AYURVEDIC MANAGEMENT OF LOW BACK ACHE

LOW BACK ACHE

• Low back Ache (LBA) is a common disorder involving the muscles, nerves, and bones of the back. Pain can vary from a dull constant ache to a sudden sharp feeling.

• Low back pain may be classified by duration as acute (pain lasting less than 6 weeks), sub-chronic (6 to 12 weeks), or chronic (more than 12 weeks).

• The condition may be further classified by the underlying cause as either mechanical, non-mechanical, or referred pain.

• In most episodes of low back pain, a specific underlying cause is not identified or even looked for, with the pain believed to be due to mechanical problems such as muscle or joint strain. If the pain does not go away with conservative treatment or if it is accompanied by unexplained weight loss, fever, or significant problems with feeling or movement, further testing may be needed to look for a serious underlying problem.

Clinical features:

• Low back ache may be a pre-monitory (prodromal) symptom in fistula in ano, sciatica, gouty arthritis, hernia, emaciation disorder etc.

• Pain is confined to lower part of the spine (back bone) especially lumbar region or lumbo-sacral area (rarely sacro-iliac region also).

• If it is secondary, earlier history of fall or injury may be associated.

• Rarely, radiating pain may be complained by the patient towards lower limbs. But it is quite common in low back aches if the defect is in the discs between vertebrae (back bones).

• Often the movements of lumbo-sacral region like flexion and rotation are hampered either partially or completely.

• Low back pain may be found in mild form in case of anemia, sciatica, rheumatoid arthritis, hemorrhoids, urinary calculi, uterine disorders etc also.

• The first experience of acute low back pain is typically between the ages of 20 and 40. Recurrent episodes occur in more than half of the people with the repeated episodes being generally more painful than the first.

• Chronic low back pain is associated with sleep problems, including a greater amount of time needed to fall asleep, disturbances during sleep, a shorter duration of sleep, and less satisfaction with sleep. In addition, a majority of those with chronic low back pain show symptoms of depression or anxiety.

Low back Ache is not a specific disease but rather a complaint that may be caused by a large number of underlying problems of varying levels of seriousness. The majority of LBA does not have a clear cause but is believed to be the result of non-serious muscle or skeletal issues such as sprains or strains. Obesity, smoking, weight gain during pregnancy, stress, poor physical condition, poor posture and poor sleeping position may also contribute to low back pain.

Women may have acute low back pain from medical conditions affecting the female reproductive system, including endometriosis, ovarian cysts, ovarian cancer, or uterine fibroids. Nearly half of all pregnant women report pain in the lower back or sacral area during pregnancy, due to changes in their posture and center of gravity causing muscle and ligament strain.

Low back pain can be broadly classified into four main categories:

• Musculoskeletal - mechanical (including muscle strain, muscle spasm, or osteoarthritis); herniated nucleus pulposus, herniated disk; spinal stenosis; or compression fracture

• Inflammatory arthritis including ankylosing spondylitis, reactive arthritis, psoriatic arthritis, and inflammatory bowel disease

• Malignancy - bone metastasis from lung, breast, prostate, thyroid, among others

• Infectious - osteomyelitis; abscess

Low Back Pain – Ayurvedic View

• Ayurveda refers this condition as Kati shoola.

• Kati refers to ‘low back’ (hip) and shoola refers ‘pain’.

• The description of this condition is available in some other conditions like ‘katigraha’, ‘prishtagraha ’etc, which are included under Vata Dosha imbalance disorders.

Causative factors:

• Intake of dry, light, bitter, pungent and cold food

• Less food intake

• Fasting or less nutritive food

• Intake of mudga (green gram), masura (red lentil), kalaya (peanut) etc

• Over-exercise

• Long walk

• Fall or injury to the back

• Injury to the vital points

• Weight lifting

• Improper lying

• Brisk walk

• Excess sexual indulgence

• Suppression of the urges

• Work exhaustion

• Stress

• Grief

• Fear

• Dissatisfaction

• Emaciation etc.

Line of treatment:

The general principles of treatment of vata dosha are adopted in case of katishoola (low back pain). It includes various measures to suit its varied clinical entities, stages and associated complaints.

1. Deepana Pachana- By Rookshana Treatments like Rooksha Kizhi(Pressure Bolus Massage), Dhanyamla Dhara( Pouring Acidic medium medicine all over the body or locally), Avikkizhi ( Steam Bolus)etc

2. Snehana (oleation) – by Sneha dhara (pouring oil), Abhyanga (oil massage), Avagaha (tub bath with oil or oleaginous medicaments), Kati Vasti (retaining medicaments on the back) etc.

3. Swedana (sudation) –Avagaha sweda  (sweating treatment with tub bath), Pizichil (kayaseka), Nadi Sweda (sudation through a tubular device – local sudation), Pinda sweda (sudation through medicated paste or powder) etc.

4. Mridu Samshodhana -Mild purgation

5. Vasti (medicated enema) like Eranda Vasti, Vaitarana Vasti, Pippalyadi Anuvasana Vasti etc.

Single drugs indicated in Low back ache:

• Lashuna – Garlic

• Eranda – Castor root and oil

• Chincha – Tamarind fruit and leaves

• Rasna – Pluchea lanceolata .

• Shunti – Ginger

• Bala – Sida cordifolia Linn.

• Sahachara – Barleria prionitis Linn.

• Ajamoda – Trachyspermum roxburghianum (DC.) Sprague

• Haritaki – Terminalia chebula Retz.

• Masha – Black gram

• Prasarini – Sida cordata (Burm. F.) Borss.

• Nirgundi – Vitex negundo Linn.

Formulations indicated in Low back ache:

1. Dashamoola kwatha

2. Shuntyadi kwatha

3. Rasnasapthakam kashaya

4. Maharasnadi kashaya

5. Rasnaerandadi kashaya

6. Lashunaerandadi kashaya

7. Sahacharadi kashaya

8. Gandharvahastadi kashaya

9. Trayodashanga guggulu

10. Saplint Liniment

11. Rhumagen Strong Pain Balm

12. Sap Sciatin Soft Gel Capsule

13. Mahamasha taila

14. Prasarini taila

15. Ksheerabala taila

16. Mahanarayana taila

17. Dhanwantaram taila

18. Murivenna etc.

Wholesome diet and habits indicated in Low back ache:

1. Godhuma(wheat)

2. Rakta shali(red rice)

3. Masha(black gram)

4. Shigru(drum stick)

5. Vartaki(small brinjal)

6. Lashuna(garlic)

7. Ghrita(ghee)

8. Amla dravya(sour substances)

9. Madhura ahara(sweet food)

10. Patola(snake gourd) etc.

Unwholesome diet and habits referred in Low back ache:

1. Bitter, astringent and pungent food

2. Jambu(blue berry)

3. Cold water

4. Fear

5. Exhaustion

6. Standing

7. Driving

8. Cold food and beverages etc.