Rehabilitation after

sports injuries
in Ayurveda
Dr Shiva Shankar Soni
Plan of the lecture
● Main components of the human body in Ayurveda
● Components of pathological process and basic principles of treatment
● General treatment principles, modalities and common formulations in the
management of sport injuries in Ayurveda
● ROTATOR CUFF SYNDROME
● TENNIS ELBOW, GOLFER'S ELBOW
● ACHILLES TENDINITES
● LIGAMENT AND TENDON INJURIES
● Diet recommendations during recovery period
Main components of the human body
in Ayurveda
In Ayurveda chief components of living body are:

● Three Dosha
● Seven Dhatu (“tissues”)
● Three Mala (“wastes”)
● Agni (“metabolic and digestive fire”)
“doṣadhātumalamūlaṁ hi śarīraṁ”
Sushruta Samhita, Sutrasthana
“Dosha, dhatu and mala are (chief) roots of the body”

Three doshas are Vata, Pitta and Kapha.

They are chief functional and regulating elements of the living body.

Three dosha control all functions in the body on every level - cells,
tissues, organs, systems and body as a whole.

Until they function in a balanced state, the person remains healthy.

 ● Vata dosha has movement as the main function.

It initiates, activates and regulates all the body movements (gross and minute)
including motor and sensory functions (conduction of nerve impulses),
respiration, circulation, excretion of wastes, etc.

● Pitta dosha has digestion and heat production as main functions.

It activates and performs process of digestion, metabolism, thermal and energy

regulation in the body.

● Kapha dosha is mass producing and moistening.

It is responsible for all the anabolic functions, physical strength, virility, immunity,
body fluids, structural integrity and density of body elements. Also connective
tissue is mainly under control of Kapha dosha.
7 Dhatu - tissues are considered as
main structural entities of the body
Rasa - chyle, plasma

Raktra - formed elements of blood

Mamsa - muscle tissue

Medo - adipose tissue

Asthi - bone tissue

Majja - bone marrow and nervous tissue

Shukra - reproductive tissue

Upadhatu
There are also few upadhatu (secondary or subordinate tissues) such as

artava - menstrual blood

stanya - breast milk

sira - blood vessels

sandhi - joint forming tissues

snayu - ligaments

kandara - tendons
3 Mala - excreta

3 main waste products, evacuated from the body are:

Mutra - urine

Purisha - feces

Sveda - sweat

They support functioning of the body by proper and timely evacuation of waste material.
Agni - metabolic and digestive fire

● One more extremely important component of the living body is Agni - fire.

● It represents all the processes in the body, where heat production is involved,

such as digestion and metabolism at every level.

● Until Agni is maintained at a balanced state (samya) the food digestion,

absorption and tissue formation is going normal, person remains healthy

13 types of Agni described in Ayurveda
1 Jathara-agni - fire in abdomen responsible for digestion of food in GIT

5 Bhuta-agni mainly located in liver, responsible for further break-down of food

components and synthesis of basic elements from which body tissues are formed

7 Dhatu-agni responsible respectively for the formation of each Dhatu (tissue)

Until all these fires work properly, the tissue formation is proper and the health is
maintained.

Once at any level it becomes deranged, either suppressed ( manda), excessive

(tikshna) or improper/irregular (vishama) then normal tissue formation is disturbed
and pathological process begins.
Importance of Three Dosha
“teṣāñca dhātvādīnāṃ doṣā eva pradhānaṃ, yato doṣebhya eva dhātūnāṃ pravṛttiḥ”

Indu on Ashtanga Samgraha

Out of all components of the body Three Doshas are main, because functioning of other
components - dhatu and mala is performed through three dosha only.

sarveṣāṃ ca vyādhīnāṃ vātapittaśleṣmāṇa eva mūlaṃ”

Sushruta samhita, Sutrasthana

As three doshas being in a balanced state perform all physiological functions and
maintain health, when they are deranged, they also become roots of all the pathological
processes and diseases in the body.
Other side of last definition is:
“nāsti rogo vinā doṣai“ - Sushruta Samhita, Sutrasthana
There is no disease, where 3 dosha will not be involved”

Hence all diseases and pathological processes in the body in Ayurveda are described
mainly in terms of three dosha through:

