Knee Joint

घुटनों में दर्द 

Knee replacement  making you anxious ? Take preventive measures.

Age related changes such as knee and hip joint pain are an inevitable part od life. As you grow older, your joints become weak and  loose mobility due to  regular wear and tear and underlying health conditions. Hence a considerable number of people have to undergo  knee and hip replacement surgeries in their old age.

With dipping temperature it is common for arthritic patients to experience joint pain and stiffness. Arthritic patient become vulnerable in  in winters, as lower barometric pressure creates room for  tissues in our body  to expand., which exerts pressure on the joints. and nerves causing inflammation and pain.

The Did you know that the reason for pain , stiffness, locking and popping of joints especially in the knees, can be more than just  lethargy and bad posture. Doctors have been witnessing a steady rise in knee pain  cases among both the young and elderly. While obesity, sedentary lifestyle , poor dietary habits are the primary factors., joint pain is also increasingly emerging as  a Post Covid 19 complication and post Chikengunia. Although all knee pain may  not necessarily  indicate arthritis, early diagnosis is critical.

Introduction

Do not take joint pain lightly. Start treatment early.....

With increasing age , a person faces many health related problems and nowadays almost every other person is facing health some issue or the other. The main reason  why this is happening is our diet, our poor routine  and lack of discipline. In this hectic pace  of life, people do not eat food  on time nor do they pay attention to the various small things, which cause them discomfort in their day to day  life. These small things which are a cause of slight discomfort, if ignored for long  may become a severe problem. One such problem is the joint pain. 

Now a days not only elderly  but  even youngsters in large numbers  are suffering from joint pain . Hence it has become  very necessary to deal  with such a condition  before it is too late. Ayurveda and panchkarma has proved  very effective in the treatment of joint pain. Many patient are leading a normal life  after getting successful lay treated.

Pain in or around the knee that may indicate a condition affecting the knee joint itself or the soft tissue around the knee.Inactivity is a major health threat, which is leading to a  high disease burden. and poor quality of life. As we age our body mechanism also slows down. Our bone and muscles gradually loose their ability to regrow and repair themselves. The knee joint has a soft tissue coating called cartilage and that with muscle support , helps smoothed the range of  motion and act as a shock absorb er. Over time this soft tissue undergoes wear and tear that causes reduced joint space, resulting in joint friction between the thigh and shin bones. The degeneration of cartilage leads to arthritis followed by knee pain, swollen and warm joint, stiffness and abnormal gait. If overlooked the pain can be debilitating restrict movement and even cause disability. Seeking timely medical help  is the key to better management of condition.

Types Of arthritis:

●     Osteoarthritis (Sandhivata)

It is a degenerative disease that results when the cartilage surrounding the joints begin to wear down. The degeneration of cartilage causes the bone to rub against each other, leading to joint pain and stiffness. It is more painful in weight bearing joints such as the knee, hip and spine.
                                                 

According to Ayurveda, arthritis occurs due to the aggravation of Vata dosha and is known as "Sandhivata" According to Ayurveda, joint pain are the result of the accumulation of toxins in the joints. The toxins are made when we eat foods that are incompatible with each other, and a rich diet that includes lots of dairies. Fried and refined foods, non vegetarian,excess of salt  and alcohol. When these foods are eaten on regular basis they overburden the digestive system. As a result, the toxins rot in the colon, spread all over the body through the blood, and ultimately accumulate in the joints.  There are three kinds of arthritis.  Vata arthritis (dry cracking joints with limited mobility; Pitta arthritis (swollen and painful joints with a burning sensation); and Kapha arthritis (due to overeating and combinations of incompatible foods)

Bacterial Infection

According to unani

• Extreme cold
• Increase of phelgm in the body
• Cold climate
• Cold temperament

 "If one has sour food excessively one may suffer from  swelling." 

