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Understanding And Preventing The Risks Of Osteoporosis In Women Aged 40 And Above

Dr. Mark Chong

Attributed to Dr. Mark Chong, Consultant Trauma and Orthopaedic Surgeon at ALTY Orthopaedic Hospital

Menopause is the natural biological process women go through that marks the end of their reproductive years in the 40s and 50s. The process is gradual and causes significant hormonal changes, resulting in many unique symptoms such as hot flashes, mood swings, sleep deprivation, moodiness and irritability.

Menopause has three stages signalling the permanent end of menstruation. At the last stage, postmenopausal, estrogen and progesterone levels start to decrease. The lack of estrogen is directly shown to have an impact on bone density, leading to osteoporosis, a condition where bones become weak and brittle over time, making them more prone to breaks or fractures.

It is important to note that in the first five to seven years of menopause, women are at greater risk of losing 20% of bone density, making them susceptible to osteoporosis. It is also important to note that decreased estrogen levels are not the main cause for osteoporosis, if combined with other factors, osteoporosis can progress faster.

Unfortunately, the disease continues to remain underdiagnosed and undertreated in Malaysia, making it harder to document its prevalence in our society. According to Bone Health Alliance Malaysia (BHAM), 77% of Malaysian women are living with undiagnosed post-menopausal osteoporosis (PMO). While the cause may not always clear, researchers have found a specific connection between menopause and osteoporosis.

Estrogen plays a critical role in maintaining bone strength, hence it is unsurprising that women reach peak bone mass at around 25-30 years, when the skeleton stops growing and bones are at their strongest and thickest. Therefore, when menopause occurs on average at the age of 50, estrogen levels drop, resulting in increased bone loss. If the peak bone mass before menopause is less than ideal, any bone loss that occurs around menopause may result in osteoporosis.

Since there are no obvious symptoms, many people do not realise they have the disease until a fracture happens. However, there are things that women can look out for:

  • Fragility related fractures
    Even when milk impact results in a fracture of the wrist, back, hip or other bones
  • Loss of height
    Over time, more than two inches of height is lost
  • Receding gums
    As the jaw is losing bone density, and teeth are connected to the jawbone, receding gums become obvious
  • Stooped or curved spine
    Because this disease also affects the vertebrae, the spine can eventually become more curved
  • Lower back pain
    Due to a weakened spine, the back is affected as it cannot handle normal stress the way it could prior to the disease

Treating osteoporosis with continuous bone care and regular treatments are important to prevent serious, damaging consequences later on. Fortunately, there are some at home practices we can incorporate in our daily lives to help prevent osteoporosis after menopause. Early introduction of these practices does help reduce the effects of osteoporosis later on

Here are a few tips to reduce the risk of osteoporosis:

  • Consume proper supplements to boost bone health
    Supplements such as Vitamin D helps the body absorb calcium as we should have an intake of at least 1,000 mg per day, with a recommendation of 1,200 mg per day for postmenopausal women. Similar to calcium, proper intake of vitamin D can reduce the risk of osteoporosis. Milk, salmon, orange juice, yogurt, and cereal are dietary sources of vitamin D.
  • Consuming a healthy diet
    The optimal diet for bone health involves getting plenty of protein and vitamin K. Vitamin K which is present in leafy greens helps increase bone density and reduce hip fractures.
  • Exercise
    Exercise involving high impact and muscle strengthening should be incorporated to help maintain bone density. Recommended exercises include strength training, walking/jogging, and jumping rope. By doing this, bones will respond by creating a stronger, denser cells.
  • Avoid unhealthy habits
    Chronic, heavy alcohol use is associated with an increased risk of osteoporosis, so keep consumption moderate. Additionally, smoking can be detrimental to our health and slows the production of bone-producing cells.

Termed as the ‘silent disease’, osteoporosis often goes underreported, underestimated and therefore, remain undertreated. Timely screening and early detection of osteoporosis can play a significant role in reducing the risk of the orthopaedic condition, and facilitate treatment before it becomes severe.

Want To Prevent Scoliosis from Progressing In School Children? Early Detection Is Key

By Dr Wong Chung Chek, Consultant Orthopaedics & Spine Surgeon

Scoliosis is common, sometimes hereditary spinal medical condition, in which a person's spine curves to the side, typically in the shape of an "S" or "C." A stable and mild case of scoliosis does not cause significant lifestyle issues, but severe cases with prominent curves can be harmful to a person's health.

People often believe, erroneously, that carrying heavy bags, having poor body posture, participating in sports, or sleeping on one side will cause the spine to bend, but that isn’t quite the case. The reality is that over 80% of all scoliosis cases have no known cause [1]. Such cases are known as idiopathic scoliosis.

According to studies, scoliosis affects two to three per cent of the Malaysian population, or between 600,000 and 900,000 persons[2]. It’s most often detected during adolescence, but it is also known to affect adults and the elderly at a lower rate.

In some cases, this condition can worsen very quickly during adolescence because children often have growth spurts during puberty. Because the signs are not always visible in mild cases, parents should examine their children on a regular basis.

The earlier scoliosis is detected, the better the odds of preventing scoliosis from causing serious issues down the line.

When should you do at-home checks?

The good news is that scoliosis can be easily checked at home by parents. As scoliosis usually starts just before the child shoots up in height, parents should begin looking for symptoms at that time.

Scoliosis usually progresses very rapidly during the growth spurts and only slows down or stops once the child reaches bone maturity. Signs of scoliosis become more noticeable as a child grows in age or as the curve progresses, but that doesn’t mean that scoliosis is impossible to notice early.

An imbalance in the height or position of shoulders, shoulder blades, or hips is one of the most common indications of scoliosis — for example, one shoulder appears to be consistently dropping below the other. Another symptom is a misalignment of the head with the rest of the body. Parents should also watch for an uneven waistline or hips, as well as whether one shoulder blade protrudes more than the other.

Should we have posture screening at school?

It might also be beneficial to have posture screening for children in schools, most possibly during regular health checks. This will aid in detecting any symptoms earlier, especially since most children are developing rapidly at this time, which is typically when scoliosis begins to occur. Aside from that, it will help to raise awareness about scoliosis, as there is a growing need for education and early detection to prevent conditions like scoliosis from progressing further.

