Thusharalal Thesis

“A STUDY ON KATI-TRIKA SANDHI SHAAREERA W. S. R.
TO
THE EFFECT OF BHUJANGASANA IN KATI-GRAHA”
BY
DR. THUSHARALAL.S., B.A.M.S.
Dissertation submitted to the

Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka.
In partial fulfillment of the requirements for the degree of
AYURVEDA VACHASPATI
(DOCTOR OF MEDICINE IN AYURVEDA)
In
SHAREERA RACHANA
UNDER THE GUIDANCE OF

DR. U.GOVINDARAJU M.D. (AYU)., Ph.D
PROFESSOR & H.O.D.
DEPARTMENT OF P.G. STUDIES IN SHAREERA RACHANA
CO-GUIDE
DR.MOHAMMED RAFIK B.N.Y.S., MD, (ACU)
C.M.O
S.D.M.Y.N.C.H
PAREEKA, UDUPI.
DEPARTMENT OF P. G. STUDIES IN SHAREERA RACHANA

S.D.M. COLLEGE OF AYURVEDA, UDUPI
2010 – 2011
Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore
DECLARATION BY THE CANDIDATE
I hereby declare that this dissertation entitled “A STUDY ON KATI-TRIKA

SANDHI SHAAREERA W. S. R. TO THE EFFECT OF BHUJANGASANA IN
KATI-GRAHA” is a bona fide and genuine research work carried out by me under
the guidance of DR. U.GOVINDARAJU M.D.(AYU)., Ph.D, Professor & H.O.D,
Department Of P.G. Studies in Shareera Rachana
.
Date: Signature of the Candidate
Place: Udupi Dr. Thusharalal.S

CERTIFICATE BY THE CO-GUIDE
This is to certify that the dissertation entitled “A STUDY ON KATI-TRIKA SANDHI

SHAAREERA W. S. R. TO THE EFFECT OF BHUJANGASANA IN KATI-
GRAHA” is a bona fide research work done by Dr. Thusharalal.S in partial fulfillment
of the requirement for the degree of Doctor of Medicine in Ayurveda, under my co-
guidance and guidance of Dr.U.Govindaraju M.D.(AYU)., Ph. D .
Date:
Signature of the Co-Guide
Place: Udupi
DR.MOHAMMED RAFIK
B.N.Y.S., MD,(ACU)
C.M.O
S.D.M.Y.N.C.H,
PAREEKA,UDUPI
ENDORSEMENT BY THE HOD, PRINCIPAL/HEAD OF THE INSTITUTION
This is to certify that the dissertation “A STUDY ON KATI-TRIKA SANDHI

GRAHA” is a bona fide research work carried out by Dr. Thusharalal.S under the
guidance of Dr.U.Govindaraju, M.D.(AYU)., Ph.D. Professor & HOD, Department Of P.G.
Studies in Shareera Rachana, S.D.M.C.A, Udupi and co-guidance of Dr.Mohammed
Rafik, B.N.Y.S., MD,(ACU), C.M.O, S.D.M.Y.N.C.H, Pareeka, Udupi.
Signature of H.O.D Signature of Principal
Dr. U.Govindaraju, Dr. U. N. Prasad,

M.D. (Ayu.) M.D. (Ayu.)
Professor and Head, Principal,

Dept. P.G. Studies in Shareera Rachana, S. D. M. College of Ayurveda.
S. D. M. College of Ayurveda.
Date: Date:
Place: Udupi Place: Udupi

© COPYRIGHT
DECLARATION BY THE CANDIDATE
I hereby declare that the Rajiv Gandhi University of health Sciences, Karnataka shall
have the rights to preserve, use and disseminate this dissertation in print or electronic
format for academic / research purpose.
Date: Signature of the Candidate
Place: Udupi Dr. Thusharalal.S
© Rajiv Gandhi University of Health Sciences, Karnataka

CERTIFICATE BY THE GUIDE
This is to certify that the dissertation entitled “A STUDY ON KATI-TRIKA SANDHI

GRAHA” is a bona fide research work done by Dr. Thusharalal.S in partial fulfillment
of the requirement for the degree of Doctor of Medicine in Ayurveda, under my guidance
and co-guidance of DR.Mohammed Rafik, B.N.Y.S. MD (ACU) C.M.O S.D.M.Y.N.C.H,
PAREEKA,UDUPI
Date:
Signature of the Guide
Place: Udupi
DR.U.GOVINDARAJU
M.D.(AYU)., Ph. D .
PROFESSOR AND HEAD,

DEPT. P.G. STUDIES IN SHAREERA
RACHANA
S. D. M. COLLEGE OF AYURVEDA
UDUPI
DEDICATED TO
MY BELOVED
GRAND PARENTS
&
MY TEACHERS
Acknowledgement
ACKNOWLEDGEMENT
Words can’t put forward thoughts with its genuity, nor if expressed in words it
could fully impart my thoughts. But these words expressed here will reach those hearts
sincerely & honestly, as the purity of dew touching the grass.
I bow my head to God almighty, whose unbound love & nearness are everytime
felt like a breeze of wind for a withered explorer.
The grace of divinity so kind to place me the seedling as my parents Dr.Jyothilal

& Dr.Sreekumary ,whose unexplainable love & moulding have turned me into a
godfearing, trustworthy, & kind soul, & to be a kin to a wonderful & magnanimous sweet
heart my dearest brother Dr.Kishore lal.
Even in new earth ,with new springs , a plant could sprout & give fruits with the
tender love & care, I value every little things & every beautiful words which encouraged
me till this day from my ever loving & ever benevolent husband Mr.Bimal.P & from the
most beautiful blossom in my life whose sweetness and fragrance drives away my
hardships and sweats with his innocent smile ,my dearest son Mater Rishivardhan.B.
I thank my father in law Mr.Prabhakaran Sir & mother in law Mrs.P.Suseela ,My
aunt Miss.Shanthamma & my brave & confident brother in law Dr.Bipin.P. for their
enthusiastic & encouraging support throught out my study period & their everloving
concern & apt decisions which in everyway was right for me & for my good,,apart from
their hardships of ageing & ill health
First of all I would like to thank almighty for providing me an opportunity to
work for the benefit of mankind by this little effort.
I express my spellbound gratitude to my Guide, Dr. U. Govindaraju, Prof. &
H.O.D., Dept. of P.G Studies in Shareera Rachana, for sharing his knowledge and wealth
of his experience with me throughout the study.
I convey my sincere thanks with utmost respect to Dr. G. M. Kanthi, B.S.A.M, DHA,
Ph.D, Professor and Head, Dept. of Basic principles, S.D.M.C.A, Udupi for his timely
inquiry about the progress of the work and for his precious suggestions.
Department of Shareera Rachana, SDMCA, Udupi.

Acknowledgement
I would like to thank my Co-guide, Dr.Mohammed rafik,B.N.Y.S., M.D

(Acu),S.DM.Y.N.C.H ,Pareeka , Udupi, for his sensible suggestions during the study.
I sincerely thank Dr. Sridhar Holla, Prof., Dept. of Shareera Rachana, for his valuable
advice and for his kind co-operation extended towards me during this dissertation work.
I am ever grateful to Dr.Jayakrishna Naik, Prof., Dept. of Shalya Tantra who lent an
unwearied ear for my problems during the study and being attentive to my sometime
overenthusiastic ideas and channeling them in the proper direction.
I wish to offer my sincere thanks to Dr. Prasad U. N, Principal and Dr. Y. N. Shetty,
Medical Superintendent and Dr. B. V. Prasanna, Dean & H.O.D, Dept. of Roga Nidana
for providing all the facilities to make my study smooth and well done.
I also have to thank my lecturers Dr.Krishna Murthy,for his alltime enthusiastic
approach for the clarifications in doubts & to throw light on the darker side of my
ignorance in the subject. And also Dr. Nithin, whose high flow of energy & knowledge
have taken me along with the current & helped in making this work possible.I also thank
Dr. Rajendra pai, Dr. Pralhad, Dr.Praveen, for their timely guidance & encouragement
bound with knowledge & experiences.,
I thank Dr.Viveka Udupa B.N.Y.S.,M.D.(yoga & Rehabilitation) & Shree Ganesh
H.R. Msc (Yoga) Devine park,Saligrama, Udupi for their valuable suggestions &
guidelines.
I wholeheartedly thank Mr.Muraleedharan Nair,Senior statistician , Trivandrum
Medical college, Kerala,for his help in the statistical observations made in this study &
Dr.Gopinathan ,Radiologist Gopinathan scanning centre, Trivandrum for their help in
Radiological assessment & alos Devi scans, Trivandrum for providing me the work
related details.
I express my gratitude & love towards Dr.Mohan lal, M.S, Retd Principal & Former
Director Of Ayurvedic Medicine,Govt Ayurveda College, Trivandrum without whom the
work might have been worthless.And my sincere thanks to my ever encouraging &
sup;porting sisters Dr.Natasha.S.Lal & Dr.Deepa .S.Lal in providing me patients as well
as helping me in taking the Goniometric reading.
I sincerely remember in this occasion my seniors Dr. Amardeep. Dr. Harshavardhan,
Dr. Prathibha, Dr. Indu and Dr. Anju for their help , support & love.And my friends

Acknowledgement
Dr.Sibgath, Dr.Vipin, Dr.Vijaynath & Dr.Seetaram who were always the pillars for my
strength & success.And my juniors Dr.Jyothi, Dr.Parameswaran, Dr.Remitha, Dr.Vibha
& Dr.Sakthi whose timely support at times of hardships have really astonished me &
provided me the security of love which I can never forget.
I acknowledge with joy and pleasure Srijith, Parthipan ,Radhika ,Sumana, Jayanthi
,Rekha,, Padma, Shwetha and many dear friends who surround me with their
unconditional love, laughter and just plain fun.
I thank Mr.Prabhakar & Sudhakara & other staffs of the Dept of Shareera rachana
who were always kind & approachable & ready to render their services.
I express my sincere thanks & regards to the staffs of Samruddi Xerox for the
services rendered on time.
Finally, I thank all those who have directly or indirectly contributed to the success of
this thesis work.
Date:
Place: UDUPI DR. THUSHARALAL.S.

ABSTRACT
Kati-Trika gata asthi sandhis are Pratara, Alpa Chestavanta Sandhis. These types of
joints are responsible for slippery & gliding type of movements; structurally these joints
are cartilaginous, synovial variety of joints.
Katigraha is a Vatavyadhi which mainly affects the Kati-Trika Pradesha. In Kati-
Trika region, Kati-Trika prishthavamshagata asthi Sandhi and the structures which form
the sandhis are involved. Kati being the Sthana of vaata dosha & Vaata with its ashraya
ashrayee sambandha with the Asthi , when becomes prakopa gets lodged in above said
structures manifesting the symptoms like Ruk, Sthambha, Grahana in the Kati pradesha.
Bhujangasana Or Cobra posture is to be done on lying down prone position & is
beneficial in toning up the Spine & relieves low backpain.
As Back ache is a common problem in the middle age & Bhujangasana being an
effective therapy for relieving stress & strain induced back ache & as it is self
practiceable daily, economical without any medication, it is being selected for the study.
Objectives of the study were, complete literary review on Kati-Trika prushthavamsha
gata asthi Sandhi Shareera, and concept of katigraha with special reference to the applied
anatomy of these joints and correlation of the anatomical features described in Ayurveda
with the contemporary sciences.
Although references regarding therapeutic induction of Asana are available,detailed
description of Regional anatomical structures involved in particular to Bhujangasana in
Kati-Trika Sandhi is yet to be observed & analyzed.
The subject of this thesis is both Conceptual and Observational study. Data related to
Kati-Trika prishtha vamshagata Asthi Sandhi Shareera & Katigraha were collected from
various classics. Dissections of Lumbosacral region in 5 cadavers were conducted.
X-rays of 20 patients of Katigraha were collected and anatomical variations were
noted Before & After the Bhujangasana Intervention & analysed.Clinical sympomatology
were compared before –after intervention by gradings & analysed.
Key words: Kati-Trika Prishtha Vamsha Gata Asthisandhi, Gridhrasee, Sciatica, Pratara
variety of sandhi, Radiological Anatomy.
ABBREVATIONS
A: Avara
A.H: Astanga Hrudaya
Ag: Agriculture
AJ: Ahara Jarana Shakti
Al: Alcohol
An: Anupa
AS: Ahara Shakti
B: Both sides
Bl: Bilateral
Bu: Business
Bh.Git: Bhagavat gita
Bh.Git.Nja: Bhagavat gita Njanayoga
C: Christian
CL: Calcification of ligament
C.N.S: Central Nervous System
C.S: Charaka Samhita
C.V.S: Cardio Vascular System
D: Diet
De: Desha
DOA: Date of Admission
DOD: Date of Discharge
Du: Duration
ES: Economic Status
EDy: Encyclopaedic Dictionary Of Yoga
F: Female
H: Hindu
Ha: Habit
HW: House Wife
HYP: Hatah Yoga Pradeepika
HYPE: Hatah Yoga Pradeepika English Translation
JP: Joint space reduction
Kr: Krusha
Khe.Sa: Kheranda Samhita
L: Labour
LM: Lower Middle
Lt: Left Side
L O Y: Light On Yoga
M: Madyama
Mm: Mamsa
Md: Medha
m: month
Ma: Male
MI: Middle Class
Mu: Muslim
Mx: Mixed
N: Normal
Ni: Nidana Sthana
No. or no.: Number
Oc: Occupation
OPD: Out Patient Department
Os: Osteophytes
P: Pravara
P/A: Per Abdomen
PK: Pitta Kapha Prakruti
Pm: Pramana
Pr: Prakruti
Ps: Present
Po: Poor
R: Religion
Rc: Rich
R.S: Respiratory System
Rt: Right Side
Rk: Ruk
S: Sex
SC: Side of Neural compromise
Sa: Sara
Sb: Stambha
Sd: Side
Sh: Shareera Sthana
Sk: Smoking
Sm: Samhanana
SN: Schmorl’s node
Sn: Sadharana
Sr: Serial number
S.S: Sushruta Samhita
St: Sthula
Stu: Student
Su: Sutra Sthana
Sw: Satwa
Sy: Satmya
Sv: Service
Tb: Tobacco chewing
Tk: Twak Sara
Td: Toda
UM: Upper Middle
UW: Under Weight
V: Vegetarian
Vi: Vimana Sthana
VK: Vata Kapha Prakruti
VP: Vata Pitta Prakruti
VS: Vyayama Shakti
Wt: Weight
y or yr: years
Y.S.T: Yoga Self Start
Y.S: Yoga sutram
Lists
LIST OF CONTENTS
Sl. No. Contents Page No.
1 Introduction 01-03
2 Objectives 04
3 Review of literature 05-124

Historical Review 05-08
Ayurvedic Review 09-30
Modern Review 31-82
Yogic Review 83-124
4 Methodology 125-130
5 Observations & Analysis 131-161

Dissection Photos 131-133
Radiological Findings 134-135
Analysis & Interpretations 136-161
6 Discussion 162-175
7 Conclusion 176
8 Summary 177-178
9 Reference Shlokas 179-187
10 Bibliography 188-205
11 Annexure 206-212
12 Master chart 213

Lists
LIST OF TABLES
Table Description Page

No. No.
1 Number of Asthi in Prushthavamsha 15
2 Divisions of the body 16
3 Marmas related with Kati-trika Pradesha 16
4 Samanya Nidana of Vatavyadhi 20
5 Marmas of Kati-Trika Prushtha and sakthi related 20

with Katigraha
6 General symptoms present in the Katitrika 22

Prushtaashrita vaata
7 Deep Muscles of the Back & its Actions 52
8 Lumbar plexus, Branches & Distribution 68
9 Sacral plexus branches and its distribution 70
10 Main features of Low back pain from various sources 74
11 Objective signs met with following herniation of the 75

various lumbar discs
12 Causes of Back pain in relation to Age 76
13 Movements possible at Synovial joints 111
14 Movements possible at Ball & Socket joints 111
15 2 types of Articular surfaces 115
16 Joint positions of Principal joints 120
17 Method of Intervention 129
18 Distribution of patients according to Age 137
19 Distribution of patients according to Gender 138
20 Distribution of patients according to Religion 139

Lists
21 Distribution of patients according to Educational 140

qualification
22 Distribution of patients according to Marital status 141
23 Distribution of patients according to Social status 142
24 Distribution of patients according to Occupation 143
25 Distribution of patients according to Habits 144
26 Distribution of patients according to History of 145

Trauma
27 Distribution of patients according to Nature of work 146
28 Distribution of patients according to Nature of 147

Vishrama
29 Distribution of patients according to Vyayama 148
30 Distribution of patients according to Nidra 149
31 Distribution of patients according to Vegadharana 150
32 Distribution of patients according to Prakruti 151
33 Distribution of patients according to Samhanana 152
34 Distribution of patients according to Ahara shakti 153
35 Distribution of Ruk Pre & Post Therapy 154
36 Distribution of Sthambha Pre intervention 155
37 Distribution of Sthambha Post intervention 156
38 Distribution of Grahana Pre intervention 157
39 Distribution of Grahana Post intervention 158
40 Radiological assessment from X-ray of Lumbosacral 159

region (Lat view) Pre & Post intervention
41 SLRT changes of Pre & Post intervention patients 160
42 Goniometer reading Pre & Post intervention 161
43 Pathological changes in joints 165

Lists
LIST OF CHARTS
Chart No. Description Page No.
1 Schematic representation of Samprapti 25
2 Tarunasthigata Vikruti 26
3 Sleshmadhara Kala & Sleshaka kapha Vikruti 27
4 Ashti Vikruti 28
5 Classification of Lumbar Vertebrae & Parts 36
6 Parts of the Sacrum 48
7 Deep muscles of the back 52
8 A Skeleton of Yoga 91
LIST OF FIGURES
Figure Description Page

No. No.
1 Lumbar curvature and Lumbar vertebrae 32
2 Compact Bone,Spongy Bone &Plates of Hyaline cartilage 43
3 Intervertebral discs between adjacent vertebra 43
4 Derangment of Discs 43
5 Typical lumbar vertebra 39
6 5th Lumbar Vertebra 40
7 Lumbosacral Triangle Of Marcille 44
8 Superficial Relations of Lumbosacral Triangle 44
9 Pelvic Cavity 45

Lists
10 Sacrum 47
11 Articulation Of Pelvis 53
12 Lumbar Plexus 68
13 Sacral Plexus & Sciatic Nerve 69
14 Sacral Plexus & Its Branches 69
15 Lowerlimb Dermatomal Pattern 79
16 Curvatures due to Imbalance 77
17 Sacralization & Lumbarization 78
18 Spondylolysis & Spondylolisthesis 78
19 Strength, Stamina & Stabilizing Excercises in Physiotherapy 80
20 Methodology Of Bhujangasana 109
21 Examination of Profile of a longtitudinal section through an 123

ovoid surface
22 Ovoid of motion of articular surface & change in mechanical 124

Axis
23 Lumbosacral angle & Goniometer 127
24 Normal Lumbosacral vertebra (X-ray) 128
25 Psoas Minor Muscle (Dissection photos) 131
26 Iliohypogastric Nerve (Dissection photos) 131
27 Ilio inguinal Nerve (Dissection photos) 132
28 Psoas Major Muscle (Dissection photos) 132
29 Sympathetic trunk (Dissection photos) 133
30 Lumbosacral trunk (Dissection photos) 133

Lists
LIST OF X-Rays
Sl. No. Contents Page No.
01 X-ray 1 Pre & Post 134

Intervention changes

O3 X-ray 3 Pre & Post 135


LIST OF GRAPHS
Graph No. Description Page No.
1 Incidence of Age 137
2 Incidence of Sex 138
3 Incidence of Religion 139
4 Incidence of Educational status 140
5 Incidence of Marital status 141
6 Incidence of Socio-economic status 142
7 Incidence of Occupation 143
8 Incidence of Habits 144

Lists
9 Incidence of Trauma 145
10 Distribution based on Nature of work 146
11 Distribution based on Vishrama 147
12 Distribution based on Vyayama 148
13 Distribution based on Nidra 149
14 Distribution based on Vegadharana 150
15 Distribution based on Prakruti 151
16 Incidence of Samhanana 152
17 Incidence of Aahaara jarana shakthi 153
18 Distribution based on Gradings of pain Post intervention 154
19 Distribution based on Gradings of Sthambha Pre intervention 155
20 Distribution based on Gradings of Sthambha Post intervention 156
21 Distribution based on Grahana Pre intervention 157
22 Distribution based on Grahana Post intervention 158
23 SLRT changes Post intervention 160

Introduction 1
INTRODUCTION
An axial endoskeleton , first as a notochord & then a vertebral column, provides

the basic distinguishing feature of the phylum, “the vertebrata” ,to which of course,
mankind belong. In the modification & elaboration to various forms of locomotion ,the
vertebral column was exposed to new patterns of force in the distribution of weight &
muscular tensions. The intervening arrangements of the skeleton, muscles & other
appendage structures permits some degree of angulation,torsion or displacement.forming
junctional regions of greater pliancy between their individual components.
The lumbosacral joint resembles the joint between any two typical vertebrae, but
is united by a very large intervertebral disc which is thicker ventrally. The Rt & Lt facet
joints of the lumbosacral articular processes are separated by a wider interval than those
of the vertebrae above. These shows its Anatomical significance & Functional
importance. The unhealthy lifestyle of modern world gives rise to many diseases. Wrong
postrue,Improper food habits, Regular driving, bike riding,& Sitting before computer for
a long time (as IT professional do), results in lower back pain & other spinal problems.
The LBA is dealt with a multidisciplinary approach in the present era, with the
combination of treatments,massage,acupuncture & strengthening exercises. There are
things that can be done to limit its impact towards a crippled state. The first & foremost
step adopted is to get into a position of least pain. Many exercises are advised in different
practices of medicine for strengthening the spine & back.
Hippocrates-the father of modern medicine have implemented Inversion therapy
(as a part of spinal traction). Not only can Inversion therapy treat back pain but also it can
be used to reverse the negative effects of ageing on the spine. In the field of Ayurvedic
medicine too-the importance of postures(Sthira sukham asana) have been highlighted &
Acharyas have advised not to do certain postures or seatings or viharas .In the
Dinacharya adhyaaya there is explanation regarding the importance of daily practice of
Vyayama,where Acharyas have specified that vyayama should not be
exertional(ayasajanana) & should be according to the bala. Yogic exercises give more
importance to the posture achieved & maintained with the least stressful
movement.Asanas aims at the ideal combination of immovability & relaxation. Yogic
Department of Shareera Rachana, SDMCA, Udupi

Introduction 2
Asanas are not exhausting or tiresome ,it doesn't include vigorous & jerky movements &
also its effect is said to be long lasting & more extending.
Kati-Trika Prishthavamsha Gata Asthis are small and movable vertebrae which
forms the skeleton of abdomen. It helps in transferring the weight of the upper body to
the ground, protection of spinal cord and provides movement of the back. Acharya
Sushrutha has mentioned 24 sandhis in prishtha region, which belong to “Pratara” variety
among the 8 types of sandhis. The number of vertebrae present in prishtha region is 30
(Sushrutha) and 45 (Charaka) and is classified under Valayasthi.
According to modern Anatomy 5 short irregular type of bones are present in
lumbosacral spine. Joints mainly belong to cartilaginous & Synovial joint. The formation
of secondary spinal curves helps transmission of weight to the lower extremities in the
erect posture. Vertebrae, being one of the axial bones help to maintain the erect posture
of the body. Primary curves or accommodation curves-accommodate internal organs. The
formation of secondary spinal curves helps transmission of weight to the lower
extremities in the erect posture. . Any malady affecting these structures could bring
suffering to one’s life.
KATI-GRAHA-is a condition caused by the Kati ashrita vayu,which causes Pida
or Graha i.e., catching or grasping pain in & around the back region.
BHUJANGASANA-or Cobra posture or Vipareeta karni (inverted posture) is to
be done in lying down prone position & is beneficial in toning up the spine & relieves
back ache.
As back ache is a common problem in this current age & Bhujangasana being an
effective therapy for relieving stress & strain induced back ache (as an occupational
hazard as well) & as it is self practiceable daily,economical,without any medication, it is
selected for the present study.
Although the references of gross anatomical features about prishthavamshagata
asthi in Kati-Trika region are available, the description of regional anatomy and applied
anatomical features in understanding signs and symptoms of Kati-graha are lacking in
ancient texts and are scattered.