Causes

• Obesity
• Sedentary lifestyle 
• Poor dietary habits  
• Post Covid 19 complication
• Post Chikengunia
• Heavy physical activity
• Lack of use
• Injuries such as sprains or strains,
• Sitting in a constrained area 
• Sitting on knees for a prolonged period.
• It forms when your body has high levels of uric acid. This acid forms sharp crystals that cause sudden bouts of pain, swelling, and tenderness. When gout affects the knee, it can make everyday movements, such as walking or standing, painful or uncomfortable.

Symptoms

• Knee pain
• Muscle pain
• Bruise
• Swelling
• Restricted movements
• Weak warm  or swollen joint
• Stiffness in joints
• Cracking of joints Sharp pain in hands, neck, shoulders, hips, knees, or any area of the joint.

Bad Lifestyle - A Cause of poor bone and joint health

The muscle that supports our joint plays a crucial role in keeping them healthy. Our biggest weight weight bearing joint  the knee, takes our entire body  load and stress while  helping us to keep us mobile. Although physical workout and activities can strengthen  its surrounding muscles, which aid in load bearing and increase joint flexibility , a bad lifestyle can do exactly opposite. 

Diagnosis

Blood test:

●     For R A factor, 

●     For C- reactive protein

●   Uric acid

●     Sugar fasting and PP

●     If the pain is severe check your Vitamin D levels.

●     X -Ray

●   M.R.I

●   Bone biopsy for spinal tumor.

Lifestyle

  Minor lifestyle changes can go along way in managing a pain better for patients

●      Control weight: Controlling your weight will reduce strain on weight bearing joints, and movement of your joints as normal as possible.

●     Soak up in sun : As reduced exposure to sunlight makes one more susceptible to joint pain.Expose your body to the sun for at least 30 minutes a day. Direct sunlight is a good source of Vitamin D, which maintain calcium level in your body and B 12. 

●     Replace Beverages : Such aerated drinks, alcohol, tea and coffee with fresh juice and water to keep your joints well lubricated.

●   Use staircase instead of lift if possible.

●   Adequate rest Joint heals if you keep them still.

●   Increase flexibility :Stretching keeps our joint fit. Take breaks to stretch. Contract and relax knee joint  while lying down.

●  The chair's backrest should support your lower back and top of your computer screen should be at eye level.  

●     Food should be warm

●     Avoid sleep during day time

●     Avoid constipation at all cost

●     Include ghee in your diet

●     Include light foods and avoid oily food items

●   Take a hot shower or warm bath: A hot shower can help reduce stiffness and pain. Swimming in a heated pool is both a great exercise and is soothing for the joints.

● Remain Physically  active : even at home  to improve blood circulation. Cold weather makes us lazy. Being active even when it,s  cold helps in reducing arthritic pain .

●  Exercise : Exercise helps release endorphins, which are the body's natural painkillers. Continue your walk and exercise in winter as well. If the cold is keeping you from going outside, exercise Indore.

● Vitamin D Supplementation: Vitamin D Deficiency  might play a role in the joint pain and stiffness.Vitamin D is also essential for maintaining good bone health and decrease the risk of osteoporosis.

Diet

Do,s

We often see fat intake increases during winter particularly saturated fats. Saturated fats are those that are solid at room temperature (ghee and butter). Increasing the intake of saturated fats not only increases the body weight and worsen joint pain  particularly in the knees, but it also increases the inflammatory response of the body and worsens arthritic pain and stiffness. On the other hand, Omega 3 fatty acids are known to be  anti-inflammatory and reduce pain, stiffness and swelling. Many arthritis patients use Omega 3 fatty acid capsules. These are naturally found in chai seeds, flax seeds, nuts, dry fruits, avocado and soyabean. Non vegetarian sources are fish and fish oil.

