Spinal Cord Injuries are dangerous disorders ,that is affecting spinal cord due to any trauma or illness. Spinal cord is the primary pathway for communication between the brain and body,  is in charge of sending motor, sensory and autonomic impulses. Damage to this vital structure can impair movement, sensation and other body functions, resulting in partial or total loss of function below the site of the injury.

According to Ayurveda, Spinal cord  injuries (SCI) are caused by an imbalance in the VATA, which controls movement, nervous system activity and bodily processes. Nervous system injuries disturbs  VATA and ayurvedic remedies try to get it back in balance.

CAUSES OF SPINAL CORD INJURIES:

The most common cause involves,

1.TRAUMA:

• Like motor vehicle injuries, falls, sports injuries, violence etc.

2.NON TRAUMATIC CAUSES:

• Degenerative disease: Conditions like spinal stenosis, arthritis or herniated discs.
• Infections: Such as tuberculosis or abscesses affecting the spinal cord.
• Congenital Disorders: Including spina bifida.
• Tumors: Growth that compresses the spinal cord.

TYPES OF SPINAL CORD INJURIES:

1.COMPLETE INJURY:

• This happens when there is so much damage or injury to the spinal cord that the brain and body below the injury site can no longer communicate.
• Below the degree of injury, it causes complete loss of motor (movement) and sensory (feeling) abilities.

2.INCOMPLETE INJURY:

• Since the spinal cord is only partially injured in this ,still there will be some degree of connectivity between the brain and regions underneath the injury site.

COMMON TYPES OF INCOMPLETE SCIs:

1.Anterior Cord Syndrome: Injury to the anterior (front) portion of the spinal cord that maintains touch, vibration and proprioception but impairs motor function, pain and temperature perception.

2.Central Cord Syndrome: Injury to the spinal cord’s center that causes weakness in the arms more than the legs and may result in issues with the bladder.

3.Brown-Sequard Syndrome: Impairment to one side of the spinal cord results in lack of sensation and movement on that side, while the other side loses its ability to feel pain and temperature.

4.Posterior Cord Syndrome: The posterior (back) portion of the spinal cord is damaged, resulting in a loss of fine touch and coordination while maintaining motor function.

5.Conus medullaris syndrome: Usually affecting at the level of L1-L2 vertebrae, this condition is brought on by damage to the conus medullaris, the cone-shaped lower end of the spinal cord. The nerve roots that regulate the lower limb, bowel and reproductive functions are located in this area. CMS may be brought on by vascular disorders, tumors, infections, spinal disc herniation or trauma.

6.Cauda Equina Syndrome: Cauda Equina Syndrome also known as Horse tail syndrome, is an occasional but dangerous disorder that develops when the cauda equina, a bundle of nerves at the base of the spinal cord is squeezed. These nerves control the lower body’s motor and sensory functions, including those of the legs, bladder and intestines.

CLASSIFICATION BASED ON LOCATION:

• Cervical Spinal Cord Injuries(C1-C8):Can lead to quadriplegia(paralysis in both arms and legs).
• Thoracic Spinal Cord  Injuries(T1-T2):Typically affects the chest and legs, often resulting in paraplegia.
• Lumbar and Sacral Spinal Cord Injuries(L1-S5):Generally affects the legs and lower body.

SYMPTOMS OF SPINAL CORD INJURIES

Depending on the extent and location of the injury, spinal cord injuries can cause a variety of symptoms. Here is a summary of typical symptoms.

• Sensation loss.
• Weakness or paralysis.
• Mobility loss.
• Loss of bowel or bladder control.
• Spasms or muscle stiffness.
• Issues with breathing.
• Sexual dysfunction.
• Pain or intense stinging  kind of sensation.
• Autonomic dysreflexia(includes hypertension, headache, sweating and flushing).
• Problems related with circulation.
• Issues with digestion.

