Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa S, B.A.M.S
Golfer’s elbow is also called Medial Epicondylitis. It is a type of tendonitis. It gives rise to pain and inflammation in the tendons around the elbow and forearm. The causes include repetitive activities like bending, grasping or twisting. These activities may further lead to minor tears in the tendons which lead to pain in the elbow and other symptoms. It is commonly seen to affect the golfers and hence called as Golfer’s Elbow. But it need not affect the golfers as a rule. It can occur in anyone. People who are involved in activities involving repetitive motions and use of wrist, forearm and elbows, as in playing tennis, carrying heavy objects, hammering or extensive typing on computers may become victims of this condition. If this condition is not treated, it can lead to chronic pain along with restricted range of movements, weakening of grip and would impact daily activities and also overall quality of life.
Related Reading – ‘Golfer’s Elbow – causes, symptoms, prevention, treatment, Ayurveda Understanding’
Golfer’s Elbow – Ayurveda Understanding
No condition exactly resembling Golfer’s Elbow has been explained in Ayurveda. But in this article we will try to understand and decode this disease from an Ayurveda perspective.
Kurpara Sandhi and Kurpara Marma
Kurpara Marma – The best single available reference related to elbow joint is the description of ‘Kurpara Marma’ by Acharya Sushruta in Sushruta Samhita Sharira Sthana.
Kurpara Sandhi – elbow joint is one among the Sandhi Marmas i.e. vital spots located in joints. There are two Kurpara Marmas, one in each elbow joint. Along with the joint, the marma involves all the important structures in its vicinity i.e. bones, ligaments, tendons, muscles and blood vessels.
Kurpara Marma is a Vaikalyakara Marma i.e. belongs to the group of those Marmas which when injured would cause deformity or crippling in the affected limb or part of the body. Injury to this marma is said to cause kunthataa i.e. functional deformity of the elbow joints. Elbow joint and the actions taking place therein contribute towards many activities that we do in a day using our upper limb.
Golfer’s Elbow may be one of the results of injury, overuse or damage to the kurpara sandhi vis-à-vis elbow joint.
Vata aggravation and Dhatu destruction link
Repetitive activities’ leading to small tears in the tendons is the main and most important event in the pathogenesis of this disease. Abnormal Vata aggravation due to repetitive activities leads to dhatu kshaya – depletion and destruction of tissues and structures including tendons which leads to tears in them. When these events occur in the elbow joints it can lead to symptoms resembling those of Golfer’s Elbow. Events explained in modern medicine and Ayurveda almost appear similar.
The events of this pathogenesis lead to chronic pain, reduced range of motion, weakened grip and other symptoms. These symptoms are caused due to the aggravated vata.
Conditions which may result in symptoms resembling Golfer’s Elbow
Golfer’s Elbow is a condition which presents with pain and inflammation in the tendons around the elbow joint. The symptoms of Golfer’s Elbow are found in one or more of the below mentioned conditions. Therefore, one of these conditions can be considered as closer correlation –
– Kurpara Sandhigata Vata
– Kurpara Snayugata Vata / Kandaragata Vata
– Vataja / Pittaja Kurpara Sandhigata Shotha
– Kurpara Sandhistha Amavata
– Kurpara Sandhistha Vatarakta
– Kurpara Sandhigata Vata
From the perspective of causes
Excessive use of forearm, activities demanding constant and vigorous gripping and frequent flexing of wrist are the main causes of Golfer’s Elbow, each of which or all of them collectively can cause vata aggravation. Repetitive activities leading to tears in tendons will cause vata aggravation, as said earlier.
From risk factors perspective
Excessive indulgence in athletic activities like golf, squash, tennis, weightlifting, baseball, rowing etc will cause aggravation of vata at the elbow joints. Similarly the occupations involving repetitive and excessive wrist movements or use of forearm and elbow – like in butchers, laborers, plumbers, computer users, cooks and painters will also predispose for vata aggravation in the upper limb, mainly elbows, leading to golfer’s elbow.
