Frozen Shoulder Ayurvedic Treatment in Kerala

Ayurvedic Treatment of Frozen Shoulder

In Ayurveda, there are two main types of treatments, Shamana Chikitsa (conservative management) and Shodhana Chikitsa (purification therapy). First, we focus on Shamana Chikitsa like correcting your digestion and improving your metabolism. then followed by Sodhana Chikitsa like External panchakarma treatment.

Samana Chikitsa (conservative management)

With the proper assessment of the physical condition of each individual patient by experienced doctors, authentic Ayurvedic formulations are prescribed. The main objective of treatment is to pacify the vata and kapha doshas.

• Nidana parivarjanam ( avoid causative factors )
• Deepana and Pachana
• Kashaya   (Decoction)

Decoction obtained by boiling course powder or Dried Drugs

• Gulika     (Tablets)

In tablet form, they are made by rolling medicinal pastes into balls and drying them with the use of a drier

• Choornam  (Powder) 

Choorna is obtained by Herbal drugs cleaned properly made dry and then powdered and steved it 

  Shodhana Chikitsa (purification therapy)

The general line of treatment for vatavyadhi (Avabhahuga) as mentioned in classical ayurveda text 

Vamana

Virechana

Basti

Nasya 

• Vamana 
• It is one of the panchakarma. Ideal and best for the elimination of Kapha dosha.
• Virechana

It is one of the panchakarma.  Ideal and best for the elimination of pitta dosha. Orally administered medicine acts on internal physiology and expels the toxins and wastes that occur as the bowel passes multiple times.

• Basti 

Basti (enema) treatment is considered to be a prime treatment among the Panchakarma. In which the drugs are administered through the anal route.

• Nasya

Administration of medicine or medicated oil through the nose is known as Nasya, Here in the case of Avabahuga nasal installation of medicine which is the most important procedure 

Types

Marsha

Pratimarsha

At the time of Nasya Karma,

Avoid exposure to a cold breeze 

Avoid head bath ( prevent you from getting cold)

Avoid dairy products (to reduce Kapha)

Avoid cold things 

Use hot water for drinking

Other external body treatments like,

• Snehana 

Sneha means oily substances and the therapies or medications to give an unctuous or oily effect in the body are called Snehana. It is done in two ways, internally by oral intake of medicated oily substances and externally by abhyanga.

• Swedana

Sweda means sweat. therapies done using steam or heat for cleansing of the body through perspirations is called Swedana.

• Dhara (Dhanyamla)

Medicated water which is prepared by fermentation of cereals is poured on your body to reduce inflammation.

• Lepanam

Application of medicated paste on the affected shoulder joint for some time which reduces Pain, Stiffness, and tenderness.

• Elakizhi 

A cloth bundle filled with herbs that balance Vata, and is dipped in warm, medicated oil and placed on the affected area which reduces pain and inflammation.

• Podi Kizhi

A cloth filled with herbal powder is dipped in oil and then placed on the affected area. To alleviate symptoms of vata dosha

• Pichu 

Medicated oil is soaked in cotton with a little warm and then placed on the affected area.

What is a Frozen Shoulder

Frozen shoulder, also known as adhesive capsulitis. Frozen shoulder is indeed a condition that affects the shoulder joint, and it typically follows a pattern of gradual onset, worsening pain and stiffness, and then a gradual improvement over time. The condition can be quite uncomfortable and limiting in terms of shoulder mobility during the period of stiffness and pain.

Causes for Frozen Shoulder 

In Ayurveda, Apabahuka is a term used to describe shoulder pain and dysfunction. The causes of Apabahuka can be attributed to various factors, including both internal and external influences. Here are some common causes of Avabahuka according to Ayurveda:

• Bahya Hetu (External Causes): These are causes that lead to injury or harm to vital parts of the body (Marma) or the area surrounding the Amsa Sandhi (shoulder joint), which is also known as Bahya Abhighata(External injury). These external causes can contribute to Apabahuka.
• Abhyantra Hetu (Internal Causes): These are etiological factors that aggravate Vata dosha, leading to its vitiation in the shoulder region. This is also known as Dosha Prakopajanya,

