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Overview

Home Remedies For Joint Pain: Procedure, Recovery, Risk & Complication

What is the remedy about?

Freedom of movement is taken for granted until it becomes limited and that too many times because of our deeds. However, sometimes, other causes come into play like arthritis or the inflammation of your joints. Home remedies can be very effective for these reasons to abolish and as first aid, you can always rely on them. Some of them are listed here. Turmeric and Ginger tea, they both are anti-inflammatory, and curcumin in turmeric is a powerful antioxidant. These lower the level of enzymes responsible for inflammation. Just bring in this tea in your meal for two times a day. Epsom salt soak is also highly effective. This salt contains magnesium sulfate and works great in getting relief from pain. Add 1/2 cup Epsom salt in the bowl of warm water and soak your joints in it. Another remedy is to lubricate with Olive Oil. Use ‘cold pressed’ olive oil to lubricate your joints and ease the pain. A compound called oleocanthal inhibits inflammatory enzymes, and one tablespoon works equal to 200mg of ibuprofen. Massage with it twice a day. Peppermint Eucalyptus blends oil have pain relieving or analgesic properties. With cooling sensation, they override your discomfort and ease the pain. Pectin and grape juice is yet another home remedy for joint pain. Pectin has been found to make the tissue into more elastic and lubricated state, resulting in pain-free movement. Mix one tablespoon of pectin with 100ml grape juice and drink 1-2 times daily. With all these home remedies doing their work and continued in your daily routine, you should never forget some basics like healthy food habit, exercise on a regular basis (which is a must) and drink lots of water. Having control over your weight is a must, and you should walk start with 15 minutes as a beginner.

Are there any side effects?

Its answer can vary person to person. A particular person can be sort of allergic to any one of the ingredients mentioned above and should take good care prior decide to go on with home remedies. You should backup yourself and avoid the products that irritate your body even if they are too good for the particular disease. Even the natural products, if not taken as prescribed or overdosed, can result in no effect or fatal respectively. A small dose test should be done where you should take only a little amount of the home remedy into use and watch out for any irritation or complication and if it is observed, immediately deny and reject that treatment and contact a doctor. Many of the above remedies are external one and are very much safe to use. If it looks safe but slow, then continue with it for longer periods and wait for the results. Always be in touch with an orthopedic doctor and if any medication prescribed by the doctor, continue them with these home remedies still running in the background. Also, remember if the combination of any medication ingested reacts badly with the food you ate prohibit that remedy.

What are the post-remedy guidelines?

If you want your treatment to be efficient at its peak, you need to support it with some post remedy guidelines that you should follow. The best guideline would be to recognize the cause of the disease and eliminate it by your daily efforts. Obese, or people who are overweight, should try losing some weight by regular cardiovascular exercise and few other methods like lowering the calorie intake. This would take off some pressure from the knees. Exercise on a routine is important as it strengthens the muscle around joints and acts as improved shock absorbers. If in extreme pain which is acute or sudden, you can apply ice to the affected part for 10-15 minutes which will give you a short relief from pain. If the pain is of long-term or chronic, you can apply moist heat as it improves blood circulation and relief from pain. Consume more omega-3 fats as they tend to reduce joint pains with their anti-inflammatory effects.

How long does it take to recover?

The type of pain or the cause of the disease can determine the duration of home remedy to produce its effects. When you determine the right remedy according to you disease type, the period to recover reduces dramatically. So first, find out what’s your problem, indications, signs and symptoms. Many times the disease is chronic, mostly in elderly persons, and just the home remedy is not enough to take you back to your healthy state. A proper guidance of an orthopedic doctor is appreciated. If the disease is acute, then home remedies can work wonder sometimes. Well said that the time taken could vary from days to month, and sometimes even years.

Are the results of the remedy permanent?

Yes, but only if the disease is acute and sudden or has a small cause to happen that can be cured quickly. In an elderly person, the bones become soft and sometimes porous, and home remedies are not just enough to treat it well. These remedies are solemnly made for a temporary cure and in major cases; surgery can be the last choice to recover. The soothing relief and the reduced pain are enjoyable only for few days if the cause is not looked upon. Seek medical help if required if pain is severe.

Is there any training or experts required?

