Presented by

Dr. K.B.Sudhikumar
Prof. & HOD
Dept. of Salyatantra,
GAC, Tripunithura.
Anatomy
Movements of Spine

• Facet joint
• Intervertebral disc
Facet joint

• Zygapophyseal joint
• Synovial joint
Intervertebral disc
Component of Articular cartilage

Milky ,glass like appearance

• Extracellular matrix 98-99% of total volume
Made up of:
• Water – 70%
• Collagen (type 2 collagen fibrils)
• Proteoglycans
• Cells – chondrocytes
Factors regulate normal articular
cartilage homeostasis
Arthritis
• Greek word
“Arthros” - joint
“itis” – inflammation
• Means inflammation of a joint
• It is a group of condition involving
damage to the joints of the body
• Affecting 50% of population world wide
• By 2020, over 60 million people
Types
• Primary • Secondary
1. Osteoarthritis 1. Lupus erythematosis
2. Rheumatoid arthritis 2. Sarcoidosis
3. Septic arthritis 3. Psoriatic arthritis
4. Gout or Pseudogout
4. Reactive arthritis
5. Juvenile arthritis
5. Inflammatory bowel
6. Ankylosing disease
spondylitis
Arthritis affecting the Spine

• Osteoarthrosis
• Rheumatoid arthritis
• Ankylosing Spondylitis
Osteoarthrosis/Spondylosis

• Is a degenerative disorders that

results from biochemical
breakdown of articular cartilage in
the synovial joint in the spine.
Statistics

• Starts earlier in men than in women

• Common cause of spinal cord dysfunction
in patient older than 55 years
• Approx 90% men ages 50
90% women ages 60 & older
have evidence of degenerative change in
the spine
Spondylosis Symptoms and
Different Spinal Levels
• Cervical (Neck) The complexity of the cervical
(neck) anatomy and its wide range of motion
make this spinal segment susceptible to
disorders associated with degenerative change.
Neck pain from spondylosis is common. The
pain may spread into the shoulder or down the
arm. When a bone spur (osteophyte) causes
nerve root compression, extremity (eg, arm)
weakness may result. In rare cases, bone spurs
that form at the front of the cervical spine, may
cause difficult swallowing (dysphagia).
Cont…
• Thoracic (Mid-Back) Pain associated with
Thoracic (Mid-Back) Pain associated with
degenerative disease is often triggered by forward
flexion and hyperextension. In the thoracic spine disc
pain may be caused by flexion--facet pain by
perextension.
• Lumbar (Low Back) Spondylosis often affects the
lumbar spine in people over the age of 40. Usually
multiple levels are involved (eg, more than one
vertebrae). The lumbar spine carries most of the body's
weight. Therefore, when degenerative forces
compromise its structural integrity, symptoms including
pain may accompany activity. Movement stimulates pain
fibers in the annulus fibrosus and facet joints. Sitting for
prolonged periods of time may cause pain and other
symptoms due to pressure on the lumbar vertebrae.
Repetitive movements such as lifting and bending (e.g.,
manual labor) may increase pain.
Pathology
Conti….
 Complications
• When the space between two adjacent
vertebrae narrows,compression of a nerve
root emerging from the spinal cord may
result in radiculopathy (sensory and motor
disturbances,such as severe pain in the
neck, shoulder, arm, back, and/orleg,
accompanied by muscle weakness).
• Less commonly, direct pressure on the spinal
cord (typically in the cervical spine) may result in
myelopathy, characterized by global weakness,
gait dysfunction, loss of balance, and loss of
bowel and/or bladder control. The patient may
experience a phenomenon of shocks
(paresthesia) in hands and legs because of
nerve compression and lack of blood flow. If
vertebrae of the neck are involved it is labelled
cervical spondylosis.
Causes
• Aging and injury are common causes of cervical
spondylosis and disc degeneration. Disc
degeneration is seen as a loss of hydration of
the disc material. This loss of water in the disc
leads to a decrease in the normal height of the
disc. The loss of height, in turn, may put
increased stress on the facet joints of the spine
causing them to degenerate and in the process
increase in size. These changes may eventually
cause pressure on the nerve roots. This may
result in sciatic-type pain.
Cervical Spondylosis
Cervical Spondylosis