● Hetu - cause of vitiation of each dosha in general and in relation to particular disease
● Purvaroopa - premonitory symptoms of particular disease in general and dominant
doshas involved
● Roopa - clinical signs and symptoms of particular disease manifestation in general
and signs and symptoms of dominant doshas involved.
● Upashaya - diagnostic tests
● Samprapthi - description of all the pathogenesis
Components of pathological process

In brief all pathological process in Ayurveda involve the next features

● doṣa vaiṣamya - vitiation of dosha (each separately, two or three combined)

● doṣa-dūṣya-sammurchana - affliction of particular body tissue or tissues by

vitiated dosha/doshas

● agni-vaiṣamya - disturbance of Agni, digestive-metabolic fire at the level of GIT

or at the level or particular tissue formation/transformation

Basic steps of treatment process

Hence in brief treatment is directed to reverse the pathological process by

● bringing doshas, responsible for the pathological process to normal limits

● removal of excess of the dosha from particular dhatu

● normalization of Agni functioning at levels where it was disturbed

● stimulation and promotion of tissue repairing

Main ideas behind treatment of sport
injuries in Ayurveda. Connective tissue.

In Ayurveda components of connective tissue include sandhi ( joints), kandara

(tendons) and snayu (ligaments), and they are considered as

● upadhatu (secondary tissues)

● mainly connected with Rakta-dhatu (blood), Asthi-dhatu (bone tissue) and

Medo-dhatu (adipose tissue) and respective dhatu-agni for its formation

● predominantly connective tissue is a site or localization of Kapha dosha

Major symptoms of dosha involvement
in traumatology.
“śūlaṃ narte'anilāddāhaḥ pittācchophaḥ kaphodayāt| rāgo raktācca”

Ashtanga Samgraha, Sutrasthana

Vata - pain ( ruja)

Pitta - local and general hyperthermia (daha)

Kapha - swelling (shopha)

And due to involvement or rakta-dhatu (blood) redness appear.

Hence therapy methods should be followed according to the predominant symptoms.

Treatment principles of sport injuries
● mainly therapy and procedures are directed to pacify Kapha and Pitta in recent

injuries and in initial stages, and Vata and Pitta dosha in case of chronic injuries

● therapy to reduce shopha (swelling) - shoola ( pain) - daha (burning sensation)

● stimulate respective Agnis and regeneration of damaged tissue.

● sandhi-asthi-snayu-balya aushadhas - medicines which help strengthen joints,

bones and connective tissue (tendons, ligaments)

● rasayana and brimhana aushadhis - restorative and nourishing drugs

● ayurvedic treatment integrated with modern sports medicine modalities shows

best results, so physiotherapy, etc sports rehabilitation techniques are advised

Treatment modalities of sport injuries
Parisheka and pichu ( pouring and local application of medicated oil with of cotton) - cooling
soon after trauma, warming in chronic trauma.

Lepana ( pastes), Abhyanga (oil massage), Swedana (sudation)

Ekanga or sarvanga dhara ( pouring of liquid on part or whole body) with taila (oils), ksheera
kashaya ( milk decoctions), plain kashaya (water decoction of medicinal plants, etc)

Local vasti - in janu (knee), greeva ( neck), kati (lower back), etc according to the site of injury

Bandaging, orthopaedic and rehabilitation equipments

Virechana ( purgation therapy) is often used in case of chronic injuries.

Basti ( medicated enema) can be used according to need in difficult cases

Common formulations in the
management of sport injuries:
Kashaya (decoctions) - Dashamoola kashaya / ksheera kashaya, Mahamanjisthadi
kashaya, Rasna panchaka and Rasna saptaka kashaya, Maharasnadi kashaya

Guggul preparations are quite effective in the treatment of sports injuries used
according to the condition, such as Laksha guggul, Yogaraj guggul, Mahayogaraj
Guggul, Trayodashang guggul, Kaishor guggul, Amritadi guggul, Rasnadi guggul, etc

Taila (oils) for external use: Murivena taila, Dhanvantara taila, Gandha taila, Karpuradi
taila, Ksheerabala taila, Sahacharadi taila, Mahanarayana taila, Mahaprasarani taila, etc.