Avoid
 Avoid using air conditioners / heaters  continuously as it aggravates body pain.
Avoid cold exposure: Wear warm cloths and stay away from cold. Also dress in layers. Always
make sure to cover your ankles, knees, and hands using socks and gloves. For local relief use a hot water bottle or a heating pad.
Avoid dehydration : During winter, fluid intake decreases. We feel less thirsty and run the risk of getting dehydrated. This is specially true for the elderly. Make a conscious effort  to stay hydrated.

The solution lie within us 

Osteoarthritis (O.A) is primarily treated with 

Pain medicines

Exercises

                                            

●      Physical exercises and yoga advocated at appropriate stages of recovery.

●      Exercise is an important part of treating arthritis. Exercise reduces joint pain and stiffness, increases flexibility and improves endurance, develops muscles strength, decreases bone loss, helps controls joint swelling, minimize fatigue and improves sleep, enhances weight loss. Keep bone and cartilage strong and healthy.

●   Daily walking for half an hour.

●     Gentle exercise for your knee Stretch your quadriceps can ease the tension in the knee joints. Stand with feet hip-distance apart. Bend your right knee and hold the top of your right foot with your right hand. Bring your right heel as far as possible to your buttocks

Quadriceps Stretch

●   Stretch your calves This gentle calf stretch increases flexibility in your leg muscles and knee joints. Bring your right foot a few feet in front of your left foot. Bend your right leg making sure your knee doesn't go past your toes. Keeping your left leg straight, press your left heel toward the ground to stretch the calf of your back leg.

Calf Stretch

●   Knee Strengthener The seated leg raise exercise helps strengthen the muscle around your knees.  Sit on a chair with both legs bent at 90 degrees. Slowly raise your right leg so that it's parallel to the floor, keeping your left foot on the ground.

Active Calf Stretch

●     Build up your leg muscles Step into stair with your right foot, then with your left foot. Step down in reverse.

Stepping up stairs

●     Leg stretch Lay on your back with your legs straight. Lift one of your legs and pull it toward your chest until you feel a comfortable stretch. Hold your leg up using your hands.

●     Swimming  

●  Cycling is good exercise to keep fit and mobile.

●   Straight Leg Lift

●   Butterfly Exercise It is good to keep the lower spine fit.

                                                  

 “Exercise is vital for those who suffer from any form of stiffness and arthritis” 

Yoga

A.    Pachimotanasana
                                                         

●     In the seated position, extend your legs out in front of your toes pointed up.

●     Inhale raising your arms above your head. Now exhale, reaching your toes, ankles, or calves.

●     Bending your knees if necessary, gently press the crown of your head towards your toes as you breathe deeply. This asana tones and flexes the spine.

                                               

B.    Bhujangasana (Cobra Pose)
                                                          

●     Lie down on your abdomen by taking legs apart
●   Keep the palm beside chest.

●     Breathing in, lift the upper part of your body, up to naval region

●     Hold it for 10 seconds by feeling the stretch on your abdomen. It is beneficial for the spine.

C.     Trikonasana  (Triangle pose)
                                              

●     Bring your legs apart so your feet are wider than your shoulders

●     Raise both arms out to the side up to shoulder height so that they are parallel to the floor, Palms turned down.

●     Turn your left foot 90 degrees outwards

●     Keep both hips facing forwards

●     Turn your right foot slightly towards the left foot and keeps the hips forward

●     Press your hips to the right and place your left hand on your thigh above your knee

●     Bring your right arm so it is straight with fingertips towards the sky

D.    Garudasana (Eagle Pose)
                                                 

●     Stand straight on both feet

●     Raise the right leg and wraps it around the left leg

●     The right thigh will be over the left thigh and the right feet will touch the calf muscles from behind

●     Similarly, wrap the right hand around the left hand

●     Place the palms together to resemble the beak of an eagle

●     Try to maintain the balance and slowly bend the left leg and lower the body until the right toes touch the ground. This is the final pose.