Introduction 3
Although references regarding Therapeutic induction of Asana are available,

detailed description of regional anatomical structures involved in particular to
Bhujangasana in Kati-Trika Sandhi is yet to be observed & analyzed.
In this study an attempt has been made to compile literature regarding Kati-Trika
and prishthavamshagata asthi sandhi shareera and kati-graha from a wide range of
Ayurvedic classics. And to compare the pathological changes in katitrika asthisandhi
before & after the intervention of Bhujangasana. This study also contains Radiological
anatomy observations of 20 cases of kati-graha before & afer the intervention of
Bhujangasana.

Objectives 4
OBJECTIVE
The present work is being taken up with an idea of updating early concept of Kati-
Trika sandhi Shareera in view of Modern anatomy. The main objective of this study is
aimed at
To make the comprehensive study and conceptual study on kati-trika sandhi

shaareera as mentioned in the classics, in view of regional and applied anatomy
described in the contemporary science.
To study anatomical features in abnormal conditions which may cause kati-graha

and various structural changes in Kati-Trika sandhi pradesha, thereby in this
disease.
To analyse the effect of Bhujangasana in Kati-trika sandhi shareera in relieving

katigraha in selected 20 patients.
PREVIOUS WORK DONE
• DR.VITALOKAR PRANOTI-”PRISHTAVAMSHAGATA KATIKASHERUKA

CA RACHANATMAKA ADHYAYAN VA SAMBANDHIT KATIGRAHA,EK
VIVECHANATMAK ADHYAYANA”-2004,Govt Ayurvedic college,Nagpur
University,Nagpur.
• DR.KUMAR PRAVEEN-”COMPREHENSIVE STUDY ON KATI-TRIKA

SANDHI SHAREERA W.S.R. TO STRUCTURAL CHANGES IN
GRIDHRASI(SCIATICA)”-2008,S.D.M.College of Ayurveda,Udupi.

Review of Literature 5
HISTORICAL REVIEW
In Ayurvedic classics we find Vata Sthana & Vata vyadhis,which refers to the vyadhis
caused exclusively by the vitiation of Vata dosha.Here a small effort has been made to trace out
history of Vatavyadhi from the Vedic period.For the sake of convenience we can divide it into 4
sections,viz.
¾ Vedic period
¾ Pauranika period
¾ Samhita period
¾ Sangraha period
VEDIC PERIOD: (2500 BC TO 500 BC)

¾ The vedas are considered as the oldest recorded knowledge in our culture.Kati-Shula is
mentioned in the Atharva veda.,while mentioning the indication of Pippali –Guda
prayoga in Kati-Vata.And also the word “Vati krita” which denotes Vata vyadhi is
availabale.Anukyam has been used to indicate the dorso lumbar spine.Even Yakshma of
Shroni,Prushtha,Uru,Majja have been mentioned.
¾ In Atharva veda practise of jangida manidharana (of arjuna vruksha)is advised in
Prushtyamaya (back pain).In Rigveda also the term “Prustyamaya “ is mentioned during
the indication of Pushkara moola.
PAURANIKA PERIOD :
¾ In Garuda purana,Ayurveda related subjects are described in details.In this treatise a
separate chapter is available as Vatavyadhi Nidana.
¾ Anukyam has been used to denote the vertebral column.
¾ Kathopanishad had used the term Sushumna to denote Spinal cord.
¾ Prashnopanishad has mentioned that Sushumna is one among the 101 Naadis.

SAMHITA PERIOD
CHARAKA SAMHITA
In the 28th chapter of Chikitsa sthana symptomatology of Prushta graha is explained.
SUSHRUTA SAMHITA
In the 1st chapter of Nidana sthana explanation regarding the effect of Kati ashrita vayu is
available.
ASHTANGA SANGRAHA
In Su.20th chapter mentioned Kati as Vatasthana,Shroni as Apana vata karmakshetra,Shroni
bheda & trika graha as vataja vikara.In Ni.15th chapter Trika Prishtha Kati graha as Lakshanas
of Pakwashaya gata Vata. Kati ashrita vayu stretches the Kandaras.
ASHTANGA HRIDAYA
In Ni.15th chapter Trika prishtha kati graha is mentioned as the Vrudha vaata karma.
VANGASENA
In vata vyadhi adhikara mentioned parshwa prushtha kati graha as the premonitory symptom of
vata vyadhi.In Guda gata vata lakshana mentioned trika shula & shopha.In basti karma adhikara
advised vaitarana basti for Ghora shoola & shotha in Kati uru prushtha caused by vata.
SHARANGADHARA SAMHITA
In 7th chapter poorva khanda-In Vataja roga varnana mentioned kati graha ,In Madhyama
khanda mentioned Kati graha as one among the 80 vata vyadhis.
RASARATNA SAMUCHCHAYA
Mentioned in Sandhi roga samanya upaya,the Nirgundi prayoga in sandhi vata & kati vata.
YOGA TARANGINI
In vata roga chikitsa mentioned application of vatahara lepa in kati ruja caused by saama vata.

SANGRAHA KALA
CHAKRADATTA
Mentioned vaksha trikadi gata vata chikitsa in vata vyadhi.
GADA NIGRAHA
In vataroga adhikara mentioned Kati ashrita aama vayu causing kati graha
YOGA RATNAKARA
In Vata vyadhi nidana mentioned Kati shula & the use of eranda taila in its treatment.While
explaining Guda sthita vata lakshanas mentioned Trika prushtha shopha.In pakwashaya gata vata
lakshanas mentioned Trika vedana.
BHAISHAJYA RATNAVALI
In vataroga adhikara mentioned Vaksha trikadi gata vata chikitsa.
MODERN ERA
¾ Back ache is known since the beginning of history.
¾ Primitive culture called it a work of a demon.
¾ From the time period of Hippocrates Spinal tractions been done for spinal disorders.(400
BC)
¾ Galen (131 A.D-202 A.D) practiced traction to treat back ache.
¾ Virchow Kocher & others described acute traumatic ruptures of the disc that resulted in
death.
¾ Goldthwait(1911) first attributed back pain to posterior displacement of disc.
¾ Dandy (1929) first reported removal of a disc tumor from patients suffering from sciatica.
¾ Barr (1932) finally attributed the source of sciatica to the herniated lumbar disc.
¾ Barr (1934) suggested surgical treatment for disc excision.
¾ Layman Smith (1963) suggested enzymatic dissolution of disc.
¾ Kirkaldy-Willis opine ageing as the primary theory in disc disease.
¾ Nuchenson(1964),White & Punjabi(1982) described biomechanics of spine.

¾ Scnack(1983) described clinical anatomy.

¾ Inversion therapy: Inversion therapy involves hanging upside down to apply gentle
traction to the spine.Inversion was invented as early as 400 BC when Hippocrates (The
father Of medicine) first watched a patient hoisted upside down on a ladder for a dose of
‘Spinal Traction’.Not only can Inversion therapy help to treat backpain but it can be used to
reverse the negative effects of ageing on the spine.(www.sports injury clinic .net)

AYURVEDIC REVIEW
KATI-TRIKA SANDHI SHAREERA.
KATI
Acharya Charaka divided Shareera in to six Anga– Shadanga shaareera ie; 4 Shakha, 1
Madyashareera, 1 Shirogreeva. Kati is a cylindrical region present in the Antharadhi or
Madhyashareera.
NIRUKTI :
Acc to Shabda kalpa druma - Kati is the waist region where the dress is worn1.
Acc to Amarakosha -Shroniphalaka themselves are called as Kati2.
Acc to Vaidyaka Shabda Sindhu - Shroni is called as Kati3.
Acc to Monier Monier Williams - Kati is the hip or buttocks.
PARYAYA :
In Raja Nighantu4 -Kati, Kukudmati, Shroni, Nitamba, Kateerakam, Aaroha,
Shroniphalakam, Kalatram, Rasanaapadam etc.
In Vaidyaka Shabda Sindhu5,6 - Shroniphalaka, Shroni, kukudmati & kata.
Among all the synonyms, Shroni7,8 has been extensively used by various Acharyas &
commentators.
LOCATION :
In Samhitas, Shroni or Kati is mentioned as a region9 rather than an organ. While numbering
the Siraas, Acharya Vagbhata has explained 32 Siras10 ,among the 136 Siras present in the
Antaradhi11 , are located in Shroni. Thus to infer that Shroni is a region in the Antharadhi.
LIMITATIONS:
Definite demarcation of the Kati region is not given in Samhitas, but limitations could be
inferred with the help of the surrounding structures.
Upper limitation – could be taken as Nabhi12, 13. Lower limitation-could be taken as the Medhra
& Mushka14.

PRAMANA :
Acharya Charaka says pramana includes Utsedha(height), Vistara(diameter, expansion),
Ayaama (length), & Parinaaha (circumference) etc.
Acc to Charaka , Kati is 16 angula in diameter15. Chakrapani comments on this quoting that
the height of Kati is not mentioned since another Sandhi is present between the heights of
Uru(thigh) & Antharadhi (thorax & abdomen).
Acharya Sushruta says Pramana of Kati in males is 18 angulas in vistara which is equal to the
vistara of Urah pradesha of females. Dalhana quotes here the opinions of other authorities that
24 angula is the vistaara of Urah in males which is equal to the pramana of Shroni in
females16.
Acharya Vagbhata mentioned the Vistara( diameter) & Parinaaha (circumference) for Kati,
Vistara as 16 angulas & parinaaha as 50 angulas17.
Deerghayu lakshanas of kati18- Acharya Charaka mentions that, the ideal Kati should be
1/3rd of the Urah(chest) pradesha. It should be equally proportionate, well built & well covered
by Maamsa.
Applied Anatomy Of Kati :

All Acharyas mentioned Kati as Vata Dosha Sthana19, 20 .
Acharya Sushruta mentioned kati as the Moolasthana for Medovaha srotas21 .
Kati has been mentioned as the region which is affected in many disorders like
• Katigraha in Kshataksheena & Vataja pradara etc2 2 .
• Kati shula in Vatodara, Vataja arsha, Vataja shula etc 23 .
•
Kati daurbalya in Darvikara vishavega24.
• Katibhanga in 7th vishavega25 .
• In disorders like Gridhrasee26 & Grahani etc27 .
Other contexts where importance of Kati has been mentioned are,

• Pain over Kati prishtha region during Asanna prasava lakshana 28 .
• Kati abhyanga in Yoni vyapat.

• Administration of Sneha basti to provide Sthirata to Kati region.

• Abhyanga over Kati paarshva in Leenagarbha etc29 .
TRIKA
NIRUKTI:
Acc to Shabda kalpa druma - Trika is considered as the region where 3 structures or parts meet
or come in unison30 .
Acc to Amarakosha - Trika forms the Adhaara or base for Prushtavamsha31 .
Acc to Vaidyaka shabda sindhu - Is the back part or extreme part of the Kati.
Acc to Monier Monier Williams - Trika is the loin region.
STHANA:
Trika is the region present in the Madhya shareera.
In Vaidyaka shabda sindhu it is mentioned as ‘the posterior part of the Kati’.
Trika is considered as the Shroni kanda Bhaaga32ie; stem part of Hip bone.
Acharya sushruta while mentioning 5 asthis present in the Kati pradesha, says one asthi is
present in the Trika pradesha.
Chakrapani opines that Trika extends from Gudasthi till Shroniphalaka33 .
PRAMANA:
Acharya Charaka tells that Trika is 12 Angulas in height , on which Chakrapani comments
that it extends from Gudaasthi till Shroniphalaka.
Acharya Vagbhata opines Trika is 12 Angula in Utsedha (height).
Applied Anatomy Of Trika :

Trika is the Sthaana for Vaata dosha. In many disorders, Trika is affected leading to many
disabilities.
• Trika graha-Nanaatmaja vikaraas, Sahaja arsha & Madaatyaya.
• Trika shula-Apatarpana vikaaras, Vaataja arsha etc.
• Trika vedana-Vaatavyadhi & Jwara etc.


PRUSHTA VAMSHA:
NIRUKTI:
The term Prushtha vamsha is made up of 2 words, ‘prushtha & vamsha”.
Prushtha means ‘ standing forth prominently’ or the back which is prominent part of an
animal.
Vamsha refers to Bamboo cane or Reed pipe.
So in total, prishtha vamsha refers to the back bones of the body.
PARYAYA :
Prushtha vamsha, Prushthaasthi, Kaseru34 .
SANKHYA :
Different opinions by different Acharyas regarding the number of Prushtaasthis.
Acharya Charaka & Acharya kashyapa counts that there are 45 Prushtaasthis34, 35,36 .
Acharya Sushruta & Acharya Vagbhata counts that there are 30 Prushthaasthis37, 38.
In Shiva samhita , 2nd chapter ,the term Merudanda has been used for prishthavamsha.
STRUCTURES PRESENT IN KATI-TRIKA PRADESHA :

Kati & Trika are regions present within the Antharadhi.
1. Asthi :
Mainly 5 Asthis 39 present in this region 1 Gudasthi, 1 Bhagaasthi, 2 Nitambasthis, 1
Trikasthi. Trikasthi forms the base of the prushtavamsha .It is present in between
Gudasthi & prushtha vamsha between 2 Kati kapaalas.
Acharya Charaka mentions that 2 Shroniphalakas & a Bhagasthi is present in
Shroni pradesha40 .
2. Sandhi :
Acharya Sushruta tells that among the 2 types of Sandhis mentioned,i.e. Cheshtaavanta
& Sthira, Sandhi present in Kati pradesha belong to Cheshtaavanta Sandhi41 .
Among the 8 variety of sandhis mentioned ,3 varieties of Sandhis are present in this
region.

In Kati kapala 42, 43 3 sandhis of Tunnasevani44 variety are present

Trikaasthi forms 2 varieties of sandhis with different asthis present in its vicinity.
• Pratara variety of sandhi with Prushtha vamsha45.
• Samudga variety of sandhi with 2 Nitambasthis46.
• Saamudga variety of sandhi with Gudaasthi46.
3. Samghaata :
Samghataas are the complex joints of asthis present in the body. One among the 14
Asthi Samghataas in the Shareera, is present in Trika pradesha47.Here there is a
communion of Trikaasthi along with Gudaasthi & 2 Kati kapaalas.
4. Sira :
Among the 700 Siras mentioned, 32 Siras are told to be present in Shroni48.
They are Vatavaha, Pittavaha, Kaphavaha & Raktavaha siraas each 8 in number49.
5. Dhamani :
Acharya Sushruta says, among 24 Dhamanis, 10 adhoga dhamanis supply
Pakwashaya, Kati50 , Mutra, Pureesha etc.
6. Snaayu :
Snaayus are structures resembling the shape of a hemp51.
Among 900 snayus in the body, 230 snayus are said to be present in the Madhya
shareera, among which 60 are present in Kati52 .
7. Kandara :
Kandaraas are considered as strong or great Snaayus53 . 16 Kandaras are present in
the body which helps in performing actions like extension & flexion54 . Among them 4
kandaras present in the Prushtha which tightly binds the Shroni with Prushtha & the
Nitamba55 & other parts of the lower regions56 .
Kaviraj Haranachandra says that these kandaras connects Shroni, prushtha &
Trikasthi57 .
8. Marma :
The marmas which are in relation with the Shroni and Trika pradesha are,
Katikataruna, Kukundara, & Nitamba58, 59.

9. Pratyangas related to this region :

Pratyangas present in Kati are, Jaghana60 , Guda61 , Medhra62 , Bhaga62 , Basti63 .
KATI-TRIKA GATA ASTHI SANDHI SHAAREERA

Kati-trika Sandhi region refers to the junction of low back region along with the region of
Ileum part of Hipbone & sacral region.
The term “sandhi” derived from the root Sam + Dha + Ki, which means Sandhanamiti,i.e .
junction, connection or holding, combination, union with, binding64 etc.
Sandhi lakshana :65,66

Sandhis are the junctions of bones and are the seats of Shleshaka kapha. They help in
binding the body parts together.
Sandhi sankhya :
Acharya Susrutha has explained 3 Sandhis in Kati kapala.
Sandhi prakaara :
Cheshtaavanta & Pratara types of Sandhis are present in the Kati Pradesha. Except the joints
present in the extremities, jaw & kati region, every other joints in the body are Sthira Sandhis.
Pratara , Tunnasevani & Samudga types of Sandhis are present in the Trika region. i.e Pratara
variety with kati Prushtha vamshasthi, Tunnasevani variety of Sandhi with Kati kapala and
Samudga variety with Gudasthi.
Asthi Sandhi rachana :

Sandhis are junctions of bones and are the seats of Shleshaka Kapha. The joints formed by
Peshis, Snaayus and Siraas are innumerable, hence Asthi-Sandhis are being considered”67.
A Sandhi is not mere the junction between Asthis. But it requires other structures which
connects these Asthis which help in providing the stability to the joint and helps in maintaining,
facilitating the movement and for weight bearing68 .”

STRUCTURES THAT CONSTITUTE A SANDHI ARE GIVEN BELOW:

• Asthi
• Snayu
• Shleshma
• Shleshmadharaa kalaa
• Sira
• Dhamani
• Maamsarajju
• Peshi
• Kandaraa
• Asthi forms the prominent part of any Sandhi. In Kati-Trika region 5 Asthis are mentioned
to be present in Shroni pradesha, & 3 Sandhis present in the Kati kapala, 24 Prushtvamsha
asthi sandhis are present & Trika is mentioned to have Asthi Samghata. Definite number of
Asthi sandhi in this region not told.
Sl. No Acharya Number of Bones in prishthavamsha
1. Sushruta 30
2. Charaka 45
3. Kashyapa 45
4. Vagbhata 30
Table No: 01: Number of Asthi
Five Asthis are present in Kati Pradesha including One Trika Asthi. Tarunasthis are
also present in between these Asthis.
69
Asthi is the fifth dhatu of the body .The main function attributed to this dhatu is the
Dharana karma. Kati-Trika prishtha vamshagata asthis help in transmitting the weight from the
upper part of the body to the lower limbs and then maintaining the erect posture of the body.
Asthi is the ashraya for vata dosha,but Asthi kshaya can lead to Vata vruddhi & vice
versa.
Kati is also mentioned as the seat for Vata dosha. Apana vata is mainly present in the
Kati pradesha.70


KATI-GRAHA RELATED RACHANA SHAREERA

All the Acharyas have divided Shareera into Angas & Pratyangas. Acharya Charaka ,
Sushruta have divided Shareera into 6 parts as -4 Shakhas( 2 Bahu, 2 Sakthi), One Madhyama
shareera & One Shirogreeva which are together called as Pratyangas.
• The structures related with Kati-Graha are the structures present in the Kati region
KATI-is the low back region along with the pelvis & sacral region.
Charaka Sushruta Bhavamisra

2 Bhahu 2 Bhahu 1Shiro
2 Paada 2 Paada 1 Greeva
1 Shiro & Greeva 1 Shiro & Greeva 2 Bhahu
1Madya Shareera 1Madya Shareera 2 Paada
1 Vaksha
1 Udara
2 Parshwa
1 Prushtavamsha.
Table No: 02: Divisions of Body
Sl.No MARMA STHANA VIDDHA LAKSHANA
1 Kukundara Both side of vertebral Sensory and Motor loss of the

column, Lateral part of lower part of the body.
gluteal region.
2. Nitamba Above the Shroni Emaciation and general
kanda. weakness of the lower part of
the body and death.
3. Katikataruna Both side of vertebral Haemorrhage,Anaemia
column,Above Shroni Debility & death
Karna.
Table No : 03 Marmas related with Kati-Trika Pradesha

KATI-GRAHA DISEASE REVIEW
KATI-GRAHA
The term Kati-graha derived from two words kati & graha.
NIRUKTI OF KATI-GRAHA :
The word Kati-graha derived from the root word kat + in, meaning “shareera avayava
vishesha”.
In Amarakosha the word meaning of Kati is “katau vastraavaranau”, meaning it is the part of
the body which is covered with cloth, according to the dress code of old Indians. The word
meaning of graham is “upadhaane”, meaning the one which gives support ie;holding.
PARIBHAASHA OF KATI-GRAHA :
The important symptom of Kati-graha is pain, so here the most suitable meaning for
“graha”71 is the grasping kind of pain. So Kati-graha means grasping pain at Low back
region.
In Ayurvedic classics Kati-graha is mentioned in various conditions. It primarily affects the
Sandhis present in the Kati pradesha & its associated structures. Susrutacharya classified
Kati under “Tunnasevani sandhi”, which is movable in nature72.
Different Terminologies similar to KATI-GRAHA :

In Ayurvedic classics there are some descriptions about the same symptomatology developed in
Kati-Trika Prushatavamsha Pradesha in different pathological conditions.. They are Kati-graha,
Kati-shula, Trika shula,Trika graham, Prushta graha.
KATI-GRAHA AS A SYMPTOM :
In Vataja jwara73 , Vidradhi in Vrukka74 & Pakwashayagata Vata Kopa lakshana 75 etc we
get the term Kati-graha as the symptom.

KATI-SHULA:
It is mentioned as a symptom in Sannipata Grahani76 , as Vata shonita lakshana77 , Atoya
udara lakshana78 , Vatodara lakshana79 , and as Bhagandara poorvaroopa80
TRIKA GRAHA :
Trika means “trayaanaam sandhayaha”, ie; union of three bones/three avayavas in any part of
the body. Pectoral girdle, Pelvic girdle & sternoclavicular joint comes under Trika.Here
Sacroiliac region may be taken as Trika.
Trika graham is seen as a symptom in Triteeyaka jwara81 , as a common symptom in
Madaatyaya roga82 & as Pakwashaya gata vata kopa lakshana83 .
TRIKA-SHULA :
Trika shula refers to the pain produced in the joint of Sphik Asthi & Prishtavamsha asthi by
the vitiation of Vata. Trika shula is a symptom in Pakwashaya sthita vata kopa lakshana84 ,
Amavata85 , Gudasthita vata86 .
PRUSHTA-GRAHA :
Prushtavamsha denotes vertebral column, it holds back causing pain in this region & is called
as Prushta graha. The terms Kati, Prushta & Trika is included in Low back region.
Depending upon the region where pain is felt, it is termed as such.
If we corelated theses structures to the modern anatomical description,the structures Trika can
be corelated to be the structures present between Sphik & Prushta ie; the lumbosacral region.
Gridhrasi also bear some importance in this regard. Gridhrasi starts from Sphik & gradually
comes down to waist, back, thigh, knee, shank & foot & affects these parts with stiffness,
distress & piercing pain & also frequent quivering87 . These symptoms are of Vata but when
the disorder is caused by vata & kapha it is associated with drowsiness, heaviness &
anorexia.

