going down is because muscle tightness. So it's either your hamstrings which are tight and all of us have tight hamstrings. >> Pyroformis syndrome where the pyroform muscle is small muscle under which the sciatic nerve goes through and gets tight.
(22:35) There are some beautiful stretches you can do. >> So even for this it's more physiootherapy, strength building and that will get resolved depending on how intense it is. >> Uh that's a very interesting point. We also spoke about ways of uh mitigating pain that don't involve medications. >> Can we talk about that? I think amongst all this podcast if there's anything that must take home is this >> that >> using painkillers to kill pain is like throwing water on the fire.
(23:05) You've dowsed it but it's still there. >> I did rather fix the fire or the cause that caused the fire. So as is our practice you know I never give painkillers and getting pain resolved with painkillers. There's no credit at all. achieving that painfree period by exercise. The pain paradox is people get pain, they stop doing activity, that's a disaster.
(23:27) >> Unless you're dealing with sciatica, unless you're dealing with fracture, unless you're dealing with tumors, that's a complete different that's less than 1% of the problem prevailing problems. If you can correct the force couples and you can identify what's gone wrong, which one is weak, which one is too strong.
(23:43) So you stretch out the one that is strong and in spasm. You strengthen the one that is weak. You'll restore function. So the whole equation on our rehab program, none of our patients get painkillers because you think I'm I'm wicked here, but I'm being cruel to be kind. Because if I give them an easy option, they're going to take that easy option.
(24:02) Keep popping painkillers till the kidneys shut down. Number one. >> Number two, my physios are under pressure that I have got two weeks and in two weeks time if the pain doesn't come down, it's going to reflect on my this. So they're going to do their best. And lastly, when the patient finishes 2 weeks and his pain is gone 50%, he's convinced this is what worked for him and self motivated.
(24:21) >> So my fellows keep asking, "Sir, we have a problem. Our patient don't comply. Nobody's going to come for 2 weeks." That's not the question. If you can't restore the pain >> in two weeks time and you give them a just cause, which is easy for them to do and no cost at home, >> so then they will do it. >> Absolutely.
(24:41) You can 90% of muscular skeletal pain you can solve with an exercise program provided you can clinically identify what's the cause what are the muscle incompetencies build up the muscle balances and that's exactly what I do so I like to walk the walk and talk the talk and this is what I practice there are exceptions no question you have a severe sciatica or a radical you have a calcification shoulder that's dangerous then that will not but you can try this there's no harm if it doesn't work out you always work out. What was the other thing
(25:10) >> talking about workout? Um what are the best forms of workout as you get older? Because sometimes I've seen that uh you know as you age you have to be a little bit more cautious but people still work out like they're in their 20s. >> Um so what are some of the dos and don'ts as you cross 40? >> So [clears throat] >> I know you are very active.
(25:27) I've seen you run. I've seen you cycle. I've seen you do calisthenics and you do a bunch of activities. So like um I know it's very individual dependent but just let's have some dos and don'ts as as a general yes >> rule. >> So starting where you come from most of the patients have an antipathy towards exercise. >> So I have to make them unlearn and relearn and get them to understand their exercise.
(25:50) I mean that's the strongest medicine ever. If you ask me if there's one pill that can solve tons of problems like obesity like fitness like pain like backachche like blood sugar thyroid that's the pill that's called exercise. Trust me and we have no other alternative for that. Number one, the other thing very broadly speaking we have if you go to a yoga class 90% of them are women and they have already have loose joints so they can do the yoga easily.
(26:18) I'd rather have men do yoga because they are more stiff. They need the yoga. >> They are already strong. The women are not strong. Their muscle quality is very poor for reasons of their hormones because of the way they are built and such thing. So the women need to focus on strength. >> So exactly the opposite is you see more men in the gym and more women doing yoga.
(26:39) Whereas of course the women and men have to continue. The women need a lot of strength training and the men need a lot of yoga is what you're saying. >> Exactly. They need flexibility. So I don't like either. >> Got it. >> So I invested in calisthenics. So I don't do weights and dumbbells and stuff. And I have a fantastic trainer because I've been doing this for 10 years.
(26:55) >> To be honest, my native DNA is not exercise. But I realized and I hit upon I and saw what exercise can do to me. So if I exercise and I do number of surgery in the whole day zero fatigue my assistants are like sir coming down full of energy when you start I'm running down the stairs they following me and that's because I have realized that this is the magic pill and that's why I would so calisthen is a beautiful integration of stretching and strengthening.
(27:23) If you can do them both in equitable proportion you'll remain the fittest. My worry is that the men want to push weights till there's no tomorrow. So I get patients who are pushing 70 kg. Yesterday we saw somebody who was doing 100 kg and he's gone. I could drop his shoulder with a finger. He said 100 kg. I've trained I've slowly improved. But that's what happens.