• Definition 
• Cervical spondylosis is a disorder caused
by abnormal wear on the cartilage and
bones of the neck (cervical vertebrae)
with degeneration and mineral deposits in
the cushions between the vertebrae
(cervical disks).
Causes & Risk Factors
• As people age, shrinkage of
the vertebral disks prompts the
vertebrae to form osteophytes
to stabilize the back bone.
However, the position and
alignment of the disks and
vertebrae may shift despite the
osteophytes. Symptoms may
arise from problems with one
or more disks or vertebrae.
Cont..
• Osteophyte formation and other changes
do not necessarily lead to symptoms, but
after age 50, half of the population
experiences occasional neck pain and
stiffness. As disks degenerate, the cervical
spine becomes less stable, and the neck is
more vulnerable to injuries, including
muscle and ligament strains.
• Contact between the edges of the
vertebrae can also cause pain. In some
people, this pain may be referred that is,
perceived as occurring in the head,
shoulders, or chest, rather than the neck.
Other symptoms may include vertigo (a
type of dizziness) or ringing in the ears.
Cont..
• The neck pain and stiffness can be intermittent,
as can symptoms of radiculopathy.
Radiculopathy refers to compression on the
base, or root, of nerves that lead away from the
spinal cord. Normally, these nerves fit
comfortably through spaces between the
vertebrae. These spaces are called intervertebral
foramina. As the osteophytes form, they can
impinge on this area and gradually make the fit
between the vertebrae too snug.
Cont..
• The poor fit increases the chances that a minor
incident, such as overdoing normal activities,
may place excess pressure on the nerve root,
sometimes referred to as a pinched nerve.
Pressure may also accumulate as a direct
consequence of osteophyte formation. The
pressure on the nerve root causes severe
shooting pain in the neck, arms, shoulder, and/or
upper back, depending on which nerve roots of
the cervical spine are affected. The pain is often
aggravated by movement, but in most cases,
symptoms resolve within four to six weeks.
Cont..
• Cervical spondylosis can cause cervical spondylitic
myelopathy through stenosis- or osteophyte-
related pressure on the spinal cord. The problems
created by spondylosis can be exacerbated if a
person has a naturally narrow spinal canal.
Pressure against the spinal cord can also be
created by osteophytes forming on the inner
surface of vertebrae and pushing against the
spinal cord. Stenosis or osteophytes can compress
the spinal cord and its blood vessels, impeding or
choking off needed nutrients to the spinal cord
cells; in effect, the cells starve to death.
Cont..
• With the death of these cells, the functions that they once
performed are impaired. These functions may include
conveying sensory information to the brain or transmitting
the brain's commands to voluntary muscles. Pain is
usually absent, but a person may experience leg
numbness and an inability to make the legs move
properly. Other symptoms can include clumsiness and
weakness in the hands, stiffness and weakness in the
legs, and spontaneous twitches in the legs. A person's
ability to walk is affected, and a wide-legged, shuffling
gait is sometimes adopted to compensate for the lack of
sensation in the legs and the accompanying, realistic fear
of falling. In very few cases, bladder control becomes a
problem. 
Symptoms & Signs
• Pain that comes and goes
• Pain that spreads into your shoulders, arms, hands, or fingers
• Morning neck or shoulder stiffness or a limited range of motion
after getting out of bed
• Neck or shoulder tenderness or numbness
• Weakness or tingling in your neck, shoulders, arms, hands, or
fingers
• Headache in the back of your head
• Loss of balance
• Difficulty swallowing (This is rare, but it may occur if the spinal
cord is compressed
• Loss of cervical lordosis
 Diagnosis
• X – ray, MRI, CT Scan, Myelography

Cervical Spondylosis
D/D
Treatment
• The goal of treatment is relief of pain and
prevention of permanent spinal cord and
nerve root injury.

• In mild cases, no treatment is required.

Symptoms from cervical spondylosis usually
stabilize or regress with simple, conservative
therapy including a cervical collar (neck
brace) to restrict motion and non-steroidal
anti-inflammatory medications (NSAIDs).
• Rarely, intermittent neck traction may be recommended
instead of, or in addition to, a cervical collar. This usually
consists of a halter-like device placed on the head and
neck and attached to pulleys and weights.

• For severe cases, hospitalization with complete bed rest

and traction for 1 or 2 weeks may be needed. Narcotic
medicine or muscle relaxants may help to reduce pain.
Surgical decompression of the spinal cord in the neck
may be recommended for severe pain or for significant
loss of movement, sensation, or function.

