Introduction to Sports Medicine with Ayurveda

Ayurveda: Optimal Exercise Practices and References to Sports Injury Treatment

Exercise (Vyayama) has been given a great importance in the daily regimen (Dinacharya). A person who follows this regimen will have lightness of the body, improved agility, and a fit and strong body, improved metabolism and reduced fat tissue. Great care has to be taken by a person following Vyayama as there are specific rules on how it needs to be followed; it can be done for a longer duration in the cold climate and spring but should be done moderately in other seasons. One has to always exercise half of one’s capacity even if he/she is strong and eats oily food. After exercise, oil application on the body (Deha mardana) needs to be done but is strictly contraindicated in very young children, old people, and the ones suffering from diseases. 

Exercise therapy in Ayurveda has been explained in various contexts, such as in the context of rehabilitation in fractures, in conditions like shoulder pain/frozen shoulder and in the context of certain neurological conditions. Traditionally, the Kalaripayattu gurus from Kerala have been treating sports injuries for centuries using innovative traditional methods of bandaging using mixtures of traditionally known herbs and oils with excellent outcomes. This branch is also sometimes referred as Kalari Chikitsa. Sprains, muscle tears, tendon injuries, ligament injuries are commonly seen in people training for such rigorous forms of martial arts.

Ayurveda Diet as Sport Medicine

The following diet as sports medicine is recommended for people suffering from sports or exercise injuries:

• Drink the first milk of a lactating cow (Ksheera) with processed ghee and Kakolyadi gana post-eating food. 
• Laksha ksheerapaka (Laccifer lacca) is said to be very good for healing ligaments and bone injuries.
• Red rice, meat soups, and legume soup processed with ghee (Kalaya Yusha).
• One has to avoid salty, spicy, alkaline, sour, and dry food. Also, one must maintain celibacy, avoid exercise, and excess exposure to sunlight.

Conditions Caused by Sports Injury

Some of the Ayurvedic terms related to Sports Injury are:

• Agantuja Vyadhi – a disease that refers to the one caused by external injury (Abhigatha).
• Fractures (Sandhimukta) and dislocations (Kandabhagna).
• Vyayama Atiyoga – is exercising in excess which can lead to electrolyte imbalance, wasting of the body, loss of consciousness, bleeding disorders, fatigue, cough, pyrexia, and vomiting. 
• Excessive jumping, running, and excessive straining may often lead to musculoskeletal injuries.
• Sadhyo vrana – where 6 types of traumatic wounds have been explained such as excised wound, open/incised wound, piercing injury, abrasion, crush wound, and kshata.

Ayurvedic Treatment Methods

The below-mentioned treatments are to be done rigorously once or twice a day as a part of in-patient care:

• Lepa and Kashaya Dharas given in the initial stages to reduce the inflammation.
• Janu vasti and Pizzichil of the affected joint with specific oils. (Murivenna, Kottumchukkadi, Balashwagandhalakshadi, Mahanaryan taila, etc.)
• Medicated steam application on the affected joint.
• Crepe bandaging using medicated oils is done in a specified way.
• Leech applications to improve vascularity.
• Specific Ksheera Vasti and Anuvasna vasti, a 15-day or 30-day medicated enema (vasti) course.

Outpatient care is not preferred in these cases because rest and immobilization (partial) are the two things that are a must for the initial 3-4 weeks. After all this, based on the condition, knee strengthening exercises are to be followed in the long run with regular use of a knee cap or crepe bandage for 4 more weeks; knee strain and rigorous activities need to be avoided. After 3 months, a kneecap has to be mandatorily used if the person wishes to get back into sports. 

As per Acharya Sushrutha, these injuries are easier to manage at a younger age, with very little dosha involvement, and in colder climates. As the age advances, so does the time for healing of these injuries with sports medicine.

As far as possible, a sportsperson needs to take care of him/her throughout the game and at the same time continue to play a good game. It may seem a hard goal to achieve but is very important. Always use the required protective gear in all sports, this can reduce the major injuries that can happen, even during practice. Never play any sport until your body is fit, hence follow exercises or Yoga regularly as per the directions in Ayurveda to have a more flexible body. Follow oil application every day as a routine post-exercise or any sport as this will strengthen the body with taking sports medicine as mentioned by Ayurveda.