KATIGRAHA AS A DISEASE:
It is mentioned in Bhavaprakasha88 & Gada nigraha89 as one of the Vata vyadhis.
According to Bhava prakasha, kati graham is the pain produced in the joint of Sphik asth i &
Prushtavamsha asthi by the vitiation of Vata.
Kati-graha is described as an independent disease in Gada nigraha. According to Gada nigraha,
when shudha Aama vayu gets vitiated in Kati pradesha it causes pain in that region.
PRATYATMA LAKSHANAS OF KATIGRAHA:

It is mentioned as one of the Vata vyadhis with Ruk & Grahana in the Kati & Sphik Pradesha as
the cardinal features.
5 FOLD ASSESSMENT OF KATIGRAHA :

Inorder to diagnose & understand a particular disease, 5 fold approaches explained in Ayurveda
called as Nidana Panchaka. ie;Nidana, Poorvaroopa, Roopa, Upashaya, Samprapti90 .
Complete assessment of disease is possible by analysing these modalities.
NIDANA91
Kati is one of the Vata sthana & the main symptom of Katigraha is pain,which is the
lakshana of vitiated Vata. So Nidana of Vata vyadhi92 can be taken as Nidana of Katigraha
also.
These nidanas can be classified under the following sub headings,

Samanya and Vishishta nidanas are enumerated in the below tables,

Aharaja ( Dietetic factors) Viharaja ( Behavioral factors ) Anya hetuja ( Miscellaneous
factors )
Kashaya,katu,tikta Vegadharana Abhighataja

Alpa ashana Vegodeerana Kaalaja
Rooksha Swapna Viparyaya
Pramita bhojana Excessive speaking,Physical
exertion,Prolonged
standing,Motor bike riding
Table No: 04 Samanya Nidanas of Vatavyadhi
Name Type of Marma Location Marma Viddha

Lakshana
Kukundara Sandhi Marma It is located on both Sparshaagnana
Vaikalyakara sides of Chestanasha.
Marma Pristavamsha
Nitamba Asthi Marma It is located upon Adhakayas’osha
Kalantara the S’roni on both Daurbalya
Pranahara the sides Marana.
Table No: 05. The marmas of Kati prushtha and sakthi related to Katigraha vyadhi
Rachanaanusara Nidana :
According to rachana we can classify the nidana into,
• Sandhivikruti janya
• Kalavikruti janya
• Asthi vikruti janya
• Tarunasthi vikruti janya
• Snayu, kandara, sira, dhamani,, peshi, maamsarajju vikruti janya
• Marmabhigata
• Dhatukshaya and Margavarana
• Margavarodha


POORVAROOPA93 :
Charakacharya states that the Poorva roopa of Vata vyadhi is Avyakta94 .
Katigraha is a vata vyadhi disorder so its poorvaroopa is also Avyakta95 .
ROOPA96:
KATI GRAHA SAMANYA LAKSHANA:
¾ Gadanigraha-19/160
“Vayu: Katyashrita: Shudha: Samo Janeyet rujam
Kati graha: Sa Vijneya: Pangu Sakthi dwayaashrita:!”
Katyashrita Sama vayu causes stiffness of Kati pradesha & causes vedana97 .
¾ Charaka .Chi.28/20-21
“Sankocha: Parvanaam Sthambho Bhedo Asthnam Parvanaamapi
Lomaharsha: Pralapashcha Pani prushtha shira grahe:!”
Vitiated Vata causes,contractures,stiffness in joints, tearing in bones & joints, horripilation,
delirium,stiffness in hands,back & head98 .
¾ Yogaratnakara- Vatavydhi nidana-
The vitiated vata firstly afflicts the Spik( buttocks region), & gradually catches the
Kati,Prushtha etc & causes Stambha,Pida,Toda & spandana of the effected regions99 .
RACHANANUSARA LAKSHANA :
Shula or pain is the main symptom of Vata roga. Pain over low back is the main symptom in
katigraha Sthambhana, Sramsana &Grahana difficulty in walking are also present.
There is derangement in Asthi,Sandhi,Sira,Snayu(maha snayu) resulting in symptomatology.
Ruk, Sthambha, Grahana, Sramsana, Shodha.

General C.S SU.S A.H A.S V.S M.N Y.R SH.S G.N
symptoms
Shopha - - - - + + + -
Ruk + - - - + + +
Toda + - - - + + +
Stambha + - - - - + + -
Spandana - - - - - + - -
Shroni + + - - - - - -
bheda
Kati + - + + + - + +
graha
Trika - - - + - - + -
vedana
Prushta - - - - - - - - -
graham
Sankocha + - - - - - - -
Table No: 06. General symptoms present in the kati-Trika-Prushtashrita Vaata
SAMPRAPTI :
NIDANA causes VATA PRAKOPA especially Apana vata,as pakwashaya kati sakthi are the
important sites of vata, vata prakopa more prominent in these regions, leading to symptoms.
Due to continuous Nidana sevana ,more increase in Apana dushti & which further vitiates other
Vayus.
SAMANYA SAMPRAPTI OF KATI GRAHA :

Nidana sevana(aharaja,viharaja,anya)
Vata prakopa& agni dushti
Sthana samsraya of prakupita sama vata in Kati pradesha.
Asthi vaha sroto vaigunya.
Kati graha.


SAMPRAPTI GHATAKA
Dosha : Vata ,kapha.
Dushya : Dhatu-Asthi, majja
Upadhatu-Sira, snayu
Mala : Pureesha
Srotas : Asthivaha
Prakara : Sanga & Vimarga gamana
Udbhava sthana : Pakwashaya
Sanchara sthana : Shakha
Roga marga : Madhyama
Sthana samsraya : Kati pradesha
Vyakta sthana : Kati-trika-prushtavamshagata pradesha
Adhisthana : Asthi sandhi
Swabhava : Chirakari
Shad Kriyakala
The Shad Kriyakalas mentioned by Acharya Sushruta follows a distinct pattern of evolutive
phases of a disease10 .
Sanchaya
Indulgence in the Vaataprakopaka nidana, leads to accumulation of Vaata dosha. Kati is
mentioned as the Sthana of Vaata dosha, hence whenever there is vitiation of Vaata dosha it
will accumulate in this region. So, in short we can say the pathology of Katigraha starts from
this place.
Prakopa
Due to Vaata Prakopaka Ahara and Vihara etc there will be increase in the qualities of Vaata
i.e. Rookshatva, Kharatva, Chalatva, Daarunatva etc.
Prasara
Vaata Dosha which possess the power of locomotion or extreme mobility should be looked upon
as the cause of the expansion or overflowing and spread, as the case may be.101
The Doshas which have become Prakupita, due to the Nidanas mentioned, expand and
overflow the limits of their respective location and circulate through the channels other than
their normal ways of circulation.


Sthana samshraya
This stage obviously represents the Prodromal phase or the phase of Poorvaroopa of the
disease which is yet to manifest fully.102
The vitiated Vata due to khavaigunya gets sthana samshraya in Kati Trika asthi sandhi pradesha
leading to the following changes to take place in the manifestation of Katigraha. The vitiated
Vata, which is localized in the Kati-trika prishthavamshagata asthi sandhi pradesha diminishes
this Slesaka Kapha by its Ruksa Guna. When Kapha is less in the Sandhi, both parts of the
Asthi comes in close proximity and friction is increased between the Asthi during the movement
of the Sandhis. Sometimes they may even adhere to each other and cause fusion of Asthis.
Vaata also starts the Shoshana of Sthayi Asthidhatu, hampers the different Karya of Asthidhatu
and Sandhi.The vitiated Vata localizes in the Kati-Trika Prishtha Vamsha Gata tarunasthi , along
with the increase in its qualities like Kharatva and Rukshatva. These Tarunasthis are Snigdha &
Jaleeyaguna predominant. Due to Sthanasamshraya of Ruksha & Khara Guna of Vaata Dosha
it leads to loss of Jaleeya guna and due to Chala gunatva displacement of Tarunasthi takes place,
leading to the Sandhimochana.
Sthanasamsraya of Ruksha & Khara Guna of Vaata Dosha in Asthi leads to Asthi Kshaya
Lakshana due to Degenerative changes.
Vyakti
This stage the result or Dosha dushya sammurchana as represented by its characteristic
symptomatology.
Bheda
The disease may become sub acute and chronic or incurable in this stage. Hence, it should be
deemed as marking or forming one of the stages of the particular disease or becomes incurable
due, probably to extensive damage sustained or irreversible structural changes having taken
place on account of the neglect of early diagnoses and prompt treatment.
UPASHAYA
Vata shamana ahara & vihara. Madhura amla lavana predominant Ahara, Rest,
Snigdhopayogas, Harsha.





SAPEKSHA NIDANA
Sapeksha nidana is necessary to arrive at the right diagnosis and to differentiate it from other
diseases.
Katigraha, can be diagnosed based on its cardinal features like pain experienced from Kati
Prushta, Sphik region causing Sthabdata & Grahana in Gamana karma which can in later
stages lead to the manifestation of Gridhrasee vyadhi when the pain radiates down towards Uru,
Jaanu, Jangha and Paada. In case of some disease like Khalli, Pangu, Khanja etc. some
symptoms can be seen in common with the Katigraha and should be differentiated clinically.
The vyavacchedaka includes,
• Khanja
• Pangu
• Gudagata vaata
• Snaayugata vaata
• Kukundara marmaabhigaata
• Pakvaashayagata vaata.
• Gridhrasee
Khanja and Pangu103, 104.

In Khanja and Pangu the vitiated Vata takes Sthana Samshraya in Kati pradesha and
affects the Kandara and Sakthi leading to symptoms like paralysis or Aakshepaka. If it affects
only one lower limb it’s called as Khanja and if it affects both the lower limbs then it’s called
Pangu. Though there is difficulty in walking, there is no pain present in this condition.
Gudagata Vaata105
In this disorder there will be pain in leg, thigh, sacral region and back associated with
retention of stools, urine, flatus, colicky pain and flatulence. But radiating pain is absent in this
disorder.
Snaayugata vaata 106
Here there will be Ayama i.e. bending along with other disorders like Khalli, Kubjatva, Sarvanga
and Ekanga roga which are not present in the Katigraha.

Pakvashaya gata vaata 107

Here along with the pain in Kati, Trika, Prushta the symptoms like distension of the abdomen
and colicky pain will be present.
Kukundara marmabhigata 108

This marma is present on the either side of the Prushtavamsha. Any injury to this marma will
lead to Sparsha ajnana and cheshta haani. However, the involvement of marma in the pathology
of Katigraha can be understood, but injury alone to the marma resulting in Katigraha is not
mentioned in the marma viddha lakshana.
Gridhrasee109
Gridhrasee is a vyadhi where structural and functional deformity of Kati-trika prushtavamsha
occurs, leading to radiating pain starting from low back till the toes of lower limb resulting in
karmakshaya

MODERN REVIEW
ANATOMY & PHYSIOLOGY OF LUMBOSACRAL JOINT

The entire Vertebral column is composed of 33 vertebrae and their Intervertebral discs.
Total length of the Vertebral column in adult male is about 70cm and in adult female about 60
cm . Four-fifth of the total length is contributed by the Vertebral bodies and one-fifth by the
Intervertebral discs.
The vertebral column possesses two basic functions:
a. Provides protection to the spinal cord;
b. Supports the trunk and transmits body weight to the lower extremities.
The vertebrae are arranged as follows-cervical 7, thoracic 12, lumbar 5, sacral 5,
coccygeal 4 (may vary from 3 to 5). Cervical, Thoracic and Lumbar vertebrae are free, and
each of them presents individual entity. Sacral and Coccygeal vertebrae are fixed; five Sacral
segments fuse to form the Sacrum and four rudimentary Coccygeal segments unite to form the
Coccyx.
The free vertebrae exhibit regional characteristics. The Lumbar vertebrae are identified
by their massive reniform bodies and presence of Mamillary and Accessory tubercles on the
their Vertebral arches.
Viewed in lateral profile, the entire vertebral column exhibits two primary curvatures –
Thoracic and Sacro-coccygeal (pelvic), and two secondary curvatures – Cervical and Lumbar
(Fig No :01). The primary curvatures are concave ventrally and appear in the intra-uterine life;
they are mainly produced by the shape of Vertebral bodies and not much by the Intervertebral
discs. The secondary curvatures are convex ventrally and contributed mostly by the thickening of
the anterior part of the Intervertebral discs and less so by the Vertebral bodies. The Cervical
curve appears when the child erects its head during 3rd and 4th months of postnatal life. The
Lumbar curve becomes apparent close to the end of first year, when the child attempts to stand
and walk. The formation of Secondary spinal curves helps transmission of weight to the lower
extremities in the erect posture110.

(Fig No: 01) shows Lumbar vertebra & Lumbar curvature
POSTERIOR ABDOMINAL WALL

It is osseo-musculo-fascial and extends from the last rib to the pelvic brim.
It is composed of –
1. Bony part- In the middle line, bodies of the five lumbar vertebrae above and laterally, the
inner surface of the lower ribs below and laterally, the iliac fossae and alae of the sacrum.
2. Muscular part – Above the iliac crest, the muscles occupy the paravertebral gutter and are
named from medial to lateral side: Psoas major, sometimes psoas minor, quadratus
lumborum and the aponeurotic orgin of the transverses abdominis. Below the iliac crest,
laterally iliacus muscle and medially psoas major and its tendon.
3. Fasical part – Fascia iliaca covers the psoas and iliacusThoraco-lumbar fascia encloses
the quadratus lumborum between its anterior and middle layers.

BONY PART
ANATOMICAL PARTS OF A TYPICAL VERTEEBRA
A body in front and vertebral arch behind; both of them enclose a vertebral foramen
for the lodgement and protection of the spinal cord and its membranes.
1. The body of a vertebra transmits body weight and is connected to the bodies of the adjacent
upper and lower vertebrae by the intervertebral discs, which form the secondary cartilaginous
joint. The body is enclosed by a shell of compact bone, except at the upper and lower
surfaces where it is composed of spongy bone and is covered by a plate of hyaline cartilage
(Fig No:02). Along the entire mobile part of the vertebral column the anterior and posterior
surfaces of the bodies are connected respectively by the anterior and posterior longitudinal
ligaments; the former is stronger than the latter.
The constrictions at the sides of the body is developed by the fusion of the lower part of the
upper somite and the upper part of the lower somite.The individual vertebra, as a whole, is an
irregular bone but its body is a modified long bone since it transmits body weight. The body
is ossified from 3 primary and 2 secondary centres. The primary centres include a median
centre which forms the centrum and two lateral centres derived from neural arches. The
secondary centres give rise to two rim epiphyses at the upper and lower surfaces of the body.
2. The vertebral arch consists of a pair of pedicles and a pair of laminae, and supports seven
processes a pair of transverse processes, pairs of superior and inferior articular processes, and
an unpaired spinous process.
The laminae of the adjacent vertebrae are connected by series of fibro-elastic membranes,
the ligamenta flava. Paired superior and inferior articular processes project respectively
above and below from the junction of pedicles and laminae, and they join with the articular
processes of the adjacent vertebrae forming plane synovial interarticular joints (facet joint)
The unpaired spinous process are connected to one another and to the external occipital crest
and protuberance by a fibrous band, the ligamentum nuchae.

Functional components of a vertebra

Any vertebra presents usually four functional components:
1. A body for weight bearing.
2. The vertebral foramen between the body and the vertebral arch for protection of the spinal
cord and its meninges.
3. Paired superior and inferior articular processes with their facet joints act as self-protecting
mechanical devices and prevent forward dislocation of the upper vertebrae from the
adjacement lower one.
4. A pair of transverse processes and unpaired spinous process act as levers for the various
movements of vertebral column by providing attachments to paravertebral and erector
spinae groups of muscles.
The spinal cord ends usually at the level of lower border of L1 vertebral and subdural and
subarachnoid spaces end at the level of S2 vertebra.
Intervertebral foramina
Each foramen is bounded above and below by the vertebral notches of the pedicles of
adjacent vertebrae, behind by the joint between the articular processes, and in front by the lower
part of the body of upper vertebra and by intervertebral disc. The foramina transmit bilaterally
pairs of spinal nerves (31 pairs in total) and spinal branches of the segmental blood vessels.
Intervertebral discs (Fig No: 03)

The intervertebral discs connect the upper and lower surfaces of the adjacent vertebral
bodies, and extend from the axis vertebra to the sacrum. Each disc intervenes between plates of
hyaline cartilages which cover the surfaces of adjacent vertebral bodies, and consists of Annulus
fibrosus at the periphery and Nucles pulposus in the central region.
In front and behind, the Annulus blends with longitudinal ligaments; some fibres sink
deeply into the bone and others are attached to the epiphyseal ring of the vertebral bodies.
The Nucleus pulposus is a gelatinous mucodial mass containing abundant water,
cartilage cells and a few multinucleated notochordal cells in children. By the end of first decade,
the notochordral cells disappear and mucoidal materials are replaced by fibro-catilage. The water

content of the discs diminishes with the advancement of age. Moreover, there is a diurnal
variation of water content of the discs producing alteration of the height of the individual to the
extent of 1 cm- 2 cm the height usually diminishes in day time due to workload, and increases in
the moring after rest at night.
Functions of the discs

a. They impart resiliency to the vertebral coloumn;
b. Offer resistance to compression and act as shock-absorber;
c. Ensure even distribution of compressive forces to the upper and lower surfaces of the vertebral
bodies.
Nutrition of the discs

Most of the disc is avascular, except the peripheral part which is supplied directly by the
plexus of blood vessels. Therefore, with the ageing process the disc undergoes gradual
degeneration. Nuclear degeneration is more marked and it becomes desiccated.
Derangements of the discs (Fig No: 04)

Nuclear retropulsion – Herination of nucleus pulposus may occur into the spongy tissue of the
vertebral body (Schmorl’s nodes) with or without break of the cartilaginous plate. The
adolescents are the usual victims of this condition.
Nuclear retropulsion- Prolapse of nucleus pulposus may take place postero-laterally due to
degeneration of the disc. It may cause gradual stretching or rupture of the posterior longitudinal
ligament. The radiating root pain may be due to stretching of the ligament or involvement of
spinal nerves. Disc prolapse is more prevalent in elderly people, with a history of mild trauma.
Spondylosis deformans – This condition sometimes occurs in old age when the intervertebral
space is reduced, osteophytes grow out from the vertebral bodies and cause fusion of adjacent
vertebrae. Growth osteophytes produces narrowing of Intervertebral foramen with pressure on
the nerves111.

LUMBAR VERTEBRAE
The word lumbar is derived from the root ‘Lumbus’ means Loin, which supports the lower
back. In a normal adult, the Lumbar curvature which is lordotic, helps in bearing and transferring
the weight of the upper part of the body to the lower limbs.
Lumbar Vertebrae
Typical lumbar vertebrae Atypical lumbar vertebrae

1st Lumbar vertebra 5th Lumbar vertebra
2nd Lumbar vertebra
3rd Lumbar vertebra
4th Lumbar vertebra
Chart No : 06 Classification of Lumbar Vertebrae & Parts
Typical Lumbar Vertebrae

Parts
Body Vertebral foramen Vertebral arch
Surfaces Pedicles Laminae Processes

Superior Superior articular(2)
Inferior Inferior articular (2)
Anterior Spinous (1)
Posterior Transverse (2)
2 Lateral

Description of the parts 112

BODY :
. They possess massive reniform bodies,Its transverse measurement is more than antero-posterior
measurement. It has 6 surfaces,
1. Superior surface
2. Inferior surface
3. Anterior surface
4. Posterior surface
5. 2 lateral surfaces
• Superior Surface: Rough and provide attachment to intervertebral disc.
• Inferior Surface: Rough and provide attachment to intervertebral disc.
• Anterior Surface: It is convex from side to side and concave from above downwards. It
bears few openings for passage of veins.
• Posterior Surface: It is flat from above downwards and slightly concave from side to side. It
bears one or more large openings for exit of basi vertebral vein and a number of small
foramina for nutrient arteries.
• Lateral Surface: These are continuous with the anterior surface and has the same features
that of the anterior surface.
Vertebral foramina:
Triangular and roomy vertebral foramina, and larger than those in the Thoracic region but
smaller than that of the Cervical vertebrae.
Vertebral Arch
Vertebral arch consists of
1. Pedicles (2)
2. Laminae (2)
3. Processes (7)

1. Pedicles:
These are short and strong. These arise from posterolateral aspect of the body just below its
lower border
2. Laminae:
These are short, strong and broad and are non overlapping. They pass backwards and medially
and gives attachment to ligamentum flava.
3. Processes:
• Superior articular processes :Its articular facets are slightly concave and face
backwards and medially. Its posterior border has a rough elevation or process called
Mamillary process. It corresponds to superior tubercle of 12th thoracic vertebra.
• Inferior articular process : Its articular facets are slightly convex and face forwards and
laterally.
• The superior articular facets are concave facing backwards and medially, and presents
non-articular mamillary tubercles at their posterior margins. The inferior articular facets
are convex facing forwards and laterally. Such do not permit rotatory movements
between the adjacent vertebrae, although the movements of flexion, extension and lateral
flexion are more pronounced in this region.
• Spinous Process : Possess quadrangular and horizonatally directed spinous processes,
The spinous processes are connected to one another by Interspinous and Supraspinous
ligaments, and provide attachment to the posterior layer of the Thoraco-lumbar fascia
and Extensor muscles of the trunk. It’s thick along its posterior and inferior borders.
• Transverse Process : In Lumbar vertebrae the transeverse processes are comparatively
slender, except the fifth lumbar vertebra. A rough elevation at the posteroinferior
aspect of each transverse process called Accessory process. It corresponds to inferior
tubercle of the transverse process of 12th Thoracic vertebra. The anterior suface of each
transverse process provides the attachments to Psoas major on the medial part and
Quadratus lumborum on the lateral part; a vertical ridge between the two parts gives
attachment to the tip of the transverse process. The transverse processes of the fifth
Lumbar vertebrae are substantial, encroach on the sides of the body from the junctions of
the pedicles and laminae, and formed by the fusion of costal and transverse elements.