EMERGENCY SYMPTOMS (RED FLAGS)

• Sudden loss of sensation, movement or function in limbs.
• Sudden onset of severe neck or back pain.
• Loss of bladder or bowel control.
• Difficulty in breathing

DIAGNOSIS OF SPINAL CORD INJURIES(SCI)

To identify the location, degree and extent of damage a combination of physical examination, neurological evaluations and imaging tests are used in spinal cord injuries.

.1.Initial Assessment and physical Examination:

• History taking and documenting symptoms.
• Neurological Examination.

2.Imaging Tests:

• X-rays
• CT-Scan
• MRI

3.Functional and Specialized Tests:

• SSEP(Somatosensory Evoked Potentials).
• Electromyography(EMG) and Nerve Conduction Studies(NCS).
• Spinal Tap(Lumbar Puncture).

4.ASIA Scale

• ASIA Scale: American Spinal Injury Association Scale.
• Scale is used to classify the severity of the spinal cord injury.

5.Additional blood tests:

Blood tests can be performed to check for infections or to monitor general health while receiving therapy, but they are not specifically used to diagnose spinal cord injuries.

TREATMENT OF SPINAL CORD INJURIES IN AYURVEDA

Our expert doctors provide excellent treatment for spinal cord injuries by integrating Ayurveda, Physiotherapy and Acupuncture. Given below are the treatment protocols that are followed in our hospital.

EXTERNAL AYURVEDA TREATMENTS ARE:

1.PODIKIZHI:

Podi kizhi, also known as Choorna PindaSweda, is an ayurvedic treatment  method that uses cotton potali bags filled with herbal medicine, which is heated and massage is done. KOLAKULATHADI CHOORNAM is normally used for the same,

Podi kizhi got various benefits in SCI like

• Pain alleviation.
• Enhances blood flow.
• Lessens inflammation.
• Makes the  joints and muscles stronger.
• Lessens spasms in the muscles.
• Encourages the healing of the neurological system.

2.UDWARTHANAM:

A special kind of ayurvedic massage is called udwarthanam (powder massage) uses herbal powders to rub the body more forcefully against the direction of the hair follicles. For this either KOLAKULATHADI or KOLAKULATHADI with TRIPHALA  CHOORNAM is normally used.

Benefits of Udwarthanam

• Activates the nervous system.
• Increases the flow of blood.
• Lessens the stiffness of the muscles.
• Reduction of oedema.
• Detoxification.

3.KADI VASTHI:

In the specialized ayurvedic procedure Kadi Vasthi warm medicinal oils are held in a dam composed of black gram dough and is placed in the lower back (lumbosacral area).Normally DHANWANTHARAM TAILA ,MURIVENNA,SAHACHARAADI TAILA  is used for the above.

Advantages of Kadi Vasthi in SCI are:

• Reduces discomfort/pain.
• Lessens inflammation.
• Supports the repairing of nerves.
• Increases mobility.
• Tissue nourishment.

4.GREEVA VASTHI:

This technique involves utilizing black gram flour dough to form a dam-like structure that retains warm medicinal oil on the cervical spine for a predetermined amount of time (20–30 minutes).
Usually DHANWANTHARAM TAILA ,MURIVENNA,SAHACHARAADI TAILA  are used for the same.

The advantages of Greeva vasthi:

• Decrease in pain.
• Decrease in inflammation.
• Reduces muscular spasms and stiffness.
• Lubricates and nourishes joints.
• Makes the cervical spine stronger.

5.MATRA VASTHI:

Small amounts of therapeutic oils or ghee (clarified butter) are administered through the rectum in Matra Vasthi and after being retained for a while (about 30 to 60 minutes), they come out. It’s considered as one of the mildest forms of enema therapy and is used primarily for nourishing and strengthening the body especially in vata related disorders.

