Osteoarthritis (OA) is a chronic, progressive joint disorder characterized by the degeneration of articular cartilage, synovial inflammation, and changes in the subchondral bone. Millions of people worldwide suffer from this most prevalent type of arthritis, which mainly affects older adults. A severe impact on quality of life is caused by OA, which causes joint pain, stiffness, edema, and diminished function.

In Ayurveda, this condition can be correlated to Sandhigata Vata, where aggravated Vata Dosha accumulates in the joints, leading to pain, stiffness, crepitus(cracking sound), and reduced mobility. The cartilage degeneration is said to be caused by Dhatu Kshaya (tissue depletion), namely Asthi (bone) and Majja (bone marrow) Dhathu.

LAKSHANAS OF SANDHIGATA VATA(SYMPTOMS):

• Sandhi shoola(joint pain): Aching pain that worsens with movement of joints.
• Shotha(swelling): Mild or moderate swelling in the joints affected.
• Sparshana Asahatwa(Tenderness): pain while touching the joint.
• Prasarana-Akunjana Pravritti Vedana(pain during movement): Flexion and extension becomes difficult.
• Atopa(crepitus/crackling sound): During the movement of a joint, a sound is heard.
• Hanti Sandhi(Joint stiffness and restricted movement): It is more common in the morning and after prolonged rest.

ETIOLOGY OF OSTEOARTHRITIS:

The etiology of OA involves multiple factors.

1. Age-related changes:

Aging is a primary risk factor for OA:

• Since the chondrocyte function diminishes, it reduces the ability to synthesize and maintain the extracellular matrix.
• Increased cartilage softening and erosion due to proteoglycan and collagen degradation.
• Increased joint stress steers to subchondral bone stiffening.
• Impairment in lubrication due to reduced synovial fluid viscosity.

2. Mechanical Factors:

Joint stress can accelerate cartilage wear and tear, leading to OA.

Contributing factors  include:

• Obesity: Increases the strain on weight joints (hips, knees), and with adipokines,  inflammation is heightened.
• Repetitive joint use: Overuse in jobs (such as construction workers), sports, and hobbies that require a lot of kneeling or squatting.
• Joint misalignment: Uneven joint loading and cartilage wear occur due to Genu Varum or Valgum.

3. Genetic and Familial Factors.

Genetics also plays a role in OA:

• Hand and Knee OA: Mostly seen in women.
• Collagen mutations: Early onset of  OA occurs due to mutations in COL2A1(Type II collagen gene). 
• Cartilage metabolism and bone remodeling are affected by variations in BMP(Bone Morphogenetic Protein). 

4. Metabolic and Endocrine Disorders:

The risk of OA increases due to systemic inflammation and altered bone/cartilage metabolism by certain metabolic disorders.

• Diabetes Mellitus: Chondrocyte apoptosis and cartilage stiffness occur due to Advanced glycation end products(AGEs).
• Hyperlipidemia: Causes oxidative stress and joint inflammation.
• Hemochromatosis: Excess iron deposition leads to cartilage degeneration.
• Acromegaly: Joint hypertrophy and degeneration due to excess growth hormone.

5. Inflammatory and Biochemical Factors:

Low-grade inflammation is a crucial part of OA, even though it is mainly a non-inflammatory type of arthritis.

• Cytokines(IL-1, TNF-alpha): Stimulates matrix metalloproteinases(MMPs), leading to cartilage breakdown.
• Leptin and Adipokines(released from adipose tissue): Promote inflammation and cartilage degradation.
• Oxidative stress: Leads to chondrocyte apoptosis and reduction in cartilage repair capacity.

6. Post-Traumatic and Secondary OA:

OA can develop due to previous joint injuries or underlying diseases:

• Joint injuries(Post Traumatic OA): Fractures, ligament tears(like ACL injury), and meniscal damage accelerate cartilage wear.
• Inflammatory arthritis: Rheumatoid arthritis(RA), gout, and septic arthritis can lead to secondary OA.
• A lack of blood flow causes avascular necrosis, which results in bone collapse and cartilage destruction.