• Surgical procedures may involve removal of bone and disc

tissue impinging on the nerves of the spinal cord and
stabilization of the neck by fusing the cervical vertebrae.
AYURVEDIC VIEW
External hetu Internal hetu

AÍpÉbÉÉiÉ -- mÉëÉhÉ विषमाजीर्ण -- समान

pÉÉU -- ESÉlÉ
ÌuÉwÉqÉcÉå¹É - urÉÉlÉ
rÉÉlÉ AÌiÉuÉÉWûlÉ -
AmÉÉlÉ
Griva – Hundanam
• Griva – Hundanam as its name suggests is a
clinical entity occurring in the region of the neck.
It is given under the disorders caused of vitiated
Vata, so it is obvious that this disease occurs due
to vitiation of Vata.

• Griva – Hundanam is comprised of two words viz.

Griva and Hundanam.

• The meaning of word “Griva” is the back part of

the neck, nape of neck, the tendon of the
Trapezium muscle.
• The word Hundanam is derived from the root
“Hudi Samghate” or “ Hudi Majjane”, which
indicates to dive, sink, to collect, be submerged.

• Cakrapani has tried to explain the word

Hundanam in his commentary. He has given two
meanings of it. The first meaning is – “Siro
Prabhutinam Antah Pravesa”. It means inward
contracture of the head and its allied parts, which
is possible due to the implication with cervical
parts. This condition is suggestive of the
structural deformity.
• The other meaning is “Griva Stambha”, which denotes
Niscalikarana i.e. the restriction of the movement of the neck
(Ck. on
Ca. Ci. 28/21). This is suggestive of the functional impairment of
the
neck. According to monier willium and V. S. Apte “Hundanam”
means
becoming benumed or paralysed, which may occur due to the
compression of involve cervical nerve roots.
• After the analysis of different meanings of Griva Hundanam it can
be stated that Griva Hundanam is the clinical condition in which
structural as well as functional dearrangement takes place in the
cervical region. Due to which the movements of the neck are
restricted and the space is diminished (Antah Pravesa) due to which
the length of neck is diminished.

• Some other disorders or conditions in which restricted neck

movement is a symptom are described in various Ayurvedic texts. Few
of them are being described here
Samprapti Ghatakas
Manya Stambha
• Manya Stambha has been enumerated in the eighty disorders of
Vata (Ca. Su. 20/14). The detail description regarding
Manyastambha has been given in almost all the Ayurvedic texts
(Ca. Ci. 28/41, Su. S. Ni. 1/67, A. H. Ni. 15/22, A. S. Ni. 15/24).
• Manyastambha derived from two different words Manya and
Stambha. According to Aruna Dutta the commentator of Astang
Hrdaya the meaning of the word Manya is two Nadis, laterally to
the Neck (Aruna on A. H. Ni. 15/22). While Amarsingh the
commentator of Bhavprakash takes the meaning of Manya as
the Sira of the posterior side of the Neck (B.P. M. Kh. 24/75).
According to Monier Willium, Manya means the back or the nape
of the neck. While the meaning of the word Stambha is
Niscalikarana (Dalhana). Stambha means stiffness, rigidity, make
stiff or immovable (Monier Willium)
• Thus Manyastambha is the clinical entity in which the back of
the neck becomes stiff or rigid and the movements of the neck
are impaired.
• The etiological factors responsible for the Manyastambha have
been mentioned by Susruta. According to him sleep in day time,
leaning or sleeping on an uneven place, constantly gazing
upword and Avarana of Vayu by Kapha lead to the disease
Manyastambha (Su. S. Ni. 1/67).
• The process of the disease Manyastambha has been described
along with the description of Antarayama in Caraka, Astang
Hrdaya and Astang Samgraha (Ca. Ci. 28/41, A.H. Ni. 15/22,
A.S. Ni. 15/24). It has been mentioned that if the vitiated Vata
getting localized in the Manya; spread in to the internal
channels, it will cause spasticity of the neck. Manyastambha is
mentioned as prominentary sign of Ayama.
Griva Stambha
• Griva Stambha is also counted under the Nanatmaja disorders
of Vata (Ca. Su. 20/14). But the separate description of this
disease has not been mentioned in the texts.
• As we have seen the meaning of Stambha i.e. stiffness or
rigidity, it could be stated that in Griva Stambha the stiffness
of neck occurs as in Manyastambha. In this way they seems
to be similar but Manyastambha has been explained in detail
by various texts whereas Grivastambha has no detail
explanation. The another difference is that after
Manyastambha the other generalized symptoms of
Antarayama have been exposed as it is a premonitory
symptom of Ayama whereas Griva Stambha is limited up to
the stiffness of the neck. It can be considered muscular
spasm of the neck.
Manya Graha
• Manyagraha has been stated with other
disorders by Caraka while describing the
indications of Dhumapana (Ca. Su. 5/28). No
further description has been found in the texts.
According to Monier Willium the Manya Graha
means muscular spasm or contraction of the
neck. From the description it could be easy to
say that Manyagraha and Grivastambha have
the similar meaning and both are used to
denote the same condition in which the
muscular spasm of the neck has been found.
 Treatment
Kevala vatha & Avarana vatha
KEVALA VATHA TREATMENT:
Sneha, sweda, virechanam, vasthi(Su. Chi)
Vasthikarma( A.H Chi)
Sneha
Internal- Snehapanam
External- Pathra potala swedam, Shashtika pinda swedam,
Pizhichil etc.
Local applications:- Pichu, Kativasthi, Bandage with
murivenna
General treatment of vatavyadhi
Kaphavrutha vatha chikitsa
Yavanna, Jangala mamsa,
Theekshna sweda,
Theekshna nirooha,
theekshna vamana, virechana,
Purana ghritha & thaila processed with thila and
sarshapa
Manya Gatavata

