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PANCHAKARMA PRE PROCEDURE AND PHYSIOTHERAPY –A UNIQUE COMBINATION FOR MUSCULOSKELETAL DISORDERS

Authors:
PANCHAKARMA PRE PROCEDURE AND PHYSIOTHERAPY –A UNIQUE
COMBINATION FOR MUSCULOSKELETAL DISORDERS
1 2 3
Dr. Abhijit Ahire, Dr. G. Y. Khati and Dr. Sandeep Binorkar
1Asst. Professor, Dept. of Panchakarma, Govt. Ayurved College Nanded.
2Dean, R. A. Podar Ayurved college Worli Mumbai.
3Asst. Professor, Dept. of Agad Tantra, Govt. Ayurved College Nanded.
used to maintain your body in its optimum state which can enhance your performance during sport and also
aid in reducing the chances of and even preventing a re-injury. Physiotherapy treatment is usually quite
gentle and is very safe. Techniques commonly used by Physiotherapists are: Joint mobilization, soft tissue
massage, triggers point therapy, ultrasound, TENS (Transcutaneous electrical nerve stimulation), combined
with home based stretching and strengthening exercises. All of the above techniques allow your joints,
muscles, ligaments, and tendons to function better.
Following pre procedures are discussed
1. Udvartan (Dry powder massage)
2. Snehan (Different massage therapy with oil base and without oil base)
3. Swedan (Different steaming method used with and without using Agni (flame)
The word Udvartana is largely used for the most famous body treatment in Ayurveda to lose weight.
However if we refer to the classics of Ayurveda we have different types of Udvartana mentioned, which are
classified according to their action on the body
Sushruta (Father of Ayurveda Surgery), divides the Ayurveda powder massages into three parts:
Utsadana, Udgharshana and Udvartana.
Here different oils and powders are mixed together to form a paste and rubbed all over the body.
METHODOLOGY USED IN AYURVEDA’S PRE PROCEDURES:
UDVARTAN (DRY POWDER MASSAGE):
Utsadana -
ABSTRACT
Panchakarma nowadays, a known therapy
used for treating the Patients of various disorders
with the principle of Ayurveda. Panchakarma
includes five different karmas these are vamana
virechana, basti, nasya and raktamokshana .Prior to
panchakarma different pre procedures are
explained in Ayurveda . These karmas are called
purvakarma which includes Rukshana Udvartana
Snehana, swedana etc.
Physiotherapy is a form of “hands-on”
manual therapy used to aid in a rapid recovery and
rehabilitation from all forms of injury, sports related
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or otherwise. In addition Physiotherapy can be
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These herbal powders and oils exfoliate and enhance the complexion and glow of the skin and are highly
rejuvenating;
This is a treatment where only powders which are dry and rough in nature are rubbed all over
the body to induce the same qualities and remove the excess water and earth element (KAPHA). It is mostly
used in obesity and diabetic cases.
Udvartana according to Sushrata is a body toning program, with application of a combination of
prescribed herbal powder and oil on the entire body .It is used in the treatment to reduce fat and strengthen
the body.
Where as Charaka (Father of Ayurvedic Medicine) gives only the term Udvartana for all the above. Thus as
we see above, Udvartana can be used to lose weight, improve skin complexion, de-stress and relax and as a
natural full body exfoliation treatment.
How does the Treatment of Udvartana work?
In the treatment of Udvartana, we use herbal powders (in form of oils or dry powders) that are dry
and rough in nature and hot in potency.
The oil taken for Udvartana is sesame-based, which is hot in potency and is infused with herbs which
create lightness, dryness, roughness, remove the blockages and stiffness, and also have a ‘cutting or
liquefying action’ on the fat tissue. This oil also takes care that the skin does not become dry superficially and
remains soft and supple after the treatment.
This herbal paste (powders and oils) when rubbed on the body in a specific manner creates friction,
which open the pores, remove blockages in vessels, increase the heat in the tissues and percolates inside to
stimulate fat metabolism.
1. Reduced cellulite/ subcutaneous fat tissue;
2. Beautiful skin complexion;
3. Cleanses and revitalizes the skin and removes body odour;
4. Better skin tone - even if you are losing weight with exercises, other forms of diet etc.
5. The best benefit of Udvartana, even when taken as a one-off treatment is that, it is one the very few
treatments that de-stresses you , but at the same time also have an invigorating effect.(reduces Vata and
Kapha);
6. The blockages in the blood vessels are removed and pores open, removing body stiffness, facilitating
better absorption of oils etc. through the skin.