During our consultations with parents, surprisingly, we find that many parents are still unaware that posture screening is available at most health clinics and can point out growth or development related issues in children.

One away to ensure early detection of scoliosis in children is to make early screening accessible in schools. School authorities and government collaborations can be considered in the future to ensure that posture screening is included as part of regular health assessments for children in primary and secondary school.

Recently, ALTY collaborated with a pharmaceutical business, Viatris, to organise a Community Scoliosis Screening campaign around Klang Valley which resulted in over 250 walk-ins. During the screening session, we discovered that a large majority of parents and guardians were unsure of what signs to look for. Through this collaboration, they were educated on early signs of Scoliosis, treatments available and ways to practice good p

Do you still need to see a doctor?

If you are still unsure, it is best to consult a doctor as soon as you can. Sometimes mild symptoms may not be easily spotted, and doctors can help perform more tests and X-ray scans.

If you see any signs of scoliosis, regardless of how minor they are, you should schedule an appointment to see a specialist to do further observation and to also check on the severity as some hospitals may not be able to do a comprehensive check.

If the curve identified is less than 20° degrees, the curve will be observed to ensure that it does not worsen. This is especially important for children who are still developing, although well-grown children may not require more X-rays. Such cases may require more testing like MRI which can be used in addition to the X-rays for more detail.

New imaging modality like the EOS is able to provide better images of the spine with a quarter of the radiation dose.

An orthopaedist who specialises in pediatric conditions will be able to recommend more tests, examinations, and preventive measures upon further consultation.

While scoliosis is not a preventable condition, measures can be taken for early detection that can slow down the worsening of the condition, thus avoiding surgery. Even in situations where surgery is still needed, early detection would translate to shorter segments and safer surgeries.

Parents and teachers should remain vigilant and place emphasis on good posture habits in young children to allow them to have a safe, health and bright future.

Disclaimer: This information is not a substitute for medical consult. If your child is experiencing symptoms like scoliosis, we encourage you to arrange for a consultation.



Benefits of Fasting, Going Beyond Weight Loss

By Dr Wong Chung Chek, Consultant Orthopaedic & Spine Surgeon, ALTY Orthopaedic Hospital

The benefits of fasting are manifold, going beyond just weight loss. One of the effects of intermittent fasting, is overall reduced calories intake, and hence reduction of body weight. Intermittent fasting also leads to improved metabolic health, increased energy and cognitive performance, and autophagy (a natural body rejuvenation process).

Weight loss can be attributed to reduction in adipose deposit, and/or reduction in muscle mass. Reduction of fat tissue is always beneficial for our body, but not so for muscle loss, as low muscle mass is associated with poorer metabolic health (especially blood glucose regulation) and lowered physical performance or even frailty.

Fasting may even increase the rate of age-related sarcopenia. Our muscles also release various myokines that modulate the functions of other organs notably the brain.

But how do we fast without losing muscle mass? This would require an understanding of our muscle cells physiology.

Net muscle mass is balanced between anabolism and catabolism. Anabolism means building, whereas catabolism refers to breaking down. Our brain cells prefer glucose over fat as a source of energy. Therefore, in a fasting state, the liver triggers a process called gluconeogenesis, to generate glucose from mainly proteins in order for the brain to use.

Hence, with prolonged fast (5 days or more), we see a decline in muscle mass, as muscle is the most readily available source of protein (to be converted to glucose via liver gluconeogenesis) in our body. On the other hand, muscle anabolism takes place via mTOR activation.

mTOR activation in muscle leads to muscle protein synthesis, increasing muscle mass and strength. This can be activated by physical exertion of muscles (resistance training) and protein (especially the amino acid leucine).

Both exercise and protein intake activate the mTOR and hence muscle anabolism for about 6 hours, and in a dose dependent manner, up till a certain limit.

The first point to reduce muscle loss during fasting is to have adequate intake of protein in our diet. Animal source of protein is the best quality in terms of mTOR activation. In general, the optimal amount of daily protein intake tends to be somewhere between 1.0-1.5g/kg of lean body weight. Therefore, for a person with a 60kg lean body mass, the daily protein intake is between 60-90g.

There is also a limit of protein absorption per meal, as proteins have to be digested, and absorbed as amino acids into our intestinal lining cells through specific transporters, and moved out of intestinal lining cells on the other side into circulation in the blood stream. It is estimated we can only absorb a maximum of 30g of protein in one sitting.

To further reduce muscle catabolism during fasting, we can activate mTOR (the anabolic switch of our cells, including the muscle cells) via physical activities like resistance exercises. Body weight resistance exercise is convenient, easy to follow and safe.

Squats, lounges and push up can be performed with various degrees of difficulty and intensity, with more focus on our torso and lower limbs as those are categorised as larger muscle groups. Be sure to also time your exercises around meal times to further activate the mTOR switch in order to build muscle mass.

There is a myriad of benefits with fasting. With a little more understanding of our body physiology, we can reap these benefits with fasting without the potential issue of muscle mass loss.

Take note of your daily protein intake, be aware of the limit of protein absorption per meal, and engage in some forms of resistance exercise around your meal time in order to reduce muscle mass reduction during your intermittent fasting period.

Selamat berpuasa!

Understanding Rheumatoid Arthritis in Young Adults

Dato’ Dr Badrul Shah Badaruddin, Consultant Orthopaedic,
Arthritis & Sports Surgeon from ALTY Orthopedic Hospital

Arthritis is an old person disease – how many times have you heard this? The truth of the matter is that while it is a condition that is often seen in the elderly, many young adults are also afflicted by it. The problem is that younger people with joint pain, swelling, or stiffness often dismiss arthritis as a cause.

It is important to note that arthritis is not a single disease. In fact, there are more than 100 types of arthritis and related conditions that many suffer from. From this list, one of the most common forms of arthritis that affect young adults is rheumatoid arthritis, a chronic inflammatory disorder which affects the lining of your joints.

