Question 1

A 35-year-old male patient presented with bilateral shoulder pain of 6 months' duration, worsening over the past month with limited range of movement. How would you work this up?

Dr. Rakesh Mahajan · Accepted Answer

First rule out diabetes and thyroid disease, which account for around 30% of bilateral shoulder presentations in practice, then check for manual/overhead work. If negative, get a plain X-ray to rule out joint space narrowing and calcific tendinopathy, then trial physiotherapy (ultrasonic therapy, TENS, shoulder exercises) with a 3-week NSAID course. In this case, rheumatoid factor came back positive with MRI showing bilateral partial-thickness supraspinatus tears and subacromial bursitis — so the approach became NSAIDs, DMARDs for the underlying rheumatoid disease, a triamcinolone injection into the subacromial bursa, and physiotherapy. A repeat steroid injection should not be given before 3 months. If there is still no response, proceed to shoulder arthroscopy to debride the bursa, assess the AC joint and address the tendon tears directly.

Question 2

Must all cases start with medical treatment before progressing to regenerative therapies?

Dr. Rakesh Mahajan · Accepted Answer

Yes. Chronicity is labelled at 3 months, with 6 to 12 weeks as the clinical boundary. A patient should start with NSAIDs, not regenerative therapy. Only if steroid injection has also failed to control the inflammation between 6 and 12 weeks should regenerative therapy be considered, and 3 months is the ideal timing.

Question 3

How is PRP prepared?

Dr. Rakesh Mahajan · Accepted Answer

Around 10 to 14 ml of blood is drawn from the patient into a kit-supplied vial containing heparin, then centrifuged to separate the platelet-rich plasma from the rest of the blood. This typically yields about 5 ml of PRP solution, which is injected as multiple pricks around the tendon or ligament rather than as a single injection, to achieve the best results.

Question 4

How does PRP promote healing at the cellular level, and what growth factors such as PDGF and TGF-beta are involved?

Dr. Rakesh Mahajan · Accepted Answer

Platelets contain multiple growth factors, including PDGF and TGF-beta, that promote healing through two mechanisms: increasing vascularisation of the target tissue and stimulating cellular regeneration. One group of factors increases local blood supply, while another increases cellular activity — together they drive ligament, tendon and articular cartilage repair.

Question 5

What nutraceuticals do you recommend for joint pain treatment?

Dr. Rakesh Mahajan · Accepted Answer

For articular cartilage involvement, collagen type 2, often combined with Boswellia, promotes cartilage cell multiplication and needs to be taken long-term. For partial tears of ligaments and tendons — which are rich in collagen type 1 and 3 — separate collagen 1 and 3 formulations are more appropriate, since they support healing of that specific tissue.

Question 6

Fitness influencers push weight training for long-term bone density, but there's a real risk of injury from bad form or pushing beyond one's capacity. How do you balance that?

Dr. Rakesh Mahajan · Accepted Answer

Go in a graded way and know your own limits — the simple principle is Young's modulus: push a muscle or tendon beyond its elastic limit and it will fail. Many young patients doing heavy weights on a gym instructor's encouragement end up damaging their elbows and shoulders. Proper training for gym instructors would prevent a lot of this. That said, if instruction is proper and progression is graded, strength training in younger years does directly help maintain bone strength into old age.

Question 7

Fitness influencers often push up to 2 grams of protein per kilogram of body weight, while doctors generally recommend 0.8 to 1.5 g/kg. What is your view on overuse?

Dr. Rakesh Mahajan · Accepted Answer

Overuse will definitely damage the kidneys, and can even cause kidney shock with permanent damage. There is also a real risk that commercial protein products are contaminated with anabolic steroids. Gym users should consult a nutritionist or dietitian to be guided on protein source and dose relative to body weight and activity level, rather than following generic online advice.

Question 8

Is there an age limit for using PRP injections for joint pain?

Dr. Rakesh Mahajan · Accepted Answer

No, there is no age limit — it can be given from young patients up to the 60s or 70s without a problem. The only practical consideration is the blood volume required: around 14 to 15 ml for PRP and 10 ml for GFC.

Question 9

Can PRP and steroid injections be used concurrently?

Dr. Rakesh Mahajan · Accepted Answer

No. Steroid is given for active pain and inflammation, early in the treatment pathway. Regenerative therapies like PRP are used once the condition is confirmed chronic with no active inflammation. Combining them is counterproductive, since steroid's anti-inflammatory effect can work against the regenerative signal from the growth factors.

Joint Pain in the Younger Population: Causes, Prevention and Modern Treatments

Questions Doctors Asked Dr. Rakesh Mahajan