E.    Virabhadrasana (Warrior Pose)
                                             

●     Stand with your legs three to four feet apart and turn your right foot slightly to the right, and your left foot 90 degrees to the left

●     Align your left heel with your right heel

●     Expand your arms out stretching them parallel to the floor, with your palms facing down.

●     As you exhale, bend your left knee, bringing your left thigh as parallel to the floor as Is comfortable for you.

●     Keep expanding your arms away from your body keeping the torso long and the shoulders entered over your pelvis.

●     Press your outer right heel into the floor and focus on firming the right leg as you bend the left knee.

●     Do not allow your back to "sway" out instead, keep the tailbone tilted slightly towards the pelvis. This asana strengthens the legs and knee muscles and improves balance.

●     This pose helps sciatica, rheumatism and osteoarthritis of knee and hip. It strengthens the legs and also makes them more flexible.

Physiotherapy

The more the disease progresses, the more evident joint stiffness becomes. Stiffness can impair daily functions and is commonly confined to the affected joint. However in chronic osteoarthritis  cases- where the initial course of treatment has failed  to give long term pain relief and has severely affected the quality of life in patient or even cause disability-total knee replacement. is most feasible treatment option. In severe chronic arthritis where condition becomes severe enough to affect one's ability, and quality of life, replacing the damaged joints helps relieve pain and restore smooth functioning of the joint.

With the advent of technology , innovations such as a single radius knee technology, which mimics the natural knee that is circular and moves around the single radius has revolutionized knee surgeries making way for efficient and effective solutions that may last for many years.

It allows more soft tissue preservation leading to natural knee motion support and early restoration of mobility and lesser physiotherapy sessions. While there are severa knee designs available, your surgeon can recommend what best suits you. It is important to understand that  an implant placed inside the body must have undergone rigourous clinical trial and a long term follow up  in a large number of people

Post TKR  an individual can resume normal activities within two months. A round knee allows stable and efficient movement while climbing or descending stairs, playing light sports among others. 

But as the saying goes "Prevention is better than cure."therefore make it a point to workout for 30 minutes daily and practice simple form of exercise to avoid knee problems.

Reduce protein intake i.e. Dal, eggs chicken, mutton etc. to reduce uric acid levels.

Pranayama

●     Bhramari- Breath in till the lungs is full of air. Close the ears with the thumb and eyes with the middle fingers. Press forehead with both the index fingers lightly closes the eyes. Then press the eyes and nose bridge with remaining fingers. Concentrate on Ajna Chakra. Chanting of om simultaneously.

●     Bhastrika- Sit in a comfortable Asana. Breathe in through both nostrils forcefully, till the lungs are full and till the diaphragm is stretched. Then breathe out forcefully. Vata, Pitta and Kapha three doshas get balanced.

●  Anulom vilom Alternate nose breathing.

●  Kapal bhatti  Normal inspiration but  forceful expiration.

Meditation
●  Meditate on agya chakra (between two eye brows) for ten minutes in the morning.
                                                 

“Rest and relaxation will help you stay strong both mentally and physically”.

Swimming
·    Swimming is the good excercise to reduse weight.

Mudra

·      Vayu Mudra
                                                   

Formation

Index finger tip is to be placed at the base of the thumb and the thumb is to be placed on the back of the index finger gently. Other fingers are to kept be straight. Good for arthritis and pain.

Apana Vayu Mudra

This mudra can save a person from 'heart attack', hence a mudra is called Sanjeevani Mudra, one that gives life to a dying person. This mudra gives instant results and the pain is reduced immediately.

Formation :

This is combination of two Mudras Vayu and Apana. From Vayu mudra by placing the tip of index finger at the base of the thumb and then form Apana Mudra by joining tip of the thumbs with the middle and ring fingers.

Effects :

There is combined effect of Vayu mudra and Apana Mudra. Vayu mudra relieves the pain instantly and Apana mudra maintains space to reinforce blood circulation to the heart. 