Rheumatoid arthritis is an autoimmune and systemic disease, which means it affects the whole body. People can get rheumatoid arthritis at any age, and in fact, eight in every 100,000 people aged between 18 to 34 are found to have rheumatoid arthritis.1 In Malaysia, it affects about five in 1000 people.2

Early indicators of rheumatoid arthritis in young adults:

  • Joint stiffness: One of the early signs of rheumatoid arthritis is the feeling of stiffness in one or more of the smaller joints. This most commonly occurs in the hands and it can occur at any time of the day. The stiffness is usually gradual, although it can also flare up suddenly. The stiffness often comes on in the morning, or after an extended period of inactivity. When joints are stiff, mobility is affected and
  • Joint pain: Joints tend to be more tender after it has gone through a bout of stiffness and the pain can be felt even at rest. The fingers and the wrists are typically the most affected although the knees, shoulders, ankles and feet hurt too. Joint paint affects quality of life, as even simple day-to-day tasks such as typing, or cooking can be an excruciating process.
  • Joint inflammation: Inflammation of the joints are also common and can cause your joints to appear bigger. Unfortunately, symmetrical joint swelling is also an identifying characteristic of this disease. The inflammation can affect the tendons and ligaments, causing deformities which can decrease the range of motion, leading to further difficulty in doing basic chores like putting on clothes.
  • Numbness and tingling: When the joints are inflamed, it can put pressure on the nerves. This can lead to numbness or a tingling sensation, particularly in the hands, and can be uncomfortable and worrisome.

Those who suffer any of these symptoms should also pay close attention to any other signs as well. For instance, when fevers are accompanied by any of these symptoms, it could be an indicator of rheumatoid arthritis.

That said, these are just the most common signs and symptoms. Studies indicate that 40 percent of the people who have rheumatoid arthritis also experience signs and symptoms that don't involve the joints.3 Rheumatoid arthritis can affect many non-joint structures as well. This includes the skin, eyes, lungs, heart, kidneys, salivary glands, nerve tissue, bone marrow and blood vessels.

Contrary to popular belief, this isn’t a disease that you only start to worry about when you’re well into your 50s. You need to start thinking about prevention before you reach your 50s and start taking steps to reduce the risk of stiff and painful joints as you age. There is clear evidence that shows the correlation between arthritis with lifestyle choices, remaining physically active will help you stay mobile and will be good for your general health.

Risk factors to take note of:

  • Gender: Research shows that women are two-to-three times more likely to get this disease compared to men
  • Genetics: While there is no specific gene that causes rheumatoid arthritis, there’s a genetic predisposition that requires one or two environmental triggers to start.
  • Smoking: Studies have shown that smoking cigarettes increases the risk of developing this disease. For those who already have it, the disease will get worse.
  • Obesity: Excess weight puts added pressure on the joints.

Given the unpredictability of the rheumatoid arthritis, taking steps to keep it at bay is important. Quit smoking, maintain a healthy weight and limit exposure to environmental pollutions.

While there is no cure for this debilitating illness, treatments have improved greatly in recent years and there's a clear benefit in starting treatment at an early stage. If you have aches and pains, take them seriously even if you think it’s nothing. Pain tolerance levels for the younger generation can be high, but pain is pain and you shouldn’t ignore them – it’s your body’s way of giving you a message. Pandemic or not, you must prioritize your bone and joint health. Rheumatoid arthritis is a disease that can occur at any point in your life, regardless of age. So, consult your specialist and get it checked out.

Memahami Artritis Reumatoid dalam Golongan Dewasa Muda

Dato’ Dr. Badrul Shah Badaruddin, Pakar Bedah Ortopedik,
Artritis & Sukan dari ALTY Orthopedic Hospital

Artritis hanya dihidapi oleh individu yang berusia – seringkah anda mendengar pernyataan seperti ini dilontarkan? Hakikatnya, meskipun kondisi tersebut lazimnya dihidapi oleh individu berumur, sebilangan besar golongan yang lebih muda juga terkesan. Hakikatnya, ramai golongan muda yang mengalami sakit sendi, pembengkakan, atau kekejangan tidak menyangka artritis boleh menjadi punca komplikasi tersebut.

Umum perlu sedar bahawa artritis tidak hadir dalam satu bentuk sahaja. Bahkan, terdapat lebih daripada 100 jenis artritis dan kondisi berkaitan yang dialami oleh ramai individu. Daripada jumlah ini, antara jenis artritis yang paling lazim dihadapi oleh golongan dewasa muda ialah artritis reumatoid, iaitu gangguan keradangan kronik yang memberi kesan pada dinding sendi anda.

Artritis reumatoid merupakan penyakit autoimun dan sistemik, yang bermakna ia mampu menyerang seluruh badan. Sesiapa sahaja berpotensi untuk menghidap artritis reumatoid, tanpa mengira peringkat usia, malah lapan dalam setiap 100,000 individu berusia 18 hingga 34 tahun didapati menghidap artritis reumatoid.1 Di Malaysia, lebih kurang lima dalam 1,000 individu mengalami kondisi ini.2

Tanda-tanda awal artritis reumatoid dalam golongan dewasa muda:

  • Kekejangan sendi: Antara tanda-tanda awal artritis reumatoid ialah kekejangan pada mana-mana bahagian sendi kecil. Ia biasanya terjadi pada bahagian tangan dan ia boleh berlaku pada bila-bila masa. Kekejangan ini lazimnya berlaku secara beransur-ansur, namun ia juga boleh terjadi serta-merta. Ia juga boleh terjadi pada waktu pagi, atau selepas tempoh ketidakaktifan yang lama. Apabila sendi menjadi kejang, pergerakan individu akan terjejas.
  • Sakit sendi: Sendi biasanya akan menjadi lebih lembut selepas mengalami kekejangan, dan kesakitan boleh dirasai walaupun ketika sedang berehat. Jari-jemari dan pergelangan tangan merupakan anggota badan yang paling kerap terkesan, dan kesakitan juga boleh dialami pada bahagian lutut, bahu, kaki dan pergelangan kaki. Sakit sendi menjejaskan kualiti hidup kerana aktiviti yang ringkas seperti menaip atau memasak juga boleh menjadi pengalaman yang menyakitkan.
  • Keradangan sendi: Keradangan pada sendi juga biasa berlaku dan boleh menyebabkan sendi anda kelihatan lebih besar. Malangnya, pembengkakan sendi bersimetri juga merupakan tanda kewujudan penyakit ini. Keradangan boleh memberi kesan terhadap tendon dan ligamen, lantas menjurus kepada kecacatan yang mampu membataskan julat pergerakan (range of motion), maka tugas-tugas yang mudah akan menjadi lebih sukar untuk dilakukan.
  • Kekebasan dan sesemut (‘tingling’): Apabila anggota sendi mengalami keradangan, ia akan memberi tekanan pada saraf – lalu menjurus kepada kekebasan atau sensasi sesemut, khususnya di tangan, dan mungkin tidak menyelesakan serta mengkhuatirkan.

