Relevance of Low back Pain

Low back pain is a very common health problem worldwide and a major cause of disability - affecting performance at work and general well-being. The 2010 Global Burden of Disease Study estimated that low back pain is among the top 10 diseases and injuries that account for the highest number of DALYs worldwide¹. The lifetime prevalence of non-specific (common) low back pain is estimated at 60% to 70% in industrialized countries. The prevalence rate for children and adolescents is lower than that seen in adults but is rising.^2,3 Prevalence increases and peaks between the ages of 35 and 55.⁴

Low back pain is the leading cause of activity limitation and work absence throughout much of the world, imposing a high economic burden on individuals, families, communities, industry, and governments.^2,4 In the United Kingdom, low back pain was identified as the most common cause of disability in young adults, with more than 100 million workdays lost per year.⁵ In the United States, an estimated 149 million workdays are lost every year because of low back pain,⁶ with total costs estimated to be US$ 100 to 200 billion a year.^7,8 Low Back Pain is the major Work Related Musculoskeletal Disorder among the IT professionals in India⁹. In the same study it was found that, more than 50% of them reported Low Back Pain at some point of time. Worldwide, 37% of low back pain was deemed attributable to occupational risk factors. The fraction varied somewhat among regions (21% - 41%) and was higher in areas with lower health status in general.¹⁰ As the world population ages, the disease burden of low back pain will increase substantially due to the deterioration of the intervertebral discs in older people.

Our great Science of Life “Ayurveda” has withstood the test of time in a glorious manner. The manuscripts/scriptures that are believed to have been written 5000 years ago contain medications and treatment modalities that are potent even today, proved through various scientific parameters of the present era. It is the eternal “TRIDOSHA” and “PANCHMAHABHOOT” Siddhanta that makes our branch of medical science evergreen.

What is Katigraha (lower back pain)

Katigraha is one of the Vata vyadhi which affects the lower limb. Even though this disease is not life threatening, it hampers the daily activity of the person. It is neurological as well as musculoskeletal disorder, cardinal features being restricted movements of the spine and pain in low back region.

Diseases related to Vata (one of the Tridoshas besides Pitta and Kapha) are many and presentation of it is in the whole body. Cardinal symptom of Vata vitiation is pain which is known as Shula in Sanskrit. “Vatadrite Rujah Nasti” This pain is universally understood as a marker of the disease and it is the most common symptom that makes a person seek physician’s advice. Almost all the Acharyas of Ayurveda have mentioned 80 Vataja Nanatmaja Vyadhi. Katigraha is a Vataja Nanatmaja Vyadhi described by Sharangadhara¹¹. He has explained it as ‘Katisthambhana Vedana Vishesha’ a condition marked by pain and stiffness in the Kati pradesha (Pelvic region). The term Katigraha is explained by Acharya Sodhala as a condition characterised by the vitiated vata either shuddha or with Ama, taking ashraya in the Katipradesha causing Ruja and Graham in the area. We also find brief description of Kati Graha as a disease with its etiological factors, symptoms, and treatment in Bhavaprakasha AmaVatadhikara¹² and Gadanigraha Vatavyadhiadhikara¹³. Here it is explained as a condition characterized by Shula and restricted movements of Kati caused by Vata. None of the Bruhatraies (Charak Samhita, Sushrut Samhita and Ashtang Hridaya) have explained Katigraha as a separate disease but have considered it as a symptom in various diseases such as Arshas , Ashmari, Bhagandara, Ajeerna, Kshataksheena, Vatajwara and some other diseases.

What is Marma?

Vyutpatti (origin) of word Marma

“Mru maneen jeevasthaane, Sandhisthaane taatparye cha”¹⁴

Its meaning is explained as Sandhisthanam or Jeevasthanam. Etymologically each letter of the word Marma has got specific meaning. Ma-means Prana or Vayu, Repha denotes house or seat. And hence marma means the site where Prana or vital energy resides.