Matra Vasthi advantages are:

• Diminution in the Vata imbalance.
• Tissue nourishment.
• Enhanced nerve function.
• Pain alleviation.
• Increased mobility in the joints.
• Detoxification

6.ELAKIZHI:

Ela kizhi is an ayurvedic treatment that involves generating sweat using a pottali (Ela meaning leaves, and Kizhi meaning  pottali).Frying herbal leaves  along with other ingredients and some medicinal oil and then they are knotted in a pottali. After dipping this pottali into hot therapeutic oil, it is gently massaged  over the body or the affected area in this treatment. Castor leaves(Eranda, Ricinus communis),Tamarind leaves(Tamarindus indica),Arka leaves(Calotropis gigantea) etc these are normally used to prepare an elakizhi.

Advantages of Ela kizhi in SCI;

• Pain alleviation.
• Relaxation of the muscles.
• Detoxification.
• Improved nerve function.
• Stress Relief.
• Increased mobility and flexibility.
• Decrease in inflammation and oedema.

7.NJAVARA KIZHI

Njavara kizhi is also called as shashtika shali pinda sweda. It uses shashtika shali(njavara rice) and is cooked with milk and herbal decoction .Then the pottali is made of it and massage is done. The benefits of njavara kizhi are:

• It’s  good for reducing pain.
• Helps in improving circulation.
• It aids in strengthening muscles.
• It reduces spasticity.
• It supports nerve health.
• It helps to reduce stress and improve relaxation.

8.NADI SWEDAM: 

Using a tube or hose, localized steam application to the affected body areas during this treatment. Dasamoola kashayam is what we use to generate steam.

Advantages of Nadi Swedam

• Diminishes inflammation and pain.
• Reduces muscle strain and stiffness.
• Rejuvenate the muscles and joints.
• Increased joint mobility and flexibility

9.NASYAM:

 Nasyam entails applying herbal powders or oils via the nostrils. The patient is made to lie down and then their face is massaged. Following the application of steam to the face, a small amount of therapeutic oil either 2 drops (pratimasrsha nasya) or 2-10 drops (Marsha nasya, where dosage begins from 2 and maximum reached to 10 then reduced to 2)is applied. Following that, a light facial massage is performed.

Advantages of Nasyam in spinal cord injuries:

• It enhances the nervous system’s performance.
• Alleviation of neck, shoulder and upper back muscle spasms.
• Improved blood flow.
• Aids in reduction of  inflammation and pain.

PHYSICAL THERAPY IN SPINAL CORD INJURIES:

For those with spinal cord injuries (SCI), physiotherapy is essential to their care and recovery. An outline of physiotherapy methods and strategies  followed in our hospital for treating spinal cord injuries are given below:

PHYSIOTHERAPY TECHNIQUES

1.Assessment and Evaluation.

• Preliminary evaluations help determine the injury’s degree of severity.
• Assessment of functional ability, balance, coordination, muscle strength and range of motion.

2.Range of Motion(ROM) Exercises:

• Passive, Active and Assisted ROM: Help to improve joint flexibility and aids in prevention of contractures.
• Normal ROM exercises are: Flexion and extension of shoulder, elbow, wrist, hip, knee . Dorsiflexion and plantarflexion of ankle.
• Stretching done passively.

3.Strengthening exercises:

• By making use of resistance bands, weights or one’s own body weight the therapist targets particular muscle groups  for strengthening.
• Prioritize both upper and lower body strength exercises based on the severity of the injuries (back and core muscles).

4.Functional Training:

• Daily tasks(eg: transfers, sitting, standing).
• Utilizing assistive devices to promote self-sufficiency.
• To enhance activities of daily living (ADL), employing  muscle and functional reeducation.

5.Gait Training:

• For individuals with some lower limb dysfunction, physiotherapists may use treadmills, parallel bars etc .
• Assistive aids  like KAFO(Knee Ankle Foot Orthotics),HKAFO(Hip Knee Ankle Foot orthosis),AFO(Ankle Foot Orthosis)etc,  helps with alignment, posture of the body and walking.