CLINICAL FEATURES OF OSTEOARTHRITIS(OA):

1. Pain:

The common symptom of OA.

• It increases with activity and improves with rest as it is mechanical.
• At first, the pain is intermittent, but as the illness worsens, it becomes persistent, even when sleeping or at rest.
• The morning stiffness normally subsides after 30 minutes (unlike rheumatoid arthritis, where it lasts longer).
• In severe situations, pain may radiate to nearby locations, such as hip pain radiating to the thigh or knee pain spreading to the shin.

2. Stiffness:

• Morning stiffness occurs but usually less than 30 minutes.
• The gelling phenomenon where stiffness occurs after periods of inactivity,(eg: after sitting for long periods, movement is initially stiff but improves gradually).

3. Crepitus:

• During the joint movement, a grating or crackling sound is heard or felt.
• It occurs due to the rubbing of roughened cartilage surfaces.
• Commonly seen in the knee joint.

4. Swelling:

• Due to synovial inflammation, mild effusion(fluid accumulation) can be present.
• Early phases of swelling are typically soft, although osteophyte production (bony outgrowths) may cause it to harden and become bony later on.

5. Deformity:

Joints may appear distorted due to unusual bone remodeling and gradual joint degeneration.

Common deformities include:

• Knee OA: Genu Varum(bow-legged deformity) or Genu Valgum(Knock Knees).
• Hip OA: Leg shortening due to femoral head collapse.
• Hand OA:

-Herbeden’s nodes(bony swelling on DIP joints).

-Bouchard’s nodes(bony swellings on the PIP joints).

6. Joint Instability and weakness:

As the disease progresses, the joint may become unstable leading to:

• Giving way to the knee/Knee buckling while walking.
• Muscle weakness, especially in quadriceps and hip abductors.
• Increased chances of falls due to difficulty in maintaining balance.

7. Restricted Range of Motion(ROM):

The range of motion is gradually reduced due to pain, swelling, and structural changes,

• Early stage: Movement causes slight discomfort.
• Last stage: Restricted movements, sometimes lead to joint contractures.

8. Joint Tenderness:

• The patient presents pain while touching that area, especially along the joint line.
• When pressing the affected joints, localized pain is present.

9. Functional impairment:

Patients experience difficulty in performing daily activities such as:

• Climbing stairs.
• Getting up from a chair.
• Walking for long distances.
• Gripping objects(in hand OA).
• Assistive devices like walking sticks are required in severe cases.

10. Muscle Atrophy:

• Further instability results from surrounding muscle weakening and atrophy brought on by joint disuse
• In OA Knee it is commonly seen in the quadriceps(thigh muscles).

11.Synovitis(Intermittent inflammation):

In some cases, inflammatory flares occur with,

• Increased swelling.
• Warmth over the joint.
• Worsening pain.
• Although it doesn’t have systemic symptoms, resembling rheumatoid arthritis.

DIAGNOSIS OF OSTEOARTHRITIS(OA):

Diagnosis of osteoarthritis (OA) involves a combination of clinical evaluation, imaging, and some laboratory tests.

1. CLINICAL ASSESSMENT:

Evaluate symptoms like:

• Joint pain: That worsens with activity and improves with rest.
• Stiffness, especially after an inactivity or in the morning.
• The affected joints have swelling and tenderness.
• Crepitus(grating sound in the joint while moving).
• Restricted range of motion.
• Deformities(in severe cases).

2. PHYSICAL EXAMINATION:

• Check for joint tenderness, swelling, and range of motion.
• Feel for crepitus or bone spurs.
• Assess muscle strength and gait.

3. IMAGING TESTS:

• X-rays: Display sclerosis (hardening of the bones), bone spurs (osteophytes), and narrowing of the joint space.
• Soft tissue damage, cartilage loss, or early-stage OA are suspected when an MRI is performed.