1. a) Aharaja Nidana (Dietary Factors):

• Rasa (Taste): Katu (pungent), Tikta (bitter), and Kashaya (astringent) tastes.
• Guna (Qualities): Laghu (light), Ruksha (dry), and Sheeta (cold) qualities.
• Matra (Quantity): Abhojana (skipping meals), Alpashana (minimal eating), and Vishamashana (irregular eating) can all contribute to the vitiation of Vata.
• b) Viharaja Nidana (Lifestyle Factors):

These factors involve various activities and exercises that directly or indirectly influence the shoulder (Amsa Desha). They include:

• Vyayama: Physical exercises.
• Plavana: Swimming.
• Bharavahana: Carrying heavy loads.
• Balawat Vigraha: Lifting heavy weights.
• Dukha Shayya: Sleeping on uncomfortable surfaces

According to the Modern view, Cause of the Frozen shoulder was idiopathic means it developed without a clear reason.On the other hand, a secondary frozen shoulder can be linked to various factors:

Systemic Diseases: Conditions like diabetes mellitus, hypothyroidism, and hyperthyroidism are systemic diseases that can contribute to a secondary frozen shoulder. These underlying health issues may increase the risk of developing a frozen shoulder.

Extrinsic Factors: Several external factors can lead to secondary frozen shoulder-like problems in the cervical spine, stroke, Parkinson’s disease, and even a previous humerus bone fracture. These conditions can indirectly affect the shoulder and trigger a frozen shoulder.

Intrinsic Factors: Certain factors originating within the shoulder itself can also be responsible for a secondary frozen shoulder. These include issues like rotator cuff tears, rotator cuff tendinitis, biceps tendinitis, calcific tendinitis (the formation of calcium deposits in tendons), and arthritis in the acromioclavicular joint. These intrinsic problems can directly impact the shoulder joint and lead to frozen shoulder symptoms.

Symptoms of Frozen Shoulder 

According to Ayurveda, The Cardinal features of  Apabahuka are as follows,

• Bahu Praspandita haram (impaired or loss of movement of the upper limb):
• Amsa Bandana Sosham (Muscle Wasting): 
• Shoola (pain): 

1. Shoulder Stiffness: 

Modern Perspective:

• Slow Onset of Pain: The slow onset of pain is consistent with the gradual development of symptoms 
• Pain at Deltoid Insertion: Pain at the point where the deltoid muscle attaches to the shoulder 
• Inability to Sleep on the Affected Side: Discomfort or pain preventing sleep on the affected side 
• Atrophy of Supra and Infraspinatus Muscles: Muscle atrophy in the supra and infraspinatus muscles 
• Minimal Local Tenderness: The minimal tenderness when pressing on the affected area 
• Restriction of Active and Passive Range of Motion (ROM): 
• Painful and Restricted Elevation and External Rotation: 

In Ayurveda, Apabahuka is a term used to describe shoulder pain and dysfunction. The causes of Apabahuka can be attributed to various factors, including both internal and external influences. Here are some common causes of Avabahuka according to Ayurveda:

• Bahya Hetu (External Causes): These are causes that lead to injury or harm to vital parts of the body (Marma) or the area surrounding the Ansa Sandhi (shoulder joint), which is also known as Bahya Abhighata. These external causes can contribute to Apabahuka.
• Abhyantra Hetu (Internal Causes): These are etiological factors that aggravate Vata dosha, leading to its vitiation in the shoulder region. This is also known as Dosha Prakopajanya,

1. a) Aharaja Nidana (Dietary Factors):

• Rasa (Taste): Katu (pungent), Tikta (bitter), and Kashaya (astringent) tastes.
• Guna (Qualities): Laghu (light), Ruksha (dry), and Sheeta (cold) qualities.
• Matra (Quantity): Abhojana (skipping meals), Alpashana (minimal eating), and Vishamashana (irregular eating) can all contribute to the vitiation of Vata.
• b) Viharaja Nidana (Lifestyle Factors):

These factors involve various activities and exercises that directly or indirectly influence the shoulder (Amsa Desha). They include:

• Vyayama: Physical exercises.
• Plavana: Swimming.
• Bharavahana: Carrying heavy loads.
• Balawat Vigraha: Lifting heavy weights.
• Dukha Shayya: Sleeping on uncomfortable surfaces

According to the Modern view, the Cause of the Frozen shoulder was idiopathic means it developed without a clear reason.On the other hand, a secondary frozen shoulder can be linked to various factors:

Systemic Diseases: Conditions like diabetes mellitus, hypothyroidism, and hyperthyroidism are systemic diseases that can contribute to secondary frozen shoulder. These underlying health issues may increase the risk of developing a frozen shoulder.