Massage in general is used for producing relaxation as well as for giving tone to the muscles.
However massage is performed to promote circulation,
During massage therapy following consideration is important
The origin and insertion of muscles, lymphatic drainage, state of circulation ,vital
parts/joints/muscles /hearts
Massage involves working and acting on the body with pressure – structured, unstructured,
stationary, or moving – tension, motion, or vibration, done manually or with mechanical aids. Massage can
be applied with the hands, fingers, elbows, knees, forearm, feet, or a massage device. Depending on the
application and technique used, massage is used to promote relaxation and well-being, and is beneficial in
treating sports injuries and other problems affecting the musculature of the body such as postural
misalignment and many painful conditions.
Udgharshana -
Udvartana -
BENEFITS:
SNEHAN-MASSAGE:
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AYURVEDIC MASSAGE
BENEFICIAL EFFECTS
SINGLE-DOSE EFFECTS:
Pain relief:
State anxiety:
Blood pressure and heart rate:
MULTIPLE-DOSE EFFECTS:
Pain relief:
Trait anxiety:
Depression:
SWEDANA THERAPY IN AYURVEDA
Ayurvedic Massage known as Abhyangam in Sanskrit is one of the most common and important
Ayurvedic therapies. According to the Ayurvedic Classics Abhayngam is an important dincharya (Daily
Regimen) that is needed for maintaining a healthy lifestyle. The massage technique used during Ayurvedic
Massage is known to stimulate the lymphatic system to expel the toxins out from the body. The Ayurvedic
Massage also stimulates production of lymphocytes which play a vital role in maintaining the immunity in
human body. Thus regular Ayurvedic Massage can lead to better immunity and also help in body de-
toxification. The other benefits of regular Ayurvedic Massage include pain relief, reduction of fatigue,
prevention of ageing and bestowing longevity.
Peer-reviewed medical research has shown that the benefits of massage include pain relief, reduced
trait anxiety and depression, and temporarily reduced blood pressure, heart rate, and state of anxiety.
Additional testing has shown an immediate increase and expedited recovery periods for muscle
performance. Theories behind what massage might do include blocking nociception (gate control theory),
activating the parasympathetic nervous system, which may stimulate the release of endorphins and
serotonin, preventing fibrosis or scar tissue, increasing the flow of lymph, and improving sleep but such
effects are yet to be supported by well-designed clinical studies.
Relief from pain due to musculoskeletal injuries and other causes is cited as a major benefit of
massage
Massage has been shown to reduce state anxiety, a transient measure of anxiety in a given
situation.
Massage has been shown to temporarily reduce blood pressure and heart
rate.
When combined with education and exercises, massage might help sub-acute, chronic, non-
specific low back pain. Furthermore, massage has been shown to reduce pain experienced in the days or
weeks after treatment
Massage has been shown to reduce trait anxiety; a person's general susceptibility to anxiety
Massage has been shown to reduce subclinical depression
Neuromuscular effects
Massage has been shown to reduce neuromuscular excitability by measuring changes in the
Hoffman's reflex (H-reflex) amplitude.
Ayurveda studies conducted showed that after three months of Ayurvedic massage, patients blood
showed a significant decrease in the free radical lipid peroxide and an improved immune response. Modern
research has proven the beneficial effect Ayurvedic massage has on all areas of the body; specifically the
neuromuscular, circulatory, lymphatic, skeletal and gastrointestinal systems.
Swedana is a process to induce sweating artificially in a patient who had already undergone
Snehana, etc. The heat is generated directly (saagni) or indirectly (niragni). Swedana liquifies the doshas,
clears the obstruction of channels of circulation and directs the doshas to selective places from where they
can be expelled easily.
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A dry or wet method of sweating is called swedana. It may be full body steam therapy. Special herb
decided on the basis of nature and intensity of doshas are fused into the steam and together the heat and
herbs dilate the channels allowing the stored ama (toxins) to move back into the digestive system.in
swedana the body is made to perspire to loosen and excrete the toxins.by this method as next is to remove
toxins from the body through panchakarma (sodhana therapy).