Benefits: 

• This mudra cures- Arthritis, Spondylitis, Parkinson and Paralysis,

Perform Apana Vayu Mudra-

1. When there is sleeplessness.
2. When there is over exertion.
3. When there is stress.
4. When climbing staircases and hills.
5. When there is crises.

·      Sandhi Mudra

Sandhi Mudra

The mudra relieves joint pain. This mudra is formed differently by each hand.

Formation :

Right Hand : Join the thumb finger tip and ring finger tip together.

Left Hand : Join the thumb finger tip and middle tip together.

The mudra helps in balancing energy in the joints.

Effects :

Space is balanced between the cartilage and the joints muscle. This mudra also provides calcium.

Benefits :

• Pain experienced while climbing down after a long hike is pacified.
• Resolves tiredness in the elbows after the long hours of work on a computer.
• This mudra helps relieve pain in the hip joints and knee joints due to arthritis.
• For people suffering from chronic pain  in the joints, this mudra resolves  the pain by persistent effort.

                                                                  

·      Prana Mudra
                                                                          

Formation

The tip of little fingers and ring fingers are joined with the tips of the thumbs.

Beneficial Herbs

●   Giloy (Tinospora cardifolia) : The stem is used after removing the skin.
●     Ashwagandha and Siddha Makardhwaj (Withania somnifera)- it helps in relieving pain in tender and swollen joints and increased mobility. 5 gram of Ashwagandha powder twice a day for three weeks with lukewarm water or milk and 100 gram of Siddha Makardhwaj daily with honey for the next four weeks.
●    Guggulu (Commiphora wightii) Tab
●   Turmeric :  (Curcuma longa) Haldi  is a well known anti-inflammatory herb. Drink turmeric milk: Add a pinch of turmeric to boiling milk, consumed just before bedtime. Or take it as a decoction twice  a day, sipping it slowly while it is still hot. Just add a pinch of haldi to water, and boil till the water turns a golden haldi color.
●    Ginger : It reduces inflammation and reduces joint mobility. Boil some in water and sip this decoction while it is still warm.

●     Methi- It helps in controlling degenerative disorders.  Fenugreek is a popular home remedy for joint pain due to its antioxidant and anti- inflammatory properties. Swallow 1 tsp of finely ground fenugreek seeds (or overnight soaked seeds) followed by a glass of lukewarm water in the morning.
                                                     

                                                       

●     A poultice of the aerial part of Amarbel  (Cuscuta reflexa) is an effective remedy for arthritis. Boil it in water add a pinch of salt and do hot fomentation.

                                              

●     Jeera- It improves digestion

●     Dhania- It is a beneficial antacid and helps in combating with gas related troubles.

●     Hing (Ferula asafoetida)Asafoetida

●     Rasna (Alpinia galangal)

●     Sunthi (Zingiber officinale) Ginger

●     Rasona (Allium sativum) Garlic. Add garlic to your food. Garlic is anti-inflammatory.

●     Guduchi (Tinospora cordifolia) Amruthaballi

●     Errands (Ricinus communis) Castor oil

●     Devadaru (Cedrus deodara) Himalayan Cedar

●     Gokshura (Tribulus terrestrial

●     Punarnava (Boerhavia diffusa) spreading hogweed

●     Chitrakoot (Plumbago zeylanica) leadwort

●     Katuki (Picrorhiza kurroa) Kutki

●     Triphala (Amla,Harda,baheda) One tsp at night with warm water.

●     Ajamoda Ajwain

●    Bala (Sida cordifolia)

●     Yashti (Glycyrrhiza glabra)

●     Shatavari (Asparagus racemosus)

●     Nagamalai (Sida veronicaefolia)

●     Varuna (Crataeva nurvala)
●   Ksheerbala taila : This oil is composed of three elements - Cow's milk, a herb named bala and till oil. This combination reduces the imbalance if air (Vata) in the body.

                                  "Oil application is the panecia for pain."

