The HEALTH | January-February . 2025

Insights for a comfortable tarawih for especially older adults

BY FARISHA RAHMAN

While the spiritual benefits of these prayers are undeniable , the physical strain on the body-especially on the shoulders and knees-cannot be overlooked . Understanding the science behind these pains and how to manage them effectively can help maintain one ’ s health while performing acts of worship .

SHOULDER AND KNEE PAIN

In a live interview with IKIMfm , Dr Jonas Fernandez , Orthopedic and Sports Surgeon at Pantai Hospital Cheras , said shoulder pain was commonly associated with issues in the rotator cuff , which consists of muscles and tendons that stabilise and move the shoulder .

The ball-and-socket joint of the shoulder can become inflamed or injured due to repetitive motion , degenerative conditions , or trauma .

Knee pain is another widespread issue , particularly among older adults . One of the primary causes of knee pain is arthritis , a condition where the cartilage in the joint wears down over time .

Dr Fernandez explained this process using a simple analogy : “ Imagine a brand-new shirt . Over time , after frequent use , it starts to tear and wear out . The same happens to our joints . The more we use them , the more they deteriorate .”

Knee pain often results from osteoarthritis , ligament injuries such as anterior cruciate ligament ( ACL ) tears , or meniscus tears . Dr Fernandez explained that ageing naturally wore down cartilage , making the joints more vulnerable .

Additionally , repetitive movements , excessive weight-bearing activities , and past injuries can accelerate this deterioration .

For many , prolonged standing , bowing ( rukuk ), and prostration ( sujud ) in Solat can exacerbate existing pain in these areas . The repetitive bending and kneeling movements put a strain on the knees while maintaining arm positions during takbir ( raising the hands ), and sujud can stress the shoulders .

SPIRITUAL AND PHYSICAL CHALLENGE

During Ramadan , Solat Tarawih can last between eight to 20 rak ’ ahs , depending on the practice of the congregation . This

The full video is available on IKIMfm ’ s YouTube channel .

Dr Jonas Fernandez with IKIMfm hosts ( from left ) El Mohsen , Tyzo Xander and Sis Yati . extended prayer performed daily for a month , involves continuous standing , bowing , and prostration , which can be demanding for those with existing joint issues .

Dr Fernandez emphasised that movement patterns in prayer can either help maintain flexibility or worsen joint conditions , depending on an individual ’ s health status .

For example , patients with osteoarthritis may find it challenging to rise from sujud due to weakened knee cartilage , while those with shoulder impingements might struggle to perform takbir comfortably .

However , prayer itself has been recognised as a form of mild physical therapy . The gentle stretches during rukuk and sujud promote joint mobility and circulation , helping to maintain flexibility . However , for individuals experiencing pain , modifying the way they pray , such as praying on a chair or using additional support , can prevent further injury .

MANAGEMENT STRATEGIES

Adopting evidence-based orthopaedic practices for managing joint pain is crucial to continue performing acts of worship comfortably . According to Dr Fernandez , one of the most effective ways to alleviate pain and prevent further damage is through physiotherapy and strengthening exercises .

For shoulder pain , targeted exercises can help stabilise the rotator cuff , reducing the risk of dislocation or impingements .

Meanwhile , knee pain caused by osteoarthritis or ligament injuries can be managed through quadriceps and hamstring strengthening , which help support the knee joint and minimise strain during movements like sujud and rukuk .

Pain management also plays a significant role in maintaining joint health . Non-Steroidal Anti-Inflammatory Drugs ( NSAIDs ) are commonly prescribed to reduce inflammation , while topical treatments such as warm compresses , muscle gels , or sprays can offer temporary relief .

In more severe cases , corticosteroid injections may be recommended to manage chronic pain . However , these treatments only address the symptoms . For long-term relief , it is essential to address the root cause of the pain , which may sometimes require surgical intervention , such as rotator cuff repair or knee replacement surgery for advanced cases .

Maintaining a healthy weight and consuming a nutrient-rich diet also contribute to joint health . Dr Fernandez emphasised that excess body weight puts additional stress on the knees , accelerating cartilage wear and worsening pain .

With Ramadan approaching , Muslims can take advantage of fasting to adopt a balanced diet that includes antiinflammatory foods such as fish rich in omega-3 , nuts , and turmeric . Proper hydration during sahur and iftar is also essential to keep the joints lubricated and reduce stiffness .

Modifying prayer postures can help prevent further injuries for those experiencing significant discomfort during solat . Using a prayer chair or placing extra cushioning under the knees can provide much-needed support for individuals suffering from osteoarthritis or ligament injuries .

Dr Fernandez advised that those with severe knee pain should avoid full sujud to prevent falls and fractures , particularly among older adults .

“ You know your body best . Don ’ t force movements that cause pain ,” emphasised Dr Fernandez , who is also a regular columnist with The Health , and is fulltime at Putrajaya Hospital .

In Islamic teachings , when a person is unable to perform an act of worship due to health reasons , they are permitted to modify it . This principle aligns with modern medical recommendations - if prayer movements cause severe pain , modifications are encouraged . Even praying in a sitting position is accepted in Islam , ensuring that worship remains accessible to all .

WORSHIP AND PHYSICAL WELL-BEING

Solat is both a spiritual practice and a form of movement therapy . While prolonged prayers like Tarawih may strain the knees and shoulders , following proper medical advice , strengthening exercises , and prayer modification can ensure that Muslims can continue their worship without compromising their health .

As Dr Fernandez highlighted in his interview , understanding the root cause of pain and seeking proper treatment was essential . By integrating both scientific and Islamic approaches , we can maintain our physical well-being while reaping the immense spiritual benefits of Ramadan . – The HEALTH