Definition of Marma

“Marmaani naama maamsa siraa snaayu asthi sandhi sannipatah; teshu svabhaavata eva praanatishtanti”¹⁵

Acharya Susruta has defined marma as the anatomical site where Mamsa, Sira, Snayu, Sandhi and Asthi dhatu meet together. Also it is the site where Prana (Vital energy) of the body resides. Agni, Soma, Vayu, Satwa, Rajah, Tamah, Bhuthatma and Panchendriyas are called Pranas¹⁶. It engulfs all basic factors that sustain life.

Acharya Charaka has opined that it is the site of Chetana, and hence the sense of pain will be more in this region compared to other parts of the body¹⁷. In Ashtanga Hridaya Acharya Vagbhatt has defined Marma as the site where Mamsa, Sira, Snayu, Asthi, Sandhi and Dhamani confluence¹⁸ . He has also said that the sites which are painful, tender and show unbearable throbbing after getting afflicted with an injury should also be considered as Marma Points.

Acharya Sushrut has clearly defined a total of 107 Marmas in our body. The points cover both the front and back of the body , including 22 on the lower extremities (11 in each), 22 on the arms (11 in each), 12 on the Thoracic, Abdominal region anteriorly, 14 on the Back, and 37 on the Head and Neck¹⁹ Marma points are located and measured by the finger widths, called anguli. Unlike the tiny, pin-pricked-sized points in comparable therapies like acupuncture, Marma points are relatively large and easy to find. They have also been classified on the basis of the effects they produce when injured into five different categories.

Marma Therapy

Marma Therapy is the art of touching/stimulating an individual in exactly the right place of marma at a critical moment in time, for the purpose of healing. Marma serve as points of access to the body’s innate intelligence, opening the doorway to health and well-being. As per Acharya Sushrut Marmas are the vital points which need utmost care while performing surgical procedures. The details of marma are present not only in our scriptures but also in Vedas ,Upanishads²⁰, and Puranas apart from our Samhitas Varmam points and Varmalogy has been meticulously described in various Tamil literatures. Also ancient Indian martial arts called Kalari utilizes knowledge of varmam points to a great extent.

It is intelligence, skill and cognition that make man the superior being on earth. Skill of the human lies mainly in his efficiency to perform various actions with his hand, with knowledge of the subject as the background for it. Acharya Sushruta has mentioned “Hastameva pradhaanatamam yantranam” (which means human hand is the most important instrument). Major marma points correspond to the seven chakras, or energy centers of the body, while minor points radiate out along the thorax, abdomen, head, neck and limbs. Marma therapy is an important tool of both disease prevention and disease treatment in Ayurveda. It can be used to balance the doshas, to increase agni (the digestive fire), for detoxification (reduce ama), as well as to promote energy (vajikarana) and aid in rejuvenation (rasayana). It can be part of special clinical methods (like Pancha Karma) but also part of self-care and our daily health regimen²¹. The treatment of marmas, though having many methods, is primarily a matter of therapeutic touch.

Why Marma Therapy?

India is still a developing country having low socioeconomic population which cannot afford much for ailments causing disabilities. Treatment of such ailments proves costly in Allopathic medicine as well as in Ayurveda by Shodhana and Shaman.

Previously a number of researches have been carried out on the management of LBP by various methods of Shodhana and Shamana which is expensive to the patients. Despite of a large amount of research in this field, there is uncertainty regarding the best approach for the management of LBP. In allopathy system at present it is treated mainly with analgesics²² which have their own side effects. Disc surgery remains the last option when all other strategies have failed, but the outcomes are disappointing²³.

Marma Therapy is a strategy to treat LBP after several evidences suggests its quick effectiveness and low economic cost.