xÉÑ.ÍcÉ.
Kasaaya: Gulika:
1. Sahacharadi kasaaya 1. Yogaraja guggulu
2. Panchamoola kasaaya + 2. Rasnadi guggulu
Nagara + Eranda taila
3. Astavarga kasaaya 3. Adithyapaaka guggulu
4. Maharasnadi kasaaya 4. Trayodasanga guggulu
5. Dasamoola kasaaya 5. Vatagajankusa rasa
6. Rasnasaptaka kasaaya + 6. Kubja vinoda rasa
nagara choornam

Gritha Taila:
1. Dasamoola gritha 1. Dhanwamtharam taila
2. Maha sneha 2. Mahanarayana taila
3. Guggulutikthaka gritha 3. Ketakyadya taila
4. Rasnadasamoola gritha 4. saindhavaadhya taila
Bandha

xÉÑ.xÉÔ.
Management

• Modifying life style

• Physical therapy – strengthens the paravertibral
and neck muscles
• General exercise which build flexibility, increase
range of motion and strength
• Neck support a corset or brace to provide
support
• Rest combined with relaxants and analgesics
Contd …

• Hot or cold pack which relieves pain

• Transcutaneous electrical nerve
stimulation
• Traction
• Pharmacotherapy –NSAIDS, Injection
therapy – epidural steroid injection or
facet joint injection
Contd..

• Massage therapy
1 act as muscle relaxant
2 reduces muscle spasm
3 stimulate pain inhibition mechanism
4 act as gateway blocking mechanism
5 counter irritant activity of medicines
Contd..

• Spine manipulation – function through

1 Release of the entrapped synovial folds
2 Relaxation of hypertonic muscles
3 Disruption of articular or periarticuar
adhesions
4 Unbuckling of motion segments that has
undergone disproportionate displacements
Contd..

5 Reduction of disc bulge

6 Repositioning of miniscule structures
within the articular surface
7 Change in neurophysiologic function
8 Reduction of muscle spasm
Finally surgery
Manya vasthi
• Local unctousness
• Relieves inter vertebral
muscle spasm.
• More effective when
associated with soft
tissue injury.
• Chronic degenerative
conditions.
SWEDANA

• Patrapottali sweda
• Jambeer pinda sweda
• Shastika Pinda Sweda
Prevention
• Avoid vata prakopa ahara & vihara
• Proper diet
• Sit, stand & learn to lift correctly
• Exercise regularly
• Attain & maintain a healthy body weight
• Avoid smoking
• Avoid excessive use of alcohol
• Prevention of injury
• Rasayana therapy
• Yoga asana
Yoga asana
• Bhujangasana
• Shalabhasana
• Dhanurasana
• Supta vajrasana
• Gomukhasana
• Ardha Matsyendrasana
• Ustrasana
• Matsyendrasana
• Trikonasana