Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa S, B.A.M.S

We do not have any condition explained in Ayurveda which can be directly correlated with ‘Extensor Tendinitis’. This article will be a hypothetical discussion of this disorder from an Ayurveda perspective.

What is Extensor Tendinitis?

Extensor Tendinitis is an inflammation of the extensor tendons which are found under the skin of the hand or top of the feet. Pain, stiffness, swelling, redness, warmth, crepitus and discoloration are the symptoms of Extensor Tendinitis and they are evidenced in the region of tendon inflammation, either in hand, foot or both. It may be caused due to prolonged and excessive activity and movement of foot or hand involving jobs demanding the same or as an effect of specific health conditions like rheumatoid or osteoarthritis, gout, flat feet etc. people over 40 years of age, smokers or tobacco users are at risk of getting this disorder.

Related Reading – ‘Extensor Tendinitis – causes, symptoms, prevention, treatment’

Conceptual Understanding of The Disease

1. Extensor Tendinitis – a Vata Vyadhi?

Excessive movement and usage of hands and feet is the main cause of extensor tendinitis. From an Ayurveda perspective it is Karma Ati Yoga i.e. too much action or activity than what is desired. This itself is the causative factor for many diseases. Ati Vyayama – too much indulgence in physical activities, including hands and feet or exercises is one of the most important causes for Vata increase. Increased vata would cause pain and other symptoms. This pathogenesis involving vata can exclusively happen in the hands and feet and when it happens it will cause pain, swelling and movement issues therein, giving rise to many disorders. Extensor tendinitis is one among them. So, Extensor Tendinitis can be simply classified under ‘Vata Vyadhi’.

2. ‘From Vata Nanatmaja Vyadhi perspective’

Seeing the symptoms of Extensor Tendinitis, we can consider the below mentioned three conditions in the context of Vata Nanatmaja Vikaras i.e. specific diseases caused by ‘only vata’, in close correlation to the mentioned condition, mainly the condition affecting the foot extensors –

–        Pada shula – pain in the foot

–        Pada bhramsha – instability of foot and

–        Pada shunyata – numbness in the foot

Similar conditions in relation to Pani i.e. hand, the counterpart of Pada has not been mentioned but should be inferred. Ayurveda has used this methodology of mentioning a part of the whole and leaving us to infer the other part. So, the below mentioned conditions can be inferred in correlation with Extensor Tendinitis affecting the hands –

–        Pani shula – pain in the hand

–        Pani bhramsha – instability of hand and

–        Pani shunyata – numbness in the hand

3. Kandara / Snayugata Vata in Foot and Hand

Kandara or Snayu means tendons. Snayu means ligaments. Kandara and Snayu are often interchangeable terms. When aggravated vata is localized in the kandaras it causes symptoms similar to those of Extensor Tendinitis.

4. Mamsagata Vata, Asthigata Vata in Foot and Hand

Extensor Tendinitis can also occur when the aggravated Vata gets localized in the mamsa – muscles and / or asthi – bones of the hands or feet. Extensor tendinitis is also said to occur due to repetitive strain on muscles, bones and tendons. Repetitive strain aggravates vata.

5. Vatarakta

Vatarakta is correlated with gout. Gout is one of the causative factors for Extensor Tendinitis. Vata or Rakta individually getting aggravated can itself cause painful conditions wherever they get localized. The combination of vata and rakta in vatarakta would produce severe painful symptoms along with swelling and other symptoms mentioned in Extensor Tendinitis. Vatarakta is also said to manifest first in padamula or hastamula – grossly taken can be understood as foot or hand. Uttana Vatarakta affects skin and muscles beneath it, which would also include the tendons.

6. Amavata and Sandhigata Vata

Amavata is a multi-systemic disorder caused due to vicious amalgamation of ama and vata. It is a severe painful condition involving multiple joints of the body, hasta = hand and pada = foot – too have been mentioned in the description. Amavata is correlated with Rheumatoid Arthritis and it is one of the causes of Extensor Tendinitis.

Similarly, Sandhigata Vata is localization of aggravated vata in the joints of the body causing pain and swelling along with causing destruction of joints. Painful movements like Prasarana – extending and Akunchana – flexion or bending is one of the predominant features of Sandhigata Vata. This may be applicable as happening at the level of finger and toe movements due to inflammation of tendons as happens in Extensor Tendinitis.

7. Rakta Vriddhi and Pitta Vriddhi

Aggravated Rakta and Pitta, both can cause inflammation anywhere in the body, in any structure, including tendons. Rakta is ashraya – abode for Pitta, who is a resident. They mutually influence each other. Though Extensor Tendinitis is predominantly caused by aggravated vata, rakta and pitta can take stakes in the later part of the disease, as it progresses. They may get simultaneously aggravated also, along with Vata. They may also worsen the picture of the disease. Vatarakta is one of the conditions manifested due to aggravation of rakta.