Extrinsic Factors: Several external factors can lead to secondary frozen shoulder-like problems in the cervical spine, stroke, Parkinson’s disease, and even a previous humerus bone fracture. These conditions can indirectly affect the shoulder and trigger a frozen shoulder.

Intrinsic Factors: Certain factors originating within the shoulder itself can also be responsible for a secondary frozen shoulder. These include issues like rotator cuff tears, rotator cuff tendinitis, biceps tendinitis, calcific tendinitis (the formation of calcium deposits in tendons), and arthritis in the acromioclavicular joint. These intrinsic problems can directly impact the shoulder joint and lead to frozen shoulder symptoms.

Theory and Ayurvedic View on Frozen Shoulder Ayurvedic Treatment

Frozen shoulder, or adhesive capsulitis, is characterized by several key factors that lead to pain and limited mobility in the shoulder joint. 

   The primary issue is the thickening and hardening of the shoulder joint capsule due to the formation of scar tissue, which restricts shoulder movement. Additionally, a reduction in synovial fluid (the lubricant for the shoulder joint) contributes to stiffness and discomfort. Inflammatory cytokines found in the joint fluid play a role in symptom development, especially in the painful stage. Thickening of the coracohumeral ligament limits both external and internal shoulder rotation. Ultimately, as adhesive capsulitis progresses, the contraction of the glenohumeral capsule becomes the primary cause of a restricted range of motion in all shoulder movements.

typically progresses through three main stages:

• Freezing Stage: This is the initial stage of frozen shoulder, during which the patient experiences constant shoulder pain, especially at night. This stage can last from 10 to 36 weeks. 
• Frozen Stage: The frozen stage is the next phase, lasting from 4 to 12 months. In this stage, the pain may improve somewhat, but the stiffness in the shoulder typically worsens.
• Thawing Stage: The thawing stage is the final phase, which can last up to 2 years. During this stage, there is a gradual improvement in the range of motion of the shoulder. 

In Ayurveda, the etiopathogenesis of the disease Apabahuka (frozen shoulder) is believed to involve both Dhatu Kshaya and Marga Avarana.

Dhatu Kshaya: Dhatu refers to the body tissues, and Dhatu Kshaya refers to the depletion or weakening of these tissues.In Ayurveda, Kapha Dosha is responsible for lubrication and nourishment of the body’s tissues. When vitiated Vata affects the shoulder joint, it can lead to the depletion (shosha) of Shleshmaka Kapha(one type of kapha located in joints) in the tissues around the joint. This depletion of lubrication and nourishing properties can contribute to the dryness and stiffness seen in Apabahuka.

Marga Avarana: Marga Avarana refers to the obstruction or blockage of the natural pathways (margas) in the body. In the case of Avabahuka, the Vata Dosha, is responsible for movement and flow, When Vata is imbalanced, it can lead to vasoconstriction, which means the blood vessels in the affected area may narrow. This reduced blood flow can contribute to pain and reduced nourishment of the tissues in the shoulder joint

Cure Prospective of Frozen Shoulder Ayurvedic Treatment

Receiving appropriate treatment, adopting a healthy lifestyle, and consistently following up with therapy and medication can significantly increase the likelihood of a successful recovery and improved health up to an extent. However, it’s important to note that the degree of assurance of a complete cure can vary depending on the specific medical condition, its severity, and individual factors.

Maintaining a healthy lifestyle, including a balanced diet, regular exercise, stress management, and adequate rest, can significantly contribute to your overall well-being and treatment success.