The above said home remedies are of the simplest forms and no such training or supervision of experts is needed. You can try them at home whenever you want with no help required from any second person. Just be careful with the ingredients used and make sure you have no harm using them. If you do not get the desired results, don’t get disheartened and take advantage of another alternative home remedy. Also if your problems are severe one then make sure you contact orthopedic doctors, with the home remedies continuing in the background. Children should be under the supervision of adults during the whole procedure.

Effectiveness: High Side Effects: Very Low Time for Recovery: High Price Range : Approx INR 10 - 40 Training Requirement: No

Popular Health Tips

Advance Joint Replacements - What To Expect?

MBBS, MS - Orthopaedics, DNB - Orthopedics
Orthopedist, Pune
Advance Joint Replacements - What To Expect?

When your daily activities are limited due to severe pain or joint damage, it is when a joint replacement may be the best option. Joint replacements are done to restore movement and reduce pain. The most commonly replaced joints are the hips and knees. With advances in medical technology and operational expertise, these procedures have undergone major changes in the way they are done. The success rates have also proportionately gone up.

Hip replacement: The hip is a bone and socket joint, wherein the hip joint sits in the femur, which is the thigh bone. This could require replacement either due to a severe injury or due to regular wear and tear with aging. Replacement is considered when non-medical therapies like exercise and painkillers fail to improve the quality of life. In advanced joint replacement, both the ball and socket portions are completely replaced with artificial components (could be metal, plastic, or ceramic).

Knee joint replacement: The knee is a modified hinge joint formed between three bones – the patella (knee cap), the femur (thigh bone), and the tibia (shin bone). The knee can be affected either due to regular wear and tear or as a part of the trauma. When the knee joint is affected, the patient’s ability to move is greatly diminished, and thus requires treatment. If nonsurgical measures fail, then surgical correction is required.

What happens during the joint replacement?

  • These are major operations and are done in the hospital setting, with 1 to 2 days of hospitalization
  • The operation takes about 4 to 5 hours
  • The damaged cartilage or bone is removed and the part is prepared to receive the prosthesis
  • Titanium alloy is often used as it has the unique ability to fuse to the bone
  • Sometimes, plastic or ceramic is also used
  • These simulate the movement that was previously produced by the natural joint
  • Post operation, infection control is extremely important
  • Pain control initially could be through injection, and then gradually move to ad-hoc basis
  • With the pain and limitation on movement gotten rid of, the new joint should be gradually accustomed to movement. The surrounding tissue also requires time to heal and support the normal movement.
  • Return to movement should be gradual and under a physiotherapist’s guidance. Advance exercise as directed.
  • Diet should be modified to ensure the required nutrition is provided for proper healing
  • Other equipment like a walking stick, shower bench, handrail, or a walker may be required.
  • The first few weeks could require extensive help to move around and get back to normal activities.

Whatever the part replaced, with total joint replacement, these precautions should be adhered to, to ensure complete recovery and successful return to a stage of pre-operative movement. In case you have a concern or query you can always consult an expert & get answers to your questions!

4318 people found this helpful

Tips For Managing Joint Pain in Winter

MBBS, MS - Orthopaedics
Orthopedist, Delhi
Tips For Managing Joint Pain in Winter

People who suffer from arthritis are more likely to experience osteoarthritis symptoms. The intensity of the feeling of knee pain in winter is often linked to barometric pressure. In winter, there is a reduction in the pressure exerted by the air around us. This drop in pressure can cause the tissues around the joints to swell resulting in increased pain. The other possible cause of knee pain in winter can be explained from the influence of heat. Fluid in tissues becomes more viscous during winter. As a result of this increased viscosity, the elasticity of the muscles decreases, resulting in winter aches and pains. 

Some scientists believe that the higher pain intensity in winter is to be more of a psychological thing. Seasonal affective disorder is more during winter, and people suffering from mental depression seem to sense more pain during winter as the weather restricts outdoor activities. Improper intake of food also causes knee pain in winter due to undigested material. Even though winter arthritis is uncomfortable, the following tips help to make the joints work better and make you withstand the season easier.