(27:45) People don't understand. Don't rely on the trainer. You have to be in control. What works 100 kg for that guy is not my forte. >> Absolutely. >> So you need to be in control. People don't know what weight trainer weight. So the best analogy I give everybody is that your speedometer on your car is 240 km. My speedometer is 240 km.
(28:06) I drive my car at 40 km an hour. You want to drive it at 200. So you'll reach earlier. I will reach later. But when an accident happens, Mr. will be formally introduced to Mr. Fan. Whereas I will get off my bike and I will go home. I have ruined my bike. I'm going to buy a new bike. Good example. can buy a new bike.
(28:26) So remain in that zone where you are optimal >> and you're getting fit. >> Don't rush it. >> Don't rush it. >> The problem with exercise is that you need motivation. >> So my watch is my motivation cuz it's telling me that today I ran and I did my 10k in 65 minutes. I'm gutted. So next week I want to come down and bring it down to 61 62.
(28:47) And so I'm competing against myself. So you do that with yourself that you're doing 20 kg, 30 kg, 40 kg on your gym. Keep improving on that. But there should be a finite limit somewhere. You must know your limit. Usually it's one/ird of your body weight, half your body weight. Don't push it beyond cuz you want to be fit. Don't compare yourself with a wrestler who's doing 7 hours exercise.
(29:07) He's competing for a medal. >> It's not practical. >> He's a different beast, not like you. No, I think this is a very good thing because you see it's it's this whole alpha male more and more trying to push yourselves and it's like you said >> um it's a very short-term fix. What about you know we spoke about workout what about uh calcium, vitamin D and food.
(29:24) >> So that's the other dynamic that should always be discussed. the trilmma of a unfit person and I'm saying person I'm not saying patient >> is uh no exercise poor nutrition and that subclinical deficiency so all of us believe we eat well and I get patients telling that why are you doing vitamin tests on me I'm fine I eat the healthiest and my weight is good there's a lot of subclinical vitamin amongst not us entire world so almost 70 to 80% population even in Europe America is vitamin D deficient.
(30:02) >> I was in Ladak last week and we were discussing there at a conference with the local guys and they were saying our patients don't heal their fractures in 6 weeks as yours do. They take 3 months. And then we sat down and started dissecting that. We realized that they have ample sun. They have the purest weather ever.
(30:22) They have the easiest lifestyle which is easy. But they're all covered up. >> There's no sun penetrating through. So all of them have a vitamin deficiency. So I went for a holiday but I got two patient. One I had operated and another came in with his family and so I had to do work on my holiday and I realized they have terrible deficient.
(30:39) Their results are the weakest. So on our study we found out that the Pune patients are reasonably optimal vitamin D levels. >> The worst are either from place like Ladak where they are covered up completely. >> Correct. >> Or where there's ample sun and it's too hot. So vidba kandesh where it goes 45 degrees.
(30:59) So they're scared of the sun >> and so they are inside tucked in they just don't even go and their vitamin D levels are the lowest. >> Got it. >> That's important. The other thing is calcium misunderstood big time amongst all professionals medical everybody. >> Why is it misunderstood? >> Problem with calcium and vitamin D is it got labeled as the bone vitamin.
(31:17) >> It is not. Vitamin D is all pervading. It is required by entire system. So the only two things two vitamins that entire body cells need not eyes not liver everything is vitamin D. >> So it's not a bone vitamin number one. The same thing with calcium. It is supposed to be a bone. >> Calcium always told us for your bones.
(31:37) >> Bones yes your heart the electric supply to the heart >> your blood clotting levels and your muscle contraction and your brain needs calcium big time. You cannot perform. So our calcium levels cannot go down. If our calcium levels goes down, the body will provide the calcium from the bones and keep the heart running.
(32:00) The heart will stop. Heart can never stop. So in our body, 99% of the calcium is stored in the bone. It's like your calcium bank, >> right? >> So even if I stop drinking milk from today for the next 10 years, I have no problem. The problem is the calcium will continue ceaselessly. >> My bones will weaken. Got it? >> And that is what happens especially postmenopause. Bones get depleted.
(32:26) They get osteoporosis. And that we don't realize. So >> our requirement of calcium is 1 g every day. >> If you do all your back of envelope calculation, I challenge you and challenge me. We don't get even 300 to 500 milligrams from our diet. >> So that's a big deficit from our food. >> Exactly.
(32:45) So do you recommend everybody needs to take a calcium tablet? >> Pretty much. >> I mean even kids you start from when you're younger. What is the age when you start taking these additional calcium? >> If you're a healthy diet, you're a milk drinker and you have your cheese and yogurt. And if you're a non-vegetarian, then maybe after 25 30.
