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    Avn Case

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    Taanisha Sharma
    case study of a male with avn and was treated with siddha therapy

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    Avn Case

    Uploaded by

    Taanisha Sharma
    8 views7 pages
    case study of a male with avn and was treated with siddha therapy

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    avn case

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    case study of a male with avn and was treated with siddha therapy

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    8 views7 pages

    Avn Case

    Uploaded by

    Taanisha Sharma
    case study of a male with avn and was treated with siddha therapy

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    Role of Siddha in Management of Avascular Necrosis Without

    Medicines and Surgical Intervention

    Introduction

    Avascular necrosis (AVN) also called as Osteonecrosis is a condition


    that occurs when there is loss of blood supply to the bone and bone
    tissues [1]. As bone is a living tissue that requires continuous supply of
    blood, an interruption to it may lead to death of bone. If left untreated for
    a longer time, the bone becomes brittle, distorts and eventually breaks.
    In 90% cases, Avascular necrosis is in the hip joint but can sometimes
    be seen in humerus and knees too [2]. Modern medicine treats only pain
    and in severe cases Total Hip Replacement surgery is done. After
    surgery also it takes a long time for recovery with limitation in
    movements and short life span of hip joint.

    Alternative therapies like Siddha vaidyam; which is an ancient and old


    therapy has proved to be beneficial in managing the symptoms of
    chronic diseases like AVN. It treats by aligning body energies (mind,
    body and spirit), to empower and activate the body’s internal healing
    mechanisms thus, resulting in cure and an improved lifestyle. It does not
    involve any kind of medications and chances are that there is no
    requirement to go for any kind of surgery.

    The Siddha system is bestowed with various special therapies like


    Pressure Manipulaiton Therapy (Varmam), Physical Manipulation
    Therapy (Thokkanam), Pranayamam and Yoga that work well on long
    term relief in pain, improvement in movements of joints and aims at the
    preservation of structure, by stopping the progression of disease without
    any complications. Though, any kind of pressure on hip joints is
    contraindicated in AVN but these pressure release technique empowers
    the body’s internal healing centres to effectively cure the condition and
    ensure long term healing of the disease condition internally. The chief
    healer assesses areas of energy blockages in the body, aiding removal
    of energy blocks, to enable uninterrupted energy flow.

    Etiology of Avascular Necrosis


    AVN can be commonly seen in individuals aged between 25-50 years
    and 7-12% undergo total hip replacement due to its severity. In India, the
    mean age of onset of necrosis is 34.5 years [3].

    AVN possibly is caused by trauma or non-traumatic injury, excessive


    alcohol intake and steroid abuse [4]. Almost 35-40% of all non-traumatic
    AVN cases are because of long term steroids dependency. AVN is
    highly prevalent among males, this could be attributed to higher
    levels of smoking and alcohol use among them. Sometimes, cancer
    treatments where radiation therapy is used, can also weaken the bone
    leading to necrosis of bone. Studies show overweight and obesity i.e
    more BMI, may also cause Osteonecrosis in some cases [5].

    In initial stages, AVN causes no symptoms; but as the disease becomes


    chronic, the joint pain increases and restrict movements of hip. At first,
    pain is felt while putting pressure on the affected bone. Later there is
    continuous pain causing discomfort. If the disease is left untreated, there
    is irreparable joint degeneration, resulting in severe pain that interferes
    with individuals ability to move the joint. It also leads to decrease in the
    height of the affected leg and causes the lower limb to shorten [7].

    Case Presentation

    A 43-years old female from Hyderabad having non-traumatic Stage-3


    Avascular Necrosis, presented in February 2022 with complaints of
    severe pain in the left hip joint and lower back since 10 years [6,7]. She
    was diagnosed to have non traumatic stage 3 AVN. The pain was
    insidious in onset and gradually progressive in nature with an intensity of
    8-9/10 on VAS pain rating scale. She had difficulty in doing any activity
    like walking, standing or sitting, bending and had continuous dull pain in
    Left hip radiating till left knee. Her left leg was 2-cm shorter than right leg
    which was visible while doing adduction of knees. She was unable to
    squat and do criss-crossing of her legs and could not climb stairs. The
    pain reduces partially on taking rest and medications.
    The patient , a teacher by profession, a single mother had to forcefully
    take a break from her work because of the pain. As the responsibility of
    the household was on her shoulders she had immense psychological
    stress because of her ailment which led to depression and deterioration
    in her quality of life[8].

    History of Past Medical Illness

    The patient is Non-diabetic and age-related Hypertensive. She has a H/o


    Bariatric Surgery 8 years back and and hernia repair with mesh
    replacement 5 years back. After 6 months of Hernia surgery, she had
    infection and was operated upon again. She observed after her surgery,
    her pain in Left hip aggravated with restricted movements. She
    consulted an Orthopaedic surgeon 4 years back who advised her to take
    out an X-Ray & MRI of hip joint along with other lab tests. According to
    Ficat and Arlet's grading system, an X-ray showed stage-3 AVN of the
    left femoral head.

    The Orthopaedic doctor advised a hip replacement surgery but patient


    was reluctant for the same and was started with a course of steroids and
    physiotherapy sessions to strengthen the core muscles. The patient
    showed minor pain reduction and some improvement in the daily
    activities. However, the pain progressed over 4 years to the extent to
    which the patient had difficulty in day-to-day activities like standing for 10
    mins, sitting, unable to sit cross-legged, and bending. During the last 2
    years due to covid restrictions, she had to do all work by herself, which
    led to the pain getting aggravated to a scale of 9-10/10.