4.LABORATORY TESTS:

• Blood tests: Helpful in ruling out infections or rheumatoid arthritis (RA).
• Joint Fluid Analysis: To rule out infections or gout, arthrocentesis is used.

Differential diagnosis:

• Both sides are symmetrically affected in inflammatory arthritis, such as rheumatoid arthritis (RA).
• Gout (acute pain accompanied by crystals in the joint fluid).
• Psoriatic arthritis(arthritis along with psoriasis of the skin).
• Infectious arthritis (infection symptoms and fever).

TREATMENT OF OSTEOARTHRITIS(OA) IN MAURYA AYURVEDA HOSPITAL:

Our hospital provides treatment for osteoarthritis by integrating Ayurveda, physiotherapy, and acupuncture.

INTERNAL MEDICATIONS GIVEN FOR OSTEOARTHRITIS(OA) ARE:

• Amrthotharam Kashayam.
• Sahacharadi Kashayam.
• Rasnairandadi Kashaym.
• Rasnasaptakam Kashayam.
• Dashamoolam Kashayam.
• Maharasnadi Kashayam.
• Punarnavadi Kashayam.
• Shaddharanam tab.
• Yogaraja Guggulu.
• Maha yogara Guggulu.
• Sallaki MR tablet.
• Sallaki liniment.

EXTERNAL TREATMENTS GIVEN FOR OSTEOARTHRITIS(OA) ARE:

PODI KIZHI:

In the ayurvedic treatment  PODI KIZHI, or CHOORNA PINDA SWEDAM, the herbal powders are wrapped in a bolus of cotton, heated, and then massaged into the body. In our hospital, Podi Kizhi is usually done with KOLAKULATHADI CHOORNAM.

Benefits of Podi Kizhi:

• It reduces pain or discomfort and releases tense muscles.
• It lessens joint stiffness and improves joint lubrication.
• It increases flexibility and circulation.
• It is extremely good for arthritic conditions.

UDWARTHANAM:

In Udwarthanam, the body is massaged vigorously after being applied with dry medicinal powders. For this, KOLAKULATHADI CHOORNAM or KOLAKULATHADI combined with TRIPHALA is utilized.

Benefits of Udwarthanam:

• It improves circulation.
• It helps in the reduction of muscle spasticity.
• It loosens up tight muscles and joints and improves the range of motion.
• It aids in bettering the muscle tone. 

 NADI SWEDAM:

In Nadi Swedam, a form of sweating therapy or sudation treatment, therapeutic steam is applied to certain body parts using a hose or tube. Musculoskeletal conditions, stiffness, muscle cramps, and other ailments caused by an imbalance between the Vata and Kapha doshas are among the conditions for which it is considered one of the greatest treatments in Ayurveda.

Benefits of Nadi Swedam:

• Increased blood flow.
• Pain alleviation.
• Aids in the elimination of toxins from the body.
• Helps in attaining more flexibility of joints.

LEPAM:

Lepam, or “Pooch,” is a topical treatment used in Ayurveda that is administered to the skin with medicinal pastes. These pastes, which are prepared using a range of medicinal herbs, oils, and powders, are applied to certain body areas based on the condition being treated. Typically, KM Lepam, Karutha Vatu, RASNADI, and GRAHADHOOMADI CHOORNAM with Jambeera (lemon) are utilized here.

Benefits of Lepam:

• Aids in pain relief.
• Reduce inflammation and swelling.
• Helps in the reduction of spasms and muscle stiffness.

DHARA:

Dhara is a common Ayurvedic treatment that involves the continuous pouring of medicated liquids into certain body parts, like the forehead, the entire body, or just certain locations.

KASHAYA DHARA (DASHAMOOLA KASHYAM) and DHANYAMLA DHARA (DHANYAMLA-a fermented liquid) are beneficial for this condition.

Benefits of Dhara:

• The pouring of warm liquid into the affected area improves blood circulation to the affected area.
• It reduces muscle stiffness and spasticity.
• Since it has an anti-inflammatory nature, it reduces pain and inflammation.
• It also improves lymphatic drainage and the elimination of toxins from the body.

