E-ISSN:2456-3110

Case Report

Frozen shoulder

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 3 March
Publisherwww.maharshicharaka.in

Efficacy of Marma Chikitsa in the management of Avabahuka (frozen shoulder) - A Single Case Study

Chouhan A1*, Marwaha R2, Bhalerao N3, Kumar Chourasia S4
DOI:10.21760/jaims.9.3.41

1* Aayushi Chouhan, Post Graduate Scholar, Dept of Rachna Sharir, Pt Khushilal Sharma Government Ayurveda College, Bhopal, Madhya Pradesh, India.

2 Rita Marwaha, Professor HOD, Dept of Rachna Sharir, Pt Khushilal Sharma Government Ayurveda College, Bhopal, Madhya Pradesh, India.

3 Nisha Bhalerao, Associate Professor, Dept of Rachna Sharir, Pt Khushilal Sharma Government Ayurveda College, Bhopal, Madhya Pradesh, India.

4 Swatantra Kumar Chourasia, Assistant Professor, Dept of Rachna Sharir, Pt Khushilal Sharma Government Ayurveda College, Bhopal, Madhya Pradesh, India.

Avabahuka (frozen shoulder) is a type of Vata Vyadhi caused by vitiated Vata Dosha with Anubhandha of Kapha Dosha. The symptoms of Avabahuka can be correlated with the symptoms of adhesive capsulitis, which is commonly known as frozen shoulder. Being a disease of shoulder joint, which has the greatest range of motion, it seriously affects routine day-to-day activities. A 56-year-old female came to the OPD of Pt. Khushilal Sharma Government Ayurvedic College and Hospital, Bhopal (MP) with pain and restricted movement in the right shoulder since 6 months, having undergone conventional treatment without any significant improvement. In this case study effect of Marma Chikitsa in the management of Avabahuka (frozen shoulder) is evaluated. The patient was treated with Marma Chikitsa for 10 days. The range of movements improved gradually from 45 to 123° for abduction, 102° to 165° for flexion, 53 to 65 for external rotation, and 30° to 45° for extension. VAS score for pain in the right shoulder was 7 before treatment, which came down to 4 after first course of the treatment regimen and gradually to 3 after completion of the treatment. The study suggested that Marma Chikitsa may be used for relieving symptoms of Avabahuka; however, study on large population was suggested.

Keywords: Ayurveda, Avabahuka, Marma Chikitsa, Frozen shoulder

Corresponding Author How to Cite this Article To Browse
Aayushi Chouhan, Post Graduate Scholar, Dept of Rachna Sharir, Pt Khushilal Sharma Government Ayurveda College, Bhopal, Madhya Pradesh, India.
Email: 		Chouhan A, Marwaha R, Bhalerao N, Kumar Chourasia S, Efficacy of Marma Chikitsa in the management of Avabahuka (frozen shoulder) - A Single Case Study. J Ayu Int Med Sci. 2024;9(3):255-259.
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https://jaims.in/jaims/article/view/3154

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-01-07 2024-01-17 2024-01-27 2024-02-06 2024-02-14
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© 2024by Chouhan A, Marwaha R, Bhalerao N, Kumar Chourasia Sand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Aayushi Chouhan et al. Efficacy of Marma Chikitsa in the management of Avabahuka

Introduction

The practice of Ayurveda can be traced back to the Vedic era, where it was a part of Atharva Veda. The word Ayurveda is a combination of "Ayu," which means life or longevity, and "Veda," which means knowledge. In essence, Ayurveda is the knowledge of life and longevity. The Marma Sthan is the convergence point of Mamsa, Sira, Snayu, Asthi, and Sandhi, where the Prana, or life force, resides.[1] Through Marma Chikitsa, the blockages of Prana are cleared, nourishing the Marma. Some of the benefits of Marma Chikitsa include instant symptomatic relief without side effects. In the fast-developing era, most of the diseases may not be life-threatening but hamper day-to-day life & human productivity. This clinical entity was first introduced by Acharya Sushruta[2] in “Vata Vyadhi Nidana. Avabahuka is a painful disease that can significantly affect an individual's daily life. It is a type of Vata Vyadhi that disrupts the normal functioning of the upper limbs, causing symptoms like Shoola, Stamba, Shosha, and Bahu Praspandan. The Marma Sthan that are affected by this disease are located in the Amsa Sandhi, specifically the Amsa and Amsa Phalak Marma Sthan. Therefore, Marma Chikitsa is used as a treatment for Avabahuka. Avabahuka which is closely resembles the disease frozen shoulder. (Adhesive Capsulitis) In Modern aspect frozen shoulder is composed of two words" Frozen + shoulder. frozen means immobile & shoulder means the upper joint of the person's arm, so constant pain, stiffness, & progressive loss of Shoulder motion is termed a frozen shoulder.