(33:02) >> Oh, that's early. >> The new fashion is the youngsters don't want to take milk. They want to do almond milk. They want to oat milk. And almond milk doesn't even scratch the surface. doesn't have 1% of the vitamins that the milk has number one is three times the price and gives you zilch if you disagree but >> lactose intolerance a lot of people feel bloated after >> let's leave lacto because we'll be here till the cows come home >> you're a non-believer >> there is no lactose intolerance but okay don't drink milk but you in one fell
(33:33) soup removed 12 very important ingredients there are 12 very critical >> the most two important that I will talk about is your calcium levels without milk you're not getting your dose of calcium your daily level protein we are all deficient protein our entire diet is you know designed >> for carb loading entire Indian diet all of us it's completely carb loaded and there's a conspiracy diabetes so our requirement especially because the large part of the population is vegetarian so their sources of your best source of protein is not your protein
(34:10) supplement because that again is going to you can absorb only one/ird of it. Synthetically >> absorption is a very big part. >> 99% of absorption on milk and eggs. So that is where you're getting everything. So >> your protein supplement is one/3 absorption but your milk and eggs is 99% >> 99% absorption.
(34:26) Hardly any you know there's no challenge there. You put it in any way you like. Just take it. Don't mix your milk with tea, coffee or boneita or I mean bonita start putting B12 into there. It's such stupid and it is such a paradox because that chocolate in that will deplete the calcium and B1. >> So these are the kind of things we have to keep in mind.
(34:45) >> Keep natural ingredients in your milk. So you could do a milkshake, you could put in your haldi or you can put in sugar also but don't mix any synthetic substance in that because that depletes your milk. That's the largest resource of health. Once you've done that then whatever you eat doesn't matter because >> and food other than milk and eggs uh any lentils or anything that you recommend >> protein is a big challenge >> so veg guys will keep talking about plant protein pea protein dal protein >> is fine but it's not complete protein
(35:15) >> so then you have to supplement because the essential amino acids are ones that are not made within the body so which is what meate eaters ready get but milk and egg will move that needle for you >> got it >> otherwise then you need to supplement because all the complete and that's why our old traditional diets included dal and rice together when you mix them together you're pretty much getting your complete protein so you can't so you need a nice wholesome meal so that you can get adequate protein and soya tofu
(35:45) can compensate >> can add to it now that we've covered some of these lifestyle things I want to go back to pain because I think we started with the shoulder then we went to the tennis elbow finger trigger trigger the finger. Then we went to knee. >> Uh we've covered sciatic sciatica, we covered neck and posture.
(36:04) >> So um are these pretty much all the cases you get or are there any key uh pain types that we may have missed out in terms of the kind of patients you see on a daily basis? >> There are tons of varieties but there are two things that I might want to talk about. One very briefly is something called as calcification in the shoulder.
(36:22) >> Oh yeah that's >> it's terrible. Is the worst pain ever. women patients come and tell me it's worse than labor pain and it comes like sudden onset. >> What causes the calcification? >> So we don't quite know but it's very very high propensity in hypothyroid patients and we know that the thyroid gland deals with calcium and vitamin D metabolism.
(36:43) So there's a surge of calcium and that creates so eating calcium doesn't cause calcification. Eating calcium doesn't cause kidney stones. It's a myth that even surgeons don't understand. is a vitamin D deficiency that causes because of the vitamin D deficiency there's something called as um hyperarathyroidism that's caused so it's pseudo hyperarathyroid because your thyroid gland wants to pull in all the calcium from your bone but then that floods your blood levels and that sometimes can get deposited in the shoulder in the knee >> and that can cause excruciating pain if
(37:12) it's sharp onset it's like a flash of pain overnight >> most shoulder conditions will be slow pain over months together like a frozen and shoulder >> but this is very aggressive and fast >> just go and see your doctor how do you deal with this if it's a small calcification you can put them on rehab and put them on analesics and enzymes to remove that >> but it's like 10 15 mm it's very big they can't do the exercise and they are disabled >> so we do sometimes ultrasound guided needling for them and then take that off
(37:41) for them >> you just break into that cap >> break into that and that can be done to allow them to do rehab and then fix them but >> they will remember that time and it's that big thing The other thing is that you must also understand that if it's a sudden onset pain at rest and if it's continuously 3 weeks no uh change in pain at all be careful it might be something more sinister it's very unusual so uh >> give me a couple of examples >> bone tumors uh can cause pain >> but the more important problem in the tip of the iceberg that we must cover
(38:14) today is osteoporosis >> oh yes extremely important especially for women >> all women in this country have osteoporosis especially beyond 60. >> Agree. >> If you're hypothyroid, if you are um had cancer previously, if you're lean >> and poor muscle, slim >> and you have hypothyroid or diabetes, you 100% have osteoporosis.