Mereka yang mengalami simptom-simptom di atas juga harus memberi perhatian ke atas petanda yang lain. Misalnya, jika anda demam dan mengalami mana-mana simptom ini, maka ia mungkin memberi indikasi mengenai kewujudan artritis reumatoid.

Meskipun begitu, ia merupakan petanda dan simptom yang paling lazim sahaja. Kajian mendapati bahawa 40 peratus individu yang mempunyai artritis reumatoid juga mengalami tanda-tanda dan simptom yang tidak melibatkan sendi.3 Artritis reumatoid juga boleh menjejaskan banyak anggota badan yang lain selain sendi. Ia meliputi kulit, mata, paru-paru, jantung, buah pinggang, kelenjar liur, tisu saraf, sumsum tulang dan saluran darah.

Bukan seperti kepercayaan umum, penyakit ini bukannya perlu dibimbangkan hanya setelah usia kita menginjak 50-an. Anda perlu memikirkan tentang cara untuk mencegahnya dari awal dan mengambil langkah yang betul untuk mengurangkan risiko kekejangan dan sakit sendi. Terdapat bukti yang jelas menunjukkan korelasi antara artritis dan gaya hidup seseorang individu. Dengan kekal aktif secara jasmani, ia dapat memelihara kebolehan kita untuk bergerak, selain secara amnya memberi manfaat kepada kesihatan kita.

Faktor risiko yang perlu dipertimbangkan:

  • Jantina: Kajian menunjukkan bahawa golongan wanita adalah dua hingga tiga kali ganda lebih cenderung untuk menghidap penyakit ini berbanding golongan lelaki.
  • Genetik: Meskipun tiada gen khusus yang menyebabkan artritis reumatoid, terdapat kecenderungan genetik yang memerlukan sesuatu pencetus untuk memulakannya.
  • Merokok: Kajian telah mendapati bahawa tabiat merokok meningkatkan risiko penghidapan penyakit tersebut. Bagi mereka yang sudah mempunyai kondisi ini, ia akan menjadi lebih buruk.
  • Obesiti: Berat berlebihan memberi tekanan pada sendi.

Memandangkan penyakit artritis reumatoid sukar untuk dijangka, pengambilan langkah pencegahan adalah mustahak. Hentikan tabiat merokok, kekalkan berat badan pada paras yang sihat dan hadkan pendedahan terhadap pencemaran alam. Walaupun penyakit ini tiada penawarnya, keupayaan rawatan telah berkembang dengan pesat sejak kebelakangan ini dan rawatan yang dimulakan pada peringkat awal terbukti bermanfaat. Jika anda mengalami kesakitan, jangan pandang enteng.

Paras daya toleransi kesakitan bagi generasi yang muda mungkin lebih tinggi, namun ia tidak bermakna anda boleh bersikap culas – tubuh badan anda berkomunikasi menggunakan kaedah seperti ini. Kesihatan tulang dan sendi harus diutamakan pada setiap masa sama ada kita sedang dilatari pandemik atau sebaliknya. Artritis reumatoid merupakan penyakit yang boleh dihidapi pada bila-bila masa, tanpa mengira peringkat usia. Oleh itu, rujuk pakar kesihatan anda, buat pemeriksaan dan ambil langkah yang sewajarnya.

Is your spine able to support you through FMCO 3.0?

Attributed to Dr Lim Sze Wei, Consultant Orthopaedic, Spine and Trauma Surgeon,
ALTY Orthopaedic Hospital

The past year has seen a transition to work from home practices by companies stemming from the coronavirus pandemic. While these practices have played a big role in enabling remote work options, improving flexibility and keeping us safe indoors, we need to start evaluating some associated health risks that have emerged in the last 1.5 years.

According to a study published in the International Journal of Health Sciences and Research, 70.5% participants between ages 18-65 years working from home reported discomfort and pain, especially in the lower back and neck region1. This information while not surprising, is definitely alarming, as more and more young professionals report increasing incidences of pain in the back and neck region.

At ALTY Orthopaedic Hospital, we are seeing rising cases of back and neck problems in Malaysians between the 25-40 year age group, particularly in those who are working from home and spending long hours in front of their devices. With Malaysia entering another full Movement Control Order (FMC0 3.0), we can continue to see a rise in back and neck related disorders amongst young working professionals.

While most of us have a tendency to wave off these aches and pains, it is important to remember that these can manifest into severe long term degenerative problems of the spine such as slipped disc and sciatica pain leading to further discomfort. Fortunately, by changing certain lifestyle habits and paying more attention to your posture, you can reduce your risk of painful spine conditions in the future. If you have been working from home and find yourself having back and neck pain during FMC0 3.0, here are some factors to take into consideration.

Set up an adequate work station

In many instances, we see people working on their laptops for long hours while slouching on the couch or even lying on the bed complain of back and neck pain. This is the inevitable outcome of improper sitting and working positions.

As we get accustomed to extended periods of working from home, it becomes very important to have a proper work station set up that allows you to sit and work comfortably. While we might not be able to have a complete commercial set up, comprising ergonomic chairs etc. at home, in most cases a table and chair is good enough. You can even place a cushion at the back of your chair to support your spine while sitting.

Another key point, and this is definitely important to reduce incidences of neck pain, is how you angle your laptop or screen while working. An ideal laptop height and angle lets you view the screen without rotating or flexing your neck. Consider using a laptop stand or larger screen when working from home. One tip is to simply elevate the laptop with a stack of books.

Investing in a simple home office set up - a table, a chair, a stool and a laptop stand will go long way in supporting your back and neck while working from home.

Include stretches in your routine

Work from home practices have shifted movement related dynamics as working professionals remain glued to their desks and screens for longer hours. Sitting for such extended periods without proper posture is detrimental to not only your spine and back muscles, but for your overall health.

