Human body is a marvel. The structure of our
skeleton, combined with the strength of our muscles and the tendons and
ligaments that connect muscles and bones together, makes the human body a
perfect bio-mechanic machine. It is able to move through several planes
of motion by the grace of our spine, which can move in four different
directions, allowing us perform a multitude of physical activities. For
example, we are capable of flowing through sun salutations, propelling
ourselves forward to walk or run, and find dynamic stability and balance while
surfing or skiing. When anatomical principles are followed, including
proper alignment and attention to proper range of motion, our bodies can
function with ease. If, however, we continuously practice activities with
improper alignment, or we are pushed out of alignment by some outside and
unseen event, our bodies can experience pain and injury. Sometimes, pain
can arise without any acute episode. The Western Medical model has a
fairly succinct system for managing both acute and chronic injury, and is only
starting to look towards ancient healing systems like Ayurveda for healing
injury. Traditional Ayurvedic treatment of injury includes some Western
allopathic methods, but moves beyond them to include healing of the mind, body
and spirit.
In general injuries are divided into two categories: acute and
chronic.
Acute injuries are those with a sudden and severe onset of
pain, possible swelling and the inability to place weight on the area, abnormal
ranges of movement, weakness and tenderness. Chronic injuries may start
out as acute injuries but continue to persist in the body. One way to
gauge whether an injury has become chronic is when pain is experienced during
participation in physical activity or exercise after the acute injury has been
healed, a dull ache occurs during rest, or when there is persistent swelling.
Chronic injury can also be defined as pain lasting greater than three
months.
Acute Injury
Some of the most common acute injuries are
sprains and strains. Sprains occur on ligaments and strains affect
muscles and tendons. Ligaments are bands of connective tissue that
connect bone to bone and hold joints, like the shoulder, together.
Tendons are bands of connective tissue that connect muscles to bones.
A sprain is a stretched or torn ligament, while a strain is a stretched
or torn muscle or tendon. Sprains and strains share some similar symptoms,
which include pain and swelling. With a sprain, however, there may also
be bruising, inability to move the affected joint and a popping or tearing
sound. The symptoms of a strain may also include muscle weakness, muscle
spasm and trouble moving the affected muscle.
Western Treatments of Acute Injury
The most commonly recommended Western allopathic
treatment of sprains and strains is to use the R.I.C.E. method: Rest, Ice,
Compression and Elevation. Following this method, at the onset of injury
the activity should be discontinued and the injured area of the body should be
rested. Next, an ice pack should be applied to reduce swelling and
inflammation. An Ace bandage or other clean wrap can be used to compress
the injury, keeping swelling at bay. Finally, the injured area should be
rested in a position elevated above the heart.
Other Western allopathic treatments of sprains
and strains include the use of NSAID pain relievers, immobilization of the
injury, and rehabilitation exercises to restore proper range of motion.
Also, a program of strengthening and stretching the affected area should
be followed so that scar tissue will not build, which could increase the
possibility of re-injury. Additional Western modalities of injury treatment
include electrical stimulation, alternating cold and hot packs, ultrasound and
massage. In certain conditions, including tearing of ligaments, tendons
or muscles, the patient may require surgery to repair the damaged tissue.
As the above methods point out, treating acute
injury involves managing symptoms and resting the injured area. In
addition to symptom management, some literature points to taking preventative
measures to reduce the likelihood of experiencing injury or re-injury.
Preventative measures are different based on where in the body injury is
more prone to occur, but all preventative measures have the same basic
principles of stretching what is tight, strengthening what is weak and
improving range of motion in all directions . Less commonly focused
on in the Western allopathic literature of acute injury recovery and prevention
is proper diet, however, one article suggests that athletes experiencing acute
injury should follow a diet high in vitamins and minerals obtained from healthy
sources like fresh vegetables. It also suggests athletes eat “balanced
protein,” and to avoid overeating so as not to gain weight while injured.
Ayurvedic Treatment of Acute Injury
Ayurvedic treatment of acute injury takes a more
holistic approach. While Ayurvedic treatment follows the same general
course as Western allopathic treatment in that it aims to reduce inflammation
and swelling and to restore the muscle, tendon or ligament to its proper
healthy function, Ayurvedic knowledge allows for identification and treatment
of the many subtleties within injuries. These include noticing the
different types of inflammation and swelling, observing different forces at
work within the injury and addressing them individually, and keeping in mind
the unique constitution of the individual so that the healing program can be as
unique as they are. In addition, Ayurveda acknowledges at the energetics
of an illness or injury, takes into consideration the amount of toxins or ama a
patient may have in their body, and assesses how well prana, the life-force
energy responsible for all movement in the body, is flowing in the injury
itself and in the patient’s body in general.