    The aim of presenting this case is to see how Siddha therapy worked on
    curing the Avascular Necrosis condition by reducing pain and
    improvement and better flexibility in hip joints without use of medicines.
    This was confirmed by noting her symptoms on VAS scale for pain and
    pre-post ROM (Range of Motion) assessment. Clinically, pre and post
    x-rays also verified the success of treatment [9].
    Treatment Protocol

    The treatment was started on 14th Feb, 2022; it was planned for 30 days
    with 20 days in the initial phase and the rest of 10 days after a gap of 1
    month. The treatment included pressure manipulation at the Lumbar and
    B/L hips till the knees especially the left leg with not too much pressure
    on the hip area. The patient was kept on a strict liquid diet to reduce
    weight and daily physio exercises for 1/2 hr. In the initial week, patient
    had less difference in pain but could see a difference in her walking
    style. She could notice that she was able to stand in the kitchen for 20
    minutes while earlier she could not stand even for 5 mins. She could
    identify her stiffness reduction as now she was able to bend while earlier
    she could not bend at all.

    In the 2nd week, she lost 5 kgs and was now able to walk for 1 km with
    very less discomfort in her joints while before treatment she could barely
    walk for 5 mins. She tried standing for 40 mins and was able to do 5
    squats without any difficulty. Earlier she had pain while doing exercises
    but now she was able to do exercises without much discomfort. In the
    3rd week, there was 50% improvement in stiffness in hip region and
    almost no radiating pain in the left leg. Even the left leg which was 2 cms
    short earlier now was seen at 1 cm only (Table1). On the VAS scale pain
    had reduced from 9/10 to 5/10. According to the plan, she was given a
    break for a month but was advised to continue diet restrictions and
    physio strictly.

    After break, her treatment was again started on 14th March, 2022. The
    patient was having low intensity pain 4-5/10 on VAS but was able to do
    all her house chores easily. She was maintaining the diet as told to her
    and had lost 3-4 kgs more. The treatment was again given to her for 14
    days and the points were closed on 1st April, 2022. On completion, the
    patient had very less stiffness in her lower back and was able to bend
    freely. She was able to stand for 1 hr in and could walk for 30-40 mins in
    good speed with bearable pain 2/10 on VAS scale (Table1). She was
    also able to take stairs which she had stopped 7 years back accounting
    to pain in joint while climbing. At the time of her completion of treatment,
    physiotherapy details were taken into account, experiencing alleviation
    from symptoms and achieved functional mobility that she had previously
    been unable to tolerate owing to pain.

    Conclusion

    Siddha Vaidya, an ancient science that treats by aligning body energies


    (mind, body and spirit), to empower and activate the body’s internal
    healing mechanisms results not only in cure but also an improved quality
    of life. Siddha therapy along with diet and physiotherapy rehabilitation
    played a vital role in this case in reducing pain; enhancing muscle
    strength, functional independence, and quality of life in patients with
    stage 3 Avascular necrosis of the femur.
    Table-1 (Pre and post rehabilitation pain rating and limb length
    measurement)

    Pre treatment post treatment

    Pain rating (VAS) 9/10 2-3/10

    Limb length 2 cm true 1 cm true


    measurement shortening shortening

    Table-2 (Pre and Post Rehabilitation ROM at Lt Hip area)

    Hip Joint before the treatment after the treatment


    Movement

    Flexion 0-60 0-85

    Extension Unable to perform 0-10

    Abduction Unable to perform 0-35

    Adduction 0-15 0-35

    External rotation Unable to perform 0-25

    Internal Rotation 0-30 0-30


    References

    1. Matthews AH, Davis DD, Fish MJ, Stitson D. Avascular Necrosis


    December 6th. 2021; 75-87.

    2. Lespasio MJ, Sodhi N, Mont MA. Osteonecrosis of the hip: a


    primer. Perm J. 2019;23:43–100. [PMC free article] [PubMed] [Google
    Scholar]

    3. Shaharir SS, Chua SH, Mohd R, Mustafar R, Noh MM, Shahril NS, et
    al. Risk factors for symptomatic Avascular necrosis (AVN) in a multi-
    ethnic systemic lupus erythematosus (SLE) cohort. PLoS One. 2021 Mar
    19;16(3):e0248845. [PMC free article] [PubMed] [Google Scholar]

    4. Shah KN, Racine J, Jones LC, Aaron RK. Pathophysiology and risk
    factors for osteonecrosis. Curr Rev Musculoskeletal Med. 2015
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    5. Sunny BP, Herbert SD. Avascular necrosis treatment & management


    December 5th. 2021; 145-80.

    6. Gaillard F. Ficat and arlet classification of avascular necrosis of


    femoral head. 2021. Dec 5th; 102-05.

    7. Pawar A, Phansopkar P, Gachake A, Mandhane K, Jain R, Vaidya S.


    A review on impact of lower extremity muscle Length. J Pharm Res
    Int. 2021:160–174. [Google Scholar]

    8. Human Physical Therapy and Sports Medicine Centres. Avascular


    Necrosis of the Hip (AVN) (2018). Retrieved from
    https://www.humpalphysicaltherapy.com/Injuries-Conditions/Hip/Hip-
    Issues/Avascular-Necrosis-of-the-Hip/a~5525/article.html

    9. Mayo Clinic. (2019). Avascular necrosis. Retrieved from


    https://www.mayoclinic.org/diseases-conditions/avascular-necrosis/
    diagnosis-treatment/drc-20369863

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