Tips to Manage Joint Pain in Winters

  1. Physical activity in winter can reduce winter aches and pains and enhance overall health benefits. Low impact activities like aerobics, swimming in a heated pool, weight training, and riding a stationary bicycle can reduce stiffness, increase the blood flow, and support the knees. Thus, winter arthritis can be well managed by doing exercises.
  2. Diet also plays a vital role. Eating a balanced diet that comprised of low saturated fat, lean proteins, more fiber, and refined carbs helps to improve body functions during the winter. Drinking water throughout the day helps to reduce winter aches and pains. It is essential to consume easily digestible foods like vegetables. Consuming vegetables like carrots and cucumbers that have diuretic properties can help to eliminate waste products from the body.
  3. Vitamin D deficiency may worsen osteoarthritis. It is necessary to take a supplement vitamin D or ensure to make your diet is vitamin-D rich. Fish oil is a potent source of omega 3 fatty acids. Increase your intake of milk, a rich source of protein and calcium that help to strengthen the bones. Exposing the body to sunlight help to obtain vitamin D.
  4. Non-steroidal anti-inflammatory drugs such as aspirin and ibuprofen can be used to reduce inflammation and pain. Injecting a viscous substance can decrease the friction of the bones and ease the condition.

Home Remedies for Knee Pain in Winters

  1. Wrap the inflamed knees with blanched cabbage leaves. This can cool down inflamed knees. Aloe vera also helps to reduce inflammation.
  2. Comfrey (symphytum officinale) can act as an anti-inflammatory agent. Create a compress using mashed root or comfrey tea soaked bandages can also be used to reduce inflammation.
  3. Applying an ice-pack can help to reduce swelling and alleviate winter aches and pains. While applying ice-pack, ensure to cover the entire knee. Applying a bag of frozen peas to the area also works well. While using ice or heat therapy, make sure to do them carefully as over agressive and over doing it, can cause problems. 
  4. Steam therapy also helps to reduce pain in your knees. Soak your knee in a steaming hot water for 15 minutes. Applying hot water bag also can relieve knee pain in winter effectively.
  5. Winter aches and pains all over the body can be relieved by administrating massage therapy by a professional.
  6. Avoid applying strain or pressure on your knees. Take adequate amount of rest to reduce pain and swelling.

These are basic guidelines to help you. Contact your doctor for further management.

2937 people found this helpful

Knee Injuries - Things You Should be Aware of

MBBS, MS - Orthopaedics, Fellowship in Arthroscopy & Arthroplasty Shoulder & Knee
Orthopedist, Gurgaon
Knee Injuries - Things You Should be Aware of

Knee injury can occur from the direct blow as well as through stretching and twisting injuries. At times the ligament that holds the knee in place gets stressed and results in sprains. Depending on the extent of the ligament and fibre damage, the sprains are graded. Then there are knee injuries that are caused by overuse of it. These injuries cause harm to the tendons and the muscles. Since the knee is interconnected to a lot of other structures, any damage to the knee can have serious repercussion to other connected bones and ligaments.

What are the Risk Factors?

1. Muscle imbalance leading to hamstring spasm.

2. Imbalance of the thigh muscle leading to injury of the knee.

3. Pregnant women and people who are overweight are at increased risk of knee injury

Signs and Symptoms of a Knee Injury:

Knee injuries that are serious in nature can result in instant swelling along with difficulty in bending it. People may find it difficult to bear any sort of weight whatsoever. Joint pain, swelling, inflammation of the muscles are some of the other symptoms of injury to the knee. Pain, instability, locking of the knee can be felt while walking fast or climbing stairs.

When to Contact a Doctor?

Any knee injury should be instantly reported to a doctor. Signs such as deformity, loss of sensation, cold ankle, swelling of knee etc. are signs of a knee injury. A doctor should be consulted, if home remedies such as rest, elevation, compression and ice treatment fail to fetch any fruitful results. If the swollen area has become warm and red and accompanies fever, it is a sign to visit the doctor.

How is a Knee Injury Diagnosed by a Doctor?

A doctor starts the diagnosis with medical history along with physical exam of the patient. Doctor first does a thorough inspection of the nerve and blood supply of the area.The next step of the diagnosis includes palpation. This is a step where the doctor tries to find out the exact location of the pain and tries to correlate the same with the injury location. The doctor might also stress the ligament in order to find out if they are fine. Other imagery tests such as X-ray and MRI are performed to find out the exact location of the injury.

Treatment Available-

The nature of the injury decides the treatment plan. In many cases, the injured area is suggested to be kept at rest or moved in the specific direction as per the direction of a physiotherapist. For serious injuries with a tendon or ligament injury, a reconstructive surgery is necessary to get the knee to the original condition. The type of surgical procedure depends on the kind of Injury one have faced.