Case Report

A 56-year-old female Patient housewife by profession consulted in the outpatient department of Pt. Khushilal Sharma Government Ayurvedic College and Hospital, Bhopal (MP) with a six-month history of chronic right shoulder pain. The patient complained of night pain, increasing severity of pain, limited painful movements, and increased stiffness. Symptoms were aggravated by household work. She was diagnosed as a case of Frozen Shoulder. She was taking analgesics and anti-inflammatory medicine for pain management.

History of Past Illness

The patient does not have a history of diabetes

mellitus, hypertension, or any physical injury or trauma to the right shoulder. There is no family history of musculoskeletal illnesses.

Personal History

  • Bowel - Clear
  • Appetite - Good
  • Micturation - Normal
  • Sleep - Disturbed due to pain

Physical Examination

Weight: 55 kg; height: 154 cm, and BMI: 23.2 kg/m2; blood pressure = 130/90 mm Hg; pulse rate = 74 minutes; pallor, icterus, cyanosis, clubbing, and edema were absent; cardiovascular system (CVS): normal; respiratory system (RS): clear no added sound; central nervous system (CNS): consciousness, attention, orientation, memory, and speech are normal; Reflexes in both upper and lower limbs were in the normal level and Prakriti: Vata Pradhana Kaphaja.

Shoulder joint examination

The right side is as follows. Left side is normal

  • Stiffness - Stiffness, relived by oral medication (grade 3)
  • Tenderness - On pressing pain appears on the face of the patient (grade 2)
  • Range of movements - Restricted: active ROM (AROM) abduction 45°, flexion 102°, extension 30°, external rotation 53°.
  • Vas score for pain in right shoulder was 7 (grade 3)
  • Sleep duration - 3-6 hours (grade 2)

Investigation

Both hematological and biochemical investigations carried out were found within the physiological limit. One-month-old X-ray of the Shoulder joint was normal.

Treatment

The treatment involved the administration of Marma Chikitsa. The present study includes stimulation of 8 Marma points that is Kshipra, Kurpar, Ani, Urvi, Kakshadhara, Amsa, Amsaphalaka,


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and Brihati Marma & these will be stimulated 15 -18 times on average in a single sitting.[3] The details of the administration are as follows.

Duration of study - 10 days
Follow up - 7th day

SNMarma NameStimulation TimeFrequencyDuration
1.Kshipra0.8 sec15-18 TimesTwice a day
2.Kurpar0.8 sec15-18 TimesTwice a day
3.Ani0.8 sec15-18 TimesTwice a day
4.Urvi0.8 sec15-18 TimesTwice a day
5.Kakshadhara0.8 sec15-18 TimesTwice a day
6.Amsa0.8 sec15-18 TimesTwice a day
7.Amsaphalaka0.8 sec15-18 TimesTwice a day
8.Brihati0.8 sec15-18 TimesTwice a day

    • Steady and moderate pressure will be applied slowly and gently.
    • pressure will be increased gradually depending upon pressure strength.

    Assessment criteria

    The assessment of the effect of treatment will be based on subjective and objective parameters of disease which will be recorded before and after treatment. The symptoms will be graded on the basis of the scoring system to be adopted as below[4] –

    1. Pain

    SNPainGrade
    1.VAS range in between 0-20
    2.VAS range in between 2-41
    3.VAS ranges in between 4-62
    4.VAS ranges in between 6-83
    5.VAS ranges in between 8-104

    2. Stiffness

    SNStiffnessGrade
    1.No stiffness0
    2.Stiffness, no medication1
    3.Stiffness, relieved by external application2
    4.Stiffness, relived by oral medication3
    5.Stiffness not responded by medicine4

    3. Flexion

    SNFlexionGrade
    1.161 °-180°0
    2.121 °-160°1
    3.81 °-120°2
    4.41 °-80°3
    5.0 °-40°4

    4. Extension

    SNExtensionGrade
    1.41°- 60°0
    2.31°- 40°1
    3.21°- 30°2
    4.11°- 20°3
    5.0°- 10°4