ELA KIZHI:

In Elakizhi, medicinal leaves are used to make Kizhi(boluses) which are massaged after being immersed in warm medicinal oil. Normally castor leaves (Eranda, Ricinus communis), tamarind leaves (Tamarindus indica), arka leaves (Calotropis gigantea), etc are used to make ela kizhi.

For the same, KOTTAMCHUKKADI and MURIVENNA  are the thailas used.

Benefits of Ela kizhi:

• Aids in strengthening muscles.
• Relieves aching of joints and muscles.
• Reduces stiffness and discomfort in the body.
• Increases the flow of blood.

NJAVARA KIZHI:

Shashtika Shali pinda Sweda (Njavara Kizhi) involves massaging the body with a warm rice poultice. The medicinal rice bolus is prepared with Shashtika(Njavara) rice boiled in milk and herbal decoctions.

Benefits of Njavara kizhi:

• It helps in nourishing tissues.
• It aids in the strengthening of muscles and tissues.
• Helps in the reduction of muscle stiffness and spasticity.
• It supports nerve regeneration.
• It aids in attaining pain relief.

JANU/KADI VASTHI:

Janu/Kadi Vasthi is a specialized ayurvedic treatment that involves retaining warm medicated oil over the Janu(knee)/Kadi(Lumbo sacral) joint for a specific duration. A leek-proof, dough ring boundary is created around the joint. Warm medicated oils like Murivenna,Karpooradi,Sahacharadi, and Kottamchukkadi oil are poured into this enclosure. The oil is kept warm and maintained for 20-30 minutes.

Benefits of Janu/Kadi Vasthi:

• It reduces pain and stiffness.
• It lubricates the joints.
• It strengthens the joint.
• It provides an anti-inflammatory effect.
• It enhances circulation.
• It delays progression and osteoarthritis.
• It improves flexibility and mobility.

 PICHU:

Pichu is an ayurvedic treatment where a cotton pad(Pichu)soaked in warm medicated oil is placed over the affected area for a specific duration. For this normally Murivenna, Karpooradi, Sahacharadi, and Kottamchukkadi oil can be used.

Benefits of  Pichu:

• It reduces pain and stiffness.
• It lubricates the joint.
• It strengthens the joint.
• It has an anti-inflammatory effect.
• It enhances circulation.
• It delays the progression of osteoarthritis.
• It improves flexibility and mobility.

NASYAM

Nasyam is a panchakarma treatment in which herbal oils or powders are administered through the nose.

Initially, a light massage to the head, face, and neck is given. Then, to help open the nasal pores, a gentle steaming (Swedana) is applied to the face and neck. The patient is instructed to lie on their back with their head slightly tilted. Next, the medicinal powder or oil is inserted into each nostril. To absorb the medicine properly, the patient lies down for a short while. The patient is advised to spit out any phlegm or mucus that comes to the throat.

Marsha Nasyam and Pratimarsha Nasyam are two types of Nasyam we normally perform here.

a)Pratimarsha Nasya:

• It is a milder, daily-use variant of Nasya therapy. It involves the administration of small quantities(1-2 drops) of medicated oil for preventive care, maintenance of health, and balancing of the doshas. Usually, Anu Taila is preferred for the same.

b)Marsha Nasya:

• It is a therapeutic procedure involving the administration of a larger quantity(6-10 drops) of medicated oil through the nostrils. Usually, we use Ksheerabala Taila here.

Benefits of Nasyam in Osteoarthritis:

• It balances Vata Dosha.
• It improves circulation and lubrication.
• It relieves pain and stiffness.
• It strengthens the nervous system and joints.
• It prevents further degeneration.

ROLE OF PHYSIOTHERAPY IN OSTEOARTHRITIS(OA):

Through strengthening joint function, lowering pain, and improving the patient’s quality of life, physiotherapy plays a significant role in managing OA.