8. Shotha

Shotha means swelling or inflammation. We can see swelling as well as inflammation in Extensor Tendinitis.

Are Marmas of hands and feet involved?

Since there are multiple structures in the hand and foot, they are Marmas for sure. When multiple structures like muscles, blood vessels, tendons and ligaments, bones and joints are involved in the disease, as it progresses, the marmas will be involved making the condition and symptoms more intense and the prognosis difficult. If only snayu or mamsa in that region is involved, it carries better prognosis. The marmas of these regions of hands and feet involved in extensor tendinitis include – kshipra, talahridaya, kurcha, kurchasira and manibandha (wrist) or gulpha (ankle). Injury to either of them or most of them would cause conditions like Extensor Tendinitis.

The Karmendriya angle

Hasta and Pada are the important Karmendriyas which are involved in Grahana – grasping, holding etc (hand) and Gamana – walking, locomotion etc (feet) and many other important day-to-day activities. Whenever they are affected by injury or any disease, these activities would be compromised, apart from causing pain, swelling and other symptoms. These indriyas are involved in the disease process.

From the perspective of causes

 

Causes of Extensor Tendinitis	Dosha involved
Prolonged standing	Vata, Rakta
Repetitive hand or foot movements / motions	Vata
Overuse of hands or feet in sports Sports injuries	Vata, Rakta
Excessive usage of keyboard, musical instruments like piano or guitar	Vata, Rakta
Prolonged walking	Vata
Injuries	Vata, Rakta

 

 

From the perspective of symptoms

Symptoms of Extensor Tendinitis	Doshas involved
Pain	Vata, Rakta
Stiffness	Vata, Rakta, Kapha, Ama
Swelling	Vata, Pitta, Kapha, Rakta, Ama
Redness and Warmth	Rakta, Pitta
Crepitus	Vata
Discoloration	Vata, Pitta, Rakta

 

Ayurveda Treatment Principles for management of Extensor Tendinitis

Nidana Parivarjana

Avoiding the causative factors, like in any other disease, is the golden principle for treating Extensor Tendinitis. All foods and activities which would increase vata should be kept away and so also those which aggravate rakta / pitta.

Vata Vyadhi Chikitsa

Since the manifestation of Extensor Tendinitis right from causative factors to symptoms resembles Vata Vyadhi its presentation, the treatment principles of Vata Vyadhi should be adopted skilfully in the management of Extensor Tendinitis which includes medicines, therapies, diet and lifestyle corrections.

Treatment of underlying diseases

If symptoms of extensor tendinitis are due to some other disease i.e. occurring as a symptom or complication of diseases mentioned above, it is important to treat the underlying main disease with suitable treatments. At the same time, external therapies shall be done to keep the symptoms under check. These conditions include –

–        Amavata

–        Sandhigata Vata

–        Vatarakta

–        Snayugata, Mamsagata, Kandaragata and Asthigata Vata

–        Shotha

Important External Therapies

 

Therapy Used	Medicines Used
Abhyanga	Ksheerabala Taila Pinda Taila Mahanarayana Taila Guluchyadi Taila Kottamchukkadi Taila
Dhara	Dhanyamla – in active inflammation Same oils as said above can be used Dashamula Siddha Ksheera – milk processed with Dashamula
Lepa (anointment, application of medicinal pastes) and Upanaha (poultice)	Dashamula Churna Kottamchukkadi Churna Grihadhumadi Churna Ellumnishadi Churna Dashanga Lepam

 

Important Panchakarma Therapies

Virechana and Vasti are the main therapies which are useful for treating Extensor Tendinitis. Small daily doses of Nimbamritadi Eranda Tailam or Avipattikara Churna will be beneficial to expel morbid doshas and also ease the symptoms in mild to moderate cases. Guggulutiktakam Ghrtam for Sneha Vasti and Dashamula Kshira Vasti as Asthapana Vasti are highly beneficial and disease modifying.

Important Formulations

–        Amrutottara Kashayam

–        Guluchyadi Kashayam

–        Guggulutiktakam Kashayam / Ghrtam

–        Punarnavadi Kashayam

–        Kokilaksham Kashayam

–        Maharasnadi Kashayam

–        Rasna Panchaka / Rasna Saptaka Kashayam

–        Kaishora Guggulu

–        Amritadi Guggulu

–        Panchatikta Ghrta Guggulu

–        Triphala Guggulu

–        Yogaraja / Mahayogaraja Guggulu

–        Simhanada Guggulu