How Marma Therapy works

Marma points are specific areas on the body, which has relation through Pranic channels to various internal organs, doshas and srotas. As the technique of massage developed, these points were used to stimulate the internal organs. As in Sushruta Samhita, Siravedha, Agnikarma and Kshara karma have been discussed. In these treatments certain points have been correlated with certain internal organs and doshas. Taking these references into account, Marma therapy has been developing. One can control (stimulation or suppression) internal organs, doshas and channels through various Marma points. As junction points between consciousness and physiology, they provide a window into interchangeability of energy and matter.

"A Marma point is the junction between physiology and consciousness," says Ed Danaher, Director of the Panchakarma department at the Ayurvedic Institute in Albuquerque, New Mexico. Touching a marma point changes the body’s biochemistry and can unfold radical, alchemical change in one’s makeup. Stimulation of these inner pharmacy pathways signals the body to produce exactly what it needs, including hormones and neurochemicals that heal the body, mind and consciousness says Dr. Vasant Lad²⁴.

What we do...?

Pareekshaam abhiprashamsanti kushalaah Acharya Charaka

A constant re-examination or re-evaluation of every theory or fact is therefore, the very essence of science. In our institute at Gurukul Kangri Campus Uttarakhand Ayurveda University we treat many patients of Low Back Ache both on IPD and OPD levels by proper stimulation of various Marmas of the lower extremities and back viz

• Kshipra
• Talhridaya
• Gulf
• Indrabasti
• Janu
• Kukundar
• Katikatarun
• Parshvasandhi

Of these also which set of Marmas to be stimulated and the duration of the therapy depends on various factors viz severity, duration, cause of the Low Back Pain. The art and technique of stimulation varies for each of the marma. Care has to be taken for adequate pressure application only to avoid complications. Identification of each marma is also very important for optimum results of the therapy and initially should be done under expert guidance only.

The Marmas are stimulated 3-4 times a day. Each marma is stimulated for 20-25 times in one sitting. The rhythm of stimulation is same as the rhythm of our respiration i.e approx 18 times per minute. It can be done both in sitting and supine posture however for optimum results various asanas and postures have been described in various texts. In our clinical practice we find great results in the reduction of pain and also improvement of range of motion and gait of patient by this method. Our most important observation is that in many cases it gives immediate pain relief which so far has been thought to be a lacuna in Ayurveda. This beautiful science has the potential to take care of this so called lacuna.