Benefits of Svedana karma or sudation therapy:(ref: sus.chi and char.sidhi)
Sthambahara - relieves stiffness of the body especially of joints,etc.
Gourava Nasha - brings in the feeling of lightness in the body and it relieves heaviness of the body.
Shitaghnam - imparts hotness or ushnata to The body by its thermal action.
Sweda kara- produces sweating in the body through which some metabolic wastes are flushed out
fromthe body as a result skin of the person appears clean,soft and glowing.
Agni deepthi - Improves digestive ability.
Maardhavam - softness of the body.
Tvak prasadam- smoothness and clearness of the skin.
Baktha sradham- desire for the food.
Srotasam nirmalatwam- clearness of bodily ducts and channels.
Hanti nidram Satandra- removes tandrayukta nidra
restores the functions of stiffness of joints.
Sulahara - removes the pain.
Perspiration or sweat is the substance produced by the sudoriferous glands, sudation therapy
activates these glands to produce more sweating so as to flush out the bodily wastes or toxins from the body
through the secretory portion of exocrine gland, which are located in the subcutaneous layer and the
excretory duct project upwards through the dermis and epidermis to terminate at a pore at the surface of
the epidermis. Exocrine sweat glands function through out life and produce a secretion that is more watery
than that of apocrine sweat glands. which produce a more viscous secretion in the skin of axilla, pubic region
and pigmented areas of the breast, as their distribution is limited to these areas only.
Ayurveda duly recognizing the function of sweat gland like eliminating toxins has successfully
adopted and designed as the Swedana chikitsa.
There is a little amount of risk in causing over sweating(continuously) as the vital factors like water,
salt, sugar, lactic acid, etc are likely to be eliminated from the body with sweat, hence attending physician
should be ready with remedial measures .Even though as safety measured declared persons who are likely
to sweat out these vital factors as Ayogya for swedana.
From the panchakarma point of view swedana karma is administered to cause vilayana
(liquification) of the aggravated dosha which are already transformed into Snigdha avastha by the pachana
and snehana already undertaken in the individual. The vilayana of ama dosha is essential for elimination
that can be achieved through vamana, virechana etc. Generally in all pathological conditions the doshas
which are in sama condition sticks on various srotamsis creating avarodha or blocking of minute channels.
these are being stimulated to move out through pachana ,snehana, and swedana as poorva karma
Joint Manipulation:, is a physical treatment primarily used by massage therapists, physiotherapists,
occupational therapists, chiropractors, osteopaths, and osteopathic physicians to treat musculoskeletal
pain and disability; it most commonly includes kneading and manipulation of muscles, joint mobilization
[1]
and joint manipulation.
MECHANISM OF SWEATING AND SWEDANA KARMA:
METHODOLOGY USED IN PHYSIOTHERAPY PROCEDURES:
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Joint manipulation is a type of passive movement of a skeletal joint. It is usually aimed at one or more 'target
synovial joints with the aim of achieving a therapeutic effect.
The clinical effects of joint manipulation have been shown to include:
Temporary relief of musculoskeletal pain.
Shortened time to recover from acute back sprains (Rand)
Temporary increase in passive range of motion (ROM).
Physiological effects upon the central nervous system.
No alteration of the position of the sacroiliac joint
Soft tissue therapy (STT) is the assessment, treatment and management of soft tissue injury, pain
and dysfunction primarily of the neuro musculoskeletal system. Licensed health care professionals who
typically provide soft tissue manual therapy include bodywork practitioners (such as massage therapists),
2
occupational therapists, physical therapists and some chiropractic, osteopathic and naturopathic doctors .
Assessments are conducted according to presenting signs and symptoms, with the purpose helping
to identify the most likely cause(s) of the pain or injury. They may include assessments of posture,
biomechanics, range of motion, and the nervous system, among others.
The specific treatment application of an ache, pain, or injury will be solely reliant on the conclusions
reached by the assessments. Any number of treatment techniques may be used to achieve optimal
treatment results.
Myofascial Therapy targets the muscle and fascial systems, promotes flexibility and mobility of the
body's connective tissues. Likewise, it mobilizes fibrous adhesions and reduces the severity and sensitivity
3
of scarring caused by injury or surgery .
Massage techniques, traditionally known as Swedish massage, may be used as part of a treatment
application. Referred to, in Soft Tissue Therapy, as broad-handed techniques, this mode of treatment aims
to reduce swelling and/or inflammation.
