Osteo-arthritis And Ayurveda !!

Osteoarthritis and Ayurveda

Osteoarthritis (OA), sometimes called degenerative joint disease or degenerative arthritis, is one of the commonest conditions of the joint. OA can affect any joint but it occurs most commonly in knees, hips, lower back and neck, small joints of fingers and the bases of thumbs and big toe.

Let’s understand anatomy of the normal joint first. A normal joint is made up of two or more joints bound loosely together by either a covering or muscular thickenings. These joints contain a factor known as Kaphais important to provide smooth surface for the movements of bones. This factor takes various forms in the joint. One of the forms is called articular cartilage. It is a firm rubbery material which acts as a cushion for bones covering their ends. The Kapha in the joint also takes another form. Many joints are covered with synovial membrane which secretes fluid called synovial fluid. The synovial fluid has a lubricating function, as it provides an emulsion-like surface for the smooth gliding of bones.

What happens in Osteoarthritis?

In OA, the cartilage breaks down due to its degeneration. And why does this degeneration take place? The matter is that when the Kapha factor is decreased in the body, and  its place is taken up by the Vaata factor which is drying, making surfaces porous. Similarly, the synovial membrane reduces the production of the fluid.

In OA, there is another phenomenon connected with inflammation. Now scientists believe that inflammation is the basic cause of OA.

As the OA worsens over time, the cartilage breaks down, causing pain, swelling and problems in moving the joint. Bits of joint or cartilage can chip off and fluid around in the joint. The cytokines and other enzymes that are a part of inflammation, damage the cartilage further. In the final stages, the cartilage is completely destroyed and the bone starts rubbing over the bone. In a sense body’s natural shock absorbers are wearing and causing more physical toll during day-to-day activities. In addition, when a person loses muscle tone and bone strength due to ageing, the physical tasks can be more demanding.

Who are at risk?

Practically, half of the world!! Common factor for developing OA is age. Most people who have OA are above 55. Yet, other factors also play a major role.

• Excess weight – Excessive weight means excessive load on the muscle and tendons, and bones and joints, obviously, causing extra wear and tear. When a person is obese, his channels are blocked. The channels are important for nutrition because the nutritive material from food passes through them, getting transported and transformed at the same time and reaching their final goal – bones and joints in this case. But, in obese patients, due to peculiarity of the metabolism these tissues are deprived and depleted, hence, they weaken further.
• Family history –

Genes play a role in developing OA. But one must understand that presence of genes of OA in the body and their expression are two different things. Genes may carry information necessary for developing but unless and until that information expresses, the disease cannot be manifested. This expression of genes depends upon the internal environment of the body, mind and consciousness. The genes have a potential capacity to make changes in the body. But for these changes to occur, there should be certain conducive environment in the body which is called as aamaavastha in Ayurveda. This not only depends on what you eat but also, how do you eat, how do you behave  at home, in the society, etc. So the effects of your actions on the mind and also the reactions of the mind to the actions of others definitely cause a change in the expression of genes.The food we eat, the exercise we do, our lifestyle, sexual indulgences, habits and addictions, our thoughts, happiness, positive feelings in our mind; all do play a role in this expression.

• Occupations – Certain occupations, such as those in construction, agriculture, cleaning, retail, weight lifting etc. increase a person’s risk for developing OA. Obviously, these jobs need much more movements of the joints and sometimes in altogether odd positions.

How OA can be treated?

Though OA is part and parcel of ageing process, its treatment is possible and can be divided in 2 categories.

• Preventive
• Curative

It is very important to control weight and prevent injuries to the joint – by the way of controlling adventurous activities. At the same time some positive actions can also be taken.

Regular abhyangam. Abhyangam, or an Ayurveda oil massage, is a very good therapy to prevent as well as treat OA. Oil massage is considered to be very effective in controlling pain on Visual analog scale(The visual analogue scale or visual analog scale (VAS) is a psychometric response scale which can be used in questionnaires. It is a measurement instrument for subjective characteristics or attitudes that cannot be directly measured. When responding to a VAS item, respondents specify their level of agreement to a statement by indicating a position along a continuous line between two end-points.) (Kate Soden, Karen Vinosent et al. – article in Journal of palliative medicine). According to Annals of Internal Medicine, a research undertaken in University of Colorado, Denver and Floride, confirmed that this kind of massage induces relaxation response, increased blood and lymphatic circulation, potentiation of analgesic effects, decreased inflammation and edema, increased endogenous endorphin release, and competing sensory stimuli to override pain stimuli.

In Charaka  Samhita[1], abhyanga therapy is mentioned as a regular procedure to slow down and (rectify) stall ( means stop)  the ageing process. In the study published in the magazine “Ayu”, it was shown that abhyanga is useful in reducing pain in 85% of the subjects.

1. Kizhi is a procedure which involves application of medication in the form of small bundles tied in silk or cotton cloth. In the study done by Dr. Bhowya B. K. et al., published in Journal of Traditional Medicine and Clinical Naturopathy, this therapy was found statistically significant in all objective parameters. It also has anti-inflammatory property and the area in contact gets improved local-metabolism and relieved stiffness. Kili also helps to reduce the guarding by muscles around the joints, thereby reducing pain. The medicines which are heated or fried in the oil and made into a bundle have an analgesic property . When this bundle is heated dipped in warm oil and applied on and around the joints, the overall effect of the warm oil and warm medicated juice, along with systematic application of strokes, is to relieve pain.

 

1. Basti or Vasti is an important procedure to reduce Vaata which is mainly responsible for degenerative disorders. It means expelling body toxins and vitiated doshas[2] by introducing medicated liquids or oils. The medicine thus given is found to reach various tissues of the body. According to the study conducted by Gyanendra Shuhla on “pharmacodynamics OF understanding of Basti” and published in International Journal of Pharmaceutical and Biological Archives, since the area of rectum is highly vascular, this unionized and lipid-soluble substances are readily absorbed directly into portal blood, thus making them  available throughout in body. The enteric nervous system (ENS) located in the intestines is a powerful mediator of many analgesic neurotransmitters. This ENS is stimulated by Basti medications relieving pain in OA.
2. The application of various medications in the form of hot paste around the joint is called Upanaha. This procedure stimulates the nerve endings and competes with pain carrying nerves and thus has analgesic effect. Nevertheless, it also causes reduction in the inflammatory process in the synovial membrane and cartilages, thereby slowing down the degeneration in OA.

 

Conclusion

 

Various treatment modalities for OA are being tried by various sciences throughout the world. If we take, for example, NSAIDs or Intra-articular injections, it must be said they have their own side effects. So much so that, NSAIDs are one of the major causes of ICU admissions in UK. Intra-articular injections on long term damage the joints. Acupressure or acupuncture can be helpful in relieving pain but it does not halt the degeneration. Ayurveda gives profound results in treating OA when coupled with yoga. Ayurveda therapies and medications are not only analgesic and anti-inflammatory but they are also helpful in restoring the joint degeneration, articular breakages and synovial swellings. Ayurveda therapies aim to restore the Kapha in the body and, as a result, heal the joint from within. But I would say rather than waiting OA to occur, if we start regular Panchakarma and other Ayurveda therapies, we prevent not only OA but many other old age related debilitating diseases like blindness!

----- Dr. Pranav Bhagwat    .

 

  

              

    

 

  

 

 

 

[1] Charaka samhita is a text book on Ayurveda.

[2] Doshas are biological factors in body responsible for health and disease.