4621 people found this helpful

Torn Meniscus - 3 Ways It Can Be Treated

MCh Ortho, ATLS (AIIMS), Diploma In Orthopaedics (D. Ortho), MBBS, MS - Orthopaedics
Orthopedist, Kolkata
Torn Meniscus - 3 Ways It Can Be Treated

Meniscus refers to the soft ligament in your knee joint, which cushions your bones and protects it from wear and tear. It is vital for the fulfilment of regular activities and the health of your bones. Thus, a damage to the meniscus can be extremely painful. Meniscuses are exposed to injuries and shocks in case of rigorous activities and this is a fairly common syndrome faced by athletes and sports persons. It can cause a substantial amount of hurt and generally impairs movement to a large extent. It potentially gets worse as the inflammation sets in and the swelling grows. The risk of a meniscus tear increases with age. The treatment for a torn meniscus depends upon the degree of tear. While minor tears repair on their own, for graver injuries, the following therapies may prove effective.

Symptoms of a torn meniscus
1. You might be able to experience a popping sensation in your knee joint
2. Stiffness and swelling
3. You will experience pain, especially while you are trying to twist your knee
4. You might not be able to straighten your knee completely

The treatment for a torn meniscus depends upon the degree of tear. While minor tears repair on their own, for graver injuries, the following therapies may prove effective:
1. Light exercises: For slightly serious meniscus tears, there are certain knee exercises which are recommended to abort any further damage as well as to repair the wound. Limiting the activities which might exert pressure on the knees, getting adequate rest, using ice packs and wearing neoprene sleeves always aid in recovery.
2. Anti-inflammatory medications: Often, meniscus tears are cured with the help of anti-inflammatory drugs like Ibuprofen. They not only reduce pain but also enable the mending of the injured tissue. However, one needs to be aware of a few side effects which often become natural repercussions of such drugs. Possibility of ulcers and bleeding get increased by leaps and bounds on the intake of such drugs.
3. Surgery: For all other forms of meniscus tears, if healing is not obtained through non-surgical methods, the only option available is that of surgery. Such a situation arises when the pain becomes unbearable and the meniscus tear does not respond favorably to superficial treatments. These surgeries are less complicated than replacement surgeries. They usually do not involve any life threatening hazard and cautious and efficiently conducted surgeries release all pains and handicaps.
 

2676 people found this helpful

Taking Care of Your Joints as You Age

Membership of the Royal College of Surgeons (MRCS), MS - Orthopaedics
Orthopedist, Gurgaon
Taking Care of Your Joints as You Age

Skin is one of the most obvious parts of our body, which ages with an increase in the number of candles on our birthday cake. As you age, joints tend to become stiffer and less flexible. The body does not recover from bumps and bruises as easily as it did before, and it becomes difficult to stand for extended time intervals. This is caused mostly by a breakdown of cartilage and inflammation of the synovium.

What is cartilage?
Cartilage is a flexible connective tissue. It connects the ends of two bones in a joint. It is softer than bone tissue but less flexible than muscle tissue. Cartilage is responsible for the smooth movement of joints. 
With age, cartilage begins to degenerate. As the cartilage gets thinner, movement becomes more and more difficult. If left untreated, the cartilage may completely wear off leaving no buffer between the bones. This is one of the leading causes of knee replacement surgery. 

What is synovium?
Synovium is a membrane responsible for keeping the cartilage healthy. It produces a thick fluid that keeps the cartilage and joint lubricated. In cases of osteoarthritis, this membrane can swell up and produce excess fluid. This in turn causes the joint to swell as well. 

Along with age, factors like being overweight, genetics, gender and lifestyle also play a role in the condition of your joints. Being obese point towards a sedentary lifestyle and puts extra pressure on joints, leading to the thinning of cartilage. While men have higher chances of becoming osteoarthritis patients before 45, women have higher chances of developing this disease after 50. A healthy lifestyle is the easiest way to ensure that your joints work well even when you're old and grey. 

Exercise
Movement of the joints keeps the fluid in them moving. It also prevents the cartilage from shrinking and stiffening up. Exercise also makes the bones stronger, and slows the rate of bone tissue deterioration. Stretching exercises are also a good way to maintain the flexibility of joints. 