Cross friction create heat, which in turn provides the impetus for the mobilization of adhesions
between fascial layers, muscles, compartments and other soft tissues. Frictions are also thought to create
an inflammatory response that instigates a focus to an injured area, thereby, promoting healing, especially
in tendon pathologies.
Soft Tissue Technique where the practitioner applies firm, direct pressure to relax hypertonic muscles
and stretch tight fascial structures.
Sustained Pressure (ischaemic / digital pressure) alleviates hypertonic (tight) areas within muscle and
fascia.
Trigger Point techniques claim to address Myofascial Trigger points, though the explanation of how this
works is controversial.
Generally, any one of these techniques alone, or in combination, may provide the solution to an
ache, pain, or an injury. However, claims that any particular soft tissue technique will alleviate a specific
CLINICAL EFFECT AND MECHANISM OF ACTION:
SOFT TISSUE THERAPY
POSTURAL AND FUNCTIONAL ASSESSMENT:
TREATMENT STRATEGIES:
MANUAL TECHNIQUES
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condition, predictably, every time, are deceptive.
Static stretching attempts to alleviate excessively hypertonic (tight) muscles.
PNF stretching (proprioceptive neuromuscular facilitation) is used in an attempt decrease the tone in a
muscle or muscle group that is assessed as being hypertonic (tight).
To treat DOMS (delayed onset muscle soreness), Proprioreceptive Neuromuscular Facilitation (PNF) is
typically used.
The use of very light muscular contractions, in very specific directions is muscle energy technique
(M.E.T.). Refined more than 100 years ago in the field ofosteopathy, this technique, alters joint restriction
and joint range of motion, through altering the length of local musculature.
Dysfunctional soft tissues are either too short and tight or too long and weak. Dependent on
assessment findings, some clients may be assigned a series of exercises, to strengthen particular muscles or
muscle groups. In some cases the muscles may be having trouble firing, which is addressed with a
combination of manual therapy and exercises. Exercises may also be used to retrain correct joint
movement.
Soft tissue practitioners and muscular skeletal specialists often use therapeutic taping techniques to
relieve pressure on swollen injured soft tissue or to alter muscle firing patterns or to prevent re-injury during
healing. Some of these techniques are designed to enhance lymphatic fluid exchange.
After an injury to the soft tissue, muscles or tendons due to sports activities, over exertion or
repetitive strain injury, swelling often impedes blood flood to the injured area, which slows the healing
process. Elastic taping methods may be used to relieve pressure caused by swollen tissue and enhancing
blood circulation to the injured fascia tissue and muscle.
Heat therapy, also called thermo therapy, is the use of heat in therapy, such as for pain relief and
health. It can take the form of a hot cloth, hot water bottle, ultrasound, heating pad, hydrocollator packs,
whirlpool baths, cordless FIR heat therapy wraps, and others. It can be beneficial to those with arthritis and
stiff muscles and injuries to the deep tissue of the skin. Heat may be an effective self-care treatment for
conditions like rheumatoid arthritis.[4] Moist heat therapy has been believed to be more effective at
warming tissues than dry heat, because water transfers heat more quickly than air. Clinical studies do not
support the popular belief that moist heat is more effective than dry heat. Moist heat results in the
perception that the tissue is heated more deeply., Heat creates higher tissue temperatures, which produces
vasodilation that increases the supply of oxygen and nutrients and the elimination of carbon dioxide and
metabolic waste.[5] Heat therapy is useful for muscle spasms, myalgia, fibromyalgia, contracture, bursitis5.
Recent studies indicate that vasodilatation, the expansion of the blood capillaries (vessels) to allow more
blood flow, is improved with dry heat therapy. Expansion of the blood capillaries is the primary objective of
heat therapy. Heat therapy increases the effect on muscles, joints, and soft tissue. Heat is typically applied
by placing a warming device on the relevant body part.
Newer breeds of heat therapy devices combine a carbon fiber heater with a cordless rechargeable
lithium battery and are built into the specific body wrap (i.e., shoulder wrap or back wrap) for targeted heat
therapy. Such devices can be used as alternatives to chemical or plugged-in heating pads, but have not been
STRETCHING
EXERCISE PRESCRIPTION
TAPING
HEAT THERAPY
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shown to improve the clinical benefit. All devices primarily provide heat to promote vasodilation.