Home Remedies

●    Having Ashwagandha powder along with milk on regular basis will quickly heal arthritis Fresh leaves of (6 -7 nos.) of Harsingar (Nyctanthes arbour- tristis), adrak  (Zingiber officinale) juice and honey are mixed and taken orally.

●     Ginger & Honey tea Reduce joint pain and inflammation with this ginger and honey drink. Crush some ginger, in three cups of water till it's reduced to two cups, and add a teaspoon of honey. Drink it warm twice a day.
 ● Garlic milk Thus garlic milk helps in a great way  to clear the clogged metabolic  paths and reduce body cholesterol. Take 4-5 cloves of garlic and boil them in a glass if milk. Do not add sugar. Consume this milk twice a day after breakfast and dinner.

●     Regular consumption of black gram (urad) is the beneficiary as it helps in strengthening the knees quicker.
●    Juice of Champa (Michelia champaca) plant is effective. It leaves tied over painful parts.

●    For Local Application- Take 1 tsp of turmeric + Lime ( चूना )+ 1 tsp of  honey, do it at night. Put a bandage over it. Apply it on the area of pain for 8- 10 days/or a month for relief. 

●   Take 1 cup of mustard oil and add 10 g camphor to it. Heat the oil till the camphor dissolves completely. Massage the lukewarm oil on the affected area. It will reduce inflammation and stiffness.

●    Take 3 tbsp. green gram, (moong) Soak in 250 ml water overnight to get sprouted gram. Add 2 crushed garlic cloves to the sprouted gram and mix well. Consume two times a day. You may add sendha namak or rock salt for taste. 

●   DIY :  Cut the distal end of old socks and wear it on knee over night, as knee cap.

Precaution to preserve your knee health

Elderly people, especially in the age group of 60 and above are most common  complainants of hip and knee pain. While joint replacement surgery is an effective treatment option, it can also be prevented. Doctors usually advise patients with these complaints to take neccessary preventive measures that majorly include lifestyle changes.

Each case of hip and knee pain is unique and while age is an important factor, it is not the only one. Doctors evaluate how the symptoms are  affecting the patients every day life, and their overall health before determining the need for surgery.. If there is no medical urgency , treatment protocol is planed for the patient in a personalized  manner to improve their function, independence and quality of life.

Way to prevent knee and hip replacement

age There are  some handy ways to avoid knee and hip replacement surgry at an advance stage.

• Low impact exercise :Moving your joints regularly  keeps your joint cushions lubricated and functional in the long term. You should engage in walking, cycling  or yoga every day to strengthen your joints and maintain your mobility.
• Physical therapy : A combination of exercises and physiotherapy is ideal to preserve your strength and balance consult a physiotherapist if you experience pain and discomfort in your knee and hip joint.
• Building up knee strength :Build up muscles around the knee so they can take up more of the stress while walking or moving. This should be done in a way that do not strain the joints such a swimming, body weight exercise like leg lifts, elliptical training, recumbent cycling, walking or even water aerobics.
• Strengthening the leg muscles : Thigh muscles can  be very useful in avoiding a knee replacement. When the thigh muscle have adequate strength  this will reduce the stress and your knees will hurt less while walking or jogging.
• Weight loss : Being overweight can increase the pressure on your knees and hips. Even losing a small amount of extra weight  can help you to reduce this stress on your joints. 
• Medication : Your doctor can prescribe medications to help alleviate symptoms.You may also ask your doctor  for joint injections to improve movement ans reduce pain.
• Bracing the knee : Knee braces can help with proper positions of the knee, thus relieving pain and improving movement.
• Nutritious diet : Your diet plays an important role on  strengthening your bones and enhancing your joint health. You should consume calcium rich food products to preserve your cartilage. Try to include dark green leafy vegetables, almonds and omega 3 fatty acids in your diet to decrease pain and nourish your joints.
• Walking aids : Your chances of falling and getting injured also increase. You can use walking aids and supports such as cranes and braces to avoid hip or knee injuries that may lead you to have a  joint replacement surgery.

