Spotlight on Lower Back Pain: An Ayurvedic Perspective

Introduction

In Ayurveda, lower back pain is known as Kativata or Katishula or Katigraha. In medical language, it is better known as lumbago. Kati denotes the lumber region and vata, the biological air.

Spondylolisthesis vs Kati Shula

The word “spondylolisthesis” is derived from the Greek words “spondylos” meaning spine or vertebra and “listhesis” meaning to slip or slide. Spondylolisthesis is a term reserved to describe the anterior displacement of a vertebra or the vertebral column in relation to the vertebrae below. Spondylolisthesis predominately occurs in the lumbar spine. Majority of the patients are asymptomatic.

Sometimes pain in the lumber region, thighs, and/or legs, in which there is radiation into the buttocks is associated with muscle-spasm, leg-pain, or weakness, tightness in the hamstrings, and irregular posture. This condition has strong correlation with Kati shula.

Lumbar spondylosis

Spondylosis is a term reserved for spinal degeneration often accompanied by pain. Spondylosis is often used as a synonym for spinal arthritis.

Spondylosis stands for degenerative changes in the spine such including and degenerating intervertebral discs and bone spurs. Spondylosis changes occurring in the spine are frequently referred to as osteoarthritis (OA).

Spondylosis normally occur in the cervical region (neck), thoracic region (upper and mid back), or lumbar region of the spine (low back).

Lumbosacral spondylosis

Lumbosacral spondylosis is defined as spondylosis which strikes the lumbar spine as well as the sacral spine.

Multilevel spondylosis

Multilevel spondylosis stands for the changes affecting multiple vertebras in the spine.

Lumbar strain

A stretching injury to the tendons, ligaments, and or muscles of the low back. The stretching injury results in microscopic tears of varying degrees in these tendons, ligaments, and or muscles. Lumbar strain is the most common causes of low back pain.

Incidence in India

Low back pain is a major socioeconomic and health problem in modern society. In accordance with the report of World Health Organization in 2002, low back pain constituted 37% of all occupational risk factors which occupies first rank among the disease complications caused by work.

Causes

  • An intervertebral disc may be degenerating
  • The bones, ligaments or joints may be damaged
  • The large nerve roots in the low back that go to the legs may be irritated
  • The large paired lower back muscles (erector spinae) may be strained
  • The smaller nerves that supply the low back may be irritated

Signs and Symptoms

  • Pain is worse at night and after back movements.
  • There may be tingling and numbness along lower back.
  • In severe cases pain may start from lumbar region and radiate throughout the leg.
  • Lifting of weights in standing position may lead to attack of lumbago.
  • Disc protrusion at lumbar level may lead to paralysis of legs and urinary blabber.
  • Urinary retention is the main problem.

Diagnosis

  • X-rays can show bone spurs on vertebral bodies in the spine, thickening of facet joints (the joints that connect the vertebrae to each other), and narrowing of the intervertebral disc spaces.
  • CT scans of the spine are able to visualize the spine in greater detail and can diagnose narrowing of the spinal canal (spinal stenosis) when present.
  • MRI scans show the greatest detail in the spine, and are used to visualize the intervertebral discs, including the degree of disc herniation, if present. An MRI is also utilised to visualize the vertebrae, the facet joints, the nerves, and the ligaments in the spine and rationally diagnose a pinched nerve.

Allopathic Treatment & Side Effects

There is no solution in Allopathic system of medicine to reverse the process of spondylosis as it is a degenerative process. The basic treatment of spondylosis is aimed the treating neck-pain and back-pain which are due to spondylosis. Hence, the treatment of spondylosis is similar to the treatment neck-pain and back-pain.

Available treatments fall into several categories:

  • adjunctive therapies (chiropractics and acupuncture),
  • and surgery
  • medications,
  • minimally invasive procedures such as injections,
  • physical therapy,
  • self-care exercise,

Ayurvedic Treatment

  • Mahayograja guggul is used in the treatment of lumber s Two-three tablets are recommended with hot water, twice a day.
  • For weakness in the arms, Ekangveer-rasa of a good brand, one tablet, twice a day is added with Mahayograja guggul for seven days.
  • Gentle massage with Mahamasha taila is helpful in reducing morning stiffness.

Kati Vasti is an Ayurvedic therapy for lower back pain. The medication agents used in the process of Kati Vasti are medicated oils processed with medicinal herbs. Various type of oils are used by Ayurvedic physicians depending on the condition.

Ayurveda Clinical Study

EFFECTIVENESS OF KATIVASTHI AND EXERCISE

An open prospective study was performed to evaluate the effectiveness of Kativasthi in patients of chronic low back pain. Mahanarayan taila is used in Kativasthi for 10 days after Sarvanga Snehana withMahanarayan taila (oil massage) and Sarvanga Baspa Svedana (steam bath).

40 patients, aged 40 ± 10.4 years were divided into two groups by a computer generated random number table. X ray of lumbo-sacral spine (antero-posterior & lateral view) was reviewed.

Differences of lumbar and ridiculer pains on an analog visual scale, ModifiedOswestry Disability score and distance finger ground test were assessed at 0-day & 10 th -day. There is significant improvement in all above parameters on 10 th day. It was found that Kativasthi was more effective than the conventional exercise practices.

Case study

A 59-year-old female with a 9-month history of lumbar spondylolisthesis was treated with this regimen. The patient had progressive pain in left lower back, right and left buttocks, and difficulty in bending forward over 5°. X-ray of lumbo sacral region indicated that patient was suffering from Grade 3 lumbar spondylolisthesis.

She was treated for 65 days with four treatment packages consisting of 13 prepared medicines. The response to the treatment was recorded and therapeutic effects were evaluated through symptomatic relief.

Clinical symptoms were significantly reduced and degree of anterior flexion increased from 5° to 90°. However, X-rays indicated that the patient was still suffering from Grade 3 lumbar spondylolisthesis.

References

Ediriweera ERHSS, Gunathilka HPD, Weerasinghe KDCM, Kalawana OTMRKS. Efficacy of traditional treatment regimen on Kati Shoola with special reference to lumbar spondylolisthesis. Ayu 2013; 34 86–89.

Panda AK, Kumar DJ. EFFECTIVENESS OF KATIVASTHI AND EXERCISE IN CHRONIC LOW BACK PAIN: A RANDOMIZED CONTROL STUDY. IJRAP 2011, 2:338-342.

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