In order to understand Ayurvedic treatment, it is
important to understand the basics of Ayurveda itself. Ayurveda is a
holistic system of health that utilizes the five-element theory, which
underlies all life on the planet. The five elements – earth, water, fire,
air and ether – combine to create the three doshas. Doshas are the forces
within nature and our bodies that are responsible for all action and inaction,
including the formation of our tissues, the metabolism of thought and food, and
all movement in the body including nutrients in and out of cells, breath in and
out of the lungs, creative flow from our minds out our hands as well as speech
and muscle movement. The definition of dosha is “fault” or
“imperfection,” which explains how these forces can move to excess through
improper diet or lifestyle and create a state of dis-ease in the body. In case of acute injury, vitiation of the doshas usually occurs from outside
factors like unexpected events.
In Ayurveda, both the treatment and management of
disease is based on the qualities of imbalances found in the body.
Ayurveda relates every state in nature, and thus in our bodies, back to
their most basic building blocks – the elements and qualities that they are
made of. Once the basic qualities of an imbalance are understood, we are
able to provide treatments that balance the disease or injury. The most
primary principle of Ayurvedic treatment is that “like increases like, and
opposites reduce each other .” In Ayurveda, dry is treated with moist,
cold is treated with heat, heavy is treated with light and so forth .
In Ayurveda all swellings, can be
attributed to either vata, pitta, kapha or all three doshas (sannipata).
Vata swelling appears red or black in color and includes prickling, soft,
fleeting pain. Pitta swelling has a yellow or red coloring to it, is soft
and hot to the touch and spreads quickly. Kapha swelling is pale or white
in color, feels cold and smooth, spreads slowly and may itch.
In general, it is recommended that anyone with
swelling, regardless of the cause, should avoid sour and salty foods, and heavy
foods such as milk, sugar and ghee . This is because most generalized
swelling is due to increased water retention in that area, caused by Kapha
dosha, and because the water element in the body (i.e. swelling) is increased
by the intake of the aforementioned foods. Based on the type of swelling and
inflammation, mentioned in the previous paragraph, Ayurvedic treatment can
include herbal formulas containing properties to treat the imbalance with its
opposing qualities. Some of the herbs recommended to treat
swelling include vidanga, trikatu, haritaki, guggulu, fresh ginger, punarnava
and pippali .
The classical Ayurvedic text the Ashtanga
Hridayam, by Vagbhata, does not talk about muscle injuries specifically, but
does talk about the healing of traumatic injuries, which he defines as those
“wounds which occur suddenly.” Vagbhata also recommends treating with
opposites. He recommends treating inflammation in acute traumatic injury
with a topical herbal application, called a lepa, using herbs with a cold
potency, sweet taste and unctuous properties . These three qualities –
cold, sweet, and unctuous – help to reduce inflammation and heat.
Most modern Ayurvedic sources encourage the use
of external herbal compounds, like lepas, for treating acute injury.
Lepas are medicinal herbs made into a paste with oil, aloe, or another
liquid, then applied to the skin. An article in Yoga Journal Magazine
recommends the use of herbal compounds to improve the circulation of prana, or
life force energy, and blood around the injury. The article states that,
if applied correctly, the active ingredients in the herbs will be absorbed by
the skin, thereby reducing pain and swelling and improving circulation.
The article also suggests the use of herbs such as Salai guggul,
kapitthaparvi, and bola, both internally and externally to reduce pain,
strengthen bones and joints, and cleanse the blood of toxins .
Additionally, white willow bark – the herb that inspired Westerners to create
Asprin – is recommended as an analgesic and anti-inflammatory. This
article also recommends that the patient rest and ice the injury.
For reducing pitta-type pain and inflammation use pitta reducing herbs that have an affinity for joints and muscles.
These include guduchi, tulsi, turmeric, licorice and the formula Kaishore
guggulu, all taken internally. Additionally, the patient could drink
anti-inflammatory teas like ginger or tulsi-turmeric-ginger. For
localized healing, the author recommends the use of anti-inflammatory oils like
castor and mahanarayan to be massaged into the affected area, and then rinsed
off in a hot shower. Once inflammation is gone, the patient could massage
the area with one of the aforementioned oils, and then follow with a ginger or
baking soda bath.
For muscle tendon injuries where there is no
inflammation present, Patrapinda Sveda therapy can be taken. Patra
means “the leaves of medicinal plants,” pinda means, “bolus,” and sveda means
fomentation or heat therapy . Therefore, Patrapinda Sveda is the
application of medicinal leaves fried in ghee or oil, and wrapped in a muslin
cloth to form a bolus. The bolus is then massaged into the injured area,
where the medicinal properties of the plant will absorb into the skin and
provide pain relief via softening of the tissues. Additionally, it is recommended that once an acute injury has healed past any inflammation, a yoga
therapy program should be started that addresses any pain, under-use, loss of
conditioning and join laxity. Finally, muscles should be slowly
conditioned to sustain maximum functional capacity.