VERTEBRAL NOTCHES:
Both Superior & Inferior notches are fairly conspicuous.
INTERVERTEBRAL DISC:
The Intervertebral discs between the vertebral bodies are thick in the Lumbar region, and are
more broad on the anterior surface. The ventral convexity of the Lumbar curve (secondary
curvature) is produced more by the discs than the vertebral bodies.
The Nucleus pulposus is central in position in Cervical and Thoracic regions, but shifts
somewhat posteriorly in the Lumbar region.
INTERVERTEBRAL FORAMINA:
The sizes of the Intervertebral foramina are getting wider from above downwards, and
concomitantly the thickness of the Spinal nerves are gradually increased in prosimodistal
direction. The lower Lumbar nerves are, therefore, more vulnerable to compression due to
derangements of Intervertebral discs, collapse of the vertebral bodies or diseases of
Intervertebral joints Upper four lumbar vertebrae are typical and bear common features(Fig
No: 05).
Superior view Inferior view Lateral view
(Fig No: 05) shows typical Lumbar Vertebra

Superior view Inferior view Lateral view
(Fig No: 06) shows 5th Lumbar Vertebra.
The fifth lumbar vertebra is atypical(Fig No:06) and presents the following identifying
features:
1. The Transverse processes are substantial and encroach on the sides of the body from the
junctions of pedicles and laminae.
2. The distance between two Superior Articular Processes is almost identical with that of
Inferior Articular Processes. In typical Lumbar vertebra the Superior Articular Processes
lie further apart from the Inferior Articular Processes.
3. The anterior surface of the body of fifth Lumbar vertebra is more extensive than the posterior
surface. This accounts for the formation of Sacro-vetebral angle between the body of the fifth
Lumbar vertebra and the base of the Sacrum. The Sacro-vertebral angle measures about 120 in
normal adult.
4. The Lumbosacral angle occurs at the junction of, and is formed by, the long axis of the
Lumbar region of the Vertebral column and Sacrum. The vertebrae gradulally becomes
larger as the Vertebral column descends to the Sacrum and then become progressively
smaller towards apex of the Coccyx.
5. The change in size is related to the fact that successive Vertebrae bear increasing amounts of
the bodies weight as the column descends. The Vertebrae reach maximum size immediately
superior to the Sacrum, which transverse the weight to the pelvic girdle at the Sacroiliac
joint.The tips of the fifth Lumbar transverse processes are connected to the posterior part of


the Iliac crests by the Ilio-lumbar ligaments and to the Alae of the Sacrum by the Lumbo-
sacral ligaments.
Sometimes the transverse processes become unduly elongated with Bifid tips and fuse with
the Illium or Sacrum or with both. Such fusion between the last Lumbar transverse process
and the Sacrum may be unilateral or bilateral producing respectively Partial or Complete
Sacralisation. The Intervertebral foramen transmitting the fifth Lumbar nerve is affected by
Sacralisation, and this may produce compression on the nerve resulting in pain along the
distribution of Sciatic nerve.
The natural tendency of forwards and downwards slipping of the fifth Lumbar ligament,is
prevented by thickened Intervertebral disc and by locking between the Articular processes
of the last Lumbar vertebra and the Sacrum.
LUMBO-SACRAL TRAINGLE OF MARCILLE 113

It is a Triangular interval on each side of the body of fifth Lumbar vertebra (Fig no:07).
Each triangle presents the following boundaries
Medially – Body of the fifth Lumbar vertebra.
Laterally – Medial border of the Psoas major muscle.
Apex – Directed above and formed by the junction of Psoas major and the body of fifth Lumbar
vertebra.
Base – by the upper surface of the lateral mass or Ala of the Sacrum.
Floor or posterior wall – By transverse process of fifth Lumbar vertebra and Ilio-lumbar
ligament.
Contents of the triangle

A number of important structures occupy the triangle (Fig No:08) and these are arranged in
three strata – Deep, Intermediate and Superficial.
• Structures of the deep stratum run vertically over the Ala of Sacrum, emerge from the
medial border Of Psoas major and are named from the medial to lateral side;
a. Ganglionated sympathetic trunk;
b. Lumbo-sacral trunk;

c. Ilio-lumbar artery: and

d. Obturator nerve.
• Structures of the intermediate stratum pass obliquely downwards and laterally, and
include:
1. Common Iliac Artery, dividing close to the Sacro-Iliac joint into External and Internal
Iliac Arteries.
2. Common iliac vein, formed by the union of External and Internal iliac veins, terminates
into the Inferior vena cava; the latter overlaps partially the right Lumbo-Sacral Triangle.
Common Iliac Veins lie infero-medial to the corresponding Common Iliac Arteries.
• Structres of the superficial stratum- They cross vertically in front of oblique structures:
a. The ureter crosses the common iliac vessels at the lateral angle of the triangle;
b. The ovarian vessels cross the common iliac vessels lateral to the ureter and thereby
enter the suspensory ligament of ovary (infundibulopelvic ligament);
c. The infereior mesenteric vessels traverse the pelvic inlet in front of common iliac
vessels at the medial angle of the left lumbo-sacral triangle.
d. The nerve fibres from the hypogastric plexues ascend in front of the common iliac
vessels on the medial side of the inferior mesenteric vessels.

FIG NO: 02 shows compact bone, spongy bone & plates of hyaline cartilage.
FIG NO: 03 shows intervertebral discs between the adjacent vertebrae.
FIG NO: 04 shows derangements in intervertebral discs

FIG NO: 07 shows Lumbosacral Triangle of Marcile.
FIG NO: 08 show superficial relations of lumbosacral triangle.

THE BONY PELVIS114

The Pelvis is derived from a Latin word which means ‘ Basin’. It is a ring of bone
consisting of two Hip bones in front and at the sides, and the Sacro-Coccygeal part of the
Vertebral column behind. The pubic parts of Hip bones are connected to each other by the
Symphysis pubis which is a secondary cartilaginous joint; the corresponding surfaces of the
Ilium of Hip bones forming a pair of plane synovial Sacro-iliac joints. Postero-laterally, pairs
of Sacro-tuberous and Sacro-spinous ligaments connect the sides of the Sacrum and Coccyx
respectively with the infero-medial margins of the ischial tuberosities and the tips of the ischial
spines. The plane of pelvic inlet (pelvic brim) slopes obliquely downwards and forwards, and
divides the pelvis into an upper, wider Greater pelvis (false pelvis), and lower narrower Lesser
pelvis (true pelvis).
(Fig No: 09) shows Pelvic Cavity.
Functions
1. The bony pelvis transmits weight in standing position from the vertebral column to the lower
extremities through the Sacro-iliac and Hip joints. The pelvis also transmits weight in sitting
position from the Sacro-iliac joint to the lower and medial part of Ischial tuberosities;
2. The true pelvis provides protection to the caudal part of the alimentary tube and the
urgogenital organs.
3. It provides a surface area for the attachments of muscles of the trunk including the pelvic and
urogenital diaphragms, and the muscles of the lower extremities.

4. The female pelvis makes room for accommodation of the foetal head and guides the act of
parturition through the birth canal.
5. A total examination of the pelvis subserves very important tools for sex determination. Studies
on pelvimetry bear significant observations in obstetrics, radiology, forensic and
anthropological sciences.
Greater or false pelvis

It lies above and in front of the pelvic inlet, and is contributed by the Iliac fossae of the Hip
bones and by the Alae of the Sacrum . Anteriorly, the greater pelvis presents no bony wall
and hence, belongs to the abdomen proper.
Lesser or ture pelvis
It lies below and behind the pelvic inlet, and resembles a ‘ true basin’ with the muscles of the
pelvic floor in position.
The posterior wall of the cavity is much longer than the anterior wall. Anteriorly, it is bounded
by the Symphysis pubis and the body of pubis with its two rami; posteriorly, limited by the
concave pelvic surface of the Sacrum and Coccyx; on each side, walled by the quadrangular area
formed by the pelvic surface of Ilium and Ischium.
The posterior pelvic wall is formed in the median plane by the Sacrum, Coccyx and Ano-
coccygeal raphe, and on each side by the Piriformis, Coccygeus and Levator ani muscles covered
by the parietal layer of pelvic fascia.Upper part of the posterior wall upto the middle of third
Sacral vertebra is covered by the parietal peritoneum except the descending limb of the root of
Sigmoid mesocolon.
Between the rectum and the posterior pelvic wall intervene the following structures-Median
sacral vessels passing along the middle of sacrum and coccyx, Superior rectal vessels reaching
the recto-sigmoid junction opposite third sacral vertebra, both Sympathetic trunks passing along
the medial margins of the pelvic sacral foramina and meeting opposite first coccygeal segment as
the Ganglion impar, Glomus coccygeum in front of the tip of coccyx, Sacral plexus of nerves in
front of the piriformis (formed by the lumbo-sacral trunk and ventral rami of the upper four
sacral nerves), Pelvic splanchnic nerves, and Lateral sacral vessels passing along the lateral
margins of the pelvic sacral foramina.

BONY PART
SACRUM (Fig No:10)

The word meaning of the term Sacrum is ‘holy’. It is large, flattened, triangular bone formed by
the fusion of five sacral vertebrae. It lies obliquely at the upper and posterior part of pelvic cavity
between two hip bones. Because of its oblique position, it forms an angle with the rest of
vertebral column known as Sacro-vertebral or Lumbo-sacral angle which is about 210 degrees115.

(Fig No: 10) shows Sacrum.

Parts
Apex Base Surfaces

1. Pelvic
2. Dorsal
3. Lateral
Chart No: 06 Parts of the Sacrum
The sacrum encloses a canal called Sacral canal.

Description :116
1. Apex :
Apex is narrow blunt end lying at the lower part and is formed by inferior surface of the body
of the 5th Sacral vertebra. It bears an oval facet which articulates with Coccyx.
2. Base :
It’s formed by upper surface of the first Sacral vertebra which articulates with the body of the
fifth Lumbar vertebra to form the Sacro-vertebral or Lumbo-sacral angle. It presents features
of a typical vertebra in a modified form.
3. Body :
Transverse measurement is more than antero-posterior measurement. Consists of ananterior
projecting edge of the body called Sacral promontory.
Vertebral Foramen : It’s large and triangular.
Vertebral Arch
a) Pedicles : These are short and widely separated. It projects backwards and laterally.
b) Laminae : These are very oblique and projects downwards, backwards and medially.
Upper border gives attachment to lowest pair of Ligamentum flava.
c) Processes:
• Spinous process : It is represented by Spinous tubercle.

• Superior articular process : It bears a concave articular facets which face

backwards and medially to articulate with inferior articular facets of 5th Lumbar
vertebra.
• Transverse process : It is represented by a broad side of the body, pedicle and
superior articular process called ‘Ala of Sacrum’. It is formed by the fusion of the
transverse process and costal element. This feature is not present in any other
vertebra. It forms upper surface of lateral part of Sacrum and is subdivided into
smooth medial part and rough lateral part.
3. Surfaces
A) Pelvic Surface :
It is concave all over, broader at its upper part and directed downward and forwards. It
has four pairs of pelvic sacral foramina which communicate through intervertebral foramina with
the Sacral canal. Median area between foramina of right and left sides is formed by the flat
pelvic surfaces of bodies of Sacral vertebrae. The line of fusion of Sacral vertebrae is seen as
four raised transverse ridges.
Bars of bone which separate the foramina from one another on each side represent the
costal element. Surface lateral to Sacral foramina, on each side is formed by fusion of the costal
elements to one another.
B) Dorsal surface :
It is rough, irregular and convex. It faces backwards and upwards. It consists of,
• Median sacral crest : Raised interrupted crest in the median plane which bears 4 spinous
tubercles. It represents the fused spines of Sacral vertebrae.
• Sacral hiatus : An inverted ‘U’ shaped gap below the 4th spinous tubercle in the posterior
wall of Sacral canal. It is due to failure of laminae of 5th Sacral vertebra to meet in the
median plane.
• Dorsal Sacral foramina : These are four in number, lying on each side of the median
Sacral crest. They communicate with Sacral canal through intervertebral foramina.
• Intermediate sacral crest : It’s a row of four small articular tubercles lying just medial to
dorsal Sacral foramina. It represents the articular processes fused together.

• Lateral sacral crest : Lies on the lateral side of dorsal Sacral foramina. It is formed by
fusion of transverse processes, tips of which appear as a row of tubercles.
• Sacral cornua : It is the free projecting part at inferior part of 5th Sacral vertebra on the
sides of Sacral hiatus. It is connected to cornua of Coccyx by inter-cornual ligament. It
represents the inferior articular processes of 5th Sacral vertebra.
C) Lateral surface :
It is formed by fused transverse processes and costal elements. It is broader above and
narrows below. It consists of an,
• Auricular surface : It’s an ear shaped surface at the upper part which articulates with
ilium of hipbone to form sacro-iliac joint. It is formed entirely by costal element. It shows
elevations and depressions. The area behind the surface is rough for ligamentous
attachments. This surface is covered by cartilage in the recent state.
• Inferior angle : It is the point at which the lower part of lateral surface bends. Below the
angle the surface is reduced to a border.
The Sacrum is displaced more backwards in female the Sacrum is more elongated than its
breadth in male, and reverse is the case in female the concavity of the pelvic surface of the
Sacrum is uniform in male, but in female the upper part of the pelvic surface is mostly flat and its
lower part becomes abruptly concave; the Coccyx is more movable in female at the Sacro
coccygeal joint.
Sacral Canal
It is formed by vertebral canal of Sacral vertebrae. It is triangular in shape. It is bounded
by bodies of the vertebrae in front. Fused laminae and spinous processes on behind and on the
sides.Lateral wall of the canal presents four intervertebral foramina through which the canal is
connected to pelvic and dorsal sacral foramina. Its lowering opening is called as the Sacral
hiatus. Sacral canal consists of Cauda equine (including filum terminale), Spinal meninges,
Sacral and Coccygeal nerve roots, and Lateral sacral vessels. Sacral hiatus emits 5th pair of
Sacral plexus, Coccygeal nerves and Filum terminale.
The floor of the Hiatus gives attachment to deep posterior Sacro-coccygeal ligament. To the
margins of Hiatus is attached the superficial posterior Sacro-coccygeal ligament.

MUSCULATURE OF LUMBOSACRAL REGION

The muscles of the back are covered by a thick deep fascia known as Lumbar
(thoracolumbar) fascia. The lumbar part of deep fascia is situated in between the Iliac crest and
twelfth rib. It forms strong aponeurosis and laterally gives origin to the middle fibres of the
Transversus and the upper fibers of the Internal oblique muscles of the abdominal wall117.
Medially, the lumbar part of the deep fascia splits into three lamellae. The posterior
lamella covers the deep muscles of the back and is attached to the lumbar spines. The middle
lamella passes medially, to be attached to the tips of the transverse processes of lumbar
vertebrae; it lies in front of the deep muscles of the back and behind the Quadratus lumborum.
The anterior lamella passes medially and attaches to the anterior surface of the transverse
processes of lumbar vertebrae; it lies in front of the Quadratus lumborum.
The muscles of the back can be classified into 2 groups. These are, 118
1. Superficial muscles of the back.
2. Deep muscles of the back
1. Superficial muscles of the back

Latissimus dorsi : Though this muscle arises from the Thoracolumbar fascia and has its
attachments with the Lumbar vertebrae it doesn’t take part in movements of the vertebral
column.
2. Deep muscles of the back
Erector spinae : This muscle and its prolongations in the Thoracic and Cervical regions lie in
the groove on the side of the Vertebral column, covered in the Lumbar and Sacral region by
Thoraco-lumbar fascia, the Serratus posterior inferior below and the Rhomboid and Splenius
muscles above. It forms a large muscular and tendinous mass, which varies in size and
composition at different levels of the vertebral column.
In the sacral region it’s narrow and pointed and its attachment is chiefly tendinous. In the
Lumbar region it forms a fleshy mass which can be felt in the living subject.
The muscular fibres form a large fleshy mass which splits into three columns,

Erector Spinae
Lateral Intermediate Medial

Iliocostalis Longissimus Spinalis
a) I. lumborum a) L. thoracis a) S. thoracis
b) I. thoracis b) L. cervices b) S. cervices
c) I. cervices c) L. capitis c) S. capitis
Chart No: 07 Deep muscles of the back
Muscle Action
1. Iliocostalis lumborum : Extensors of the vertebral column and lateral flexors.
2. Longissimus thoracis : Bend the vertebral column backwards and laterally.
3. Spinalis thoracis : Extensors of the vertebral column.
4. Intertransverse muscles : they work for the most part as postural muscles.
5. Multifidus : Lateral flexion, rotation and extensors of the vertebral
column.
6. Rotators : These muscles lie deep to the multifidus and are best
developed in the thoracic region. They mainly help in the
rotation movement.
Table no : 07 Shows Deep Muscles of the Back & its Actions
The other muscles which act on the lumbo-sacral part of the vertebra are,
1) Quadratus lumborum : It’s a muscle of the posterior wall of the abdomen. The main
actions of this muscle are to extend the Lumbar part of the vertebral column when both the
muscles act together. In the pelvis is fixed and may act upon the vertebral column flexing it to
the same side.
2) Psoas Major : Psoas major muscle acts along with the Iliacus. When these muscles act
from below, they contract powerfully to bend the trunk and pelvis forwards against resistance, as

in raising the trunk from the recumbent to the sitting posture.Contraction of one psoas major
might flex the vertebral column forwards and laterally.
3) Psoas minor: It’s a weak flexor of the trunk.
ARTICULATION OF THE LUMBOSACRAL JOINT :

The vertebrae are articulated to one another by a series of cartilaginous joints between
vertebral bodies and a series of synovial joints between the vertebral arches. Hence these
articulations can be divided into two parts, i.e. Intervertebral articulation and Articulation of
Vertebral column with the Hip bones.
Intervertebral articulations are classified into,
a. Articulations of vertebral bodies.
b. Articulations of vertebral arches.
(Fig No : 11) shows Articulation of Pelvis.

a. ARTICULATIONS OF VERTEBRAL BODIES : 119.

It mainly consists of,
1. Anterior longitudinal ligament
2. Posterior longitudinal ligament
3. Intervertebral ligamnent
1. Anterior longitudinal ligament :
• It is a strong band which extends along the anterior surfaces of the Vertebral bodies. It is
broader below than above, thicker and narrower in the thoracic than in Cervical and
Lumbar region and somewhat thicker and narrower opposite the bodies of the Vertebrae
than opposite the Intervertebral discs. It extends from the basilar part of the Occipital
bone till the upper part of the Sacrum.
• It consists of Longitudinal fibres, firmly attached to the Intervertebral discs and to the
margins of the Vertebral bodies, but loosely attached at intermediate levels of the bodies.
In the latter situation the ligament is thick and fills up the concavities on the anterior
surfaces, and makes the profile of the vertebral column flatter. It is composed of several
layers of which,
• The most superficial fibres which are long and extend from three to four vertebrae.
• The intermediate fibres extend between two or three vertebrae.
• The deep fibres which extend from one vertebra to the next.
2. Posterior longitudinal ligament :

• This ligament is inside the Vertebral canal on the posterior surfaces of the bodies of the
vertebrae. It extends from the body of the Axis till the Sacrum downwards. At Cervical
and upper Thoracic levels the ligament is broad and nearly uniform in width, but in the
lower Thoracic and Lumbar regions its denticulated, being narrow over the vertebral
bodies and broad over discs. It consists of
• Superficial layers bridging the interval between three or four vertebrae.
• Deeper layers which extend between adjacent vertebrae.

3. Intervertebral discs : 120

• These are interposed between adjacent surfaces of Vertebral bodies, from the Axis to the
Sacrum and are the chief bonds of connection between them. Their shape corresponds
with that of the bodies between which they are placed. Their thickness varies in different
parts of the vertebral column and in different parts of the same disc. They are thicker in
front than behind in the Cervical and Lumbar regions and thus contribute to the anterior
convexities of these levels. The discs are thinnest in the Thoracic region and thickest in
the Lumbar region.
• The discs are avascular and are supported by diffusion through the spongy bone of the
adjacent surfaces of the vertebrae.
• These Intervertebral discs constitutes the one-fifth of the length of the vertebral column,
exclusive of the first two vertebrae, but this amount is not equally distributed, the
Cervical and Lumbar portions having, in proportion to their length, a much greater
amount than the Thoracic region, with the result that they are more pliant.
• Their physical properties permit them to serve as shock absorbers when the load on the
vertebral column is suddenly increased. Their elasticity allows them to move one on
other.
Structure of the Intervertebral disc : 121
Each disc consists of outer laminated periphery, the Annulus fibrosus, and an inner core, the
Nucleus pulposus.
Annulus fibrosus:
• It consists of a narrower outer zone of collagenous fibres and a wider inner zone of
fibrocartilage.
• Its laminae are convex from above downwards and form incomplete collars which are
connected by strong fibrous bands and overlap or dovetail into one another. In the
posterior region of the disc the laminae join with each other in the complex fashion.
• Within each lamina the majority of the fibres lie in parallel and run obliquely between
two vertebrae; the fibres in contiguous laminae run in different directions and lie at an
obtuse angle to each other, thus exercising control over the rotatory movements in
different directions.

• A predominantly vertical direction of fibers in posterior part of the annulus fibrosus has
been described with suggestion that this predisposes to herniation.
Nucleus pulposes :
• The nucleus pulposus is better developed in the Cervical and Lumbar regions than in the
Thoracic part of the spine. It lies nearer to the posterior than the anterior surface of the
disc.
• At birth it is soft, gelatinous, relatively large and consists of mucoid material containing a
few multinucleated notochordal cells, into the periphery of which extend cells and fibres
from the inner zone of the adjacent Annulus fibrosus.
• Observations done on Intervertebral discs of Lumbar region showed that the cellularity
of the structure is highest in the periphery of the Annulus fibrosus and in the Hyaline
cartilage nearest to the vertebral bodies.
• Its water binding capacity and elasticity diminishes according to age advancement. This
is due to decrease in Mucopolysaccharide and Protein content of Nucleus pulposus. It
gives the suggestion that herniation is more common in old age or in degenerative
conditions.
b. ARTICULATIONS OF THE VERTEBRAL ARCH : 122
The joints between the articular processes of the vertebrae are synovial and vary in shape;
the laminae, spines and transverse processes are connected by Ligamenta flava, Interspinous,
Supraspinous and Intertransverse ligaments, which can all be regarded as Accessory ligaments
of these joints. Each has also an Articular capsule.
1. Ligamentum flava :
• These connect the laminae of adjacent vertebrae and are best seen from the interior of the
Vertebral canal. Their attachments extend from the articular capsules to the regions
where the laminae fuse to form the spine.
• These are thickest at the Lumbar level. They permit separation of the laminae in flexion
and at the same time brake the movement so that its limit is not reached abruptly, thus it
assists in restoring the Vertebral column to the erect attitude after it has been flexed and
may protect the discs from injury.