Heat creates higher tissue temperatures, which produces vasodilation that increases the supply of oxygen
[6]
and nutrients and the elimination of carbon dioxide and metabolic waste.
[6]
Heat therapy is useful for muscle spasms, myalgia, fibromyalgia, contracture, bursitis.
[6]
Moist heat can be used on abscesses to help drain the abscess faster. A study from 2005 showed heat
[7]
therapy to be effective in treating leishmaniasis, a tropical parasitic skin infection.
Heat therapy is also sometimes used in cancer treatment to augument the effect of chemotherapy or
[8]
radiotherapy, but it is not enough to kill cancer cells on its own.
Heat therapy is contraindicated in case of acute injury and bleeding disorders (because of vasodilation),
[5]
tissues with a severe lack of sensitivity, scars and in tissues with inadequate vascular supply (because of
increased metabolic rate and demand which a tissue with poor blood supply may fail to meet resulting in
[9]
ischemia).
In medicine, the term diathermy [di´ah-ther?me] means "electrically induced heat" the use of high-
frequency electromagnetic currents as a form of physical or occupational therapy and in surgical
procedures.
Diathermy is commonly used for muscle relaxation, and as a method of heating tissue
electromagnetically or ultrasonically for therapeutic purposes in medicine. It is used in physical therapy and
occupational therapy to deliver moderate heat directly to pathologic lesions in the deeper tissues of the
body.
1. Pain management:
Improves range of joint movement
2. Treatment of neuromuscular dysfunction:
Improvement of strength
Improvement of motor control
Retards muscle atrophy
Improvement of local blood flow
3. Improves range of joint mobility:
Induces repeated stretching of contracted, shortened soft tissues
4. Tissue repair:
Enhances microcirculation and protein synthesis to heal wounds
Increased blood flow to the injured tissues increases macrophages to clean up debris
Restores integrity of connective and dermal tissues
5. Acute and chronic edema
Accelerates absorption rate
Affects blood vessel permeability
Increases mobility of proteins, blood cells and lymphatic flow
6. Peripheral blood flow
Induces arterial, venous and lymphatic flow
7. Urine and fecal incontinence
Affects pelvic floor musculature to reduce pelvic pain and strengthen musculature
Treatment may lead to complete continence
DITHERMY
THE USE OF ELECTROTHERAPY/DIATHERAMY FOR:
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8. Lymphatic Drainage
Stimulate lymphatic system to reduce edema
Infrared (IR) is invisible radiant energy, electromagnetic radiation with longer wavelengths than
those of visible light, extending from the nominal red edge of the visible spectrum at 700 nanometers
(frequency 430 THz) to 1 mm (300 GHz) 10
Relief of pain due to infra-red therapy in acute pain happens probably due to the sedative effect on
the superficial sensory nerve endings. Heating stimulate the sensory nerve endings.
Pain due to acute inflammation or recent injury is relieved most effectively by mild heating where as
for chronic pain it requires more heating.
Muscle relax most readily when the tissues are warm and the relief of pain also facilities relaxation.
Infrared irradiation is thus of value in helping to achieve muscular relaxation and for the relief of muscle
spasm associated with injury or inflammation.
This effect is most marked in superficial tissue and may be used in the treatment of superficial
wound and infections. .In case of deep wound and infection it helps in relieving congestion. Also infrared
radiation is the only antidote to excessive ultra violet radiation.
Heat therapy is useful for muscle spasms, myalgia, fibromyalgia, contracture, bursitis.
Because heat is a vasodilator, it should be avoided in tissues with inadequate vascular supply, in case
of acute injury, in bleeding disorders (because heat would increase bleeding), in tissues with a severe lack of
sensitivity, in scars.
Another use is the treatment of infection and cancers by the use of heat. Cancer cells and many
bacteria have poor mechanisms for adapting to and resisting the physiological stresses of heat, and are
more vulnerable to heat-induced death than normal cells
Heat therapy can be used for the treatment of headaches and migraines. Many people who suffer
from chronic headaches also suffer from tight muscles in their neck and upper back. The application of
constant heat to the back/upper back area can help to release the tension associated with headache pain. In
order to achieve heat therapy for headaches, many use microwaveable pads which can often overheat,
potentially leading to injury, and lose their heat after a few minutes.