A good way to avoid aches and pains at the end of the day is to include some light stretching movements in your work day. Simple stretches like cat and cow posture, toe touches, leg and calf extensions and head rotations are good enough to begin with. Together, this simple routine done for a few counts can alleviate the stress in your back muscles, reduce the risk of musculoskeletal injuries and improve posture and muscle coordination.

Not only is stretching beneficial for your back, it is also a great way to take a break from the screen, improve blood circulation and mental stimulation.

Mind your posture

Typically, good posture is defined as a position when your ear, shoulder and pelvis are all aligned in one straight line. However, it is natural to lean forward while working on a laptop or sit in a slouched position. Slouching or incorrect posture is often the main culprit that can lead to injuries of the spine and back, especially in the younger demographic.

Often when working in a commercial set up, ergonomics can solve this problem. The challenge then is how we can maintain the same while working from home.

One way to maintain good posture at the desk is to provide your back and neck good support. Consider using a toadstool so that your feet are well supported, keep your elbows at a 90-degree angle as you work on your laptop and change your position a few hours to avoid slouching on the desk. Include regular intervals from the screen and walk around your workspace to keep your spine and back muscles active. You can also get a family member or friend to nudge you when you start slouching, so you can correct your sitting position.

Don’t ignore those aches and pains

Lastly and most importantly, if your pain continues to persist over 6 weeks, is accompanied by sensations of numbness, tingling and has started to spread to the hip, legs, foot region, consult your physician immediately.

In most cases, mechanical pain or pain that arises from incorrect postures, sitting for longer hours etc. improves if followed by periods of rest. If your pain has not improved after long resting periods and you experience other symptoms like loss of appetite, fever etc. it could be an indication of several other disorders including spinal infection. This requires proper diagnosis and further consultations in order to ensure that medical intervention is given at the right time.

Back related problems, more particularly, lower back related problems have been on a steady rise since work from home became a norm in the pandemic. While there are several factors that contribute to this – such as unlimited sunlight, perceived deficiency of Vitamin D, restricted movement – small steps and changes at home can prevent these issues from leading to other lifestyle complications.


作者:林诗伟, ALTY骨科医院(ALTY Orthopaedic Hospital)


根据发表在国际健康科学与研究期刊(International Journal of Health Sciences and Research)上的一分报告,70.5%的18至65岁居家办工受访者表示感觉不舒服和疼痛,特别是在下背和颈部 。虽然这个资料不让人觉得意外,但绝对值得我们警惕,因为愈来愈多年轻专业人士回报说背部和颈部疼痛。

ALTY骨科医院(ALTY Orthopaedic Hospital)发现,愈来愈多25至40岁的大马人背部和颈部出了问题,特别是居家办工及久坐在电脑前面的人。随著大马再度实施全面行动管制令(FMC0 3.0),我们将看到年轻专业人士的背部和颈部问题继续攀升。1



















Don’t Ignore That Shoulder Pain – Here’s What You Need To Know About Frozen Shoulder

Dato’ Dr Badrul Shah Badaruddin, Consultant Orthopaedic,
Arthritis & Sports Surgeon from ALTY Orthopedic Hospital

By now, most Malaysians are probably well-adjusted to the whole working from home routine. Some parts of it may be enjoyable but other parts like aches and pain from a poorly set-up workspace – not so much. At ALTY Orthopaedic Hospital, we saw that shoulder pain is a common occurrence among patients, especially now where people are working from home and spending long hours in front of their devices.

The abnormal posture when someone crouches over a laptop for several hours each day can lead to shoulder injuries and pain. In addition, Malaysian are also living an increasingly sedentary lifestyle – especially during the pandemic that made keeping active a challenge. Our muscles become flaccid with limited movement, and this means even regular activities like opening a door or stretching to reach something might lead to muscle strain eventually leading to inflammation, or worse – a frozen shoulder.

What causes Frozen Shoulder

Frozen shoulder, also known as ‘adhesive capsulitis’, is a condition in which the movement of the shoulder becomes limited, characterized by stiffness and pain in the shoulder joint. Frozen shoulder occurs when the capsule that surrounds the normal shoulder joint become thick, stiff, and inflamed.

Other factors that can lead to frozen shoulder includes a sudden jerk of the shoulder or awkward sleeping position which could cause tendonitis. Tendonitis is an inflammation around the tendon that may spread to the capsule and causing it to be inflamed and stiff – resulting in a frozen shoulder.

Sometimes inflammation around the capsule that causes frozen shoulder can also occur as an acute response to viral fever or flu such as COVID-19 infection. It is quite common to experience joint inflammation when our body’s immune system is tackling the infections. This condition is known as viral arthralgia, and it usually disappears on its own without any lasting effects. Although in rare cases, the symptoms can prolong.

The process of getting a frozen shoulder usually begin with an inflammation. Inflammation causes pain that is worse with movement and limits the shoulder's range of motion. If the inflammation around the capsule is not treated properly, the pain and stiffness may develop into a chronic state. Therefore, any shoulder pain is worth getting looked at soon before something simple to deal with develops into something a lot harder, which may need surgery.

How to reduce inflammation?

Below are some ways to help reduce inflammation and keep it in check:

  • Muscle movement: Regular exercise is an excellent way to prevent inflammation. According to research published in the journal Brain, Behavior and Immunity, one 20-minute session of moderate exercise can stimulate the immune system, producing an anti-inflammatory cellular response.1
  • Heat or cold therapy: Heat can help to soothe stiff joints and relax muscles as it improves circulation and blood to flow to a particular area. While cold helps to reduce inflammation and swelling that causes pain, especially around a joint or a tendon. For basic heat therapy, you could use small heated gel packs, a hot water bottle, or a warm bath. For cold therapy, a water bottle filled with cold water, a pad cooled in the freezer, or cool water can be used.
  • Anti-inflammatory medicines: If the pain is causing a lot of discomfort, you could also speak with your physician for prescription drugs that can help to reduce your inflammation.