From the perspective of symptoms
The symptoms of Golfer’s Elbow are also due to Vata aggravation. If Vata is predominantly aggravated in the elbows, pain will be predominant. Inflammation and inflammatory signs will be predominant in the elbow when pitta is associated with vata. Vatarakta or Amavata occurring at the elbow joint can also cause inflammatory symptoms involving the tendons therein. Severe swelling may depict involvement of ama if the condition is with pain or kapha if it is associated with less pain and more of heaviness and stiffness.
Pain with wrist flexion, which often radiates from elbow to little finger, pain during handshakes, weak hand grip, are all due to vata aggravation in the elbows.
Difficulty in moving the elbows and stiff elbow may be due to vata, ama, samavata, amavata or kapha. Tingling sensation and weakness of wrist joint is definitely due to vata aggravation in elbows.
Treatment Principles
Nidana Parivarjana
One should consciously avoid all the causative factors which have been mentioned as causal for Golfer’s Elbow. From Ayurveda perspective, all vata aggravating factors should be avoided.
If other doshas are found to cause or are associated with vata, the causative factors of the same too shall be avoided.
If symptoms resembling Golfer’s Disease are caused by some other disease, treatment principles specific for that disease shall be implemented.
Treatment for Vata
Considering that most of the symptoms are caused by aggravation of vata around the elbow joints, all treatment principles meant for combating Vata shall be implemented, including medicines, therapies, lifestyle modulation and habitual changes and diet schedules.
Associated doshas including pitta or kapha, rakta or ama shall be dealt with by administering appropriate treatments.
External Therapies
Abhyanga – herbal oil massage to combat pain, swelling, inflammation and movement restriction / stiffness.
Murivenna is ideal when there is injury. Ksheerabala Taila is good when there is inflammation or degeneration in the backdrop of symptoms. Mahanarayana Taila would combat vata and related pain while Mahamasha and Balashwagandha Taila are beneficial for strengthening the muscles, tendons, joints and soft tissues. Pinda Taila should be used in case Vatarakta is causing the symptoms and Kottamchukkadi Taila in the presence of ama.
Dhara and Pichu – The same oils can be used for dhara – showering the joint with oil and pichu – pad soaked in oil kept in place over the affected joint and bandaged.
Swedana – Sudation followed by massage is ideal to combat vata and related symptoms. Sud
ation without application of oil or applying minimum oil (like Kottamchukkadi Taila) is ideal for amavata. Ruksha Sweda i.e. dry sudation is good in these cases, example – valuka sweda (sand bolus sudation). Swedana shall be avoided or minimal in Vatarakta or inflammatory symptoms involving pitta along with vata. Dry sudation is good for edema due to involvement of kapha along with vata.
Nadi Sweda – tubular sudation or Upanaha Sweda – poultice sudation are good for symptomatic relief. Decoctions like Dashamula Kashaya shall be used for Nadi Sweda.
Upanaha, Lepa and Churna Pinda Sweda – Medicated Powders like Dashanga Lepa Churna, Kottamchukkadi Churna, Grhadhumadi Churna, Ellumnishadi Churna etc shall be used as and when required for upanaha, lepa – application as paste and churna pinda sweda – powder bolus fomentation / sudation.
Patra Pinda Sweda – leaf bolus fomentation / sudation should be done with vata mitigating leaves (or leaves chosen as per dosha aggravation) and Shashtika Shali Pinda Sweda – for strengthening the muscles and soft tissues around the joint.
Paste of Cheriya Marmani Gulika or Karutta Gulika mixed or unmixed with oil should be applied on the affected part.
Internal Therapies
Virechana should be administered to combat pain and inflammation. If the symptoms are severe, stubborn or chronic, Vasti should be planned. Raktamokshana may be needed if Vatarakta is causal.
Beneficial formulations
– Mahayogaraja Guggulu
– Kaishora Guggulu
– Simhanada Guggulu
– Maharasnadi Kashayam
– Mustadi Marma Kashayam
– Guggulutiktakam Kashayam / Ghrtam