2. Supraspinous ligament :
• It is a stron g fibrous cord which connects together the apices of the spines from the
seventh Cervical Vertebra to Sacrum. It is thicker and broader in the Lumbar region and
intimately bonded with the neighbouring fascia.
• Most superficial fibres extend over three to four vertebrae, those more deeply seated pass
between two or three vertebrae, while the deepest connect the spines of neighboring
vertebrae and are continuous with the Interspinous ligaments.
3. Interspinous ligaments :
It is thin and almost membranous, connects the adjoining spines, and their attachments
extend from the root to the apex of each process. They meet the Ligamentum flava in front and
the Supraspinous ligament behind. These are broader and thicker in the Lumbar region.
4. Intertransverse ligaments :
These are present between the Transverse processes. In the Lumbar region these are thin
and membranous.
ARTICULATIONS OF THE PELVIS123

The joints encountered in the pelvis are as follows Lumbo-sacral, Sacro-coccygeal, a
pair of Sacro-iliac, and Symphysis pubis. The Iliolumbar ligaments serve as additional
connections between the Vertebral column and the Pelvis. The Sacrotuberous and
Sacrospinous ligaments act as accessory ligaments of the Sacro-iliac joints.
LUMBOSACRAL JOINT :
The articulation between the fifth Lumbar vertebra and the first segment of the Sacrum
resemble the joint between any two typical Vertebrae. The bodies of the fifth Lumbar vertebra
and first Sacral vertebra are united by a very large Intervertebral disc which is thicker
ventrally, and this accounts for the prominence of the Lumbosacral angle, which measures about
1200 . In long and slender individuals the Lumbosacral angle is often less than normal, and in
short and thick subjects the angle may be exaggerated.
The right and left Zygapophyseal joints between the inferior articular processes of the
fifth Lumbar vertebra and the Superior Articular Processes of the Sacrum are separated by a

wider interval than those of the Vertebra above. In addition to the fifth Lumbar vertebra , it is
attached to the Ilium and Sacrum by the Iliolumbar ligament. The Iliolumbar and Lumbo-
sacral ligaments, and the articular facets between the articular processes of the fifth Lumbar
and first Sacral vertebrae deserve special mention.
Iliolumbar ligament :
• It is attached to the tip and to the lower and front part of the transverse process of the fifth
Lumbar vertebra and occasionally has an additional, weak attachment to the transverse
process of the fourth Lumbar vertebra.
• It radiates as it passes laterally and is attached by two main bands to the Pelvis. The lower
band which is often termed as Lumbosacral ligament runs from the inferior aspect of the
fifth Lumbar transverse process to the anterior part of the upper surface of the lateral part of
the Sacrum, blending with the Ventral Sacro- Iliac ligament.
• The upper band, which gives partial origin to the Quadratus Lumborum, is attached to the
crest of the Ilium immediately in front of the Sacroiliac joint and is continuous above with
the Thoracolumbar fascia.
• The Iliolumbar ligaments limit the axial rotation of the fifth Lumbar vertebra on the
Sacrum.
SACROILIAC JOINT :
It is a Synovial joint between Auricular surfaces of the Ilium and Sacrum. But for a
Synovial joint it is atypical on three accounts, cartilage is fibrocartilage, surfaces are jagged and
the movements allowed are little. The Sacroiliac articulation depends entirely upon ligaments.
The two joint surfaces lie in diverging planes, the weight of L5 vertebra tends to push the
Sacrum down towards the Symphysis. There is no bony factor in stability.The articular surface
of the Sacrum is covered with hyaline cartilage, and that of Ilium with fibro-cartilage. In early
part of life both surfaces are flat, but with maturity irregular elevations and depressions appear
on the articular surfaces in reciprocal manner; this ensures joint stability by interlocking
arrangements. The spaces between the articular cartilages are filled with the synovial fluid and
are lined by synovial membrane on the inner aspect of the fibrous capsule. After mid-adult life


the joint space is obliterated partially or completely; this is more so in adult males. The ligaments
which help in the formation of this joint are, These consist of Capsular ligament, Ventral,
Interosseous and Dorsal Sacro- Iliac ligaments. The Sacrotuberous and Sacrospinous
ligaments subserve as Accessory ligaments.
Capsular ligament :
The capsular ligament attached to the margins of the auricular surfaces.
Sacroiliac ligament :
• It’s very strong posteriorly and weak anteriorly, and surround the capsule. The ventral
Sacroiliac ligament is a flat band joins the bones above and below the Pelvic brim.
• Dorsal surface a mass of ligaments attaches the Sacrum to the Ilium behind the joint. Most
of them constitute the very strong interosseous Sacroiliac ligament whose fibres are
attached to deep pits on the posterior surface of the lateral mass of the Sacrum. The most
superficial fibres form the dorsal Sacroiliac ligament. They mainly act in opposing the
gliding movement of the joint surfaces.
Sacrotuberous ligament :
• It’s a flat band of great strength. It is attached to the posterior border of the Ilium between
the Posterior Superior and Posterior Inferior Iliac spines, to the transverse tubercles of
the Sacrum below the Auricular surface and upper part of the Coccyx. From this wide
area the ligament slopes down to the medical surface of Ischial tuberosity.
• The main action is opposing the forward rotation of the Sacral promontory around the
joint.
Sacrospinous ligament:
• Pelvic aspect of the Sacrotuberous ligament. It has a broad base which is attached to the
side of the lower part of the Sacrum and the upper part of the Coccyx.
• It nervous as it passes laterally where its apex is attached to the spine of the Ischium.
• Its action is opposing forward rotation of the sacral promontory around the joint.

SACROCOCCYGEAL JOINT:
• It is a symphysis between Apex of Sacrum and the base of Coccyx with an intervening
disc or fibrocartilage. The ligaments are,
• A ventral Sacrococcygeal ligament which is short and present ventrally, represents a
remnant of the Anterior longitudinal ligament.
• Two dorsal Sacrococcygeal ligaments which are short and are deep consist of superficial
and deep parts. The superficial part fills up the Hiatus sacralis and extends from the margin
of the Sacral hiatus to the posterior surface of the Coccyx. The deep part connects the
adjoining surfaces of the Sacrum and Coccyx. The space between the two parts is
occupied by the Filum terminale, fifth pair of Sacral nerves and one pair of Coccygeal
nerves.
• Lateral Sacrococcygeal ligaments present on each side of the Sacrum. connects the
rudimentary transverse process of the first Coccygeal vertebra with the infero-lateral angle
of the Sacrum.
• The paired Intercornual ligaments connect the Sacral and Coccyeal cornua.
Anterior relation of the joints

• Lumbo-sacral trunk, ventral rami of first Sacral nerve and the Superior Gluteal Artery
intervening between them.
• Nerve supply – Ventral surface of the joint is supplied by the Superior Gluteal Nerve (L4,
L5, S1) and the Dorsal surface by branches from S1 and S2. In joint lesion, pain is
sometimes felt in the posterior part of the Iliac creat and along the line of Sciatic nerve in
the upper part of the back and medial side of thigh.
Movements at the Sacro-iliac joints

• Some rotator movement takes place around a transverse axis which lies about 5 cm to 10
cm below the sacral promontory. This movement is associated with slight translation. The
complex rotation is observed during flexion and extension of the trunk, and more so while
rising from recumbent to standing position, The rotator movement occurs in both sexes,

and during pregnancy the range is increased. About 5mm to 6mm of forward rotation of the
sacral promontory is considered to be the normal range during weight transmission.
MECHANISM OF THE PELVIS124

• One of the basic functions of the Pelvis is to transmit the body weight from the Sacro-iliac
joints to the Hip joints during standing and to the Ischial tuberosities in sitting. A coronal
plane joining both Acetabular cavities divides the True pelvis into two arches, posterior
and anterior. The summit of the posterior arch is formed by upper three Sacral segments,
and its two pillars extend from the Sacro-iliac joints to the Acetabular cvities. The
posterior arch is designed for weight transmission to the Femoral heads. The anterior arch
acts as a tie-beam preventing the separation of the pillars of the posterior arch, and is
contributed by the Pubic bones and their rami.
• The body weight transmitted through the Vertebral column falls on the Lumbo-sacral
joint, where it is resolved into two component forces. One force attempts to displace the
Sacrum downward and backward, while the other component force tends to push the
Sacrum downward and forward into the Pelvic cavity.
• The backward and downward displacement of the Sacrum is prevented by the wedge-
shaped architecture of the bone with the broader base being directed above, by the
interlocking mechanism of the articular surfaces of Sacro-iliac joints and by the attachment
of strong interosseous Sacro-iliac and Iliolumbar ligaments.
• A section through the first Sacral segment reveals that both anterior and posterior margins
of the auricular surfaces are equidistant from the body of Sacrum. As such, forward and
downward movement is possible at the first Sacral segment. In section through the second
Sacral segment, the dorsal margins of the auricular surfaces are found to be further away
from the Sacral body than the ventral margins. Thus the auricular surfaces of the second
Sacral segment present a wedge, the base being directed dorsally. Eventually, the Sacro-
iliac joint at the second Sacral segment does not permit forward movement. The auricular
surface at the third Sacral segment is wedge-shaped, but in reverse direction with the
broader base being directed ventrally. Such articular surface may permit forward

movement of Sacrum. Since the second Sacral segment is fixed at the Sacro-iliac joint, it
acts as transverse axis around which a hinge movement takes place, so that when the first
Sacral segment rotates downward and forward, the third Sacral segment together with the
Coccyx rotates upward and backward. The backward tilt of the Sacrum and Coccyx is,
however, prevented partly by the nature of the auricular surface of third Sacral vertebra but
mainly by the tensions of Sacrotuberous and Sacrospinous ligaments. During pregnancy,
the ovarian hormones relax the ligaments of Pelvic joints. As a result the Sacro-coccygeal
curve undergoes a slight backward tilt, which makes the Pelvis more roomy for the
accommodation of the foetal head. During involution after child-birth the ligaments are
tightened and the Sacro-iliac joints restore the normal position. Faulty setting of the joints
is known as Sub-luxation which may produce persistent low back pain after parturition.
NEURAL & VASCULAR CONTENTS : 125

• Inferior end of the Spinal cord (medullary cone), the loose bundle of Spinal nerve roots
caudal to the termination of the Spinal cord (cauda equine) and Filum terminale, which is
the vestigial remnants of the caudal part of the Spinal cord forms the neural content of the
Lumbosacral spine. Vascular content is formed by the Lumbar and Lateral Sacral
Arteries.
• Spinal cord is surrounded by Spinal meninges, which consists of Dura mater,
Arachnoid mater and Pia mater.
• The Spinal cord is enlarged in two regions in relationship to innervations of the limbs.
The Cervical enlargement (C4-T1) and the Lumbosacral enlargement (T11-S1). The
Anterior Primary Rami of the Spinal nerves arising from this enlargement make up the
Lumbar and Sacral enlargement.
• Each Spinal nerve is connected to the Spinal cord by two roots – Ventral and Dorsal
root. The dorsal sensory root consists of afferent fibres enter Spinal cord where as ventral
motor root exit the Spinal cord. 126
• The Spinal nerve roots pass from the Spinal cord to the level of their respective
Intervertebral foramina, where they unite to form the Spinal nerve. Here the motor and
sensory nerve is made up of a mixture of motor and sensory fibres.


• The roots of the Lumbar and Sacral nerves below the level of the termination of the
cord (lower border of the first vertebra in the adult) form a vertical leash of nerves around
the Filum terminale. Together these lower nerve roots are called the Cauda Equina.
• After emerging from the Intervertebral foramina each Spinal nerve immediately divide
into a large anterior ramus and a smaller posterior ramus each containing both motor and
sensory fibres.
• The anterior rami join one another at the root of the limbs to form complicated nerve
plexus. Lumbar and Sacral are found at the root of the lower limb.
• Four pairs of Lumbar arteries arise from the Aorta opposite the bodies of the upper four
Lumbar vertebrae. The small, fifth pair is usually represented by the Lumbar branches of
the Iliolumbar arteries, but may occasionally arise from the Median Sacral Artery.
127
The upper four Lumbar arteries run across the sides of the bodies of the upper four
Lumbar vertebrae. Each Artery gives off a dorsal branch which arises at the root of the
transverse process. The dorsal branch gives off a Spinal branch to the Vertebral
canal.The fifth Lumbar artery, when present, ends by anastomosing with the branches of
the Iliolumbar artery.
• Lateral Sacral Arteries are two in number, upper and lower. They run downwards and
medially over the sacral nerves. Their branches, enter the four anterior sacral foramina to
supply the contents of the sacral canal. Their terminations pass out through the posterior
sacral foramina and supply the muscles and skin on the back of the Sacrum.
• Spinal veins form venous plexuses along the vertebral column both inside and outside the
vertebral canal. These are Internal vertebral venous plexus and External vertebral plexus
respectively. These plexuses communicate through intervertebral foramina. The large
tortuous basivertebral veins form within the vertebral bodies. They emerge from foramina
on the surfaces of vertebral bodies (mostly posterior aspect) and drain into the Anterior
External and especially the Anterior Internal vertebral venous plexuses which may form
large Longitudinal sinuses. 128
• The Intervertebral venous plexuses as they accompany the spinal nerves through the
Intervertebral foramina to drain into the segmental veins of this region i.e. Lumbar and
Sacral veins respectively.

FUNCTIONAL ANATOMY : 129

• The Lumbar spine contains five moderately large vertebrae which are present atop the
Sacrum. These bony segments acts as attachments for muscles and ligaments in the
Lumbar spine and also encase and protect the lower Spinal cord and Lumbar nerve
roots.
• The Lumbar vertebrae are aligned in a reverse ‘C’ creating a normal Lumbar lordosis.
The five vertebral bodies are the weight bearing portion of the spine and has largest
diameter compared to any other vertebrae. The Sacrum which is formed by five
vertebrae fused together into a solid unit. Five Lumbar nerve roots and five Sacral nerve
roots are present.
• As the Lumbar vertebrae are located between the Pelvis and upper torso, the degree of
stress endured by the Lumbar spine is great. These abnormally high degrees of stress
result in frequent Lumbar vertebral subluxations- misalignments and improper motion
patterns of the lumbar vertebrae. If left uncorrected these alignments and faulty
biomechanics of the lower spine can result in spinal injury and irreversible degenerative
changes.
• The anatomic structures that have been implicated as pain generators include the
Vertebral discs, Nerve roots, Ligaments, Zygapophyseal joints, Sacroiliac joints and
the Musculature
• Normally the articular facets of the inferior articular processes of the fifth Lumbar
vertebra are directed forwards and laterally, and the Sacral articular facets are
reciprocally curved with the concavity directed backwards and medially. The natural
tendency of forward and downward displacement of the fifth Lumbar vertebra into the
Pelvis is prevented by the strong Intervertebral disc, by the Iliolumbar ligaments and by
the locking arrangements of the articular facets.
• Sometimes the articular processes of the two sides become asymmetrical, permitting
abnormal movements. If the Lumbar facet is deep on one side and shallow on the other,
the lateral bending is greatly restricted to the side with deep facet. This may produce
intractable low back pain on the less movable side of the Lumbosacral joint.

• When the transverse process of the fifth Lumbar vertebra is abnormally long and
possesses bifid tip, it may articulate with Sacrum or Ilium or both. Such bilateral fusion
is known as the complete Sacralisation. This may encroach on the Intervertebral foramen
and compress the emerging fifth Lumbar nerve with consequent shooting pain along the
distribution of the Sciatic nerve.
• The five Lumbar nerves run obliquely downwards and lateral aspect of the dural sac,
emerging at their respective Intervertebral foramina lying inferior to the Lumbar pedicle
in the upper part of the foramen. Each nerve root is intimately related to the medial and
inferior aspects of the adjacent vertebral pedicle.
• The ventral rami of the Sacral nerve enter the Pelvis through the Pelvic Sacral
Foramina of the Sacrum. The upper four Sacral nerves pass through the Pelvic sacral
foramina and fifth between Sacrum and Coccyx.
• The first three Lumbar nerves and the greater part of the fourth form the Lumbar
plexus(Fig no : 12). The small part of the fourth Lumbar nerve joins with the fifth
Lumbar nerve to form the Lumbosacral trunk, which assists in the formation of Sacral
plexus along with the first three Sacral nerves(Fig No : 13,14).
• Intervertebral discs are interposed between Lumbar vertebral bodies till first Sacral
vertebra. Usually no identifiable disc spaces between the Sacral segments are present.
• A cartilaginous endplate exists between the disc and the adjacent vertebral bodies and is
considered as part of disc. The disc is composed of central Nucleus pulposes and
surrounded peripherally by Annulus fibrosis.
• The Annulus fibrosis consists of 10-20 concentric collagen fiber layers that surround the
nucleus. The layers are arranged in alternating orientation of parallel fibers lying
approximately 650 from the vertical.
• The Nucleus pulposes is a semi fluid mass of mucoid material. The nucleus is composed
of approximately 70% - 90% of water in a young healthy disc, but this percentage
generally decreases with age. The primary nuclear constituents include
glycosaminoglycans, proteoglycans and collagen. Type 2 collagen predominates in the
nucleus. Biomechanically the nucleus can display properties of either a solid or liquid
substance depending on the transmitted loads and its posture.

• The principal functions of the disc are to allow movement between vertebral bodies and
to transmit loads from one vertebral body to next. When axial loads are transmitted to the
spine, the Annulus and Nucleus display a complex intertwined role, allowing for
pressure dispersal. The Nucleus has the capacity to sustain and transmit pressure. This
ability is invoked principally during weight bearing.
• During movement, the Annulus acts like a ligament to restrain movements and partially
stabilize the inter body joint. The oblique orientation of the Annular fibers provides
resistance to vertical, horizontal and sliding movement. The attention in the direction of
the annular fibers in consecutive lamellae causes the Annulus to resist twisting motions
poorly.
• Zygapophysial joints ( Z-joints ) are formed by the articulations of the superior articular
processes of one vertebra with the inferior articular processes of the vertebra above. Thus
Z joints are part of an interdependent functional spinal unit consisting of the disc-
vertebral body joint and the two z-joints with z joints paired along the entire
posterolateral vertebral column.
• The upper Lumbar z-joints are oriented in a sagittal plane, whereas the lower Lumbar z-
joints approach a more frontal orientation. Thus, as the Lumbosacral z joints maintain a
progressive coronal orientation, greatest at the S1 level, they functionally able to resist
rotation in the upper Lumbar region as well as resist forward displacement in the lower
Lumbosacral region.
• The z-joint is considered a motion restricting joint, able to resist stress and withstand both
axial and shearing forces. In Back Extension, the z-joints, along with the Intervertebral
discs, absorb a compressive load.
• The z-joint is a common pain generator in the lower back. The z joints are Diarthrodial
joints with a synovial lining, the surfaces of which are covered with hyaline cartilage,
which is susceptible to Arthritic changes and Arthropathies.
• The Intervertebral foramina have fixed boundaries, though its dimensions vary
depending on the height of the individual disc spaces. It is bounded above and below by
the Vertebral pedicles. Its floor from above downwards is formed by the posteroinferior
margin of the superior vertebral body, the intervertebral disc and the posterosuperior

margin of the inferior vertebral body. Its roof is formed by the Ligamentum flavum,
terminating at its outer free edge and posterior to this structure lies the Pars
interarticularis and the Apophysial joint formed between the adjacent inferior and
superior vertebral facets.
• The vertical height of Intervertebral foramen is being determined by the vertical height
of the corresponding Intervertebral disc place.
• The nerve root canal, by contrast, is a tubular canal of variable length, arising from the
lateral aspect of the dural sac. Viewed from within the dural sac, the hiatus through which
the component motor and sensory nerve roots pass to the spinal nerve has the shape of a
funnel. Viewed from without, the dural sheath clothes the spinal nerve on all sides as it
courses obliquely downwards and laterally towards the Intervertebral foramen. In life,
epidural fat surrounds the spinal nerve root throughout its course to the Intervertebral
foramen.

(Fig No: 12) shows Lumbar Plexus.
Muscular T12-L4 Quadratus Lumborum

L2-L4 Psoas Major
L1 Psoas Minor
L2,L3 Iliacus
From L1 Ilio Hypogastric Nerve
Ilio Inguinal Nerve
From L1 & L2 Genitofemoral Nerve
From L2 & L3 Lateral Femoral Cutaneous Nerve(Dorsal
division)
From L3 & L4 Accessory Obturator Nerve(Ventral division)
From L2,L3,L4 Femoral Nerve(Dorsal division)
Obturator Nerve(Ventral division)
Table No: 08 Lumbar Plexus , Branches & Its Distribution

LOW BACK PAIN RELATED ANATOMY
(Fig No: 13) shows Sacral plexus and Sciatic nerve.
(Fig No : 14) shows Sacral Plexus & Its Branches.

Nerve Origin Distribution
Sciatic L4,L5,S1,S2,S3 Articular branches to hip joint and

muscular branches to flexors of knee &
all muscles in leg and foot.
Superior gluteal L4,L5,S1 Gluteus medius amd gluteus minimus
Inferior gluteal L5,S1,S2 Gluteus maximus
Nerve to piriformis S1,S2 Piriformis
Nerve to quadratus femoris L4,L5,S1 Quadratus femoris amd inferior

and inferior gemellus gemellus muscle
Nerve to obturator internus L5,S1,S2 Obturator internus and superior

and superior gemellus gemellus muscle
Pudendal S2,S3,S4 Structures in perineum,sensory to

genitalia; muscular branches tom
perineal muscles, external urethral
sphincter and external anal sphincter
Nerves to levator ani and S3,S4 Levator ani and coccygeus muscles
coccygeus
Posterior femoral cutaneous S2,S3 Cutaneous branches to buttock and

uppermost medial and posterior
surfaces of thigh
Perforating cutaneous S2,S3 Cutaneous branches to medial part of

buttock
Pelvic splanchnic S2,S3,S4 Pelvic viscera via inferior hypogastric

and pelvic plexus
Table No: 09 Sacral plexus branches and its distribution : 130

(Fig No: 15) shows Lower limb dermatomal pattern

LOW BACK PAIN:131

Anatomical considerations:
The functional unit of the Lumbar spine consists of 2 vertebral bodies & an Intervertebral
disc anteriorly & the facet joints posteriorly.
The Anterior portion is flexible & serves the functions of shock absorbency & weight
bearing.The Nucleus pulposus provides shock absorbency of the futo the disc & Annulus
fibrosus allows for the flexibility of the functional unit.
The posterior portion of the unit protects the Neural elements.It acts as a Fulcrum &
guides the movements for the functional unit.The lower Lumbar dics need to bear a load of
1000kg when stressed with pure compression forces.The posterior segment muscles &
Abdominal Muscles dissipate these compression loads.
The Sacrum & Iliac bones functions as one unit.The Lumbosacral angle also plays an
important role in determining the posture & degree of spinal curvature.
Low back pain is one of the most common musculo-skeletal disorders. The pain affects
the lower lumbar spine, lumbosacral area, and sacroiliac joints. It may radiate down the legs in a
radicular or sclerotomal distribution.
The source of pain can be vertebrae, intervertebral joints (disc and facet joints),
ligaments and fasciae related.
AETIOLOGY
Low back pain can be acute and self-limited or chronic.
Acute: if duration is < 1month
Subacute: if duration 1-3 months
Chronic: More than 3 months or if pain occurs episodically within a 6 month period.
Chronic Back pain can be classified into 4 groups based on Location & Radiation of Pain.
1. Localised LBP, Not radiating below Gluteal region.
2. Sciatica, Radiating pain below the knee.
3. Anterior thigh pain
4. Posterior thigh pain (due to back strain referred pain due to damage of Muscles in the
Lumbosacral Spine or a high herniated disc (L3-L4 level)

The causes can be classified as

1. Developmental defects, e.g. abnormal vertebral facets, sacralisation of L5 transverse process,
spondylolysis or listhesis between L5-S1 vertebrae
2. Trauma to ligaments, muscles, vertebrae or annulus with disc prolapsed
3. Infections : pyogenic, tuberculous, etc.
4. Inflammatory : ankylosing spondylitis (SSA)
5. Degenerative : disc disease, facetal arthropathy, spinal canal stenosis
6. Mechanical : poor posture and conditioning often aggravated by obesity, pregnancy and
overuse
7. Soft tissue rheumatism, e.g. fibromyalgia
8. Malignancy involving vertebrae, pelvis or retroperitoneum
9. Miscellaneous conditions : osteitis, condenasas ilii, Paget’s disease
10. Pain arising from abdominal viscera (pelvic inflammatory disease) and secondary to
spinal cord tumours. Visceral pain is often dermatomal in distribution.
SIGNS, SYMPTOMS AND DIAGNOSIS

The main sources of low back pain are spine, disc, nerve roots, spinal canal stenosis and referred
visceral pain .
While analysing low back pain, the main features that need to be noted are the onset and
character of pain, location of pain, its radiation and mechanisms that intensify the pain. Presence
or absence of neurological signs and symptoms should be noted.