Conditions Caused by Sports Injury

Some of the Ayurvedic terms related to Sports Injury are:

• Agantuja Vyadhi – a disease that refers to the one caused by external injury (Abhigatha).
• Fractures (Sandhimukta) and dislocations (Kandabhagna).
• Vyayama Atiyoga – exercising in excess which can lead to electrolyte imbalance, wasting of the body, loss of consciousness, bleeding disorders, fatigue, cough, pyrexia, and vomiting. 
• Excessive jumping, running, and excessive straining may often lead to musculoskeletal injuries.
• Sadhyo vrana – where 6 types of traumatic wounds have been explained such as excised wound, open/incised wound, piercing injury, abrasion, crush wound, and kshata.

Ayurvedic Treatment Methods

The below-mentioned sports medicine are to be done rigorously once or twice a day as a part of in-patient care:

• Lepa and Kashaya Dharas given in the initial stages to reduce the inflammation.
• Janu vasti and Pizzichil of the affected joint with specific oils. (Murivenna, Kottumchukkadi, Balashwagandhalakshadi, Mahanaryan taila, etc.)
• Medicated steam application on the affected joint.
• Crepe bandaging using medicated oils is done in a specified way.
• Leech applications to improve vascularity.
• Specific Ksheera Vasti and Anuvasna vasti, a 15-day or 30-day medicated enema (vasti) course.

Outpatient care is not preferred in these cases because rest and immobilization (partial) are the two things that are a must for the initial 3-4 weeks. After all this, based on the condition, knee strengthening exercises are to be followed in the long run with regular use of a knee cap or crepe bandage for 4 more weeks; knee strain and rigorous activities need to be avoided. After 3 months, a kneecap has to be mandatorily used if the person wishes to get back into sports. 

As per Acharya Sushrutha, these injuries are easier to manage at a younger age, with very little dosha involvement, and in colder climates. As the age advances, so does the time for healing of these injuries with sports medicines.

As far as possible, a sportsperson needs to take care of him/her throughout the game and at the same time continue to play a good game. It may seem a hard goal to achieve but is very important. Always use the required protective gear in all sports, this can reduce the major injuries that can happen, even during practice. Never play any sport until your body is fit, hence follow exercises or Yoga regularly as per the directions in Ayurveda to have a more flexible body. Follow oil application every day as a routine post-exercise or any sport as this will strengthen the body.

Reviving Athletes: A Case Study of Ayurvedic Approach to Sports Injuries and Non-Surgical Recovery

Statistics show a steady rise in sports injuries, and thus, a rise in arthroscopic surgeries in today’s age. People are seeking non-interventional management; specifically, what Ayurveda can provide. 

A young man in his thirties comes for his consultation in a wheelchair. He is a sportsman and a football player. 10 days back he twisted his right knee while running and since then has been unable to bend his knee or walk without pain. Examination revealed swelling on his right knee with mild effusion and tenderness with restricted range of motion (ROM) of a joint from full extension to full flexion (bending) measured in degrees. He consulted an orthopedical who advised for an X-ray and MRI, after seeing which he concluded that there was a partial high-grade tear of the anterior cruciate ligament (ACL runs diagonally in the middle of the knee), with a partial tear of the medial collateral ligament (MCL injury is a stretch, partial tear, or complete tear of the ligament on the inside of the knee), lateral collateral ligament (LCL in knee), and medial retinaculum (a tendon of the knee that crosses the knee joint on the medial side of the patella. It plays important roles in the formation of the fibrous capsule of the knee and the extension of the knee joint), horizontal tear in the posterior horn of medial meniscus with moderate joint effusion and Femoral and Tibial condylar Bone Marrow contusion. He was advised surgery for the same followed by physiotherapy and weight bearing.

Post-treatment with sports medicine,the footballer recovered very well and is back into sports following all the precautions as advised to him. In a few cases (mostly with complete tear of ACL) have to completely give up sports, as any form of rigorous and twisting activity can make the joint very unstable. Although they may become pain-free and comfortable enough to carry on their day-to-day activities without any hassle, they would have to restrict themselves concerning certain rigorous sports and activities and follow the sports medicine as mentioned.

This is the usual scenario we come across. People come to Ayurvedic surgeons with sports medicine after doing their homework and seeking non-surgical management of the said condition. Can we do something then? The answer is YES!  After a thorough examination of the patient and analysis of their reports, intensive in-patient care is all that is required for the patients for 3-4 weeks. The main aim of all the treatments is to reduce inflammation, promote healing, increase vascularity, provide stability with adequate rest, and, prevent stiffness and repetitive stress on the affected joint. 

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