Tailas (oils) like Gandha 101, Dhanvantaram 101, Ksheerabala 101 can be used also
internally and for nasya ( nasal drops) purpose
Formulations contd

Bhasmas (“ashes”/oxides) such as calcium containing - Mukta ( pearl), Pravala (coral),

Kaparda (cowries), Shankha (conch shell)

Or wider spectrum such as Abhraka ( mica), Rajata (silver), Suvarna (gold), etc

Herbo-mineral preperations such as Mahavata-vidhvamsan rasa, Vatagajankusha rasa,

Ekangaveer rasa, Sameerapannaga rasa etc

In advanced chronic cases - Brihat Vata chintamani ras, Yogendra rasa, Trailokya
chintamani rasa, etc

Shilajeet containing formulas - Shiva gutika, Chandraprabha vati, Shilajitwadi vati

AVABAHUKA - ROTATOR CUFF SYNDROME
● It represents a spectrum of disorders ranging from subacromial bursitis to rotator
cuff tendinopathy to a partial, or full, thickness tear of the rotator cuff.
● It commonly affects sportsmen and also patients older than 40 years of age.

Risk factors in sport:

● Sports that involve overhead motions, such as swimming, water polo, volleyball,
baseball, tennis, badminton, javelin throw and American football quarterbacks etc
are at greater risk
● Striking-based combat sports, such as boxi, typically when their punches miss the
target, or overusing the shoulder by throwing excessively large amounts of punches.
In brief two main causes in sport are repeated overuse or direct trauma.

Cold weather conditions or neglecting warming-up procedures increase

the risk factors.

Some other causes are:

● Early degenerative changes.

● Thickened coracoacromial ligament.

● Inflamed subacromial bursa.

● Hook-shaped acromion.

● Calcium deposits in the tendon.

Clinical Features
● Dull, aching pain on the front or lateral side of the shoulder that is worsened

when arm is extended or raised above the shoulder and also when the patient

lies on the affected side.

● Examination often demonstrates tenderness along the lateral acromion or the

lateral aspect of the proximal humerus. Also area may be red and swollen.

● In some cases patient will feel burning sensation also.

● Abduction in the 70 to 120 arc increases pain, which can be decreased by

moving the arm into internal rotation.

Line of treatment.
Panchakarma Therapy

1. Sadyo-virechana with Gandharvahastadi Taila-20-40 ml with warm milk.

2. Local massage with Mahamasha taila or Balashwagandha lakshadi taila or

Murivenna taila

3. Patra Pinda sweda (leaf bolus sudation).

4. Nasya with Ksheerabala 101 or Dhanvantaram taila 101-8 drops for 7 days
Line of treatment. Internal medicines
Guggul based formulations: Kashaya - decoctions

● Amritadi Guggulu—2 tab. BD or TID ● Maharasnadi kashaya - 20ml BD or TID

● Lakshadi Guggulu - 2 tab. BD or TID ● Rasnairandadi kashaya-20ml BD or TID

● Kaishor guggul - 2 tab BD or TID ● Kokilakshadi Kashaya-20ml BD or TID

● Mahayogaraja Guggulu - 1 tab BD or TID ● Marma Kashaya - 20ml BD

Taila - oils:

● Ksheerabala taila 101-10 drops BD with milk

● Gandha Taila - 10 drops BD with milk
KURPARA SCHOOL
TENNIS ELBOW, GOLFER'S ELBOW
● Tennis elbow or lateral epicondylitis
● Golfer's elbow or medial epicondylitis

Signs and symptoms:

Affected part ( respectively right or left epicondyle) becomes soft and tender, which
may be accompanied by burning sensation and radiating pain in forearm and wrist

Main cause

Overuse of arm and forearm by a specific pattern of movement and load

Treatment
Local Abhyanga with - Mahamasha taila or Balashwagandha lakshadi or Murivenna taila

Upanaha Sveda - with Nagaradi churna

Ekanga Dhara or local picu with - Murivenna Taila

Nasya with Ksheerabala 101 or Dhanwantaram tailam 101 (8 drops-12 drops)

Formulations - Same as Rotator cuff syndrome

Trayodashang guggul - 2 tab BD or TID in recovery phase when inflammation is reduced

SNAYU GATA VATA
ACHILLES TENDINITES
● Common for runners, cyclist, tennis, badminton, basketball, football players and
some other sports
● Stiff shoes, some structural/anatomical abnormalities, hypertight or weak hamstring
and calf muscles, heel deformities are some other causes.