Source Nature Distribution Aggravating Neurological

factors deficit
Spinal pain Sharp or dull Sclerotomal Motion, None
Local movement
Discogenic Deep aching Sclerotomal Bending, sitting None
Nerve root pain Paraesthesia Radicular Coughing, Present
numbness sneezing
stretching
Spinal canal Paraesthesia Radicular, Lumbar Present
, stenosis claudication, extension(flexion
sclerotomal relieves)
Walking and
standing
(not sitting)
Referred visceral Deep aching Dermatomal Not affected by None

Motion ,
walking, etc
Muscular Crampy, aching Local Movement None
Table No: 10 Main features of low back pain from various sources

Root Pain Motor weakness Reflex Sensory Muscle

compre referred changes changes wasting
ssion
L4 Lateral Foot inversion & Reduced or Antero Thigh

thigh, ankle dorsiflexion, absent knee medial calf
medial knee extension reflex
calf
L5 Buttock, Extension and Reduced Lateral calf Calf

back side adductor of hip. ankle reflex dorsal &
thigh, Flexion of knee, medial food
lower leg dorsiflexion of especially
ankle, foot and hallux
toes eversion
S1 Buttock, Flexion knee, foot Reduced or Lateral foot Calf

back of eversion and ankle absent ankle ankle and
thigh and plantar flexion reflex lower calf
calf to back of heel
heel and sole of
foot
Table No : 11 Objective signs met with following herniation of the various lumbar discs.132
The mechanism of pain is irritation of the roots or nerve anywhere in the spinal canal,
intervertebral foramina, in the pelvis or buttocks. The important causes are intervertebral disc
protrusion or intraspinal tumour, degenerative disease of spine or spondylolisthesis.
Spinal canal stenosis (SCS) can be considered a special form of sciatica syndrome. It is
due to narrowing of the spinal canal causing pressure on nerve roots. There is neurogenic
claudication which may be mistaken for vascular claudication. Presence of neurologic deficit and
normal peripheral pulsations help to differentiate SCS from vascular claudication. Typically, the

claudication distance is shorter when walking with an extended spine. Degenerative disease of
the spine is its most important cause.
Ruptured disc, muscular tears and ligamentous strain have a sudden onset, usually
starting within 24 hours of heavy weight-lifting. There is limitation of spine movements and
paravertebral muscle spasm. Vertebral fracture with or without dislocation should be easy to
diagnose.
Posterior facet joint arthropathy is an important cause of low back pain. It by itself does
not cause root irritation. Typically, the pain is more on hyperextension.
Ankylosing spondylitis, infections, tumours and fibromyalgia are important causes of low back
pain Psychogenic low back pain is an important cause especially in industrialised societies. The
pain and disability persist or even worsen after the initial injury has healed.
Postural back pain :

Any posture that reverses the normal curves of the spine and is held for a long time can
cause back pain. A short leg, by causing pelvic tilt, causes strain on the lumbar spine. Leg length
correction relieves the pain.
Children Malignancy
Infection
Psychogenic
Adolescents Ankylosing spondylitis
Osteochondritis
Young adults Prolapsed intervertebral disc
Ligamentous injury
Middle age Degenerative diseases
Spondylosis
Posterior facet arthropahy
Aged Osteoporosis
Malignancy
Paget’s (rare in India)
Table No : 12 Causes of back pain in relation to age

Typically Lumbar spine is where people tend to place too much pressure.Such as when
lifting up a heavy box, twisting to move a heavy load, or carrying a heavy object.
Its activities can cause repeated injuries that can damage the parts of the Lumbar spine.133
(Fig No :16 )shows changes in curvatures due to imbalance.

(Fig No :17 ) shows SACRALIZATION & LUMBARIZATION
( Fig No :18 )shows SPONDYLOLYSIS & SPONDYLOLISTHESIS

INVESTIGATIONS
Investigations include plain X-ray, CT, MR and bone scan.
PROGNOSIS
A single acute attack of low back pain usually recovers fully. Attacks can however recur, making
it chronic. In other conditions the prognosis is that of the underlying cause.
TREATMENT
Acute low hack pain is treated with bed rest, with hips and knees held in the flexed position.
Local heat and gentle massage are helpful Traction is not usually required. Later lumbosacral
support (corset) may be worn while walking. Abdominal muscle strengthening exercises are
advised.
Chronic low back pain needs weight reduction, exercises to improve abdominal muscle tone and
strength, correction of posture and working habits. Pain relief is achieved with the help of
analgesics. Nacrotic analgesics should be avoided Lumbo-sacral flexion exercises may aggravate
pain. In the presence of neurologic symptoms or deficit or intractable pain, surgical intervention
is indicated. Common conditions needing surgery are disc disease, spinal canal stenosis and
unstable vertebral articulation.
• Regular exercise is an essential part of having a healthy back. In the treatment of back
pain.
• Physical therapy is an important treatment option for most back pain sufferers.
• A physical therapist is trained to carry out your doctor's orders to stretch,
• Strengthen, And exercise your back in a safe and effective way.
• Yogic asanas Mainly to strengthen the spine and muscles
• Eg Bhujangasana ,Dhanurasana ,Tadasans ,Vakrasana ,Shalabhasana, Katichakra asana,
Marjarasana, Pada hastasana, Trikonasana etc.
Dont take Back Pain lying down is the present trend.
Acute LBP: Progressive mobilization & exercise should follow after the 2 days of rest ie; as
the pain improves
Chronic LBP: may not be curable but atleast it can be made bearable133.

(Fig No : 19) shows Strength, stamina, & stabilizing excercises in Physiotherapy.
Excessive stress of the joint should be avoided while excercising as it may aggravate further
degeneration of the cartilage.135

MODE OF ACTION OF MODERN PHYSIOTHERAPY

McKenzi Technique :136
Repetetive movements changes the forces which the Disc Nucleus exerts on the wall of
the discs, the Annulus Fibrosis,which enable the ability of the vertebral elements to sustain the
pressure effects .As an increase in pressure against the Posterior disc wall can worsten symptoms
while a decrease can improve pain.
Repeated movements in 0ne plane establish a directional preference, a direction of
movements which improves the presenting symptoms.
• Stage wise changes in Physiotherapy:137
1. Reaction Phase( >4 days)
Supports Tissue Healing Process Where Range of motion is within the Pain-free range
without resistance.
2. Regenerative Phase(0-6 week)
Optimize the Normal regenerative phase (Elimination of the Debris, Revascularization,
Fibroblast proliferation) Minimize Inflammation, protect Neurovascularization, limit duration of
Inflammatory response, stimulate Protein production.
3. Remodelling Phase(1-3+ months)
Influence the Remodelling phase (Contraction of Scarr tissue, Maturation of Collagen,
Increase in Tensile strength, Re-establishes Range of movement, enhance Proprioception.
4. Ultimately
Restore R O M & Joint mobility.
Ie; Beginning with Active assisted & Active excercises with specific focus on restoring rotation
& lat flexion.
Use Manual Therapy Technique such as Joint glide to mobilize areas of stiffness.
Use Soft tissue techniques to reduce Soft tissue Resistance.
Decrease Muscle Spasm.
The Soft tissue & Manual therapy techniques restore Pain free R O M Manage Pain & Reduce
Reliance On Medication.
Providing Reassurance & Education modalities regarding the Nature of complaints & the
Rehabilitation & Recovery process

Teach Relaxation Strategies

Restore Ability To manage the symptoms.
By educating the persons with Hurt v/s Harm,by keeping up Pacing & Prioritizing
Provide functional dynamic strengthening excercises.
Restore Ability to manage the demand of job.
By adopting postural changes & day to day excercises.
Prevent chronicity & Reaggravation.
By emphasizing “Less pain , More restoration of Normal functions.”

YOGIC REVIEW
YOGA-HISTORICAL REVIEW
The word Yoga is derived from the Sanskrit root ‘Yuj’ (rÉÑeÉ) meaning to bind, join, attach
and yoke, to direct and concentrate one’s attention on, to use and apply. It also means union or
communion138. It is the true union of our will with the will of God. It thus means says Mahadev
Desai in his introduction to the Gita recording to Gandhi the yoking of all the power of body,
mind and soul to God, it means the disciplining of the intellect, the mind, the emotions, the will
which that Yoga pre-supposes; it means a paise of the soul which enables one to look at life in all
its aspect evenly. (L.O.Y)139.
The earliest and most popular yoga book is the Bhagavat Gita,which defines yoga as
‘balance’ or equanimity (samatva)
In the second aphorism of the first chapter of the Yogasutra, Patanjali describes yoga as
rÉÉãaÉ Í¶É¨É uÉ×Í¨É ÌlÉUÉãkÉ:
Means the restraint of mental modifications or suppression of the fluctuations of
consciousness is yoga.
The word chitha denotes the mind in its total or collective sense as being composed of
three categories: a) mind (manas) that is the individual mind having the power and faculty of
attention, selection and rejection; it is the oscillating indecisive faculty of the mind(b)
intelligence or reason (budhi) that is the decisive state which determines the distinction between
things and (c) ego (ahamkaram) literally the I maker, the state which ascertains that ‘I know)’ .
The word ‘uÉ×Í¨É’ (vrithi) is derived from the Sanskrit root uÉ×¨É meaning to turn, to revolve, to roll
on. It thus means whose action, behaviour, mode of being, condition or mental state. Yoga is the
method of which the restless mind is calmed and the energy directed into constructive channels.
Acharya Charaka admiring Yoga like this:
The eight prosperities which can acquire by the yogi are 1) ) cÉãiÉxÉÉã AÉuÉãvÉ the
stimulation of intellect 2) AjÉÉïlÉÉÇ ¥ÉÉlÉÇ the deep knowledge in the object 3) NûlSiÉ: the desire to
work 4) SØÌ¹ the extra sense of viewing things 5) jÉÉãiÉ - the extra sense of analyzing the hearings

6) vÉ×ÌiÉ - the recollecting capacity 7) ÌSurÉMüÉÎliÉ - devine beauty in the body (8) CwrÉi¤cÉÉmÉ SvÉïlÉ
the capacity to see what the wish. These are known as A¹ÌuÉkÉæμÉrÉïÇ . So the base of it is the
healthy body, healthy mind and the pure soul.
HISTORY AND ORIGIN OF YOGA

Yoga has a history of nearly 3000 years as compared to 2,000 years of Christianity and
perhaps 250 years of modern secular civilization. The earliest faintly Yogic ideas and practices
are to be found in the Vedas. Mystical and psychocosmological speculations are present already
in the ‘Rig-veda’(date back to above 1500BC). Other more concrete speculations and practices
of a proto yogic type can be found in the Atharva veda. Yoga was originally also most intimately
associated with the samkhya tradition. Both Budhism and Jainism, the other two great religious
cultures spawned on Indian soil next to Hinduism140, had a strong influence on the further
evolution of Yoga particularly Mahayana Budhism influenced the philosophical formulation of
Yoga under Patanjali who seems to have lived in the second century A.D.
Yet there can be no doubt that the basic ideas and techniques of Yoga ae old.
There are so many legends about the origin of Yoga.
In the fourth chapter of Sreemat Bhagavat Gita (Njana Yogam) God Sreekrishna says to
Arjuna as follows:
“This non-annihilated Yoga was adviced by me to the Adhithyan (sun) Adhithyan
adviced it to Manu. From Manu to Ishwaku”. (Bh.Git.Nja Yo.1)
“Dear Arjuna, the destructor of the enemy, thus the kings who has become equal
to Rishi by his penance (Rajarshi) traditionally acquired this. But that Yoga gradually
disappeared from this world through a long period of time”. (Bh.Git.Nja.Yo.2)
“That same Yoga is now I advising to you in the consideration as you are my
beloved devotee and companion, because it is an excellent secret truth”. (Bh.Git.Nja.Yo.3)
So it gives the evidence that firstly the Yoga introduced in the world by God
Krishna and once more he brought it through Arjuna as a part through Geethopadesam in the
field of Kurukshetra war.
Yogis believed that the creator of Yoga is God Paramasiva who adviced it to his
beloved wife Sree Parvathi.


Yoga is firstly clearly spoken of the ‘Katah Upanishat’ which was probably composed in
the 5th or 6th century. Other 21 upanishats are also describing Yoga as a part.
In the 4th, 5th and 6th centuries. A.D, after the period of Buddist decadence in India,
some great Yogis took this science act out to purify the tantric system; Matsyendranath,
Gorakshanath and a few other Yogis in the tradition found that this important science was being
ignored by the serious minded people and was being wrongly taught by others. So they separated
the Hatah Yoga and the Raja Yoga practices of tantra from the rest and they left out the rituals of
tantra altogether, and they did not even mention it.
Patanjali ,In the Yoga sutras he has divided Rajayoga into eight steps. Yama and Niyama
are the first two, to be followed by Asana and Pranayama. Then Pretyahara, Dhyana and
Samadhi are the final four. Patanjil’s contention is that you have to first perfect Yama and
Niyama, otherwise Asana and Pranayama may fail to give desirable results. (H.Y.P.E)141.
By the text Yogaparichayam Sri. Nityachaithanya Yeti, the world famous philosopher
and writer from Kerala, mentions that, in the Yajnavalkasmruthi it is said that the first Acharya
of Yoga is Hiranya Garbhan. (Yo.pa.)142 Yogaparichayam is the translation and explanations of
Patanjali’s Yogasutram in Malayalam which is considered as the best one of it.
In Yogic literature we have a few reliable texts on Hatah Yoga. The Hatah Yoga
padeepika by Yogi swatmarma is a very well known one. Another by Yogi Gorakshanth is
known as the Gorakshasamhitha. A third text is Kherandasamhita by the great sage Kherand.
Besides these there is a fourth major text known as Hatharetnavali which was written later by
Srinivasa Bhatta Mahayogindra. All these texts are considered to have been written between the
6th and 15th centuries A.D. Sivayogapradeepika, Goraksha Padhati, Chitasanthi, the Light on
Yoga etc are other well known books in Yoga. The main book publishers of India and out of the
country published a number of books about the research studies done on this subject or
explaining the main aspects on Yoga therapy. The research centres of yoga in India like. I.C.
Yogic Health Centre Bombay and International Sivananda Yoga Centre etc. published a lot of
books on this subject.

YOGIC CONCEPTS OF BODY FUNCTIONS:

As yogic practices were evolved over the years with a specific purpose of influencing
various psycho physiological functions, it would be worthwhile for us to know how the structure
and function of the human body was viewed by the yogis who contributed to this evolution.
These concepts seem to gave been based more on an empirical approach and therefore have less
objectivity, when compared to the modern concepts, which are based on experimental, analytical
and objective approaches.
The yogins had arrived at these concepts by introspection, in the form of subjective
experiences accompanying various yogic practices eg. Asana, Pranayama etc., with different
functions of the body. At the same time they also used background knowledge of Anatomy, as
recorded in the various texts of Ayurveda. The Susrutha samhitha, a treatise on surgical aspect of
Ayurveda clearly states that the anatomical description given therein is not only for the
practitioner of Ayurveda but also for the student of yoga. (Su.su.3/17)
It is essential to note here that from the yogic point of view, the body and mind unit was
never considered as made up of two separate entities. They were rather looked upon as a one
single composite organism. In the same way the structure of the human body and its functions
were never considered as two separate things but were rather treated as the two aspects of the
same organism.
The major concept which can give us the basic ideas regarding what is the nature of the human
being, its dynamism, and its body structure and functions are described below.
PANCHAKOSHA
The human body is considered to be existing and carrying out its activities
simultaneously at five of plans. The term used for this level is Kosha, which literally means the
cocoon or the sheath. And therefore panchakosha means the five different levels of existence and
operation.
The first level is that of the physical body which is made up of and is sustained by the
food (Anna) we eat, it is therefore known as Anna maya kosha (maya-full of made up of ). This
Annamaya kosha is enlivened by the prana or the life force which carries out various
physiological functions. This level of physiological activities is known as pranamaya kosha .
Apart from the vegetative functions there are various subtle functions eg. That of the mind and

intellect. The level of mental (Manas) functioning responsible for the feeling of emotion,
memory etc. is known is vijnanamaya kosha. The level of existence which is beyond all these
and which has for its basis a pure blissful conciousness (Ananda) is known as Ananda maya
kosha.
Thus a human being exists simultaneously on the level of physical body, on the level of
physiological vegetative function, on the level of emotion and memory, on the level of intellect
and on the level of pure consciousness. Not only these five levels exist simultaneously but are
inter linked, inter dependent and are interpenetrating.
We can safely say that whole of the yogic discipline aims at increasing the internal
awarness, which ultimately embraces the whole of existence of human being from the level of
gross body to the level of pure consciousness.
Prana
The human body is enlivened by the vital force which is known as prana. This prana shakthi is
responsible for the various functions being carried out within the body. There are five basic
functions for which this pranashakti works through its five different aspects. They are, prana,
samana, vyana, Apana and udana.
Nadi
The prana shakthi which works all over the body uses some specific channels through which it
moves,. These channels or passages are known as Nadi. According to the ancient scriptures there
is not a single part in the human body which has not been contact by any of the Nadis. There are
thousands of Nadis amongst which major are three Nadis:- Ida, Pingala, sushumna.
Chakras
In the process of awakening Kundalini, sadhaka has to not clear the energy channels
(nadis), but also increase the quality of prana and store it. Prana is accumulated in six main
centres along the spinal column. These centres are located in the subtle body and correspond to
the nerve plexus in the physical body. In the subtle body they are known as chakras. Chakra
means a ‘circling’ nition or wheel’. Pranashakti and manas shakthi collect in the chakras and
from swirling masses of energy. Each chakra is a conjuctive point for many nadis. There are
numerous chakras in the body, but the seven major ones situated along sushumna nadi are
specifically concerned with human evolution.

Dr. Hiroshimotoyama of Japan has devised instruments which can detect the activity of
these chakras and he has found that depletion of energy and the para normal functioning of any
of the chakras causes imbalance or disease in the associated physical organs and body functions.
This is exactly what is stated in the hatah yoga texts (H.Y.P.E)143.
Yamam, Niyamam, Shadkriyas and Pranayama are the main procedures for the
purification of chakras and nadis. Asans helps to maintain the health and stimulating the function
of these vital centres.
AYURVEDA AND YOGA
Yoga, broadly may be indicated as or related to Culture, Exercise and Autoregulation of
mind, which is achieved through regular practice of yoga, that consists of the eight steps
indicated at the outset of Yoga is intimately related to the Principle Of Equilibrium, propounded
earlier. (Ayurveda Yoga)144.
Ayurveda and Yoga are related to each other very intimately. Whatever means are there
in Ayurveda for relieving of pain may be more effectively released through regular practice of
Yoga. Indeed Yoga may be looked upon as the applied aspect of the Ayurvedic notion that pain
can be relieved through application of autoregulating mechanism inherent in human being, as
stated earlier.
In Charakasamhitha sareeram 1/130-142, 5/10-11 and 21-23 in Ashtanga hridayam
soothrasthanam 4/24, and utharasthanam 39/178 and in Ashtanga Sangraham suthrastanam 20/2
etc. admiring the Yoga as method to control the mind and Indriyas.
YOGA
Before taking to the practice of meditation, you must purify the body and its elements’.
This is the theme of Hatah Yoga.. It is true that the practices require more time and effort on the
part of the patient than conventional therapies, but interms of permanent, positive results, as well
as saving the enormous expenditure on medicines, they are certainly more worthwhile.
What makes this method of treatment so powerful and effective is the fact that it works
on the principles of harmony and unification, rather than diversity. The three important
principles on which physical and mental therapy is based as follows:
1. Confering absolute health to one part or system of the body and thereby influencing the rest of
the body.

2. Balancing the positive and negative energy poles Ida/Pingala, Prana/Apana)

3. Purifying the body of the three types of wastes (doshas)
Physical and mental therapy is one of the most important achievements of Hatah yoga. So
far, Hatah Yoga has succeeded in diseases like Asthama, diabetes and blood pressure, where
modern science has not. (H.Y.P.E.)145
The Hatah Yoga (Yamam, Niyamam, Asanam, pranayamam) and Mudras, shadkriyas are
adopted as yoga therapy. Early scientific investigations carried out by late Swami
Kuvalayananda the first scientific exponent of yoga (1924-66) and later by other sciebtists during
the last few decades could break the mystical sheeth, over so many yogic practices and reveal
their scientific explanations could be given for traditional techniques of various yogic practices
in the light of modern science like Anatomy, Physiology, Bio-Chemistry etc. due to these
researches. Possible psycho-physiological channels through which the yoga practices work
inside the body are being understood through these sciences. (A.P.Y.P)146
Lord Patanjali with his yogic method helps us to eradicate this root-cause of disease by
bringing Sarira Sudhi, Manah Sudhi, Karma Sudhi, Tithe Sudhi and as result of all these that of
Atma Sudhi.
Lord Patangali says ÌWûÇrÉ (Y.S. Sadhanapadam 16) means the pain which is yet to come
can be and is to be avoided. Therefore, Yoga is a science of preventing the suffering. Lord
Patanjali offers the ‘Astanga yoga’ as a curative and preventive measure.
The Asana Pranayama therapy147 is effective on the body mind apparatus.
Yoga, just similar to Ayurveda accepts two ways of treatment called ‘Sodhanavidhi’ and
‘samanvihi’ (ie the method of purification and the method of pacification.) Though Asana
Pranayama therapy falls mainly under the method of pacification.
What we call as a bio-chemio-therapy, in which the body chemicals are vitalized in the
body in a proper way through Asana and Pranayama.
Lord Patanjali says ÎxjÉÇUxÉÔZÉqÉÉxÉlÉqÉç (Y.S. Sadhanapadam. Sutram.46) one easily
forgets here that Lord Patanajali is stating this as perfection which comes as an ultimate result.
When the perfection comes as an ultimate result, the sadhaka will find.
1. Firmness in the body
2. Steadliness in the intelligence


3. Benevolence in the consciousness

4. Ceasing of the effort
5. Body and mind totally merging or assuming infinit form of the seer.
6. Finally the ending of dullties and differentiations at the level of body and mind.
The method of doing Asana involves action, which ultimately leads towards passivity.
Asanas consists of the actions or movements such as rubbing, squeezing, freezing, pacifying,
activising, stimulating, supporting, soothing, penetrating, narrowing, spreading, fixing, warming,
cooling etc. The movements consists of contortion, contraction expansion, extention,
circumduction and abduction. Again there are vertical, horizontal, circular, spiral and
circumfertial movements. The Asana penetrates the physiological body depthwise, widthwise,
and lengthwise.
The Asana pranayama therapy is administered according to the root cause of diagnosed
disease through the visible and peripheral symtoms are not neglected, since these symtoms need
an immediate pacification. The order and sequence of Asana pranayama on every disease is
characterized out on the basis of anatomical structure, physiological functioning, intensity,
purifying and pacifying capacity, the stage of the disease, the age of the patient as well as the
basic constitution of the patient and combination of diseases and disorders in the person.
While doing Asana the sadhaka has to undergo the three stages in performing the Asana
namely.
1. Beginning of the Asana to reach the Asana (Arambha)
2. Remaining in the Asana (sthithi)
3. And concluding the Asana to regain normal position of the body (visarjana)
Medical research on ‘Health yoga’ has shown that many of its techniques are remarkably
potent therapeutic instruments. They can restore health to an ailing body, they can to some
extend, slow the aging process, they can even reverse some of its effects.

