In the previous ‘First-aid’ post we looked at first-line tips for pain relief.
Here we delve into the Ayurvedic approach to addressing low back pain.
An optimal healing protocol in Ayurveda, is one that treats from both sides of the disease spectrum-vyadhi viparitam (treating the symptoms) and hetu viparitam (treating the root causes ) to bring long-term relief and minimize recurrences.

So what is Low-back pain and what are some of its root causes?
Called Kati Shoolam or Kati Graham in Ayurveda, Lower back pain can be seen as disease in itself if, for example, the causative factor is a single acute injury.
Alternatively, It may be a symptom of underlying causes like Chronic constipation, Diarrhea, Menstrual issues, Emotional stress, Pregnancy, Pelvic inflammatory disease, Endometriosis, Fibromyalgia to name a few, or Musculoskeletal disorders which have developed over time like disc injuries, spinal issues or repetitive stress.
Doshas (Functional energies) and Dhatus (Tissues) involved: The low back region, colon, lower abdomen and pelvic region are considered the seat of Vata dosha (the energy principle of air and ether). Pain& any movement impediment in this area is broadly considered a Vata impairment and more specifically with the flow of Apana Vata (the downward flowing sub-dosha of Vata). With musculoskeletal pain in the back, Mamsa dhatu ( Muscle tissue ) Asthi (Bone tissue) and Majja dhatu (Nerve tissue and Marrow) are involved.
Other doshas and sub-doshas involved will vary.
Vata pain can feel variable, feel worsened by activity; Pitta pain may present with inflammation, intensity, burning sensation; Deep pain, constant pain, associated with congestion or heaviness, aggravated by lack of movement could be a Kapha associated pain.
Assessment:
During an Ayurvedic assessment, we examine the eyes, skin, hair nails, tongue, pulse. We look into the nature of the pain itself; What makes the pain worse, what makes it better; What is your prakriti (body constitution), your vikriti (current imbalances), state of Agni (metabolic fire), Ama ( toxin build-up) , Srotas (the bodily channels) that are affected because of your current imbalances;
We look at your lifestyle and factors that aggravate your condition- Are you an athlete? Do you stand for long periods of time? Do you have a sedentary job? What else is your back pain related to- do you have Endometriosis, a history of constipation, are you going through menopause, does travel aggravate it, are there emotional stresses related to anxiety/ loss/ grief?...
Such an approach brings clarity and nuance to the specific energetics involved in each individual case. With this, we draw up an individualized Ayurvedic protocol.
Management
Having identified the root cause, the first step is eliminating the causative factors and preventing further aggravation. We pacify the vitiated doshas, address agni, ama, the systems and srotas involved by working with herbs, diet, lifestyle, bodywork, yoga and self-care.
Herbs and Herbal formulations:
The hallmark of Ayurvedic medicine is the rich tradition of Ayurvedic herbalism. A qualified practitioner draws from the root texts of Ayurveda in choosing herbs and herbal formulations. These herbs and synergistic formulations, work with us at many levels, educating the body’s cells, improving dhatu (tissue) quality, improving the dhatu agni (metabolic fire) seamlessly across the different bodily systems and supporting the whole person while providing targeted relief.
The choice of herbs and regimens are completely individualized and will be different from person to person. A few examples of herbal formulations can include
Sahacharadi Kwatham[1]
Gandharvahasthadi Kashayam[2]
Yogaraj Guggulu[3]
Gandha Tailam[4]

Nutrition and Lifestyle:
The line of communication between the gut, the nervous system, immune system, sleep and emotions is well understood in Ayurveda.
Maintaining a balanced agni (digestive fire) is fundamental to healing and good health. When the agni is optimal, the body is able to extract maximum nourishment from everything we take in. To further support healing and longevity, our lifestyle has to align with our constitution, agni, age, climate and life circumstances.
Holistic bodywork: Depending on the nature and chronicity of the problem a practitioner will make recommendations for bodywork . Abhyanga massage with oil formulations like Murivenna, Sahacharadi, Kottamchukkadi, Mahanarayana tailam to name a few; Kati Vasti , which is a treatment involving pooling of warm medicated oil in the lumbo-sacral region, Kati Pichu- A treatment involving application of Cotton swathes saturated in Warm medicated oil, Different kinds of Pinda Swedana (Compress treatments) are all highly effective.

Self-Care through Movement, Yoga, Breath-work, Sense care: I find self-care practices sustainable when they are simple and bring joy. In my consultations, I love to share tips and techniques that I have found effective, that have stayed with me over the years.
Panchakarma:
Complex conditions and diseases that accumulate over a lifetime involve deeply lodged toxins in the tissue layers of the body which are not healed simply by diet& lifestyle changes and palliative care. A Panchakarma program is a specialized detoxification; It brings deep healing to the tissues, channels, digestion, nervous and endocrine systems. It restores equilibrium and builds strength in the whole system.
Panchakarma is a comprehensive system of knowledge- An ocean within the ocean of Ayurvedic medicine.
Panchakarma treatments are administered as an individualized regimens, under the supervision of a qualified practitioner and span several days. A Panchakarma program has different stages- Purvakarma (the preparatory stage), Pradhanakarma (The main panchakarma cleansing stage), Pashchatkarma ( The important post- cleanse stage) and Rasayana (the rejuvenation phase).
Holistic bodywork therapies like Abhyanga, Pinda Swedana, Shirodhara, Kati Vasti, Pizhichil and many more are part of different stages of a Panchakarma program.
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[1] Ashtanga Hrdayam, Chikitsa Sthanam Ch 21/ Shloka 56 [2] Sahasrayogam, Kasayaprakarana, 394, vatahara kvata [3] Bhaishajyaratnavali, Amavatarogadhikara Shloka 90-95 [4] Ashtanga Hrdayam, Uttara Sthanam Ch 27/ Shloka 36-41 ____________________________
Bibliography:
Vagbhata. Ashtanga Hrdayam (Vol 1-3). Translated by Prof. K.R Srikantha Murthy, Chowkhamba Krishnadas Academy, Varanasi, 2000.
Caraka Samhita (Vol 1-7). Translated by R.K. Sharma & Bhagwan Dash, Chowkhamba Sanskrit Series Office, Varanasi, 2016.
Sri Govida Das Sen. Bhaishajyaratnavali. Translated by Dr. G. Prabhakara Rao, Chaukhamba Orientalia, Varanasi, 2014.
Sahasrayogam. Translated by Dr. G. Prabhakara Rao, Chaukhamba Publications, New Delhi, 2016.
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