    5. External Rotation

    SNExternal RotationGrade
    1.81°-90°0
    2.61°-80°1
    3.41°-60°2
    4.21°-40°3
    5.0°-20°4

    6. Abduction

    SNAbductionGrade
    1.161°- 180°0
    2.121°- 160°1
    3.81°- 120°2
    4.41°- 80°3
    5.0°- 40°4

    7. Tenderness

    SNTendernessGrade
    1.On pressing patient does not feel any pain0
    2.On pressing patient feels pain, but no sign on the face (wincing)1
    3.On pressing pain appears on face of the patient (wincing)2
    4.Wincing of the face and withdrawal of the affected part on the pressure3
    5.A patient is not allowed to touch4

    8. Sleep

    SNSleepGrade
    1.More than 8 hours0
    2.6-8 hours1
    3.3-6 hours2
    4.Less than 3 hours3
    5.No sleep4

    Observation

    Diagnostic criteriaBefore treatmentAfter treatment
    PainVAS score 7Absent (Grade 0)
    StiffnessStiffness, relived by oral medication (Grade 3)No Stiffness (Grade 0)
    Flexion102° (Grade2)165° (Grade 0)
    Extension30° (Grade 2)45° (Grade 0)
    External rotation53° (Grade 2)65° (Grade 1)
    Abduction45° (Grade 3)123° (Grade 1)
    TendernessOn pressing pain appears on face of patient (Grade 2)On pressing patient does not feel any pain (Grade 0)

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    Discussion

    The results mentioned above were evaluated by considering the improvement in symptoms using the VAS scale for subjective criteria such as pain. Additionally, the range of motion (ROM) was evaluated using a goniometer scale for objective parameters which include symptoms like stiffness and difficulty with ROM. According to all Samhitas and Sangraha Granthas, Avabahuka is described as a Vatavyadhi.

    The demanding workload and fast-paced lifestyle, combined with improper dietary habits, can lead to numerous health issues, especially disorders caused by vitiation of Vata known as Vatavyadhi. One such painful condition is Avabahuka, which can severely affect the patient's daily routine. The practice of Marma Chikitsa can help improve both pain levels and restrictions in shoulder movement. In a study, participants underwent ten days of Marma Chikitsa treatment which resulted in significant improvements in their symptoms. Pain severity decreased and movement became easier. The study also observed an improvement in extension and rotation flexibility following the treatment.

    Probable mode of action of Marma

    Marma Chikitsa is a traditional Indian therapy that offers various benefits such as relieving muscle tension, promoting better sleep, removing energy blockages, clearing obstructions of Srotas, pacifying Vata Dosha, controlling Vyana Vata, balancing the functioning of the autonomic nervous system, and improving physical flexibility. This therapy is particularly beneficial for people who experience Avabahuka, a condition characterized by stiffness, rigidity, and degeneration caused by Ama and Vata aggravation. Marma Chikitsa can reduce the vitiation of Vata and relieve Ama aggravation, thus alleviating the symptoms of Avabahuka.[5]

    Conclusion

    The case report shows significant relief in signs and symptoms such as pain, stiffness, tenderness, sleep disturbances, and restricted range of motion within 10 days. This indicates that Marma Chikitsa is a prompt and non-pharmaceutical method of treatment that provides immediate pain relief to the patient.

    References

    1. Shastri Dr. Ambika Dutta, Sushrut Samhita, Ayurveda Tattva Sandipika, Varanasi Chaukhambha Sanskrit Sansthan Varanasi, Volume-1, 2012, Sharir Sthan. chap. 6/3

    2. Shastri Dr. Ambika Dutta, Sushrut Samhita, Ayurveda Tattva Sandipika, Varanasi Chaukhambha Sanskrit Sansthan Varanasi, Volume-1, 2012, Sharir Nidana 1/86

    3. Joshi SK. Marma Science and Principles of Marma Therapy. 1st ed. Delhi: Vani Publications; 2010. ISBN: 8189221-64-7. p. 46

    4. Mavani Shrija, A comparative clinical study to evaluate role of Nasya and Physiotherapy in the management of Avabahuka S.R to Frozen shoulder, IPGT Jamnagar 2018

    5. Ayurveda and Marma therapy by Frawley David, Ranade Subhash and Lele Avinash. Lotus Press. PO Box 325, Twin Lakes, 2003; WI 53181.


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