A SKELETON OF YOGA
EIGHT STAGES SHORT DEFENITIONS
Yamam Universal moral
rÉqÉqÉç Commandments
Niyamam Self purification

ÌlÉrÉqÉqÉç by discipline
Asanam Posture
AÉxÉlÉqÉç
Pranayamam Rhythmic control

mÉëÉhÉÉrÉÉlÉqÉç of the breath
Prathyaharam withdrawl of senses

mÉëirÉÉWûÉUqÉç from objects
Dharana (kÉÉUhÉÉ) Concentration
Dhynam (krÉÉlÉqÉç) Meditation
Samadhi (xÉqÉÉÍkÉ) Super consciousness
Mudras
1. Mahamudra (qÉWûÉqÉÑSì)
2. Nabhomudhra (lÉpÉÉãqÉÑSìÉ)
3. Uddiyanam (EÌ®rÉÉlÉqÉç)
4. Jalandharam (eÉÉsÉlSUqÉç)
5. Moolabendham (qÉÔsÉoÉlkÉqÉç)
6. Mahabendham (qÉWûÉoÉlkÉqÉç)
7. Mahavedas (qÉWûÉuÉãkÉxÉ)
8. Khechri (ZÉãcÉËU)
9. Vipareethakarini (ÌuÉmÉUÏMüUÍhÉ)

10. Yoni (rÉÉãÌlÉ)
11. Vajroli (uÉeÉëÏÍsÉ)
12. Sakthichalini (mÉvÉÌ£ücÉÉÍsÉÌlÉ)
13. Thadagi (iÉÉQûÉÌaÉ)
14. Mandooki (qÉhQÕûÌMü)
15. Sambhavi (vÉÉqoÉÌuÉ)
16. Panchadharana (mÉgcÉkÉÉUhÉ)
17. Aswini (AÍμÉÌlÉ)
18. Pasini (mÉÉÍvÉÌlÉ)
19. Kaki (MüÉÌMü)
20. Mathangi (qÉiÉÉæÌaÉ)
21. Bhujangini (pÉÑeÉÇÌaÉÌlÉ)
Chart No. 8 A Skeleton of Yoga
HATAH YOGA148
It is composed of two parts, the physical and the mental.
The physical part is composed essentially of two elements, the postures (Asanas) and
controlled respiration (pranayoga). But it is the mental part. (Yamam) The hatah yogi wishes to
acquire a body as strong as steel, healthy, free from sufferings, ready for longevity. This aspects
of Hatah Yoga is adopted by the medical scientists for preventive and curative effect for the
diseases.
The suitable place to practice Hatah Yoga
The Hatah Yogi should live alone in a hermitage and practice, in a place the length of a
bow (one and a half meter), where is no hazard from rocks, fire or water and which is in a well
administered and virtuous kingdom (nation or town) where good aims can be easily attained
(H.Y.P.1/14 page – 46)149
The four limbs of Hatah Yoga are Yamam, Niyamam, Asanam and Pranayama.

YAMA :
According to the Yoga sutra (II.30) there are five yamas. They are ahimsa (non-harming)
satya (truthfulness) asteya (non-stealing) brahmacharya (chastity) and aparigraha
(greedlessness.)
The Yoga Tatva Upanishat treats scan diet (laghu ahara) as the single most important
discipline.(E.D.Y)150
Therapeutic importance of Yama

It is proved that the cause of so many diseases are emotional tensions.
So controlling the emotional tension is very essential not only for preventing the disease
but also to prevent the aggravation of the disease. The limbs of yama helps the patients to control
the emotional tensions by getting a more relaxed and peaceful state of mind.
NIYAMA:
Niyama (Patanjali. (Y.S.II/32). It has five constituent practices, namely shouch (purity)
Santhosha (contetments) Tapas (asceticism), svadhyaya (study) and Ishvara Prenidhanam.
(devotion to the Lord). The niyama ecomposses the following ten practices. Tapas (ascetism),
samthushti (contentment) astikya (affirmation) of the vedic heritage or of the existence of the
Divine, dana (liberality) aradhana (aboration) Vedanta sravana (listening to the scriptures of
Vedanta), hri (modesty) mati (conviction) Japa (recitation) and vrata (vow).
Hatah yoga pradeepika also explains the ten Niyamas as said in Trisikhi Brahmana
Upanishat. (H.Y.P.1/20)
Therapeutic Importance of Niyama
It generally denotes ‘increased’ psychological distress as a result of excessive nervous strain in
life. The stress producing agents or stressers may either be acute sudden and seven type or
chronic recurrent and milder type stress hazards decrease the quality of life and could lead to
many ailments.
The stress disorders can be planned depending mainly on the stage at which the patient has
sought medical advice.
In countries like India other measures as worshipping God either at their residence or in
the temple or by regular chanting of mantras, reading holy books like Quran or Bible etc., loudly

may also produce some mental satisfaction or relief. It appears that many of the traditional
practices and ceremonies which are directly or indirectly related to offering to God are nothing
but a sort of psychotherapy.
All these psychotherapeutic measures have a great Preventive value, but also have a great
bearing in enative medicine.
Thus the limbs Niyama develops wareness expansive feeling and deep relaxation to the
practitioner. It will bring immense benefits in physical health and emotional stability151.
ASANA :
Originally, this term denoted the surface on which the ‘yogin’ is seated. That surface is
supposed to be firm, neither too high nor too low, sufficiently big, level, clean and generally
pleasant. The word is equally applied to the cover of the seat, which can be mode of grass, wood,
cloth or different types of animal skin.
The most common technical significance of the term Asana is “posture”. This is
considered as one of the regular limbs (anga) of the yogic path and is usually listed first. The
yoga sutra the text book of classical yoga, simply stiplulates that the posture should be steady
and comfortable ie. ÎxjÉUxÉÔZÉqÉÉxÉlÉqÉç (11.46). The latter qualification implies that it should be
practiced in a state of relaxation (shaithilya). A common piece of advice is that one should also
sit up straight, with the trunk, neck, and head aligned.
Different postures are known and described in the scriptures of yoga. Originally, they
served as stable poses for prolonged meditation. Later, they were greatly elaborated and acquired
a variety of therapeutic functions leading to the sophisticated Asana technology of hatah yoga.
The scriptures of post classical yoga declare that God Shiva propounded 8,40,000
different postures. This figure is thought to represent the total number of classes of living beings.
Of this wide variety, only a limited number of ‘seats’ (peetah) are said to have been
recommended by ‘Shiva’ for spiritual practitioners. Thus the Goraksh paddhati (1.9) states that
eighty four postures are particularly suited, where as ‘Kherandra Samhitha’ (11.2) claims that
thirty two are useful to human beings (11.3.b). the new text books on ‘hatah yoga’ describes as
many as many as two hundred such postures.
Thus the Hatah yoga pradeepika (I/17) claims that the regular practice of posture induces
stability, health and bodily lightness.


The names of the Asanas are significant and illustrate the principle of evolution. Some
are named after vegetation like the tree (vr.ksha) and the lotus (padma); some after insects like
the locust (salabha) and the scorpion (vrischika); some after acquatic animals and amphibians
like the fish (matsya), the tortoise (kurma), the frog (bheka or manduka) or the crocodile (nakra).
There are Asanas called after birds like the named after birds like the cock (kukkuta), the heron
(baka), peacock (mayura) and the swan (hams). They are also named after quadrupeds like the
dog (svana) the horse (vatayana) the camal (ushtra) and the Lion (simha) creatures that crawl like
the serpent (bhujanga) are not forgotten, nor is the human embryonic state (garba panda)
overlooked. Asanas are named after them. Some Asanas are also called after Gods after Gods of
the Hindu pantheon and some recall the avatharas or incarnations of divine power. While
performing Asanas the yogi’s body assumes many forms resembling a variety of creatures. His
mind is trained not to despise any creature, for he knows that through out the whole gamut of
creation, from the lovelietst insects to the most perfect sage, there breathes the same universal
spirit, which assumes innumerable forms. He knows that the highest form is that of the formless.
He finds unity in universality. True Asanas is that in which the thought of Brahman flows
effortlessly and incessantly through the mind of sadhaka.
Therapeutic Importance Of Asanas
Difference between Yogic Exercises and Physical Culture
There are numerous modern physical culture systems designed to develop the muscles.
Physical culturist develop them by mechanical movements and exercises. Yogic exercises not
only develop the body, but also broaden the mental faculties. More over, the yogi acquires
masterly over, the involuntary muscles of his organism.
The fundamental difference between yogic exercises and ordinary physical exercises is
that physical culture emphasizes violent movements of the muscles, where are yogic exercises
oppose violent muscle movements as they produce large qualities of lactic acid in the muscle
fibres, thus causing fatigue. The effect of this acid and the fatigue it causes neutralized by the
alkali in the muscle fibres as well as by the inhaling oxygen.
It is on this theory that modern physical culturists work. They try to increase the intake of
oxygen. So that fatigue may be lessened while working. Muscular development of the body

does not necessarily mean a healthy body, as is commonly assumed, for health is a state when all
organs function perfectly under the intelligent control of the mind.
Rapid movement of the muscles causes a tremendous strain on the heart. In the yogic
system, all movements are slow and gradual with proper breathing and relaxation. Carbon
dioxide and other metabolities are produced by active muscles. A moderate excess produce their
own essential heart stimulant.
Starling’s Law of the heart
During exercise, more blood is returned to the heart than during rest. This is due to an
increased venous return, which the contracting skeletal muscles introduce into the flow blood.
The pressure on the vessels by the contracting muscles pushes the blood along and the venous
valves prevent the backward flow. The blood must move on toward the heart when pushed by the
active muscles; as a result, the heart is better filled, which in turn stretches the fibres. When the
fibres are stretched they contract more forcibly, which means a stronger heart beat and more
blood being pumped out. The more forceful contraction owing to stretching the muscles was
discovered by the physiologist starling and is called starling law of the heart.
Hence it is advisable to avoid strenuous exercises that put extra strain upon heart. The
main purpose of exercise is to increase the circulation and the intake of oxygen. This can be
achieved by simple movements of the spine and various joints of the body, with deep breathing
but without violent movement of the muscles.
Function of the muscles in heavy and moderate exercise like Yogic exercises.
When muscles contract glycogen breaks down to lactic acid and additional energy is
released. This energy is used for the reforming of organic phosphates from in organic phosphates
and/or organic compounds. One-fifth of the lactic acid so produced is oxidized to carbon dioxide
and water, energy again being released. This last batch of energy is utilized in the reformation of
glycogen from the remaining four fifth of the lactic acid. Fatigue is the result of the muscles
become temporarily unable to contract. During the strenuous exercises, for instance, we are
unable-even though respiration is deeper and faster-to breath in difference between the amount
of oxygen actually needed by the active muscles and what is actually received. Thus, after the
completion of the exercise, we continue to breath deeper and faster than we do ordinarily at rest,
inorder to repay the oxygen debt.

What happens in moderate exercise? With the beginning of moderate exercise like
housework, walking at moderate speed etc the skeletal muscles become more active than before.
A series of events occurs which results in a greater flow of blood carrying in increased supply of
oxygen and fuel to the active muscles. As muscle activity increases, muscle metabolism does
likewise. The increased metabolism means greater heat production. The warming of the muscle
slowers their viscosity and increases the efficiency of the work they perform. Body temperature
probably will not rise appreciably. The warmed blood leaving the muscles will shortly reach the
heat lowering centre in the hypothalamus. Reflex dilation of skin vessels will allow more heat
loss by radiation, balancing the increased heat production.
The increased muscle metabolism will also mean a greater output of carbon dioxide,
resulting form the increased oxidation of glucose. Increased amounts of Carbon dioxide will
diffuse into the smaller blood vessels of the muscle fibres causing the walls of these vessels to
relax. Their consequent dilation will allow more blood to flow more blood to flow more quietly
through the skeletal muscles.
The increased amount of carbon dioxide in the blood will not only exert local action but
will, in its travels help to co-ordinate regenerate responses of the circulatory and respiratory
systems with the demands placed upon them. Upon reaching the heart, the carbon dioxide
directly stimulates the cardiac muscle to stronger contraction. The more forceful beat of the
muscle will result in an increased out put of blood per beat.
The increased carbon dioxide concentration in the blood flowing through the medulla of
the brain directly stimulates the respiratory centre. (eventually the diaphragm and inter costal
muscles undergoes stronger than usual contractions). Thus breathing becomes deeper.
Stimulation of the vaso constrictor center (constrictions of arterioles of the abdominal cavity).
Causing significant increase in the peripheral resistance and the general arterial blood pressure
rises. Constriction of these blood vessels also serves to shunt blood from the abdominal organs to
the skeletal muscles whose vessels are dilated: The increased number and force of skeletal
muscle contractions squeeze down upon the veins more vigorously and thus help to pump blood
back to the heart more quietly. The respiratory pump also aids in this; deeper breathing means
greater fluctuation of the pressures with in the thoracic and abdominal cavities. The alternating

expansions and compression’s of the large veins in these cavities will be increased in force and
more blood will be forced onward to the heart.
The increased return of blood to the heart stretches the heart muscle, increasing its force
of contraction and, thereby, its output per beat. The faster heart rate plus the stronger
contractions of the cardiac muscle increase the cardiac output per minute and this, inturn, aids in
producing the raise in blood pressure. Faster and deeper breathing ventilates the lungs more
thoroughly. A greater amount of carbondioxide is thus removed in the expired air which prevents
its concentration from rising for high in the blood because too much carbondioxide can increase
the acidity of the blood to a dangerous extent.
During exercise the active muscles oxidize more glucose and do it more rapidly that before,
because of the increased temperature in them. This tends to deplete the blood sugar
concentration. Since the sugar in the blood is inequilibrium with the glycogen in the liver, a fall
in blood sugar concentration causes more glycogen to break down into glucose, which is released
into blood. As the muscles drain more glucose from the blood, more is poured into it from the
liver. Some of the lactic acid formed in the breakdown of glucose also gets into blood, is carried
to the liver and is there converted to glycogen. There is an adequate mechanism, then, for
supplying fuel to the active muscle. In moderate exercise the oxygen supply can be keep pace
with the oxygen used and no oxygen debt results. The only residual effects will be a depletion of
the carbohydrate reservation and a need for more protein to be used in rebuilding the cells that
broke down inactivity.
As we prepare to take strenuous exercise, there usually involves a mental and emotional
worming up. The memories and emotion caused by previous experiences, especially if the
exercise involves competition of the sort of another, stirrup the nervous system, to an increased
‘tone’. This helps to ready the body for the demands soon to be placed upon it. The subjective
feelings may induce autonomic effects; a quickened pulse, faster breathing and dialation of the
pupils are not uncommon at times like this.
The many changes previously described for moderate exercise take place in strenuous
exercise too. You might imagine there would be even more, but where differences occur they are
mainly differences in degree rather than in kind. The heartrate is faster, blood pressure higher,
respiration faster and deeper and circulated time more rapid than in moderate exercise.

Adrenalin may be released from the adrenal medulla and, in the respiratory and circulatory
changes. It would also favour the release of glucose from liver glycogen and delay fatigue of
skeletal muscles.
The greatest limiting factor for the maintenance of severe exertion is the oxygen supply.
Eventhough the spleen is stimulated to contract and discharge red blood cells into the blood, the
intake of oxygen cannot meet the muscular demands for it, consequently, lactic acid is
accumulated in muscle and in blood. Without sufficient oxygen to reconvert, fatigue sets in.
There is a limit to the size of the oxygen debt that an individual can incur and here is where the
yogi emphasizes slow-motion exercises.
What factors modify or influence the efficiency of a muscular act? There are five important
factors – the initial stretch of the muscles, temperature, the viscocity of the muscles, the speed
performance and fatigue. It has been noted that stretching a muscle before it contracts enables it
to contract more forecibly. A stretched muscle can, therefore, perform more work than one only
normally relaxed.
It has been proved that more work is done in lifting moderately heavy weights than in
lilfting higher or heavier ones. Thus moderately loading a muscle is the most efficient way of
getting the most work done. When not stretched enough, the muscle is not very efficient.
By viscocity is meant internal friction, the friction resulting when molecules rub against
the frame work of the muscles fiber during contraction and retard the contraction process. Part of
the energy developed during contraction must be used in overcoming this internal resistance.
Viscocity thus decreases efficiency. It has been shown that when a muscle contracts slowly, less
energy is required to perform a given amount of work than when it contracts slowly, less energy
is required to perform a given amount of work than when it contracts rapidly. The greater the
rapidity of contraction, the faster the fluid protoplasm flows through the structural frame work of
the muscle fibre and the more friction develops. Although viscosity is wasteful of efficiency, it is
really an inherent factor of safety. It acts as a brake to prevent muscles from responding so fast
as to tear themselves apart.
From what has just been said about viscocity, it must be apparent that there is some
optional speed of muscular contraction which is most efficient. Too great a speed of contraction
results in little work, because of increased internal friction and consequent lowered efficiency.

Too slow as a speed, on the other hand, although it permits a large amount of work to be done,
results in the expenditure of much energy in maintaining the contracted state, efficiency is again
low. A moderate speed of performance is, therefore, most efficient. It is now being recognized
that driving a man at his work to the point of exhaustion is not practical, with regard to the health
of the individual or with respect to getting more and better work done.
Much of the increased efficiency is due to the increase in co-ordination and sureness of
performance that training develops. These effects depend upon the central nervous system.
Moderate and consistent yogic exercises, aside from making you feel better and relax, can help
your body to become more adequate for the demands placed upon it. By properly following the
yogic exercises, we can check the accumulation of toxic acids and can eliminate than if already
over accumulated in the blood itself. Yogic exercises pay great attention to the spinal column and
other joints. More, over they maintain an even supply of blood to every part of the body.
And also it maintains the elasticity of the muscles and arteries, pressure between beat of
the heart, steady blood flow etc.
Mobilisation of the joints
The first indication of ossification of bones is noted in the eighth week of intra uterine
life. Long after birth, the final stages in the replacement of the cartilage by bone occurs. Bones
continue to grow in circumference by the deposition of new bone from the deeper layers of the
deeper layers of the periosteum, on the external surface. The cessation of growth of bone occurs
at about eighteen years of age in girls and soon after twenty in boys.
In addition to supporting the frame work, the skeleton provides places of attachment for
muscles, tendons and ligaments. Above the pelvis are piled twenty four vertebrae. The frame
work of the body not only stands, but bends, sways and twists.
The movements are restricted for most persons, owing to biologic shortening of ligaments.
The average individual can no longer touch the floor with his finger tips when his knees are
straight, even at the age of twenty. This type of ligamantous stiffening can be kept at a minimum
through yogic exercises and the body will be as pliable as a child’s even at the age of eighty.
The bindings in man are known as ligaments, which are bands of sheets of fibrous tissues,
connecting two or more bones, cartilages or other structures. If posture and balance are good, the
ligaments have along and elastic life. If not, they cause discomfort, pain and trouble. There fore,

it is essential that we examine the nature, function and mobility of the spine and its ligaments
that play a prominent role in yogic postures.
As man grows older his backbone, stiffens because the ligaments become
tighter(dehydrated). It must be remembered here that the ligaments structures are continuous and
if mobility is restricted in any area, the entire attachment is affected, this brings general
immobility of the body.
Excessive stiffness can be due to different causes, but especially to faulty body alignment
and poor-balance, which cause shortening of the ligaments in the vertebral column can be
noticed in those who sit a good part of the time, such as students, office workers, and artists. This
is because persons in a sitting position thrust the head and neck forward and cause the spine to
compensate by forming a round back.
The yogi gives great attention to the vertebral column and its ligaments the pillar of the
support of the trunk and cranium, which also protects the spinal cord and the roots of the spinal
nerve. The spinal nerves energe between the vertebrae.
For definite curves are noticeable in the vertebral column, namely, cervical, thoracic,
lumbar and pelvic or sacral.
All four curves lend resilience and spring to the vertebral column, which are essential for
walking and jumping. Improper positions may exaggerate the curves of the vertebral column. An
increase in the thoracic curve is called kyphosis; in the lumbar curve, lordosis. A lateral
curvature of the spine is called scoliosis. Owing to tuberculosis of the vertebrae, erosion of the
bodies of the vertebrae may take place, resulting in abdominal curvature.
Yogic exercises are mainly designed to keep the proper curvature of the spine and to
increase its flexibility by stretching the anterior and posterior longitudinal ligaments.
A yoga practitioner, even at an advanced age, maintains flexible ligaments and spine.
Some of the difficult yogic exercise demonstrate just to what degree the human body can be
trained to maintain maximum pliability of the spine and the various joints.
Connection between the Endocrine system and Yoga
Yoga therapy aims through its various postures to restore the internal secretions of these
glands to their normality. There are different exercises for the strengthening of different glands.