Physiotherapy techniques used in Osteoarthritis are:

1. EXERCISE THERAPY:

I)Strengthening Exercises:

a)Isometric Exercises(Static strengthening):

• This is best for patients with severe pain and restricted mobility.
• It involves joint movements without contracting muscles.
• It helps attain muscle strength without excessive stress on the joint.

A few examples of Isometric Exercises are:

• Quadriceps set.
• Gluteal squeeze
• Straight leg Raise.

b)Isotonic Exercises(Dynamic strengthening):

• It is done by joint movement against resistance.
• It enhances the joint function and strength of the muscles.

Examples of Isotonic Exercises:

• Seated Knee Extension.
• Mini squats.
• Step ups.
• Bridges.

c)Resistance Band Exercise:

• Using resistance bands provides controlled strengthening of the muscles.
• It gives results for progressive resistance training.

Examples:

• Knee extension with the band.
• Hamstring curls with band.
• Hip abduction with band.

d)Functional Strengthening Exercises:

• It helps the patient perform daily activities easier.

Examples:

• Sit-to-Stand Exercises.
• Heel raises.
• Lunges.

II)Range of motion exercise(ROM):

It is mainly classified into three types.

• Active Range of Motion: Without assistance, the patient moves their joint.
• Active Assisted Range of Motion(AAROM): With some external help, the patient moves the joint.
• Passive ROM(PROM): Without the patient’s conscious effort, a therapist  moves the joint on their behalf.

Examples:

 

• Knee OA: Heel slides(Knee flexion and extension), Seated Knee extension, Standing Knee bends.
• Hip OA: Hip Flexion and abduction, seated hip external rotation.
• Shoulder OA: Shoulder circles and flexion, pendulum exercise.
• Ankle OA: Ankle circles, toe to heel rocking, ankle dorsiflexion, and plantar flexion.

III)Aerobic exercises:

• Reduces inflammation and improves heart health.
• E.g.: Walking, cycling, swimming.

2. MANUAL THERAPY:

a)Joint mobilization:

• Gentle, passive joint movements are performed at varying speeds and amplitude.

b)Soft tissue mobilization:

• Massage techniques are performed to release muscle tightness and fascia restrictions and improve circulation.

A few techniques are:

• Myofascial trigger point release.
• Deep tissue massage.

c)Manual Traction:

• A gentle pulling force is applied to separate joint surfaces.

d)Passive stretching:

• Therapists do stretching to improve flexibility and range of motion.

3. ELECTROTHERAPY MODALITIES:

• Ultrasound therapy: It reduces deep tissue inflammation by using high-frequency sound waves.
• TENS(Transcutaneous Electrical Nerve Stimulation): It uses low-voltage electrical currents and relieves pain(a non-invasive technique of pain management).

4. HEAT AND COLD THERAPY:

• Heat Therapy: It relaxes muscles and improves blood flow.
• Cold therapy: It reduces swelling and numbs pain.

5. ASSISTIVE DEVICES AND BRACING:

• Using Knee braces, shoe inserts, and walking aids reduces joint stress.

6. LIFESTYLE AND ERGONOMIC ADVICE:

• Instructions are given to the patients for using appropriate footwear and joint protection techniques to prevent further damage.

Benefits of Physiotherapy in Osteoarthritis:

• It gives pain relief.
• It improves joint mobility and flexibility.
• It strengthens muscles around the joints.
• It gives stability and balance.
• It enhances functional independence.
• It prevents further joint damage.

ROLE OF ACUPUNCTURE IN OSTEOARTHRITIS(OA):

I)Traditional body acupuncture:

It involves inserting fine needles at specific meridian points to stimulate pain relief and circulation.

Common points for knee OA: 

These points are commonly used for OA in various joints.

• ST36(Zusanil): Improves circulation and reduces inflammation.
• SP9(Yinlingquan)Resolves dampness and reduces swelling in joints.
• L14(Hegu): Regulates pain and inflammation.
• LV3(Taichong): Improves blood circulation and reduces stiffness.
• Ashi points(Tender points): Localized points at the site of pain for targeted relief.