Symptoms are:

● Pain and in the backside of the heel on movement

● limited range of motion on foot flexion.
● skin on the heel may feel overly warm to the touch
● swelling may be associated
Treatment

● Upanaha Sveda - with Nagaradi churna or Kottamchukadi churna

● Dashamoola kashaya avagaha or parisheka

● Picu and abhyanga with Murivenna taila or Balashwagandha lakshadi taila

Internal medicines
Guggul based formulations: Kashaya - decoctions

● Amritadi Guggulu—2 tab. BD or TID ● Maharasnadi kashaya - 20ml BD or TID

● Lakshadi Guggulu - 2 tab. BD or TID ● Rasnairandadi kashaya-20ml BD or TID

● Kaishor guggul - 2 tab BD or TID ● Kokilakshadi Kashaya-20ml BD or TID

● Trayodashang guggul - 2 tab BD or TID ● Sahacharabaladi kashaya-20ml BD or TID

Taila - oils:

● Ksheerabala taila 101-10 drops BD with milk

● Gandha Taila - 10 drops BD with milk
LIGAMENT AND TENDON INJURIES

Sprains and strains are used interchangeably, but they are two specific injuries:

● A sprain is a stretch or tear in a ligament (the bands of fibrous tissue that

connect our bones at the joints).

● A strain is also a stretch or tear, this time affecting the muscle itself or a tendon

(the tissues that connect the muscles to the bones).

Sprains are graded on a scale from I to III

• Grade I is stretching of the ligament or a very mild tear

• Grade II is a more serious injury but still incomplete tear.

• Grade III is a completely torn or ruptured ligament. It can feel like a broken bone
since it is often impossible to put weight on the joint or use the affected limb

Prognosis

According to Ayurveda also, both these tissue take longer time for complete healing.

Usually it takes 3 to 6 months.

 Treatment
● The gold standard of care for sprains and strains is known as RICEtherapy.

● RICE stands for Rest-Ice-Comression-Elevation (well-known)

● RICE therapy is particularly important during the first 24-72 hours after a sprain or

strain occurs.

● During this time, medication to alleviate pain are given, if required, either modern

or ayurvedic (like Mahavata-vidhvamsan rasa)

After 72 hours then ayurvedic therapy can be given

Treatment
● Svedana (sudation) - Nadi sveda (be steam), patra potli sveda (with leaves and

oil), Kayaseka (by pouring decoction)

● Upanaha (sudation by paste and bandaging) with Nagaradi churna

● Yapana Basti (enema) - For lower body ligament injuries

● Nasya - For upper body ligament injuries - Ksheerabala taila 101, Dhanvantaram

Taila 101 or Gandha taila 101

● Local Abhyanga will be !contraindicated! in initial stages

Formulations
● Marma kashaya-20ml TID

● Vidaryadi kashaya-20ml TID

● Marma Vati-2 tab. TID

● Lakshadi Guggulu - 2 tab. BD or TID

● Gandha taila-10 drops BD with warm milk

In recovery phase also:

Trayodashang guggul - 2 tab BD or TID

Murivenna Taila or Maha Lakshadi Taila for abhyanga, pichu, pariseka

Diet recommendations during recovery
period after sports injuries
● Godhuma - Wheat ● Madhu - honey (old)

● Priyangu - Millet ● Lashuna - garlic

● Shali - rice (indian red rice) ● Patola - Luffa

● Mamsa rasa - meat soups ● Shigru - Moringa Oleifera

● Navanita - butter ● Draksha - dry grapes

● Ksheera - Milk ● Amalaki - Emblica officinalis

● Ghee - clarified butter ● Vajra-valli - Cissus qudrangularis

● Mudga - green gram ● Laksha - Laccifer lacca

Things to be avoided
● Vata and Pitta increasing substances (causing constipation, abdominal distension,
flatulence, burning sensation etc)
● sour (amla), salty (lavana), spicy (katu) food items
● ruksha ahara - dry and drying food items ( pulses, beans, strong tea etc)
● alcohol intake
● abnormal food habits such as overeating, irregular food intake, having a meal
before digestion of previous meal, etc
● night awakening and day sleep
● prolonged exposure to sun and fire
● excessive physical exercises
● excessive sexual intercourse
THANK YOU!