6.Electrical Stimulation:

 

• Using FES(Functional Electrical Stimulation),certain nerves and muscles can be activated. This helps in muscle contraction and helps in the movement of arms and legs.
• Additionally, FES  also promotes neuroplasticity by activating neuronal networks.
• Using TENS(Transcutaneous Electrical Nerve Stimulation),where in it stimulates sensory nerves, helps in reduction of pain and improving muscle tone.
• Ultrasound: It helps to reduce inflammation, enhances tissue healing and helps increase mobility of joints.

7.Breathing Exercises:

• For patients with severe injuries, lung capacity and respiratory function maintenance are crucial.
• Spirometer can also be used in some cases.

8.Posture and body Mechanics Education:

• To avoid strain and injury, the patient is taught good body mechanics and posture.

9.Endurance and Agility training:

A)Endurance training

• Cardiovascular exercises.
• Exercises for breathing and interval training.

B)Agility Training

• Maneuvering in a wheelchair.
• Balance and coordination exercises.
• Strengthening of core muscles.
• Strengthening and flexibility for upper body .

GOALS OF PHYSIOTHERAPY IN SCI

• Maximize mobility: Assist patients in reaching their maximum range of motion.
• Boost endurance and strength: Build up patient’s muscles to support everyday tasks.
• Avoid complications: Lower the chance of developing secondary complications such as breathing problems, bed sores and contractures.
• Improve functional independence by helping people carry out everyday tasks on their own.
• Pain management: Use a variety of therapeutic approaches to address pain and suffering.

REHABILITATION PROGRAM COMPONENTS

1.Individualized treatment plans:

• Customized to meet the needs, abilities and objectives of the patient.
• Periodic review to modify the plan in light of advancements.

2.Education and support:

• Educating patients and their families on how to handle the healing and recovery process after an injury.

ROLE OF ACUPUNCTURE AND ACUPRESSURE IN SCI

Acupuncture has been explored as a complementary therapy for individuals with  spinal cord injury offering potential benefits in various areas.

1.Traditional Acupuncture:

This involves inserting fine needles into specific acupoints along the body’s meridians to balance energy and improve overall function. For SCI, common acupoints targeted include:

• Hegu(L1-L4) and Taichung(LV-3): To promote pain relief and reduce spasticity.
• Shenshu(BL-23) and Mingmen(DU-4):To support lower back and spinal health.
• Ciliao(BL-32):For the bladder control and lower limb dysfunction.

2.Electroacupuncture:

This technique involves attaching electrodes to acupuncture needles, delivering low-level electrical stimulation. Its commonly used  for:

• Pain relief
• Spasticity reduction.
• Nerve regeneration.

3. Acupressure:

• Similar to acupuncture but without needles, pressure is applied using fingers ,hands or tools on specific points.
• Used for patients who are uncomfortable with needles. It can help in reducing  spasticity and improving circulation in SCI patients.

MECHANISM AND EFFECTS:

• Pain Management: Acupuncture help to reduce inflammation and modulate pain signals.
• Spasticity: Electro Acupuncture may help relax hyperactive muscles and reduce spasticity by modulating the central nervous system.
• Neuroprotection and Neuroplasticity: Some studies suggest that acupuncture can promote neuroplasticity, which is beneficial in SCI recovery.

DIETARY RECOMMENDATIONS IN SPINAL CORD INJURIES

Our hospital’s general dietary guidelines are as follows:

• Drink roughly 2.5–3 L of water each day.
• Steer clear of strenuous activity.
• Eating vegetables that have been cooked.
• During the duration of treatment, foods such as chapati, puttu, steamed idiyappam, hot Kanji and unfermented appam can be consumed.

Patients are advised to stay away from:

• Pickles, cold meals, nuts and dry fruits.
• Fermented appam, idli and dosa.
• Tubers such as sweet potatoes, potatoes and tapioca.
• Non-vegetarian foods include meat, fish and eggs. Mutton can be consumed in curry form if required.
• Milk and its derived products.
• Steer clear of fried, oily and heavy  meals as well as baked items.

 

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.

 

For consultation,

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 )