As discussed above the pre procedures in Ayurveda helps in increasing the blood circulation ,give the
tone to the muscle give luster to skin help nervous system to work in proper manner. massage therapy helps
in relieving pain, reduced trait anxiety and depression, and temporarily reduced blood pressure, heart rate,
and state of anxiety. Additional testing has shown an immediate increase and expedited recovery periods
for muscle performance. Theories behind what massage might do include blocking nociception (gate
control theory), activating the parasympathetic nervous system, which may stimulate the release of
endorphins and serotonin, preventing fibrosis or scar tissue, increasing the flow of lymph, and improving
sleep . From the panchakarma point of view swedana karma liquefies the dosha and helps in elimination of
it. Otherwise the doshas present causes avarodha or blocking of minute channels. Generally in all
INFRARED (IR):
THERAPEUTIC USES OF INFRA RED:
RELIEF OF PAIN:
MUSCLE RELAXATION:
INCREASED BLOOD SUPPLY:
DISCUSSION:
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pathological conditions the doshas which are in sama condition sticks on various srotamsis. these are being
stimulated to move out through pachana ,snehana and swedana as poorva karma.
The basic of physiotherapy also work in same manner. Joint manipulation therapy works same as of
snehana therapy. It helps in relieving Temporary relief of musculoskeletal pain, Shortened time to recover
from acute back sprains (Rand) , temporary increase in passive range of motion (ROM),physiological effects
upon the central nervous system. The heat therapy explained in physiotherapy also works by providing
luster to skin give tone to skin muscles also works on the nervous system. vasodilatation, the expansion of
the blood capillaries (vessels) to allow more blood flow, is improved with dry heat therapy. Expansion of the
blood capillaries is the primary objective of heat therapy. Heat therapy increases the effect on muscles,
joints, and soft tissue. Heat is typically applied by placing a warming device on the relevant body part.
In certain diseases of joint it is observed that while treating the pain in rheumatoid arthritis cases as
per Ayurveda patient is advise to take ruksha swed the if the patient is giving swedan and wax bath together
shows significant results in relieving together
Different light therapy like infrared therapy ultraviolet therapy along with snehana and swedana
also shows very significant reduction in pain symptoms.
As the principal of all the treatment used in physiotherapy and panchakarma is same and the
treatment is focused on increase the blood circulation releasing the congestion increasing the muscle tone
it is advisable to use the both therapy combinely. It will help us to modernise the snehana swedana therapy
by maintaining proper dose proper temperature of the procedure
Furthermore it requires more study to be conducted for comparative study of Ayurveda
preprocedure along with different physiotherapy procedure.
1. French HP, Brennan A, White B, Cusack T (2010). "Manual therapy for osteoarthritis of the hip or knee - a
systematic review". Manual Therapy. 16 (2): 109–17.doi:10.1016/j.math.2010.10.011. PMID 21146444
2. "Soft Tissue Sports Massage". The Treatment Table. The Treatment Table. Retrieved 2016-06-07.
3. Paul van den Dolder, Paulo Ferreira, and Kathryn Refshauge. "Is soft tissue massage an effective treatment
for mechanical shoulder pain? A study protocol". National Institutes of Health. US National Library of
Medicine. Retrieved 2016-06-07.
4. Thermotherapy for treating rheumatoid arthritis, from Cochrane Library
5. Raj, P. Pritvi, Practical Management of Pain. Mosby. 2.000. ISBN 978-0-8151-2569-3.
6. "Skin abscess: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 2016-08-03.
7. Reithinger, R.; Mohsen, M.; Wahid, M.; Bismullah, M.; Quinnell, R. J.; Davies, C. R.; Kolaczinski, J.; David, J.
R. (2005-04-15). "Efficacy of Thermotherapy to Treat Cutaneous Leishmaniasis Caused by Leishmania
tropica in Kabul, Afghanistan: A Randomized, Controlled Trial". Clinical Infectious Diseases. 40 (8):
1148–1155. doi:10.1086/428736. ISSN 1058-4838.PMID 15791515.
8. "Hyperthermia to Treat Cancer". www.cancer.org. Retrieved 2016-08-03.