(38:38) >> The problem with osteos is twofold. Number one, there is no speciality who's ready to take the owners for that. The orthopetic surgeon don't do, physician don't do, gynecology don't do. It should be a collective responsive for all of us. There are no symptoms of osteoporosis. You could be osteoporosis moving around till such time that you fall >> and get that fracture.
(38:56) >> You'll have nothing and once you get the fracture then what's the point? The whole thing is to avoid the fracture. >> Absolutely. >> So all ladies must screen themselves at the excess scans. >> The problem with dex 40 plus you >> 60 plus. Okay. If you're high risk, you're lean, thin, osteoporotic, known wrist fracture in the past, known hip fracture in the past, do it early.
(39:18) >> Yeah. >> The DEXA scans itself in this country are dubious. Not enough. You need a good quality. Pune probably has three or four which are good quality. >> That's it. >> That's it. We need at least 100 in Pune. >> Oh, >> we need thousand in Mumbai. And a good dexa scan is the one which does lateral spine and hip.
(39:37) >> Most of them don't do that. So, but you must screen yourself every passing year. Don't do it as a one-off on my 60th birthday done every day because if you detect it, we will solve the fraction femur, the hip fractures and the wrist fractures. Reduce the patient population and the amount of >> disability treat osteoporosis.
(39:56) >> Several medications very successful. You could have injections, you could have tablets and uh they are very useful and but before you start them you must do the dex scan because if you don't know what's your threshold value you don't >> you know where you're at and where you need to get to >> correct and the whole treatment for me >> to make that delta >> it takes one and a half year >> right >> so if you have not done the threshold X-ray and after one year I know I'm still there I've wasted one year patient
(40:22) has wasted their time they gone worse than before and that's very important not being frivolous but the only advantage obese people have is they will never get offis [laughter] so when the obese lady come some positive things there is a vague you know >> they probably kill their knees in the process >> they will they will that's a price to pay but I never send yeah I never send obese lady for dexa because whatever I've done they've all been positive so that's one flip side of the whole thing we we not treating even 1% of the
(40:54) osteoporosis population the other problem is They don't have symptoms. The symptom is fracture. It's too late. >> You want to prevent that and that's true across the world. >> Which is why I mean think about if Puna has four and needs 100 and you got to first go figure out where you're at and get it annually done.
(41:09) >> Fabulous. Any other pain? I know there are lots of pains but any other like important pains we missed out in today's episode because the title of the episode does say pain. >> There's something called as fibromyalgia. >> It's a very nice term to tote around. >> I've heard about it unexplained. Many patient come with I have fibromyalgia and there's no solution for this.
(41:28) It's a good handle to give the patient but if I can translate English into English again if a consultant physician says you have fibromya it means I have no damn clue what's happening to you. That's what I said. Put it into any compartment. It's true. The Harrison's textbook gives you the best definition.
(41:46) After you've ruled out every physical condition, whatever remains is fibromyalgia. It's like a dozen diagnosis. >> But what >> I don't think there is any fibromyalgia. It's again the problem that just because they have pain here, >> we're not finding the root cause. That's the victim. You have to find out what's the root cause.
(42:04) It's either the neck muscles, it's either the trapezius that's too tight. >> Most commonly, it's a rotator cuff weakness. So you put them on exercise, you correct the posture, you bring their core back to normal, goes away. I can tell you there's no magic bullet for fibromyalgia. People give painkillers, they give patches, then they put steroid injections.
(42:23) >> Yeah, >> it's all pass. It's like no chance. >> Always a pleasure talking to you Dr. Ashish. >> It's a pleasure. Thank you Namita. You gave this opportunity because normally we don't bring these topics up. Yes, it came through very informally but it was a very important take home and thanks for using your stage to get this across.
(42:39) >> No, and you know we said the same thing at the beginning that you know how do we deal with this and I I always tell doctors that the best way to have a conversation is forget their cameras, forget everything and just remember that we are here for a larger good. We are here uh because we're putting our heart and soul into helping people get educated and when you really put that cause um at the very forefront everything just flows.
(43:01) >> That's true. And it was just a beautiful flow today. So, thank you so much for that. >> Thank you. [laughter] >> Thanks, doctor. >> Thank you. Welcome. >> Bye. >> Thank you. >> Superb. That was a I think we covered like everything under the sun today. >> I heard so many of these giggles and gasp in the background.
(43:22) So, I think every two minutes like people were really relating to it because I don't think there's anyone here who doesn't have some kind of pain or hasn't dealt with some kind of pain. >> I hope so.