Treatment
Alopathic
·    Medicines :

Pain killers only way to manage pain, yes it provides pain relief. However regular consumption of  these medications can retentively impact your health.

Pain killers/Calcium supplements
  DMARDs- disease modifying anti rheumatic drugs
a . NSAIDs Non-steroid anti- inflammatory drugs Ibuprofen 300mg TDS, Meftal 500 mg TDS, Diclofenac 50 mg TDS, Indomethacin sustained release SR 75mg at bedtime all the drugs should be taken after food.

b    b . Paracetamol 100 mg TDS to reduce pain and stiffness.

     c . Chondroprotective agents for protection of cartilage, like glucosamine sulphate and chondroitin sulphate. 

         d .   Steroid In Rheumatoid Arthritis as  Intra- articular    

For acute septic arthritis  needs surgical opinion and treatment with intravenous antibiotics. 

Knee Replacement Surgery : For the patients with chronic arthritis where the knee joint  is significantly damaged and is impacting daily activities of individual, medications and conservative treatment therapies may not be useful. In such cases, replacement of the  worn out knee is the last  treatment option for  pain relief and restoring mobility.. A delay in surgery in such situation  may only worsen the knee damage.

      ●   Physiotherapy  physiotherapist can teach you how to work out stiffness without further damaging your joints. Physiotherapy is also useful after an injury and joint surgery. It is recommended for hip and knee osteoarthritis.  Get physiotherapy to ease the discomfort. It helps in muscle strengthening, increasing spine flexibility, But it should be started only after consulting a doctor.

Fo 

●  Hydrotherapy- Functional difficulties of osteoarthritis patients are generally walking and climbing stairs and much can be done to re-educate such patients in the pool.

●   Thermotherapy- It involves the application of heat. It helps in improving circulation and relaxing muscles. Heat can be conveniently applied by using infra red light, heating pads, hot towels or paraffin wax, which relieves pain and stiffness in an easy way.
●  Electrotherapy- It is the use of electric currents for medical treatment. The patient frequently wears the device while sleeping. It helps  reduce pain, enhance blood circulation, increase joint flexibility and promote deep tissue repair.

●  External support devices- Knee sleeves maintain warmth and (mild) compression. Corrective brace can also be used. Or apply a cotton band or socks over a knee overnight.(cut the socks from front).
●   Occupational therapy - Application of heat locally.
● Knee replacement. Sometimes severally damaged knee joints and hip joints are surgically replaced  
●   Tuberculosis of spine : Anti-tubercular treatment for 18 months and absolute bed rest for about 3 months is mandatory. If surgery is required decompression and fixation of the spine is done along.
●   Spinal tumor can be treated effectively with chemo/radiotherapy. If the tumor has to be ex iced completely the spine stabilized with screws, rods and an inter-body cage. Surgery should be done in well equipped centers.
 Ayurvedic 

According to Ayurveda diet correction and improving metabolism are the long term and sustainable solution for arthritis. Ama Pachana correction of metabolism: By increasing the ‘Agni’ or digestive fire either through therapeutic fasting, deepana and pachana- Appetizer & digestive drugs and also through 
Ayurvedic treatment includes detoxification of the body, which would help in  reducing the inflammation,pain killers,steroids prescribed to suppress the pain and inflammation do little to cure the pain.
Treatment includes internal medicines,oil massages and Panchkarma therapies with diet restrictions and exercises.
* Vata arthritis- Avoid irregular meals, cold foods (cold Prakriti) foods like white rice, curd, cucumber, radish, ice creams and sherbets. Instead eat cooked oats, whole wheat porridge, soups and spices. Also avoid pulses that are not easily digestible, such as Rajma, Lobhia, urad and white Channa
* Pitta arthritis- Avoid all fermented foods curd, alcohol and wine, old cheese, and animal proteins. Cut down on quantities of food you eat and avoid fried and refined foods. Colonic detoxification helps this group the fastest. This Group is also prone to food and other allergies. Bitter herbs like Karela, and neem benefit this group immensely.
* Kapha arthritis- This occurs due to obesity, which stresses the joints. This group should not only loose weight but also reduce the quantities of food they eat,as well as cut down on rich foods.
*  Herbal supplement like Shallaki and Guggulu, chandra prabhavati.