Healthy diet
Foods that are known as natural antihistamines, antioxidants and foods that fight inflammation promote healthy joints. Some of these are:

  1. Green tea: It prevents the breakdown of collagen and cartilage
  2. Nuts and seeds: These are rich in omega 3 fats that are essential for good bone health
  3. Ginger: It relieves pain and joint swelling
  4. Yogurt: It helps soothe tender joints and fights inflammation
  5. Pomegranate: It protects the cartilage against damage

Hot and cold therapy can also help relieve joint pain and reduce inflammation. As you get older, avoid putting too much pressure on your joints and give them adequate rest. Lastly, avoid smoking, as people who smoke have an increased risk of cartilage loss.

Related Tip: "How Homeopathy Can Cure Muscle and Joint Pain?"

4216 people found this helpful

Popular Questions & Answers

I have pain in my knee joints. Doctors have suggested for knee replacement. I don't want to go for surgery. Please suggest alternative medicines.

Hand Surgery SR Ship, MS - Orthopaedics, Thesis Work, M.B;B.S
Orthopedist, Jaipur
Dear sir, if you can send me the following x ray this can be discussed further. X ray knee joints b/l ap and lat views, (weight bearing x rays)

I am 60 years old & having chronic pain in my knee joint which has become more severe after chikungunya 5 months back. I can't walk properly & have very much pain in my knees. I have consulted a Dr. & they have advised for knees replacement option as the only solution. Is there any other alternative? As I don't want to undergo an operation. What is rheumatology? I have heard that there is a treatment under rheumatology. please advice.

BPTh/BPT
Physiotherapist, Kolkata
You can consult with Orthopaedic Arthroscopic surgeon for your knee joints and Rheumatology is joint pain disease its original name Lupus consult with Rheumatologist better for you use good quality knee brace menopause happens thats why knee jt pain can come sit on floor, flex your knee, knee bending all are X use choamote for potty take IFT over knee joints 12 days @ 15 min in a joint in a month take 3 months ok.

I am 48 yrs, I am having pain in right knee, doctors saying for KRT, but I am not interested. Do you have any alternative treatment for my pain?

MS- Orthopedics
Orthopedist, Ahmedabad
Go for Physio and hyaluronic acid injections and if arthritis not in very advanced stage you may consider high tibial osteotomy operation at a later stage if not relieved by above treatment.

Hello but Dr. its being 7 months pls tell me should I go for physiotherapy as my joint pain badly like anything. Any natural medicine which will help me in post chikungunya arthritis.

BPTh/BPT, MPT - Orthopedic Physiotherapy
Physiotherapist, Jamshedpur
Dear you can concern. And also you have to do exercise in concern with physiotherapist. It will take time and you can recover from your problem.

Table of Content

What is the remedy about?
Are there any side effects?
What are the post-remedy guidelines?
How long does it take to recover?
Are the results of the remedy permanent?
Is there any training or experts required?
Play video
Joint Pain
Ayurvedic treatment for joint pain and arthritis.
Play video
Joint Pain
Joint Pain: Causes and Treatment
Play video
Osteoarthritis Of Knee Joint
Hi!

My name is Dr Deepak Kumar Arora. I am joint replacement and orthopaedic surgeon. Today I will tell you about osteoarthritis of knee joint.

Osteoarthritis is a very disabling disease of old age. In osteoarthritis a healthy cartilage of knee is worn down post pain and knee stiffness of knee joint and the treatment of osteoarthritis depends upon the grade of osteoarthritis. In grade 1-2, usually require medications and in grade 3 usually require intra RTO injections which lubricate knee joints. Sometimes in rare cases the patient requires Arthoscopy to relieve the pain in grade 4 if the patient remains symptomatic in spite of all measures then total knee replacement is the best available option total knee replacement nowadays it is very successful surgery.

In total knee replacement we replace the roll out cartilage with body friendly implants and bone and the muscles remain same total knee replacement is a simple procedure of 7 days in which patient remains hospitalized for 7 days first De we investigate the patient for surgical fitness on second day we operate the patient it takes about 2 hours for both knees and third day we start with physiotherapy 4th and 5th day we make the patients sit walk and stand go for washroom everything 7th day patient goes home.