Ayurvedic Diet and Lifestyle Changes to Cure Frozen Shoulder

Wholesome Food and Habits:

• Wholesome Food: Wholesome food typically includes a balanced diet with a variety of fruits, vegetables, lean proteins, and whole grains. Warm and unctuous (oily) foods, like soups and stews, can be soothing and nourishing, especially in colder weather.
• Proper and Regular Exercise: Engaging in regular physical activity can help maintain joint flexibility and overall health. Gentle exercises can be particularly beneficial for preventing stiffness.
• Warm Water Bath: A warm water bath can help relax muscles and alleviate stiffness, making it a good choice for those experiencing muscle tension or discomfort.

Unwholesome Diet and Habits:

• Unwholesome Diet: Unwholesome diets often involve excessive consumption of unhealthy foods, such as those high in saturated fats, sugars, and processed ingredients. Excess oily and fried foods can contribute to inflammation and other health issues.
• Cold Water Bath: Cold water baths may not be suitable for people with muscle stiffness or conditions like frozen shoulder, as they can cause muscles to tense up further.
• Excess Use of A/C: Spending too much time in an air-conditioned environment, especially if it’s very cold, can exacerbate stiffness and discomfort for some individuals.
• Heavy Exercise for Frozen Shoulder: For individuals with frozen shoulders or similar conditions, heavy exercise can potentially worsen the condition. It’s usually recommended to start with gentle range-of-motion exercises and gradually progress as pain and stiffness improve.

Recommended Yoga Asanas for Frozen Shoulder

yoga can be a valuable complement to traditional medical treatment for managing frozen shoulder. It can help reduce symptoms like pain and stiffness while gradually improving the range of motion in the shoulder joints.

1. Surya Namaskara (Sun Salutations):

• This series of yoga poses can improve overall flexibility and circulation, benefiting the entire body, including the shoulders.
• It includes a sequence of asanas that flow together, involving forward bends, backward bends, and stretching.

2. Ardha Matsyendrasana (Sitting Half Spinal Twist):

• Alleviates breathing difficulties.
• Reduces stress and muscle tension.

3. Bhujangasana (Cobra Pose):

• Strengthens back muscles.
• Tones the abdomen.
• Reduces stress.

4. Halasana (Plow Pose):

• Helps relieve back pain.
• Promotes rejuvenation.
• Strengthens muscles.

5. Dhanurasana (Bow Pose):

• Opens the chest, neck, and shoulders.
• Relieves back problems.
• Reduces stress, promoting overall well-being.

6. Salabhasana (Locust Pose):

• Strengthens the muscles around the shoulder blades and upper back.

7. Makarasana (Crocodile Pose):

• This pose is excellent for relaxation and stretching the shoulders.

8. Ardha Baddha Hastasana (Half Bound Hands Pose):

• This asana gently stretches and improves flexibility in the shoulders.

9. Gomukhasana (Cow Face Pose):

• This pose involves interlocking your arms behind your back, which can improve shoulder mobility and flexibility.

Shoulder Arthritis and Frozen Shoulder: What’s the Difference?

frozen shoulder is primarily characterized by severe shoulder stiffness and limited range of motion, often with an unknown cause, while shoulder arthritis is characterized by pain, stiffness, and cartilage wear and tear within the joint.

Shoulder Arthritis:

Shoulder arthritis is a condition that involves inflammation in the shoulder joint, specifically the glenohumeral joint where the upper arm bone (humerus) meets the shoulder blade (scapula). This inflammation can lead to cartilage loss and result in a range of symptoms.

Cause:

Shoulder arthritis is primarily caused by the wear and tear of the cartilage in the shoulder joint. It can also result from inflammatory conditions like rheumatoid arthritis or post-traumatic injury.

Symptoms:

• Pain: Pain in the shoulder joint, which may worsen with movement.
• Stiffness: Stiffness in the shoulder joint, particularly after periods of inactivity.
• Decreased Range of Motion: Limited ability to move the shoulder, affecting daily activities.
• Noises: Popping, clicking, and grinding noises when moving the shoulder (crepitus).