The treatments utilized
by Ayurveda to heal acute injury are: internal medicines (like herbs and diet),
external medicines (like lepas and patrapinda sveda), varma chikitsa
(procedures to increase joint mobility and function and decrease pain), pancha
karma (removing toxins and cleansing the body), and traditional physiotherapy.
With this holistic approach, Ayurvedic treatment of injury can be a good route
to healing and even an alternative to surgery .
Chronic Injury
As stated above, chronic injury can be described
as injury lasting more than three months, or twelve weeks. The original
cause of chronic musculoskeletal pain may have been an infection, injury, or
wear and tear from incorrect movement over an extended period of time.
Chronic pain or injury are often difficult to manage because many times
the cause is unknown , and sometimes pain occurs in the body for no apparent
orthopedic reason, with no acute episode of injury. Both Western medicine
and Ayurveda offer treatments for chronic injury.
Western Allopathic Treatments of Chronic Injury and
Pain
For the most part, Western treatment of chronic
injury includes following the plan laid out for acute injury, and then adding a
recovery and maintenance phase of healing. In the recovery phase, the
American Academy of Physical Medicine and Rehabilitation recommends building
strength and flexibility around the injured area to repair normal function and
range of motion. Then, they suggest a maintenance phase during which the
patient minimizes the chances of injury recurrence by engaging in a supervised,
total-body fitness program .
Chronic injury, however, can have more of an
effect on the body than just the area of injury and surrounding tissues.
Long-term chronic injury and/or pain can have psychological effects also.
Often, pain can change the regular patterns of a person’s life, their
relationships to others and the way they function in everyday life.
Reduced coordination or strength in an area of a body can make a person
less independent than they once were, and create a need for them to rely more
on others. These changes due to pain, when left untreated, can lead to
psychological problems and even more pain.
Pain and depression are closely related.
Depression can cause pain – and pain can cause depression.
Sometimes pain and depression create a vicious cycle in which pain
worsens symptoms of depression, and then the resulting depression worsens
feelings of pain.
Therefore, not only does pain affect the physical
body, it also affects how a person thinks and feels. When thoughts and
emotions are particularly negative, they can increase the pain that the person
experiences. There are some Western techniques for addressing the
emotional/psychological component to pain. They include occupational
therapy, and psychotherapy or counseling.
Occupational therapy helps people manage both the
physical and psychological effects of pain. Occupational therapists teach
people to manage their daily activities and lifestyle in accordance with their
pain or injury through several methods. They teach people how to identify
behaviors that increase pain and then offer alternative methods instead, and methods
for decreasing the frequency or intensity of pain. They teach patients
new ways for using their bodies to decrease pain during everyday tasks.
Occupational therapists also help the patient by collaborating with their
team of health care professionals to keep a clear path of treatment.
Psychotherapy or counseling can help patients by
guiding them to reduce stress and tension, and to make lifestyle changes when
necessary. Because of the aforementioned link between pain and
depression, it can often be difficult to tell which came first if there was no
acute injury to musculoskeletal tissue. In these cases, psychotherapy can
be quite effective at getting to the bottom of what is causing the pain and/or
depression – whether it be a stressful job, a negative living situation, or an
unsupportive relationship. Patients may be guided through counseling to
change the situations that may be aggravating their chronic pain or injury.
Ayurvedic Treatment of Chronic Injury and Pain
Similar to Western Allopathic treatments of
chronic injury, Ayurvedic treatment of chronic injury and pain will firstly
follow their same treatments for acute injury, and also include phases in
treatment for maintenance and prevention. All of the aforementioned
Ayurvedic treatments would continue to be applied as needed for pain and
healing of tissues. Also similar to Western medicine, Ayurveda treats
chronic injury and pain with both physical application and psychotherapy –
specifically, Ayurvedic psychology, which differs from Western. Ayurveda
always includes treatment of the mind, body and spirit, and believes that
health and healing must address each of these aspects of our being. In
addition, because it believes that every physical manifestation had first a subtler
component, complete Ayurvedic treatment will provide treatment for pain and
injury through subtle body anatomy, including the nadis, chakras and auric
field.
Beginning with treatment for the physical aspects
of chronic injury, Ayurvedic body therapies for chronic pain would include
those listed above – internal medicine, external medicine , marma chikitsa,
Pancha Karma and physiotherapy – but would be adjusted as necessary as vitiated
doshas come into balance. Next, a patient would be treated using Ayurvedic
psychology, which teaches the patient about who they are as an incarnated soul
and the specific growth and challenges that they may face in the this life.