Play video
Ayurvedic Treatment for Joint Disorders
The Ayuredic approach to cure joint pain and other joint disorders

Good morning everyone my name is Dr. Pratik Bhoite and today we are going to discuss Joint disorders and its remedies by Ayurveda.

Ayurveda is the science of life it is a non side effective treatment which is there from ancient times. Ayurveda is known to cure chronic diseases and joint problems from the past many decades. Now what exactly is joint disorders any problem happening to your joint in which there is pain stiffness swelling is called joint disorders. The most common form of joint disorders is arthritis. Arthritis today affects more than fifteen percent of the Indian population. it is a serious problem basically a problem which was occurring in the age of 60s today is knocking those when you are at the age of 30s. So it is a great concern for everyone. How does Ayurveda help in the joint problems.

Joint disorders have been or to immune in nature. Rheumatoid arthritis, alkalizing spondylitis, gout these diseases have grabbed people of today. So in Ayurveda basically the ayurvedic formulations along with panchakarma therapy has been found very effective in the joint diseases. Ayurveda is known to give a specific disease wise a dietary regime which when followed by the patient is really helpful and is found to be effective. Ayurveda has do's and don't which when followed in the right manner helps the patient to reduce the symptoms. Joint disorders basically include the main symptom pain. Patient are really worried regarding the pain when they are walking or when it is paining continuously and if their pain subsides they find joint disorders to be cured but actually the joint disorders is not cured.

So Ayurveda believes in removing the disease from the root cause. Hence it is very important to get rid of the diseases causing elements and eliminate the cause which is causing the disease. Thus by having prepared formulations and following a dietary regime along with a specific exercise really helps in joint disorders. Now let us move on to panchakarma today the pancha karma treatment is known to all now what exactly is this panchakarma treatment.

Panchakarma treatment is nothing but a natural way in which the diseases causing elements are removed out of the body. For joint disorders basti that is medicated anima is found to be the most effective treatment of all. Thus when these Ayurvedic formulations are taken it reduces that increased vata dosha in the body which causes decrease in the vitiation of pitta and cough and ultimately the defective asti and mojada to which are the integral part of the joint are cured thus, in the long run, the joint remains healthy. So you can imagine at the age of 60 someone saying hey I am consuming Ayurvedic medicines and am healthy. It reduces the degeneration which is happening in the body and keeps you healthy thus the Ayurvedic medicine is found to be very effective in joint disorders even though the treatment takes time but having a longer duration treatment helps you to make sure that the healing of the body and the diseases causing elements are removed from the body.

So, I hope that with the treatment surely helps you in your joint problems for ayurvedic treatment and punchkarma therapies. It is very easy to get in touch with me at lybrate.com. thank you stay blessed, stay healthy. God bless you.
Play video
Top Home Remedies to get rid of Dandruff
Looking over your shoulder while driving is a healthy habit. But looking over your shoulder to check for dandruff could be quite embarrassing, especially for women.

Dandruff is a common scalp condition that is usually chronic but not contagious (unless caused by infection). Formation of dry, white flakes of dead skin on hair and scalp is dandruff. It may also be accompanied by itching and burning sensation.

Those with oily skin are more prone to this problem because it is often a mild form of seborrheic dermatitis.

Dandruff is caused by:

- cold, dry weather
- infrequent shampooing
- overgrowth of yeast-like fungus (malassezia)
- sensitivity to hair products
- conditions like eczema and psoriasis
- hormonal changes
- stress
- a diet lacking in zinc and b vitamins

Try these home remedies to get rid of dandruff:

Home remedy 1
- take a handful of neem leaves.
- boil them in 4 cups of water.
- cool and strain this solution.
- rinse your hair with this decoction 2-3 times a week.

Home remedy 2
- take some coconut oil.
- add half the amount of lemon juice in it.
- mix them thoroughly.
- apply this mixture to the roots of your hair and massage for a few minutes.
- leave on for about 20 minutes before rinsing it off.

Home remedy 3
- take 2 tablespoons of apple cider vinegar.
- add an equal amount of water.
- add 15-20 drops of tea tree oil.
- mix the ingredients well.
- massage your scalp with the mixture.
- rinse after a few minutes.
- follow this remedy 2-3 times a week.

Now you can confidently say" look, no dandruff anymore"

Having issues? Consult a doctor for medical advice