References

1. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 2012, 380(9859):2163-96. doi: 10.1016/S0140-6736(12)61729-2. Erratum in: Lancet, 2013, 381(9867):628. Al Mazroa, Mohammad A.
2. Taimela S, Kujala UM, Salminen JJ & Viljanen T. The prevalence of low back pain among children and adolescents: a nationwide, cohort-based questionnaire survey in Finland. Spine, 1997, 22: 1132–1136.
3. Balague F, Troussier B & Salminen JJ. Non-specific low back pain in children and adolescents: risk factors. Eur Spine J, 1999, 8: 429–438.
4. Andersson GBJ. The Epidemiology of Spinal Disorders. In Frymoyer JW (ed.) The Adult Spine: Principles and Practice. Philadelphia, Lippincott-Raven, 1997, pp. 93–141.
5. Croft P et al. The prevalence and characteristics of chronic widespread pain in the general population. Journal of Rheumatology, 1993, 20:710-3.
6. Guo HR, Tanaka S, Halperin WE, Cameron LL. Back pain prevalence in US industry and estimates of lost workdays. Am J Public Health, 1999, 89(7):1029-1035.
7. Katz JN. Lumbar disc disorders and low-back pain: socioeconomic factors and consequences. J Bone Joint Surg Am, 2006, 88(suppl 2):21-24.
8. Rubin DI. Epidemiology and risk factors for spine pain. Neurol Clin, 2007, 25(2):353-371.
9. INTERNATIONAL JOURNAL OF SCIENTIFIC & TECHNOLOGY RESEARCH VOLUME 2, ISSUE 7, JULY 2013 ISSN 2277-861680IJSTR©2013 www.ijstr.org Prevalance Of Work Related Low Back Pain Among The Information Technology Professionals In India – A Cross Sectional Study P Shahul Hameed at all..
10. Estimating the global burden of low back pain attributable to combined occupational Exposures..Laura Punnett, Sc.D.,1 Annette Prüss-Ustün, Ph.D.,2 Deborah Imel Nelson, Ph.D., CIH,2,3 Marilyn A. Fingerhut, Ph.D.,2,4 James Leigh, M.D., Ph.D.5 SangWoo Tak, M.S.1, Sharonne Phillips, BSc, MOHS6)
11. Pandit Parashurama Shastri Vidyasagar edited Sharangadhara Samhita, Deepika Commentory by Adamalla on Prathama Khanda, Chapter 7, Shloka No.105, 3rd edition 1983, Pub:Chawkambha Orientalia, P.B.32, K, 37/109, Gopal Mandir lane, Varanasi (UP), Page No.103.
12. Prof. K.R. Srikantha Murthy edited Bhavaprakasha, Dwithitya khanda, 26nd Chapter, Shloka no. 53, Edition First 1998, Pub: Krishnadas Academy, Varanasi (UP)
13. Sri Ganga Sahaya Pandeya Edited Gadanigraha,Chapter 19, Shloka 160 Chaukhamba Sanskrit Samsthan K.37/117, Gopal Mandir lane, Post box No.1139, Varanasi (UP), Edition:Reprint 2005, Page No 508
14. Radakant dev. Varada Prasad, editor. Shabda kalpa druma. Vol 5. ed. Delhi: Naga publishers; 1987. Pp- 792, p-641
15. Acharya Sushruta. Yadavji Trikamji Acharya, editor. Susruta Samhita with Nibandha Sangraha of Dalhanacharya. 8thed. Varanasi: Chaukhambha Orientalia; 2008. Pp-824, p- 371
16. Susruta. Yadavji Trikamji Acharya, editor. Susruta Samhita with Nibandha Sangraha of Dalhanacharya. 8thed. Varanasi: Chaukhambha Orientalia; 2008. Pp-824, p- 354
17. Agnivesha, Charaka Samhita, Sutra Sthana, Chapter, Edited by Vaidya Jadavaji Trikamji Acharya, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129,Varanasi (UP), Edition:Reprint 2008
18. Vagbhata. Harisadasivasastri Paradakara Bhisagacarya, editor. Ashtanga Hrudayam with Sarvangasundara of Arunadatta & Ayurvedarasayana of Hemadri. Varanasi: Chaukhambha Orientalia; 2005. Pp-956, p- 413
19. Susruta. Yadavji Trikamji Acharya, editor. Susruta Samhita with Nibandha Sangraha of Dalhanacharya. 8thed. Varanasi: Chaukhambha Orientalia; 2008. Pp-824, p- 369
20. Pt. Ram Chandra Shastri Kinjawarkar, editor. Garbhopanishad; 108 Upanishada, Mathura: Jagadeesh Prasad Bhutiya Bambai Bhusthan Press. Pp: 2949, p: 1933.
21. Ayurveda and Marma Therapy by Dr. David Frawley, Dr. Subhash Ranade and Dr. Avinash Lele, Lotus Press, PO Box 325, Twin Lakes, WI 53181. ©2003
22. Priority Medicines for Europe and the World 2013 Update Chap 6.24
23. Phillips FM, Slosar PJ, Youssef JA, Andersson G. Lumbar Spine Fusion for Chronic Low Back Pain due to Degenerative Disc Disease: A Systematic Review. Spine, 2013, (Phila Pa 1976).
24. Marma Points of Ayurveda by Dr Vasant Lad http://www.narayana-publishers.com/Marma-Points-of-Ayurveda/Vasant-Lad/b9673/partner/leseprobe