Types of Shoulder Arthritis: mainly

• Osteoarthritis: This is the most common type of shoulder arthritis and occurs due to the gradual wear and tear of the joint cartilage over time.
• Rheumatoid Arthritis: An autoimmune condition where the immune system attacks the lining of the joint capsule, leading to inflammation and cartilage damage.
• Post-Traumatic Arthritis: Arthritis can develop following a traumatic shoulder injury, such as a fracture or dislocation.

Frozen Shoulder Ayurvedic Treatment: Prevention

• Maintain Shoulder Mobility: Regularly perform gentle shoulder exercises to maintain or improve your shoulder’s range of motion. Simple exercises like arm circles or pendulum exercises can help keep the shoulder joint flexible.
• Strengthen Shoulder Muscles: Focus on strengthening the muscles around the shoulder, including the rotator cuff muscles and deltoids. Strong shoulder muscles can provide better stability to the joint.
• Proper Posture: Maintain good posture in your daily activities. Sit and stand up straight, and avoid slouching. Proper posture can reduce stress on the shoulder joint.
• Avoid Overuse: Be mindful of repetitive shoulder movements and activities that place excessive strain on the shoulder. Take breaks during activities that involve repetitive shoulder motions.
• Warm Up Before Activity: Always warm up your shoulder with gentle movements before engaging in physical activities or exercises. Warming up can help prevent injury and stiffness.
• Lift Properly: When lifting heavy objects, use proper lifting techniques. Lift with your legs rather than your back or shoulders to prevent strain on the shoulder joint.
• Maintain a Healthy Weight: Excess body weight can place additional stress on the shoulder joint. Maintaining a healthy weight through a balanced diet and regular exercise can help reduce the risk of shoulder problems.
• Avoid Immobilization: After surgery or injury, follow your healthcare provider’s recommendations for rehabilitation and recovery. Avoid keeping the shoulder still for extended periods to prevent stiffness.
• Manage Chronic Conditions: If you have conditions like diabetes or thyroid disorders that increase the risk of a frozen shoulder, work closely with your healthcare provider to manage these conditions effectively.
• Regular Check-ups: If you are at risk of developing a frozen shoulder or have a history of shoulder problems, consult with a healthcare provider or orthopedic specialist for guidance on preventive strategies tailored to your situation.

When to Visit a Doctor in Case of Shoulder Pain?

Shoulder pain can be caused by a range of conditions, including but not limited to frozen shoulder, osteoarthritis, rheumatoid arthritis, rotator cuff tear arthropathy, bursitis, tendonitis, cervical radiculopathy, and even non-musculoskeletal issues like heart-related problems.

  In cases where shoulder pain is due to strain or sprain, initial home care measures such as rest and ice packs may help alleviate symptoms. However, if the pain persists beyond a day or two, it’s important to seek medical care.

Immediate Medical Attention: 

Immediate medical attention should be sought if shoulder pain is accompanied by the following symptoms:

• Difficulty breathing
• Chest tightness
• Sweating

These symptoms could indicate a serious condition like angina or a heart attack, which requires urgent medical evaluation.

Injuries: If the shoulder pain is the result of an injury, such as a fall or accident, it’s advisable to seek immediate medical attention in the following situations:

• If the shoulder joint appears deformed or dislocated.
• If you are unable to move your shoulder or arm.
• If you experience intense and persistent pain.
• If there is sudden and significant swelling in the shoulder area.

 Frozen Shoulder Ayurvedic Treatment at Dheemahi Ayurveda

Dheemahi Ayurveda is dedicated to prioritizing patient health and well-being through a rich tradition of Ayurvedic wisdom passed down through five generations. Our team comprises expert doctors who are committed to your health journey. Dheemahi Ayurveda Is an authentic and traditional Ayurveda Hospital.

With daily consultations we provide more reliability as by doing physical examinations, doctors can get more findings about the condition of the patient.

For chronic diseases – routine follow-up check-up is also an essential requirement that cannot be ignored. In the case of therapies needed for the relief of the symptoms, the supervision of a doctor is very important. Dheemahi facilitates the supervision of our doctors in every Panchakarma therapy with exact documentation of your treatment schedule

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