Journal of Ayurveda and Integrated Medical Sciences

Introduction

The term “frozen shoulder” was first introduced by Codman in 1934. The three hallmarks of this disease are insidious shoulder stiffness, severe global pain even at night and near complete loss of passive and active external and internal rotation of the shoulder joint. It presents usually in the sixth decade of life, and onset before the age of 40 is very uncommon. The peak age is 56, and the condition occurs slightly more often in women than men. In 6-17 % of patients, the other shoulder becomes affected, usually within five years, and after the first has resolved. The non- dominant shoulder is slightly more likely to be affected. A patient with frozen shoulder traditionally progresses through three overlapping phases.^[1]

• Painfull / Freezing Phase - Inflammation in the shoulder joint capsule causes pain, which worsens when the shoulder is moved. When there is a shoulder pain that is aggravated by motion there is tenderness while using that shoulder. At this stage pain is the main problem not stiffness. It lasts for 6-12 weeks.
• Frozen Stage - Inflammation damages tissues & as it heals scar tissue forms. The normally loose capsule thickens & shrinks. Pain gradually subsides but stiffness worsens. Pain often reduces during this stage, range of motion decreases significantly. It can last for 4-12 months.
• Thawing stage - A year or more of physical therapy may be needed to “thaw” (restore the mobility). The progress is gradual. Mean duration from onset of frozen shoulder to the greatest resolution is over 30 months. It lasts for 12-42 months.

Frozen Shoulder is closely resembles to Avabahuka. Avabahuka is one such disease that hampers the day-to-day activity of an individual like ability to carry out daily activities like dressing, eating, personal hygiene and work. Acharyas mentioned Avabahuka in Vatavyadhi chapter.^[2] Vatavyadhi is one among Astamahagada^[3] is itself explanatory with regard to the consequence caused by Avabahuka.^[4] It is considered to be a disease that usually affects the shoulder joint. Modern medical science has no such long term effective modality for frozen shoulder. The side effects of steroids and

• Patients with uncontrolled Blood Sugar Level.
• Patients who need Surgical Care or have undergone any Surgical Intervention.
• Patients having Fracture and Dislocation in the Shoulder Joint.
• Patients having chronic systemic illness.
• Patients having any history of Malignancy, Tuberculosis, HIV, etc.

Criteria for assessment

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 below -

The special scoring system for Frozen Shoulder (Avabahuka), used in the Shalya Tantra Department of I.P.G.T. and R.A. will be adopted for the statistical analysis of the overall effect of Marma Chikitsa.^[5]

1. Pain

2. Stiffness

3. Flexion

4. Extension

The present pilot study includes stimulation of 8 Marma points that is Kshipra, Kurpar, Ani, Urvi, Kakshadhara, Amsa, Amsaphalaka, and Brihati Marma & these will be stimulated 15 -18 times on average in a single sitting.^[6] The details of the administration are as follows.

Duration - 10 days

Follow-up - 07 days

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

Statistical Analysis

For assessing the improvement of symptomatic relief and to analyze it statistically, the observations were recorded before and after treatment. The mean, mean difference, SD, SE, and Wilcoxon sign rank test were calculated from the observations recorded.

(P=0.0050).

Sleep - The mean score of Sleep in this study, before treatment was 2.43 and after treatment, it was reduced to 1.00. So, the mean difference was 1.43, with a percentage relief of 58.84% which was very statistically significant (P=0.0060).

Discussion

Due to disturbance of daily activities, patients become panics who are suffering from Avabahuka. There are many treatment protocols given in classics to treat Avabahuka. Marma Chikitsa is one of them. In modern science, Avabahuka can be correlated with Frozen Shoulder. Frozen shoulder is a common troublesome problem among the therapeutic disorders. Although the disease is not fatal but its duration and attack of pain at night makes the life of sufferer miserable and crippled. Avabahuka is a disease which hampers most of the functions of the hand. Among the category of diseases it is been considered Vata disorder as an important entity. Vata disorders are considered under the heading of Ashta Maha Gadas. Avabahuka is one among them and Vata Kapha dominant disease. It is affecting the Amsa Moola (root of shoulder girdle) exhibits the symptoms in hand. It is often said that “the pain is often severe enough to disturb the sleep”. Losses of Bahu Praspandana (movement of arm), Stambha (stiffness) and Shoola (pain) of the shoulder joint are the cardinal features of Avabahuka. The Marmas can be considered as the various points of nervous, vascular and muscular system, which plays a vital role in the normal functioning of the joints. In reference to etiopathogenesis of Avabahuka, Sushruta has clearly stated that aggravated Vata localised in the region of the shoulder causes wasting of local musculature (Snayu), ligaments (Kandara), constricts the veins (Sira) present there and produces Avabahuka.

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 Shrotas, 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