*  Laxative  Take Triphala daily it detoxifies the system, it  is not just a laxative, it is also a colon tonic.1 tsf Triphala powder with honey followed by warm water at bed time.
*  Medicines Tab Rumalaya forte.

 Tab Lakshadi guggul- to consume 30 min after food.
 Gandha oil- 10 drops to be taken with hot milk 1 hour before breakfast and dinner.

●   Tiger Balm for local application.
·    Kayakalpa therapies For detoxification and rejuvenation.
  Panchkarma as detoxification or cleansing therapy. To treat arthritis the first step is to detoxify the colon. In this phase, avoid heavy cereals and stick to a diet of fruits, vegetable juices, tulsi tea / herbal tea. One meal should consist of light khichadi (of rice and moong dal). After the correct assessment of local toxins in the  body, few detoxifying Panchkarma therapies such as virechana (purgation) and vasti (medicated enema) to expel the root cause out of the system followed  by a course of internal palliative medicines and achieve sustain relieve from the symptoms.

●   Abhyanga  Massage therapy : External oleation of affected joints with medicated oil.  Massage with oil daily an important part of the lifestyle. Apply gentle pressure while massaging. Sesame oil, Mustard oil, coconut oil are used as base oil for external application. Oil massage helps in  removing the stiffness and muscles spasm and improves blood circulation. Once the oil reaches beneath the skin, it starts healing from inside. Other oil includes :

 a . Dhanvantaram Tailam- It is a poly herbal Ayurvedic medicated oil with anti inflammatory and anti rheumatic properties. This oil is useful in arthritis, fracture pain. The oil is generally for external use.
b .   Mahanarayana tel (oil) This oil is used for massage for arthritis.

c .  Narayana Herbal oil- Narayana oil is used in the treatment of arthritic pain, backaches, sprains etc. 
Take two tbsp of mustard oil, along with the whole clove of garlic. The oil should be heated. When the oil is still hot start massaging your aching knees. 

●   Janu Vasti- A type of oleation by retaining the oil for a stipulated time over the affected area.

●     Janu Dhara- Medicated oil poured over the knee.

●     Patra potli sweda- Fomentation with Herbal leaves like betel leaf.

●     Shashtica Sali Pinda Sweda- Special type of fomentation made of rice and milk.

●    Vasti- Treatment with medicated liquids

●    Potli massage (Poultice Massage)

●    Pizhichil (Rich oil massage)

●     Svedana (Steam bath)

●     Vasti (medicated enema)

 ●    Virechana Purgation.Triphala 1 tap at bed time with warm water. Or Isabgol.

 ●    Shamana chikitsa- Includes oral medicine and external application.

 ●    Shodhan chikitsa- Includes Ayurveda Panchakarma and Kayakalp therapies for detoxification and rejuvenation.
    Naturopathy
●    Skip one meal a day.

●  Fasting (langhana)- Some patients are made to fast in initial, acute stages: the digestive and metabolic systems are strengthened and digest accumulated  ama (Toxins)
●   Control your diet: Take plenty of green cooked vegetables and reduce the quantity of rice intake.
●   Practice yoga and start walking

"Be regular with your medicines, and if these self remedies don,t help you much do visit your Rheumatologist for expert care".

     

"Formula for Arthritis - 1:1:1:1 Turmeric, dry ginger, fenugreek & ajwain.(aniseed), mix all,  take 1 tsp twice a day for 1 week."

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