Treatment for Frozen Shoulder

The treatment for a frozen shoulder is focused on relieving pain and restoring the shoulder's normal range of motion. Below are some of the common treatments that we’d recommend for patients who is experiencing frozen shoulder:

  • Physiotherapy: Physical therapy is the mainstay of treatment for frozen shoulder. A physical therapist can provide exercises to help restore the shoulder’s range of motion and mobility. They may also prescribe anti-inflammatory drugs depending on the conditions. If the pain doesn’t subside for 3 to 6 months, patients may be given corticosteroids (anti-inflammatory drug) directly to the capsule.
  • Ultrasound treatment: An alternate treatment for frozen shoulder, ultrasound improves blood circulation and dilate the vessels. It can also help with improving the ability of the shoulder stretch and quicken the healing process by reducing pain as well as increasing flexibility and range of motion.2
  • Closed manipulation of the joint: A non-operative procedure done under full anaesthesia where the doctor will move the arm at the shoulder joint to break up the adhesions and loosen the stiff joints, resulting in improved range-of-motion. 95% patients will show immediate improvement and in many cases, they will be completely cured in this instance.
  • Surgical treatment: if all the conservative treatment fails, minimally invasive arthroscopic procedure may be the definitive treatment. It involves a keyhole surgery to release the adhesive capsulitis of the shoulder joint and only need one or two days of hospitalisation.

Shoulder pain can interfere with so much in your life, from work and play to sleeping. It’s important to get your shoulder checked if your pain doesn’t go away because with some injuries, such as frozen shoulder, the longer you wait for medical help, the harder it can be to treat the problem. If you have shoulder pain or swelling and it’s not going away, speak with your doctor about your diagnosis and treatment options.

Back to School Soon – Should You Be Worried About Heavy School Bags & Scoliosis?

Attributed to Dr Lim Sze Wei, Consultant Orthopaedic,
Spine and Trauma Surgeon, ALTY Orthopaedic Hospital

With schools reopening soon, it is time again for children to lug their heavy bags after almost two years of virtual learning. Prior to the pandemic, the topic of heavy school bags has been widely debated and the health issue that is commonly associated with it is scoliosis, a curvature of the spine that is often diagnosed in adolescents.

In Malaysia, studies suggest that scoliosis affects two to three per cent of the population — between 600,000 and 900,000 people1. Scoliosis usually affects teenagers from the ages of 10 to 17 during their growth spurt. The curves are often C-shaped or S-shaped and anything that measures more than 10 degrees on an X-ray is considered scoliosis. Possible complications of scoliosis include chronic pain, breathing difficulties, and a reduced capacity for exercise.

Are Heavy School Bags Causing Scoliosis

For many years, people have mistakenly believed that heavy bags can cause the spine to curve. However, research and medical reports have noted that there are no associations between the occurrence of scoliosis and heavy school bags2. It also doesn’t support the idea that heavy bag can structurally change a child’s growing spine.

Although heavy bags do not cause scoliosis, using them incorrectly or for prolonged periods can cause other forms of spinal problems such as back pain, bad posture, muscle weakness and fatigue. It is proven that adolescents who suffer from back pain will probably have chronic back pain as adults.

So, What Really Causes Scoliosis?

For one, scoliosis is not caused by carrying heavy school bags or anything a child or parent did or did not do. Scoliosis can occur in people with conditions such as cerebral palsy or muscular dystrophy but in most cases, scoliosis is idiopathic - which means there is no known cause. Nonetheless, there are a few risk factors that have been identified such as:

  • Age – Most cases occur when a child reaches their growth spurt at the age of 10 and older
  • Gender – Girls might have a higher risk of developing scoliosis than boys.
  • Family History – Scoliosis can be inherited genetically from parents, affected siblings or close relatives with the condition

Most cases of scoliosis are mild, but some curves worsen as children grow and severe scoliosis can be disabling. Cases of scoliosis with a known cause are rarer than idiopathic scoliosis cases. Non-idiopathic scoliosis is often caused by a poorly developed spine or as a side effect of other diseases such as neuromuscular conditions, connective tissue disorders, and genetic conditions.

How to spot if your child is showing signs of scoliosis

Scoliosis can worsen very quickly during adolescence because the child is growing fast during this period. The symptoms are also not always obvious in mild cases, thus, it is important that parents check their children from time to time. The earlier it is detected, the better the odds of preventing scoliosis from causing serious issues down the line.

The good news is parents can easily check for signs and symptoms of scoliosis at home. One of the most prevalent signs of scoliosis that can be observed include a difference in the height or position of shoulders, shoulder blades or hips – for example, one shoulder seems to be consistently drooping below the other. Another one is the head not being centred with the rest of the body.

Parents may also do a quick ‘Adam’s Forward Bend Test’ to see the curvature of the spine. They can do this by asking their children to bend forward with both palms between the knees, any disparity in the rib cage or other deformities along the back could be a sign of scoliosis. If there is a suspicious situation, it is absolutely necessary to consult the doctor without wasting time.

The Treatment for Scoliosis

For mild scoliosis cases, nonsurgical treatment methods such as exercise and bracing can help to slow or stop the progression of the curve, and it can also help to relieve the back pain associated with the condition. However, these methods cannot fix the curvature in the spine and patients will need to be monitored throughout their lives to ensure that the condition does not worsen.

Surgery is only necessary if the curvature in the spine is severe and interferes with the patient’s quality of life. If surgery is necessary, advances in surgical methods have made for a safe and effective procedure, with much shorter recovery times than were associated with scoliosis surgery in the past.

At ALTY Orthopaedic Hospital, when determining a child's best treatment plan for scoliosis, our team of specialists considers the severity of the curve, where it occurs in the spine, and the child's age and stage of growth. If there is a delay of many months in diagnosis or follow-up, we may miss the chance to use very effective methods to prevent scoliosis progression during growth and it can make the treatment more challenging.

It is critical that new scoliosis cases continue to be treated as quickly as possible, notwithstanding COVID-19. In adolescent cases particularly, even a few weeks can make a significant difference to the path of treatment as well as the potential outcome. The pandemic may have put a stop to many activities in our lives, but it hasn’t stopped kids from growing fast.

As a healthcare provider, I would recommend parents to consult their medical practioners as soon as they detect any changes in the child’s growth. With routine check-ups and timely intervention, conditions like scoliosis can be managed better, giving you child a better quality of life.

Should the COVID-19 Vaccine Impact your Surgery Schedule?

Dr Mohamad Fadhil Hadi, Consultant Anaesthesiologist & Critical Care
from ALTY Orthopedic Hospital

Malaysia has recently seen a surge in COVID-19 cases contributed by the highly transmissible Delta variant of the disease. As the number of COVID-19 cases in the country continue to rise, vaccinations play a huge role in our march forward to achieve herd immunity as well as protecting individuals from acquiring further infections.