From this understanding of soul development, the patient can gain an
understanding of their pain or injury in the context of their life journey.
This can help a patient understand the lesson behind the pain, which can change
the perception of pain from something that occurred outside “to” the patient to
a signal from the body to create change within the patient’s life.
Additionally, while Western psychology focuses on revisiting the past in
order to understand how a current situation manifested, Ayurvedic psychology
emphasizes taking stock of the current situation and making positive changes to
transcend the situation and create the life that is wanted.
To begin to address chronic musculoskeletal pain
and injury through Ayurvedic psychology, the practitioner may look at the
tissues affected and their related psychological function.
Musculoskeletal injuries, by definition, are those that affect the muscle
tissue, tendons and ligaments, and bone tissue. Ayurveda calls muscle
tissue and ligaments mamsa dhatu, and the related psychological function is
courage, fortitude and self-confidence. Symptoms of deficient mamsa dhatu
can result in muscle wasting, loose ligament (which often cause many chronic
injuries in athletes), and fear, worry, low self-confidence and low
self-esteem. The Ayurvedic term for bone tissue is asthi dhatu, and its
related psychological function is stature and the ability to stand tall.
Deficient asthi dhatu can result in osteoporosis and other weak-bone
disorders, as well as arthritis.
Using the above information as a guide, the
patient should be guided to recognize what in their life is causing them to
feel a lack of confidence and support, and be guided toward building confidence
and self-esteem so that they can stand tall and have no doubt that they can
support themselves. In order to do this, we must understand all aspects of the
Self – moving past the physical body and into the subtle and causal aspects of
our existence. Ayurvedic philosophy states that all physical reality had a
subtler component that preceded it, so only addressing the physical component
is not necessarily addressing the root cause. For mind-body-spirit
healing, Ayurveda will of necessity address the subtle components of pain – the
underlying thoughts, behaviors or attitudes that may keep the body in distress.
Looking at the bodily tissue associated with the
injury is just one way to treat the underlying psychological issue.
Additionally, chronic pain can be assessed based on where it is in the
body and how that relates to the subtle or astral body and the chakra system
that energizes it. The subtle body is an energetic copy or template of
the physical body and is projected by the seven chakras, which are the
energetic templates of the nerve plexuses of the body. Our chakras serve two
basic purposes – first as pumps that run energy through our bodies via the
nadis, or energetic channels that run along the spine, and second as
determinants of our experience. Chakras can run two types of energy –
ordinary subtle energy, which is necessary for everyday experience and
function; and heightened subtle energy, which changes our perceptions and
allows our consciousness to be raised. When energy in a chakra is
partially blocked or moving too slowly, dis-ease in the physical body may
manifest. Until the underlying issue has been addressed at the chakra
level – which usually includes self-reflection and work in underlying values,
beliefs, and emotional attachments – the physical pain will persist. Much
research has been conducted and written about the different chakras and the
life lessons they provide. Therefore, the location of the chronic injury
or pain as it relates to the nearest chakra can give the practitioner more
information about the cause and purpose of the pain and how to treat it.
The first principle of whole body healing is that our subtle
biography becomes our physical biology:
As our lives unfold, our biological health
becomes a living, breathing biographical statement that conveys our strengths,
weaknesses, hopes and fears. All our thoughts, regardless of their content,
first enter our systems as energy. Those that carry emotional, mental,
psychological, or spiritual energy produce biological responses that are then
stored in our cellular memory. In this way our biographies are woven into
our biological systems, gradually, slowly, every day.
Ayurvedic treatments for chronic injury and pain
on the subtle body level to address chakra or energy imbalance could include
self-inquiry, meditation, pranayama, sound therapy (both listening to music and
chanting), and repeating affirmations or Sanskrit chants. Because chronic
injury or pain is signal that there is a long-term imbalance in the body,
subtle body healing is critical in addressing the underlying cause of
discomfort and eliminating it from the body.
Both Western medicine and Ayurveda treat chronic
injury and pain through both physical modalities and psychotherapy (the body
and mind). However, because Ayurveda believes in the connection of the
mind, body and spirit, it is able to take a healing a step further with its
utilization of subtle body anatomy to aid in understanding and releasing the
underlying causes behind chronic injury and pain that Western medicine often
misses.
Conclusion
Both Western Medicine and Ayurveda offer options
for healing acute and chronic injury. When working with acute injury,
Western medicine generally utilizes a one-size-fits-all approach that generally
helps people recover; however, through its doshic theory, Ayurveda has a more
intricate healing method and can offer more individualized healing. For
chronic injury, Western medicine has recognized that both the body and the mind
must be treated in order to realize healing. However, Ayurveda’s
knowledge of the subtle body system make it an excellent choice for patients
ready to take charge of their own healing path and realize healing of the
entire mind, body and spirit.