Acupuncture points for specific joints in OA:

a)Knee osteoarthritis(Most common OA location):

• ST 35(Dubi): Local point for knee pain and inflammation.
• GB 34(Yanglingquan): Strengthens knee tendons and ligaments.
• SP 9(Yinlingquan): Reduces swelling and dampness in the knee.
• EX-LE4(Neixiyan) and EX-LE5(Waixiyian): Extra points for knee pain relief.

b)Hip Osteoarthritis:

• GB 29(Juliao): Relieves hip joint pain and stiffness.
• GB 30(Huantiao): Major point for hip and sciatic pain.
• LV 3(Taichong): Improves blood circulation in the hip region.
• BL 54(Zhibian): Strengthens the hip and lower back region.
• ST 31(Biguan): Alleviates hip and thigh pain.

c)Spine(Cervical/Lumbar)Osteoarthritis:

• BL 23(Shenshu): Strengthens the lower back and kidneys.
• GV 4(Mingmen): Improves lumbar stability and pain relief.
• BL 40(Weizhong): Reduces lower back pain and stiffness.
• GB 20(Fengchi): Common point for cervical osteoarthritis.
• GV 14(Dazhui): Relieves upper back and neck stiffness.

d)Shoulder Osteoarthritis:

• LI 15(Jianyu): Major point for shoulder pain and stiffness.
• SJ 14(Jianliao): Enhances mobility in the shoulder joint.
• SI 9(Jianzhen): Reduces pain in the shoulder and upper arm.
• GB 21(Jianjing): Relaxes shoulder muscles and relieves tension.

e)Hand/Wrist Osteoarthritis:

• L14(Hegu): Relieves pain and stiffness in the hand.
• L15(Yanxi): Treats wrist and thumb OA.
• SI(Wangu): Strengthens the wrist joint.
• TB 5(Waiguan): Helps with wrist and elbow movement.

f)Ankle/Foot Osteoarthritis:

• SP6(Sanyinjiao): Improves blood flow and reduces swelling in the ankle.
• ST 41(Jiexi): Enhances ankle mobility.
• GB 40(Qiuxi): Reduces lateral ankle pain.
• BL 60(Kunlun): Effective for foot and heel pain.

II)Electro-Acupuncture:

• To improve stimulation, low-frequency electrical current is administered through acupuncture needles in electroacupuncture.
• It provides superior pain relief and improved joint function compared to manual acupuncture.

Benefits of Acupuncture in Osteoarthritis(OA):

• It helps in lowering inflammation.
• It aids in pain reduction.
• It improves joint function.
• It improves sleep and mental well-being.
• It enhances the quality of life.

DIET RECOMMENDATIONS IN OUR HOSPITAL:

Our senior physicians suggest to avoid 

• Milk, milk products, cold food, pickles, fruits, dry fruits, nuts, fast food, fried and oily foods.
• Fermented foods like dosa, idli, and fermented appam.
• Tuber items like potato, tapioca, and sweet potato.
• Nonvegetarian items like fish, egg, and meat(Can be taken in curry form, if necessary).

A few recommended food items to be taken are:

• Hot kanji.
• Steamed food items like idiyappam, put, and chappati.
• Vegetable in boiled form.

General Suggestion:

• Avoid strenuous activities.
• Drink enough water(2.5L-3L).

 

DISCLAIMER: The information provided in this article is intended solely for educational  purposes. Treatment decisions should be made exclusively by a well-qualified Ayurvedic physician. Self-medication is strongly discouraged.

Maurya Ayurveda Hospital,opposite to Sabine Hospital,Pezhakkapilly P.O,Muvattupuzha,Ernakulam;PIN:686673,Contact no:9947183000

Email: [email protected]

Maurya Ayurveda Ortho & Neuro Rehabilitation Centre ( Ayurveda Hospital )