Despite a slow start of the COVID-19 National Immunisation Programme (NIP), Malaysia now boasts one of the fastest vaccination rates in the, doling out up to 500,000 doses a day in July.

Vaccines can protect the people from getting and spreading the virus, and from getting seriously ill in the event when one is infected. This is especially vital for those who have underlying health condition and vulnerable to the virus.

One of the barriers in speeding up the vaccination program was the negative public opinion and misinformation of the vaccine, spread by ‘anti-vaxxers’. According to WHO, the risk of serious adverse reactions of vaccination is much lower than the risk of serious disease or even death caused by the infection with COVID-19.

Here’s why:

  • COVID-19 vaccines were developed using science and research that has been around for decades.
  • COVID-19 vaccines went through all the required stages of clinical trials, extensive testing and monitoring that proven the vaccine as safe and effective.1

Are there any associated risks to surgery after getting the COVID-19 vaccine?

That said, we are also seeing a rise in myths associated with the administration of the vaccine. One of the most recent pieces of misinformation circulating online is regarding the risk of getting adverse reactions from anaesthesia, especially for those who are vaccinated. This claim has been dismissed by The Malaysian Society of Anaesthesiologists and the College of Anaesthesiologists2, Academy of Medicine of Malaysia, and as to date, there is no scientific evidence to validate the unfounded misinformation.

For this, it becomes important for patients to have a little background understanding of anaesthesia. Anaesthesia is a treatment using drugs called anaesthetics to keep patients from feeling pain during surgery or medical procedures.

There are three main types of anaesthesia:

  • Local anaesthesia: used to numb just a specific location of the body temporarily while the person stays fully awake.
  • Regional anaesthesia: Block sensations of pain from a large area of the body, for example, spinal and nerve block anaesthesia.
  • General anaesthesia: Used to make a patient who undergoes a surgery or procedure to be completely unconscious or “put to sleep” temporarily. General anaesthesia can be injected into a vein or inhaled.

As described, anaesthesia and the COVID-19 vaccine operate in two completely different systems and as such anaesthesia does not pose any effect to our antibody, immune system or reaction towards any vaccines. Hence it is safe for patients to undergo surgery under local anaesthesia even after getting the COVID-19 vaccination.

At ALTY, in fact, we would encourage our patients to complete their COVID-19 vaccination before their surgery as this will pose a minimal risk of infection to not just the patient themselves, but also the healthcare workers in the hospital.

What should you do before going for your surgery

The type of anaesthesia used is usually determined by anaesthesiologists, depending on the type of procedure. They will determine the best course of action via thorough investigation of vitals and make sure that the patient is medically fit before undergoing any procedure.

It is best for patients to go for their pre-operative visit and consult with their doctor or anaesthesiologist, so they can schedule or plan for the elective surgery accordingly. During this session, I would encourage patients to share their medical history with their doctor, talk about previous their experiences with anaesthesia and clarify any further questions that they might have.

As an anaesthesiologist, I would advise my patients to rest for a few days after they have completed their COVID-19 vaccination, if it is an elective case. This is because some patients may experience side effect such as fever, muscle ache or nausea post the vaccine, which are commonly seen. However, if it is an urgent case such as bone fracture or spinal injury, we would proceed to perform the procedure.

In the face of uncertainties, people often turn to social media platforms for information. However, it is important to ensure that the information is obtained from trusted sources. You can always consult your doctor or meet a doctor through telehealth service for medical advice, if you are still unsure or need more information.

Rest assured, Malaysia operates an internationally lauded healthcare system, and was also ranked first as the world's best in healthcare with its world-class healthcare services and sophisticated infrastructure, by International Living in 2019. This should give patients further confidence in their healthcare professionals in Malaysia as they strive to do their best to deliver a seamless patient experience.

Patutkah Vaksin COVID-19 Mempengaruhi Jadual Pembedahan Anda?

Dr. Mohamad Fadhil Hadi, Pakar Anestesiologi & Penjagaan Kritikal
dari ALTY Orthopedic Hospital

Mutakhir ini, Malaysia sedang menyaksikan lonjakan kes COVID-19 dengan wujudnya varian Delta yang lebih mudah berjangkit. Berlatarkan situasi ini, vaksinasi memainkan peranan yang penting dalam usaha kita untuk memperoleh imuniti kelompok, di samping melindungi sesama kita daripada terus dijangkiti oleh virus ini.

Meskipun bermula pada kadar yang perlahan, Program Imunisasi COVID-19 Kebangsaan (PICK) kini mempunyai kadar vaksinasi yang merupakan antara tertinggi di dunia, dengan pemberian mencecah 500,000 dos sehari yang direkodkan pada bulan Julai.

Vaksin dapat melindungi orang ramai daripada dijangkiti lalu menyebarkan virus tersebut, selain berpotensi untuk menghidap penyakit yang serius. Kenyataan ini khususnya perlu diberi perhatian oleh mereka yang mempunyai masalah kesihatan yang sedia ada atau jika tubuh mereka lemah untuk melawan virus berkenaan.

Antara cabaran yang terpaksa dilalui untuk menggiatkan program vaksinasi ini ialah tanggapan negatif daripada warga umum di samping maklumat salah yang sering disebarkan mengenai vaksin, dibelakangi oleh golongan anti vaksin. Menurut WHO, risiko berlakunya reaksi negatif yang serius adalah lebih rendah berbanding risiko penyakit berbahaya atau kematian yang disebabkan oleh jangkitan virus COVID-19.

Sebabnya ialah:

  • Vaksin COVID-19 telah dibangunkan menerusi sains dan penyelidikan yang berusia berdekad lamanya.
  • Vaksin COVID-19 telah melalui semua peringkat ujian klinikal yang diwajibkan, termasuk ujian dan pemantauan ekstensif yang membuktikan bahawa vaksin ini adalah selamat dan berkesan1

Wujudkah risiko yang berkait dengan pembedahan selepas memperoleh vaksin COVID-19?

