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TITLE OF CASE

Standalone Ayurvedic management of chronic case of Sciatica (Grdhrasi) in a young female, who got no significant relief with conventional medicines - A Case report

Dr Sreelekshmi VS

ABSTRACT

A 21-year-old female patient was suffering from sciatica in 2016. The X Ray done initially was normal but to address the symptoms, pain killers were prescribed. But the pain persisted. She consulted a Neurologist only in the year 2019. An MRI (lumbar spine 2019) at baseline revealed - moderate disc desiccation changes at the L5-S1 level, and a mild posterior disc bulge with focal central protrusion indenting the anterior thecal sac. No nerve root impingement and neural foramina narrowing. She was provisionally diagnosed as Sciatica based on the clinical presentation. After 2 years of taking conventional medicines, the pain was still aggravating, and the patient was developing an altered gait. So, she opted for Ayurveda. Dr Sreelekshmi diagnosed this condition as Grdhrasi [2], and the Vatavyadhi cikitsa sutra was followed. After 1 month of Ayurvedic treatments both as Outpatient and Inpatient, subjective assessments were done to measure the outcomes. She got complete relief from her symptoms. The Bragards, Faber and Schober Test that was positive before treatment, became negative after treatment. She is advised to not involve in exhaustive and intense physical activities.

KEYWORDS

Sciatica, Grdhrasi, Ayurveda, Standalone

INTRODUCTION

Sciatica [1] is pain experienced due to an injury or irritation to the sciatic nerve that has its origin in the buttock/gluteal area. The sciatic nerve is the longest and thickest (almost finger-width) nerve in the body. Compression or pinching of the nerve can also cause this type of pain. The most common cause of nerve compression or pinching can be caused by a slipped disc or a herniated disc.

Diagnostic Criteria: History taking, and physical examination are the basis for diagnosis. Subjective and objective assessments are the primary diagnostic criteria. In the subjective assessment, SLR with clinical presentations is considered. In the objective assessment, Imaging may be advised to assess the severity of the damage.

PATIENT INFORMATION

A 21-year-old female presented with severe pain in the right low back region radiating to the right ankle since 5 Years.

Medical History:

Patient was normal 5 years back. In 2015, a car hit her lower back. There were no major injuries but only that of a mild hand injury. Later in 2016, the patient started experiencing pain in the right calf region. She was active in dance and sports. This aggravated the pain. She consulted an allopath and X Ray was done, but it was normal. At this point, she was prescribed pain killers, but despite this she did not get relief. In 2019, she consulted a Neurologist, who suggested MRI. MRI revealed disc desiccation at L5-S1 with mild posterior bulge. She took allopathic medications for another 2 years but got no significant relief. At the same time, she started experiencing pain in the right lower back region radiating through the posterior aspect of thighs and calf up to the ankle. Pain aggravated on lying posture and resolved sitting in dorsal stretch posture with forward bending. Patient also started developing altered gait. On 30.7.21, she consulted in Nangelil, and decided to take Inpatient treatment as suggested by the Doctor.

PHYSICAL EXAMINATION/CLINICAL FINDINGS

Nothing specific. There is no swelling or discolouration. On Palpation- tenderness on the low back region at the level of L5-S1 right side. There is a slight rise in temperature noted. Lumbar Spine Movements- Compression & extension movements are painful and restricted. Left side bending is normal. Right side bending is painful. SLR positive 40-degree right side. Bragard Test positive. Faber Test positive on the right side. Faber Test positive on the right side.

TIMELINE

Image 1. Timeline of events attached below

DIAGNOSTIC ASSESSMENT

Modern Diagnostic parameter: The diagnosis was basically made based on clinical presentation. MRI reports dated 2019 helped identify the cause and confirm the diagnosis.

Image 2. Old MRI Reports dated 2019 attached below

Ayurvedic Assessment was done based on the clinical evaluation by the ayurvedic physician, the confirmed diagnosis from the modern hospital.

Differential Diagnosis- This does not apply as the patient came in with a definite diagnosis.

Prognosis- Grdhrasi2 is considered as Yapyam, according to Ayurveda. Sciatica resolves itself within 6 months, but if the pain has persisted for more than a year, then the prognosis is very grim. Years of medication may not give any relief at all as in the case of this patient. This patient had been suffering from severe pain for 5 years, without any response to conventional medicines. Her symptoms were gradually aggravating, and she was also developing an altered gait. With Inpatient Ayurvedic treatment, she got complete relief from pain and is able to lead a normal life.

THERAPEUTIC INTERVENTION

See the tab "Treatment Details' 

FOLLOW-UP AND OUTCOMES

Follow up done after 2 months (20.11.2021): There is no pain, and the patient is leading a normal life. All ayurvedic medications were stopped and advised a strict diet and lifestyle. SLR right leg - above 60 degrees, but she can perform all her activities with ease and comfort.  She is advised not to indulge in heavy physical and exhaustive activities like lifting heavy weights, climbing stairs, indulge in dancing and intense sports.

Clinician-based assessment: 30 Days of treatment- patient had remarkable change in symptoms. After 20 days the pain completely disappeared. SLR - 90 degree after treatment. Bragard Test negative: Faber Test negative on the right side: Schober Test is negative.

Objective parameters:

Imaging was done during the Ayurvedic treatment in 2021, which revealed that over the two years (2019-2021), the clinical condition had worsened. But endpoint MRI though crucial could not be done owing to the expenditure, and the low economic status of the patient.

Image 3. MRI Reports September 2021

Patient-assessed: Not relevant

Follow up test results: No repeat MRI was done owing to the cost.

Intervention adherence and tolerability – The patient adhered to the prescribed treatments and tolerated the treatments well. 

Method of assessment- By monitoring the patient.

Adverse and unanticipated events: Gandarvahastadi Eranda tailam 30 ml was administered at 5 am for Virecanam on 14.8.21. Patient vomitted at 8 am (1 Vamana Vega). Virecana Vega started at 9 am (2 Vega).

DISCUSSION

Condition was diagnosed as Grdhrasi, vasti was planned but could not be done as the patient was unable to be positioned for it. To manage the pain, general Vatavyadhi treatment line especially that of Sandhi asthi siragata vata was taken into consideration. Hence internal medicines and external treatments targeted pacifying vata dosa.

PATIENT’S PERSPECTIVE

Not available.

LEARNING POINTS/TAKE-HOME MESSAGES

Even in chronic cases of Sciatica, as in this patient, where after taking conventional medicines for a long period, there was no significant relief, Ayurveda can be very effective.

INFORMED CONSENT

Written consent obtained from patient, for publishing this case report.

ACKNOWLEDGEMENTS

None

CONFLICT OF INTEREST

None declared.

FUNDING

None

REFERENCE:

1. Jensen RK, Kongsted A, Kjaer P, Koes B. Diagnosis and treatment of sciatica. BMJ. 2019 Nov 19;367:l6273. doi: 10.1136/bmj.l6273. PMID: 31744805.
2. Mohan M, Sawarkar P. Ayurvedic management of Gridhrasi with special respect to Sciatica: a case report. J Indian Sys Medicine 2019; 7: 131-8

 

Image 1. Timeline of events 

Image 2. Old MRI Reports dated 2019 attached below

Image 3. MRI Reports September 2021