9. West, Sterling (2014-10-23). Rheumatology Secrets. Elsevier Health Sciences. ISBN 9780323172875.
10. Liew, S. C. "Electromagnetic Waves". Centre for Remote Imaging, Sensing and Processing. Retrieved
2006-10-27
CONCLUSION:
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... Abhyanga (local Ayurveda massage) and Swedana (fomentation) increase skin and muscular temperature, improve blood circulation and improve the performance of muscle movement, and enhance neck holding. [22,23] Considering CP nearby to Vatavyadhi in Ayurveda, Abhyanga and Swedana has specified role in pacifying elevated Vata dosha. [24] Abhyanga also produces a typical "Mass reflex" which helps in proper defecation and urination of spastic children which relieves undue stress of constipation. ...
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Very little research has been conducted into the effectiveness of soft tissue massage as an intervention for the treatment of mechanical shoulder pain. Studies that have been conducted suffer from methodological issues, poor long-term follow-up and have conflicting results. The aim of this study, therefore, is to provide treating clinicians with improved evidence regarding the effectiveness of soft tissue massage for shoulder pain of local mechanical origin. Participants referred to the trial with mechanical shoulder pain will be assessed for range of motion, functional ability, and pain by a blinded assessor. Participants will then be randomly allocated to either an exercise-only group or an exercise and soft tissue massage group. Both groups will receive seven treatment sessions from a physical therapist over a period of 4 weeks. One week after the cessation of treatment, all participants will be reassessed by the same blinded assessor. Three months after cessation of treatment, subjects will again be reassessed. The primary outcome will be pain measured on a visual analogue scale (VAS) 1 week following the cessation of treatment. Secondary analyses will be pain at 3 months, the descriptive and present pain index sections of the short form McGill pain questionnaire, patient specific functional scale, and percentage improvement in pain scores and range of motion at 1 week following the cessation of treatment and at 3 month follow-up. Analysis of data will be carried out by a statistician who is blinded to group membership. Primary analyses will by intention-to-treat.
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Pentavalent antimony is the agent recommended for treatment of cutaneous leishmaniasis (CL). Its use is problematic, because it is expensive and because of the potential for drug-associated adverse effects during a lengthy and painful treatment course. We tested the efficacy of thermotherapy for the treatment of CL due to Leishmania tropica in a randomized, controlled trial in Kabul, Afghanistan. We enrolled 401 patients with a single CL lesion and administered thermotherapy using radio-frequency waves (1 treatment of >or=1 consecutive application at 50 degrees C for 30 s) or sodium stibogluconate (SSG), administered either intralesionally (a total of 5 injections of 2-5 mL every 5-7 days, depending on lesion size) or intramuscularly (20 mg/kg daily for 21 days). Cure, defined as complete reepithelialization at 100 days after treatment initiation, was observed in 75 (69.4%) of 108 patients who received thermotherapy, 70 (75.3%) of 93 patients who received intralesional SSG, and 26 (44.8%) of 58 patients who received intramuscular SSG. The OR for cure with thermotherapy was 2.80 (95% confidence interval [CI], 1.45-5.41), compared with intramuscular SSG treatment (P=.002). No statistically significant difference was observed in the odds of cure in comparison of intralesional SSG and thermotherapy treatments. The OR for cure with intralesional SSG treatment was 3.75 (95% CI, 1.86-7.54), compared with intramuscular SSG treatment (P<.001). The time to cure was significantly shorter in the thermotherapy group (median, 53 days) than in the intralesional SSG or intramuscularly SSG group (median, 75 days and >100 days, respectively; P=.003). Thermotherapy is an effective, comparatively well-tolerated, and rapid treatment for CL, and it should be considered as an alternative to antimony treatment.
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The aim of this systematic review was to determine if manual therapy improves pain and/or physical function in people with hip or knee OA. Eight databases were searched for randomised controlled trials (RCTs). Data were extracted and risk of bias assessed by independent reviewers. Four RCTs were eligible for inclusion (280 subjects), three of which studied people with knee OA and one studied those with hip OA. One study compared manual therapy to no treatment, one compared to placebo intervention, whilst two compared to alternative interventions. Meta-analysis was not possible due to clinical heterogeneity of the studies. One study had a low risk of bias and three had high risk of bias. All studies reported short-term effects, and long-term effects were measured in one study. There is silver level evidence that manual therapy is more effective than exercise for those with hip OA in the short and long-term. Due to the small number of RCTs and patients, this evidence could be considered to be inconclusive regarding the benefit of manual therapy on pain and function for knee or hip OA.
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