Pada masa yang sama, kita juga sedang melihat penularan mitos yang berkaitan dengan pemberian vaksin. Antara maklumat salah yang disebarkan baru-baru ini adalah mengenai risiko berlakunya reaksi negatif daripada prosedur anestesia, khususnya bagi mereka yang telah divaksinasi. Kenyataan ini telah disangkal oleh Persatuan Pakar Anestesiologi Malaysia dan Kolej Pakar Anestesiologi2, Akademi Perubatan Malaysia, dan setakat ini, tiada bukti saintifik yang dapat mengesahkan kenyataan yang tidak berasas ini.

Berlatarkan situasi ini, para pesakit kini perlu memahami sedikit sebanyak mengenai anestesia. Anestesia ialah rawatan yang dibuat menerusi pemberian ubat yang dinamakan anestetik untuk mengelakkan pesakit daripada merasai kesakitan ketika menjalani pembedahan atau prosedur perubatan.

Terdapat tiga jenis anestesia:

  • Anestesia setempat: Digunakan untuk mengebaskan lokasi kecil yang spesifik pada anggota badan buat sementara waktu ketika pesakit masih sedar.
  • Anestesia sebahagian: Menghalang rasa sakit daripada anggota tubuh yang lebih besar, misalnya anestesia tulang belakang dan saraf.
  • Anestesia am: Menjadikan pesakit tidak sedarkan diri atau “tidur” buat sementara waktu ketika menjalani pembedahan atau sesuatu prosedur. Anestesia am boleh disuntik ke dalam urat atau dihidu oleh pesakit.

Seperti yang dijelaskan, anestesia dan vaksin COVID-19 beroperasi dalam dua sistem yang berbeza, maka anestesia tidak memberi sebarang kesan ke atas antibodi, sistem imun atau mencetus reaksi terhadap mana-mana vaksin. Justeru, pesakit boleh menjalani pembedahan menerusi anestesia setempat dengan selamat selepas memperoleh suntikan vaksin COVID-19.

Malah di ALTY, kami akan menggalakkan para pesakit kami untuk melengkapkan dos vaksinasi COVID-19 mereka sebelum menjalani pembedahan kerana risiko berlakunya jangkitan dapat diminimumkan bagi pihak pesakit serta kakitangan kesihatan di hospital kami.

Apa yang patut anda lakukan sebelum menjalani pembedahan

Jenis anestesia yang akan digunakan lazimnya ditentukan oleh pakar anestesiologi mengikut prosedur yang akan dijalankan. Mereka akan menentukan kaedah yang terbaik setelah membuat pemeriksaan kesihatan secara teliti di samping memastikan tubuh pesakit bersedia untuk menjalani sebarang prosedur.

Adalah lebih baik jika pesakit membuat lawatan prapembedahan dan merujuk doktor atau pakar anestesiologi masing-masing untuk menjadualkan atau merancang prosedur yang dipilih dengan sewajarnya. Ketika sesi ini, saya akan menggalakkan pesakit untuk menunjukkan rekod perubatan mereka, berbincang mengenai pengalaman lampau melibatkan anestesia, dan menjawab sebarang pertanyaan.

Sebagai pakar anestesiologi, saya akan menasihatkan pesakit saya untuk berehat selama beberapa hari selepas mereka mengambil suntikan vaksin COVID-19, jika ia merupakan kes elektif. Ini adalah kerana sesetengah pesakit mungkin akan mengalami kesan sampingan seperti demam, sakit otot atau loya selepas vaksinasi, yang lazimnya akan berlaku. Bagaimanapun, dalam situasi kecemasan yang misalnya melibatkan isu patah tulang atau kecederaan pada tulang belakang, kami akan menyegerakan prosedur tersebut.

Orang ramai cenderung untuk merungkai ketidakpastian dengan memperoleh informasi dari platform media sosial. Namun begitu, kita perlu memastikan maklumat yang diperoleh adalah daripada sumber yang boleh dipercayai. Anda boleh merujuk doktor anda secara bersemuka atau melalui perkhidmatan telekesihatan bagi mendapatkan nasihat dan maklumat mengenai perubatan.

Percayalah bahawa Malaysia mempunyai sistem penjagaan kesihatan yang teriktiraf di persada antarabangsa, malah kita turut menduduki tangga pertama di dunia sebagai pembekal perkhidmatan penjagaan kesihatan terbaik yang menyediakan perkhidmatan bertaraf dunia serta infrastruktur yang bersofistikasi tinggi, dianugerahkan oleh International Living pada tahun 2019. Justeru, orang ramai patut berasa lebih yakin terhadap kakitangan kesihatan di Malaysia kerana mereka bersedia untuk membekalkan pengalaman yang terbaik buat kita semua.


ALTY骨科医院(ALTY Orthopedic Hospital)麻醉科及危重病部
Mohamad Fadhil Hadi医生






  • 开发新冠疫苗所应用的科技和研究,已经存在好几十年。
  • 新冠疫苗历经所有规定的临床实验阶段丶大量的测试及侦测,证明疫苗安全且有效 。1


我们也看到接种疫苗的相关迷思愈来愈多。最近在网络上流传的错误信息之一是打麻醉剂会有引起不良反应风险,特别是接种疫苗后的人。大马麻醉师协会(Malaysian Society of Anaesthesiologists)及麻醉科医学院(College of Anaesthesiologists2, 丶大马医药学会(Academy of Medicine of Malaysia)都驳斥了这点,截至目前,没有任何科学证据证明这种没有根据的错误信息。



  • 局部麻醉:暂时麻痹身体的特定部位,病患完全清醒。
  • 区域麻醉:阻断身体大部位痛感,例如脊椎及神经阻断麻醉。
  • 全身麻醉:暂时让接受手术或疗程的病患完全失去知觉或“入睡”。全身麻醉可以透过注射进入静脉或吸入。








请放心,大马的医疗保健系统都受国际赞美,International Living在2019年时更因大马的医疗保健服务及发展快速的基建属世界级而将大马名列世界榜首。这将进一步提升病患对大马医疗保健专业人员的信心,因为他们会尽最大努力提供无缝医疗体验。

How to Get Here

ALTY Orthopaedic Hospital
Ground Floor, Menara ALTY
187 Jalan Ampang, 50450
Kuala Lumpur


  • Operating Hours:
    Monday – Friday: 8.30am – 5.00pm
    Saturday: 8.30am – 1.00pm
    24-Hour Emergency Department
ALTY malaysia