Crackling. Crunching. Popping. Crisp. Swaying. Hues of red. You may think that I am describing the fall/winter vata weather as the leaves change and fall to the ground. But if instead I am describing the condition of your joints (or those of many of your clients), then you will want to continue reading our discussion on joint health in this issue. The CDC estimates that about 50 million adults in the U.S. have arthritis diagnosed by a physician; that is about 1 in 5 Americans.1 Considering joint health from an Ayurvedic perspective can help alleviate this number.
The joints are a critical part of the body, though often overlooked until they start creating problems. Let’s briefly review the anatomy of joints. Joints, also called articulations, occur where two bones come together. There are actually three different types of joints, classified based on their mobility.2 Synarthroses joints are immovable joints, such as the joints that occur between the bones of the skull. Amphiarthroses are slightly movable joints, such as the joints that occur between the vertebral bones in the spine. And diarthroses are freely movable joints, which make up the greatest number of joints and are the ones that we routinely think of when we use the word joint; examples of diarthroses joints would be the knee, hip, and elbow. It is these diarthroses joints that we will particularly consider in this article.
Diarthroses joints have multiple components,3 seen in the image below. Between the two bones there is a layer of articular or hyaline cartilage, which provides cushion and keeps the bones from eroding by preventing them from rubbing against each other. There is also a synovial membrane, which lines the joints and forms a capsule around it. The synovial membrane secretes synovial fluid, a viscous fluid which serves to lubricate the joint to allow for smooth, effortless motion. These joints are also called synovial joints, implying the critical nature of a healthy synovial membrane and fluid. To further prevent friction, there are also fluid-filled sacs called bursas, which can be found between bones, ligaments, and other structures. Ligaments are a type of strong connective tissue that connect to bone on both sides and provide stability and structure to the joint, so that the motion of the joint is limited only to appropriate movements. And there are also tendons, which are also strong bands of connective tissue, and which connect to bone on one side and muscle on the other side; these tendons allow the muscles to control the movement of the joints by pulling on the bones.
In terms of function, the most important and obvious function of joints is to allow the body to have mobility. It is because of the joints that we are able to flex, extend, abduct, adduct, and rotate. Structurally, joints also hold the skeleton together in a particular form, allowing for the connection of bones throughout the body.
Now for the Ayurvedic perspective; joint health can be affected by two major issues: imbalanced doshas and the presence of ama (natural buildup of toxins).
Imbalanced vata brings vitiated air and space to the joint. Excess of the dry, light, rough, cold qualities can cause erosion and dryness in the joint space. This usually manifests as loss of the lubricating synovial fluid, followed by wearing down of the cartilage, and finally erosion of the bone itself from dry friction. Excess vata can also effect the stability of the joint by making the ligaments and tendons more prone to strain injuries and hypermobility or laxity, allowing the joint to move beyond its normal range of motion and leaving room for injury. Vata in the joints creates the typical cracking and popping sounds. This type of arthritis usually gets worse with activity and feels better with rest, and warmth and lubrication can help soothe vata in the joints.
Pitta, when it is vitiated, brings fire to the joint, creating heat and inflammation. Although pitta is often seen after acute injuries, it can also have a chronic component, creating hot, red, swollen joints. Pitta inflammation can cause joints to be painful even without movement, and the pain is often sharp, stabbing, or burning in nature; cooling treatments help relieve the pitta type pain.
Kapha arthritis brings the dense earth and water qualities to the joints. The joints can be swollen and stiff, but also cold to the touch. The pain caused by kapha is usually dull and aching in nature, and both warmth and movement can relieve it.
In addition to imbalanced doshas, ama is a significant factor in arthritis. Ama occurs when toxins build up in the body, due to low agni, poorly digested food, environmental exposures, and insufficient removal of wastes (irregular bowel movements, etc.). Ama, as it settles in the joints, causes redness, inflammation, heat, and pain, similar to the effects of pitta. The key is that in treatment of ama, you must address kindling of the agni as well as complete elimination of wastes through regular bowel movements.
The allopathic diagnosis of various types of arthritis can be correlated with an Ayurvedic perspective, often combining multiple vitiated doshas and/or the presence of ama. Some of the most common types of arthritis include osteoarthritis, rheumatoid arthritis, and gout. From an Ayurvedic perspective, it is key to understand that vata is involved in most of these cases, along with other aggravating doshas and toxins.
Osteoarthritis, the most common type of arthritis,5 occurs when vata is allowed to remain imbalanced for prolonged periods of time; the “wear and tear in the joint” diminishes synovial fluid and gradually wears down the protective cartilage, eventually leading to chronic pain, stiffness and reduced mobility. Osteoarthritis is particularly helped by Ayurveda early in the process. Reducing vata is key, both through diet and lifestyle. Massage of the joint with Mahanarayan oil and/or Joint Balm can provide lubrication as well as vata dispelling and tissue nourishing herbs. Yoga and exercises to strengthen the thigh muscles are particularly helpful, as strong muscles can remove stress from the joints. And, of course, healthy bowel movements are key, as the colon is the seat of vata, and vitiated vata must be flushed from the system.
Rheumatoid arthritis is an inflammatory arthritis that is believed to have an autoimmune etiology. The pain and inflammation can come and go, and eventually RA results in deformities in the joints that can be debilitating. Its effects are often seen on the smaller joints of the hands and feet. In Ayurveda, it is correlated with Ama Vata. Accumulated ama is carried by vata to the joints, where the ama deposits. By its irritating nature, the ama then causes an inflammatory response. Anti-inflammatory measures in the diet and lifestyle can be helpful, as can cooling herbs. Massage with Mahanarayan oil can be soothing and calming. Additionally, you must address the ama, with herbs such as guggulu to scrape the natural toxins and triphala to detoxify the system. And finally, agni must be kindled in order to prevent further ama from accumulating, with herbs such as ginger and pippali.
Finally, gout is a painful ailment of the joints that comes as bouts or flares and causes red, inflamed joints (often affecting the big toe) along with intense pain that worsens with even mild touch. Gout is caused by urate crystals depositing in the joint, when there is excess uric acid in the blood (for a variety of reasons). Gout is called Vatarakta in Ayurveda, because build up of uric acid in the blood is involved, with vata circulating the urate crystals to the joint space and causing sensitivity to the lightest touch. Again, pitta is also then involved, causing inflammation and sharp pain. The treatment would involve vata and pitta balancing diet and lifestyle, as well as herbs. The key in gout is to also cleanse the blood (for which panchakarma could be helpful), optimize the agni/metabolism, and support the kidneys as this is how uric acid is usually removed from the system. Altering the diet is key in gout, with avoidance of high protein foods and pitta provoking foods, particularly sour, salty, fermented, spicy, and heavy/fried foods. Again, herbs such as guggulu and guduchi can be helpful in both removing toxins and soothing the system.
We will take a look at a few key formulas for joint health in the next newsletter.
4 Kinesiology of the Musculoskeletal System, Foundations for Rehabilitation, 2nd Edition, Donald A. Neumann, 2010, Mosby Elsevier, ISBN 978-0-323-03989-5