Yogic postures help to strengthen the endocrine system through exercise, and also being
the emotions under control through concentration and relaxation152.
Mechanism of A sanas
We know that the central nervous system (CNS) uses the lower centres of integration for
the maintenances of posture and equilibrium. These lower centres are situated in the medulla,
pons, cerebellum, midbrain and basal ganglia. Various reflexes are integrated by these lower
centres, below the level of consciousness to maintain the posture. Postural reflexes take place
involuntary due to the stimulations of different sensory proprioceptors and visceroceptors in
muscles, joints, tendons, sole of the foot etc. A tonic rhythm could be regulated by the lower
centres quite independently and efficiently when the higher centres in the cortex do not interfere
with them.
Any voluntary effort on the part of body or mind signifies an activity of the higher
centres which dominate the lower centres for the postural reflexes. The motor impulses are
directly passes on to the skeletal muscles. In this, one may exceed his own limits to bend or to
stretch which would cause many more further disturbances to him.
Some considers Asanas as exercise, practice then either in the form of isometric or
isometric or isotonic exercises, and continue this practice forever.
Naturally the results will be different according to the way of performance. We would
consider first the isometric elements as and when brought about in the practice of Asana and then
discuss their performance according to the tradition.
Inorder to achieve the final stage in Asana one puts his voluntary efforts. The muscles and
joints are actively stretched and are maintained as such for sometime in the final stage. Such
sustained contractions of the muscles against resistance is nothing but the isometric exercise.
Active stretching-pulling of the muscles results in an active contraction as a result of stretch
reflex mechanism. Tension is increased which is felt in the joints, tendons and muscles. If it is
severe, it gives arise to pain and one becomes uncomfortable. This brings in fatigue and
exhaustion or even tremors in the body. Such isometric activity puts extra load on the circulation
and the respiration as the demand of energy and oxygen from muscles increases. Experimentally
it was observed in the case of pachimottan that when it is practiced with such isometric element,
increases the heart rate. One remains disturbed by the sensation of tension, pain and discomfort

in the body. He cannot concentrate his mind anywhere and gets irritated and despaired. Due to
these disturbances, one is compelled to release the A sana in a very short time.
Such performance acts mainly on superficial muscles than on the deep muscles and their
nerves. Internal pressure changes and proprioceptive mechanisms hardly get any time to
influence the nervous system. One cannot experience the special pattern of posture as the
sensations are dominated by heavy muscular tensions. The active element in the practice will
stimulate the sympathetic activity which would give rise to some other unwanted mechanisms in
the body and develop more psycho-physiological tensions.If the individual continues such
practice for months together Irritability, tension inflated ego-consciousness, offensive and
impulsive nature etc., are the probable symptoms in such individuals practicing the A sanas in
this way.
However, for the hypotonic conditions of the individual, slightly active stretchings and
sustained contractions will develop necessary tone and strength in various muscles. The
individual would feel active, fresh and enthusiastic due to sympathetic action.
Experimentally, it has been observed that inspite of an excellence in the posture the
degree of contraction of muscles(EMG activity) was increased due to such isometric element
brought into the practice and the duration of maintenance was decreased. This indicates a heavy
strain, developed unnecessarily in the musculature which may reflect upon the cardio vascular
system.
Sometimes Asanas are also practiced as freehand (isotonic) exercises where each A sana is
repeated for three or four times rapidly even with jerky movements. Here the movements are
more prominent, leaving no time for the maintenance of the posture. The yogic value of such
isotonic (dynamic) practice is very much doubtful eventhough they may improve stamina and
endurance of the body. They cause more heat and sweat production, and give rise to sympathetic
activity. They strain the cardio vascular system, consume lot of energy and consequently exhaust
the body. For hypotonic conditions of the muscles however, this sort of exercise is useful along
with a slight increase in the muscular efforts.
Now let us consider what happens when A sana is practiced with proper relaxation in the
muscles or with reduced voluntary efforts and without any tension in the joints, muscles tendons
etc. The attention is focused on the infinite or simply on the breathing process(pranadharana).

This attitude of an observer (as a third person) where the awareness is directed towards the
breath, further relaxes the body and slackens the voluntary efforts. Mind remains engaged in
such a thing from where no thoughts are possible to come. In the absence of mental thought
processes and voluntary efforts, there is no cortical activity for the period of maintenance of
Asana. The tower brain centres of posture and equilibrium are now free to work efficiently. The
type of postural reflexes and their stimulations, however, depend upon the particular pattern of
posture adopted.
It will be seen that most of the A sanas resemble the postures which are natural postures
for the lower animals like crocodile, cobra, fish, peacock etc. Which are maintained by their
lower brain centres involuntarily. It seems therefore that the patterns of A sanas have been
purposely designed to give maximum scope to the lower centres of integration. Also, in the
absence of cortical influence there is no activity on the emotional or intellectual level and
therefore there is no tension to disturb the individual atleast for a few seconds.
In such type of effortless, easy and comfortable maintenance of the posture, various
muscles- tendons and joints are stretched smoothly and pleasantly. This static stretching with
relaxation is known as passive stretching where the stretching of the muscles and tendons do not
cross the natural limits and therefore there is no strong reflex contraction of the muscles. On the
contrary muscle may surrender easily to such passive stretching, offering no resistance. There is
no question of muscular tension on the other hand the muscle tone remains at its optimum level
or even gets reduced to a great extent depending upon which muscles are involved in which
pattern of posture. We have seen that the muscle tone is the basis of posture and gets influenced
by emotional or psychological state of an individual. When the muscle tone is reduced due to the
passive stretching of the joints and muscles, it has got a soothing or tranquilising effect on the
nerves. the emotions cannot remain elevated. They are calmed down. The sympathetic activity is
with drawn and the para-sympathetic activity restores the stability on various levels. Now the
body starts telling the mind through various sensations which are perceived from proprioceptors
and are integrated by the lower centres, involuntarily. That is why a long term effect of such
performance is seen on the behavioral pattern of the individual.
Electromyographic (EMG) studies have also shown that the effortlessness and the
relaxation brought by the above method could reduce the muscular activity or tension in the

muscles. The duration of maintenance was also increased by 10 to 50% and the Heart rate did not
increase more than 6%. This indicates that energy cost of these A sanas was reduced to a great
extent. Therefore there is no question of exhaustion or strain on the cardio respiratory systems.
Individual could spend more time to maintain the Asanas, which is important to get maximum
benefits from the adopted postural pattern. The passive stretching of muscles and ligaments get
more time to percolate deeply upto the periosteum (covering of the bone) and capsules and
stimulates the circulation around them. This mild exercise thus maintains their normal healthy
condition by making them more flexible.
The visceral organs are made of smooth muscles which are also influenced by the
emotional state of the individual. When the skeletal muscles of the limbs are relaxed, A sanas
mainly work on the trunk area and the smooth muscles of the visceral organs. The mild pressure
changes in the internal organs get enough time to stimulate the autonomic nervous system,
particularly the parasympathetic branch of it, which maintains the muscle tone of these organs at
the optimum level. Thus the emotional activity (of hypothalamus) of the individual is tackled
also through the mechanism.
It will be clear by now that the hypertonic conditions of the individual, could be easily
tackled with such performance which would reduce the rigidity of the various joints. The
relaxation thus started at the muscle joint level is important to release the tensions at the higher
level.
Hints and cautions for the practice of Asanas
Hatah yoga pradeepika gives so much advises on the diet and other restrictions and
certain precautions. It do not giving any age bar for practicing yoga and also says that one who
practicing yoga will get better results but not get it only on reading the literature of the
same.(H.Y.P.1/74)153.
But in the new edition of the text light on yoga (published on 1994) the Hints and
cautions for the practice of A sanas given as follows: (important points only)
The requisites
Without firm foundations a house cannot stand. Without the practice of the principles of
Yama and Niyama, which lay down firm foundation for building character, there cannot be an

integrated personality. Practice of A sanas without the backing of yama and Niyama is mere
aerobatics.
The qualities demanded from an aspirant are discipline, faith, tenacity and preservance to
practice regularly without interruptions.
Cleanliness: Before starting to practice A sanas, the bladder should be emptied and the bowels
evacuated.
Food: A sanas should preferably be done on an empty stomach. (satvik food [vegetarian food] is
recommended)
Cloth: Loose cloths like pyjama and half shirts are more suitable for both gents and ladies.
Time: The best time to practice is either early in the morning or late in the evening. (5 AM to
7AM, 5PM to 7Pm)
Place: They should be done in a clean airy place, free from insects and noise. Do not do them on
the bare floor or on an uneven place, but on a folded blanket laid on a level floor.
Closing the eyes: In the beginning keep the eyes open it will help to correct the mistakes in what
you are doing. Keep the eyes closed only after getting perfection in A sanas.
The brain: During the practice of A sanas, it is the body alone which should be active while the
brain should remain passive, watchful and alert.
Breathing: In all the A sanas the breathing should be done through the nostrils.
Sava sana: After completing the practice of A sanas always lie down in Save sana for atleast 10
to 15 minutes, as this will remove the fatigue.
Continuity: Continuous practice will change the outlooks of the practitioner. So do it daily. (At
the menses period the female patient must avoid doing yogasanas. When doing A sanas they take
special care in Sirshasana and Sarvangasana)

BHUJANGASANA REVIEW
BHUJANGASANA
Definition-It consists of 2 words- Bhujanga+ Asana
¾ Bhujanga-sarpe (serpent)
¾ Asana-Asyate aste va anena iti Asana.That which gives steadiness & comfort to the body.
¾ The Asana which resmbles the “hooded snake”
¾ Bhujangasana comes under Yogic procedures done in lying down prone position.
¾ Also called as the “cobra pose”-as it resembles the pose of hooded cobra & also as it is said
to influence the kundalini shakti.
Procedure-Gheranda samhita-155
AÇaÉÑ¸ lÉÉÍpÉ mÉrÉïliÉÇ AkÉÉå pÉÔqÉÉåÌuÉïÌlÉlrÉxÉåiÉç |
kÉUÉÇ MüUiÉsÉÉprÉÉÇ WØûiÉç FkuÉïÇ zÉÏwÉïÇ TühÉÏuÉWûÏ ||
SåWûÉÎalÉuÉïkÉïiÉå ÌlÉirÉÇ xÉuÉïUÉåaÉ ÌuÉlÉzÉMü |
eÉÉirÉjÉïÇ pÉÑeÉaÉÏ SåuÉÏ pÉÑeÉ…|xÉlÉ xÉÉkÉlÉÉiÉç || (ZÉåUhQû.xÉÇ.Ì²iÉÏrÉ EmÉSåzÉ.)
¾ The lower part of the body from toes upto the navel touch the ground.place the palms on the
ground & raise the head like a serpent.
¾ Lower the buttocks & hip to the floor,straightening the elbows,arch the back & push chest
forwards into the cobra pose.bend the head back & direct the gaze upward to the elbow
center.The thighs & hips remain on the floor & the arms support the trunk.Unless the spine is
very flexible the arms will remain slightly bend.
¾ Step by step adoption of procedure & the complete lumbosacral extension when achieved
(during the headed cobra pose) will be maintained for about 1 minute & slowly coming to
the prone position.
Portions involved
Neck, chest,abdomen , back & waist.
Breathing
Slow inhalation while extension & exhale while lowering the torso.

Duration
Practice upto 5 rounds daily,gradually increasing the time of the final position.
Awareness
Physical on relaxation of the spine.
Effects.(yoga science for everyone)
Neck muscles are stretched & thyroid gland stimulated.
Muscles of the chest & abdomen slowly stretched
All the vertebrae & concerned muscles are stretched & relaxed.
Neurovascular Functions of spine improved
Back ache is relieved.
Benefits156-AÇaÉÑ¸ lÉÉÍpÉ mÉrÉïliÉÇ AkÉÉå pÉÔqÉÉåÌuÉïlrÉxÉåiÉç |
MüUÉprÉÉÇ cÉ kÉUÉÇ M×üirÉÉÇ WØûiÉÔkuÉï zÉÏwÉïÇ TühÉÏuÉWûÏ ||
SåWûÉÎalÉuÉïkÉïiÉå ÌlÉirÉÇ xÉuÉïUÉåaÉ ÌuÉlÉÉzÉMÇü |
eÉÉirÉjÉïÇ pÉÑeÉaÉÏ SåuÉÏ pÉÑeÉ…|xÉlÉ xÉÉkÉlÉÉiÉç || (WûPûrÉÉåaÉ mÉëSÏÌmÉMü )
Kundalini is aroused,heat of the body increases & all the diseases are destroyed.

METHODOLOGY OF BHUJANGASANA 157:
(Fig No : 20) shows Methodology of Bhujangasana.

Bhujangasana Related Anatomy pertaining to Lumbosacral jt:

Spine is made up of bones & cartilages .Ligaments & muscles connect these bone to
form the spinal column.
Bone158 is a connective tissue impregnated with the inorganic materials calcium salt which
makes it hard & rigid,which can afford resistance to compressive forces of weight bearing &
impact forces of jumping. The organic connective tissues collagen fibres makes it tough &
resilient(flexible), which can afford resistance to tensile forces.In strength,bone is comparable to
Iron & steel.& it is highly vascular,with a constant turn over of its calcium content.It has greater
regenerative power than any other tissues of the body,except blood.It can mould itself according
to changes in stress & strain it bears.It shows disuse atrophy & overuse hypertrophy.Bones store
97% of the body calcium & phosphorous.Bone marrow contains reticulo endothelial cells which
are phagocytic in nature & take part in immune responses of the body.
Vertebra: Body is long bone
Classified as Irregular Bone
Intervertebral Joints: Amphiarthrosis, Secondary Cartilaginous joints.(between the body)
Plane Synovial joints.( Jts between the Articular process of vertebra)
Hip Joint: Ball & Socket joint (spheroidal joint),where globular male surface fit into a cupshaped
female surface.
Cartilages are connective tissue composed of chondrocytes & collagen & yellow elastic fibres
embedded in a firm gel like matrix which is rich in mucopolysaccharide.It is much more elastic
than bone.It has no Blood vessels & lymphatics & nutrition of cells diffuse through the
matrix.Cartilages have no nerves,hence it is insensitive.The articular cartilage has no
perichondrium,so that its regeneration after injury is inadequate.when cartilage calcifies,the
chondrocytes die & the cartilage is replaced by the bone.
Joint is a junction between 2 or more bones or cartilages.It is a device to permit
movements.Amphiarthrosis- are joints with slight movements.A pad of cartilage lies between the
bone surfaces, and there is a fibrous capsule to hold the bones & cartilages in place.Like The
intervertebral discs ,which strengthened by extra collagen fibres.The joints between the Articular
processes of vertebrae are Plane Synovial joints,where the articular surfaces are more or less
flat/plane.They provide gliding movements/translations in various directions.

Angular Flexion: decreasing the angle between two bones.

Extension: increasing the angle between two bones.
Abduction: moving the part away from the mid-line.
Adduction: bringing the part towards the midline.
Rotatory Rotation: turning upon an axis.
Circumduction: moving the extremity of the part round in a circle so that the
whole part inscribes a cone .
Gliding One part slides on another.
Table No: 13 Movements possible at synovial joints
Angular Flexion: decreasing the angle between two bones.
Extension: increasing the angle between two bones.
Abduction: moving the part away from the mid-line.
Adduction: bringing the part towards the midline.
Rotatory Rotation: turning upon an axis. Medial & Lateral

Circumduction: moving the extremity of the part round in a circle so that the
whole part inscribes a cone .
Table No: 14 Movements possible at Ball & Socket Joints
At the Hip joints movements occur around at an indefinite number of axes which have a
common centre & all the movements occur quite freely159.
Classification & Movements of Synovial joins:160

Terminology & Definition
Human Kinesiology: Study of Geometry of surfaces & their associated movements.
Male Surface:An articulating surface which is larger in surface area & always convex in
all directions.

Female surface:An articulating surface which is smaller & concave in all directions.
Simple Joints:Joints with only 2 articulating surfaces,ie; Male & Female.
Compound Joints: Joints possessing more than one pair of articulating surfaces.
Degrees Of Freedom: Number of axes at which the bone in a joint can move.
Uni-Axial: Movement of bone at a joint is limited to one axis ie;with one degree of
freedom.
Bi-axial: With 2 degrees of freedom
Multi-axial: Three axes along with intermediate positions also.
Translation:Sliding movements of 1 articulating surface over the other.
ORTHO KINETICS :161

• Ortho kinetics is derived from 2 terms
• OrthoÆStraight/Normal/Correct /pertaining to the erect posture.
• Kinetics/ kinematicsÆThe scientific study of the turnover or rate of change of a specific
body factor.
• KinesisÆmovement or activation.
• KinesiologyÆscientific study of movement of body parts,which is a branch of
biomechanics.
• Kinesi therapyÆthe treatment of disease by movements or exercise.
• Humans have the capacity to produce a nearly infinite variety of postures and movements
that require the structures of the human body to both generate & respond to forces that
produce & control movement at the body joints.
• Kinematics includes the set of concepts that allows us to describe the motion
(displacement) of a segment without regard to the forces that cause that movement.
Kinesiology includes-2 fields of study osteo kinematics( deals with bone movements) &
athro kinematics ( concerned with the analysis of articular movements)
Description Of Motion:
• Motion can be described as the displacement of a body segment (bone & joint).
• There are kinematic variables to describe the displacement they are

-type of displacement
- location in space of the displacemet.
-the direction of displacement of the segment.
-the magnitute of the displacement.
-rate of displacement or rate of change of displacement (velocity or
acceleration)
Types Of Movements:
• Joints permit 4 kinds of movements.
• Gliding,Angular,Circumduction,Rotation.
• GlidingÆTranslation, one surface slides over another..It is an important element
combined with other movements in many joints.
• Angular movementÆIncreasing or decreasing the angle between adjoining
bones.Occurs around axis set at Rt angles to each other.Its of 2 types (in limbs especially)
Flexion/bending-Extension/straightening
Abduction-Adduction.
Flexion-occurs around a transverse axis & results in the approximation of 2
morphologically ventral surfaces.Considered to be the position of foetus in uterus.
Extension-Approximation of 2 morphologically dorsal surfaces.
Abduction-AdductionÆOccurs around an Antero-posterior axis. It’s the movement away
from & towards the midline of the body.
• CircumductionÆOccurs when a long bone circumscribes a conical space,(where base
of the cone is described by the distal end of the bone) & Apex is at the articular cavity.It
is a derived movement with flexion-extension, abduction-adduction elements
compounded.
• RotationÆOccurs when a bone moves around some longtitudinal axis.eg:atlanto axial
joint.
2 types of rotationÆAdjunct & Conjunct rotation
Adjunct rotation-carried out as an independent movement.
Conjunct rotation-occur as inevitable accompaniment of some other main movement.

• With the exception of simple movements of translation, all other movements of bones are
in fact rotations.
• Flexion-extension, abduction-adduction ,all angular movements are rotations of bone
around other 2 axis.
Ortho kinetics deals with
• Generalization of movements
• Contribution of joint surfaces to these basic movements
• Significance of certain joint positions.
Generalization Of Movements:
• Generalization of movements possible by first considering the shape of the articular
surfaces by replacing the irregularly shaped bone by a single straight line called the
`mechanical axis’.
• Basic types of bony movements & movements of joint surfaces are contemplated.
• Certain joint positions & its significance is understood.
Joint Design:
• Form follows Function.
• To ascertain the function of different joints we need to examine their structure (anatomy
of joints).
• Once joint & tissues have assumed their final structural form,they can still be influenced
by change in functional demands.
• Human joints are composed of living tissues( which can change its structure in response
to changing environmental or functional demands),comprising-connective tissue in the
form of bones,bursae, capsules, cartilage, discs, fatpads, labra, menisci, plates, ligaments,
& tendons.
Types Of Articular Surfaces :
• Close examination of articular surfaces shows that they are never perfectly flat,
neither are they parts of spheres, cylinders, cones or true ellipsoids.
• They appear much more nearly parts of the surface of ovoids (egg-shaped bodies) ,&
some with the shape of saddle.

Ovoid. Sellar/Saddle shaped.

Male-if surfaces are convex convex in one plane &
in all directions. & concave at Rt angles
Female-if surfaces are concave to this.
in all directions.
Table No: 15 Two types of Articular surfaces
• Degree of Curvature of the Articular surfaces (Ovoid/ Sellar shaped)

There is difference in the displacement of joint with the difference in degree of curvature of
the articular surfaces.
• Descriptive terms applied to the ovoid surfaces.
• Chord (Geodesic)-A curved line across the surface on a plane, joining the two points on an
ovoid surface.It forms the shortest distance between two points which is a straight line.
• Arc (Non-Geodesic)-Longer curved line joining the point is an Arc.
Any point moving across an ovoid surface traces either a chordal or an arcuate path.
• Triangle-The figure enclosed by 3 chords is termed a Triangle.The sum of its angles exceeds
180* on an ovoid surface.It is less than 180* on a sellar surface.It is precisely 180* if the
surface is flat.This amount of variations in the surface degree is based on the degree of
surface curvature.
• Trigone-Any 3 sided figure in which atleast one side is an arc is called a Trigone.
• Evolute-Is considered as the line joining the centres of the circles(with changing diameter in
a profile) of longtitudinal section of the ovoid surface
• Examination of the profile of a longtitudinal section through an ovoid surface reveals 2
important properties of joint mechanics.
(i) Radius of curvature of surface varies continuously across the profile. Like being
formed of a series of short segments of circles of changing diameter.The line joining
their centres is known as evolute of the profile.
(ii) The rotation of a body across such a surface slide across the successive points on the
evolute.

If we consider the male ovoid surface (with extensive surface area) is sliding over smaller
female ovoid surface 2 will perfectly fit in the closed pack position.
In all other positions- surface is not congruent( Area of contact between them is reduced &
wedge shaped intervals seperates the surfaces)
Mechanical Axis Of a Bone & Movement of a Bone:

It is a reference point around which the joint mechanics can be studied & around which the
most habitual conjunct rotation occurs.
• Similar articular movements will result in similar displacements of the mechanical axis
but the accompanying movements of the remainder of the bone may appear dissimilar.
Basic type of Bony movement & Movements of the Articular surfaces

Spin: Simple Rotation around the bone’s stationary mechanical axis.
Swing:Any other displacement of the bone & its mechanical axis apart from spin is termed a
swing.Pure/ Impure swing( based on the element of spin along with it)
Ovoid of Motion: This represents the imaginary surface which would include all possible paths
of a point on the mechanical axis at some distance from its related joint.
is a useful concept considering the positional changes of a bone.
• During any swing,a point on the mechanical axis of the bone some distance from its
related joint will describe a curved path in space & if all such paths are considered , they
are found to fall upon part of the surface of an ovoid.
• Area & shape of ovoids of motion vary greatly with individual bones & articular surfaces
- in any swing the point on the mech.axis will move from position X to position Y on
the ovoid of motion either along a chord(cardinal swing) or along an arc (arcuate swing-
inevitably associated with spin).(Fig No:21 )
• In every bone movements the axis will be tracing a reciprocal arcuate or chordal path of
the ovoid of motion in the joint surface. (Fig No : 22)

Habitual Movements
• Habitual movements of all joints are always accompanied by some degree of conjunct
rotation.
• They are considered as the fundemental arthro kinematical considerations.Conjunct
rotations necessarily accompany particular movements or successions of movements at a
joint.
• Conjunct rotationssÆare spins accompanied by certain varieties of swing & are
characteristics of movements at both sellar & ovoid joints.
• Adjunct rotationsÆany other rotation of the bone (resulting from the interplay of
gravity,additional externally applied forces & muscle action)
• They may involve the joints where the bone is undergoing no simultaneous conjunct
rotation or one in which the latter is to be considered.
• The factors causing adjunct roataion generates a pure spin of the bone.
• The factors which can add to or nullify the effect of the oncoming conjunct rotations.
cospin-with additive effect,increasing the rotation anti spin-with opposite
effect,nullifying the effect of conjunct rotation.This occur gradually through out the
evolution of movement & suddenly near its termination.
Accessory Movements
• The term accessory movements will be used to designate all movements which cant be
performed actively in the absence of resistance.
• The active movements performed by a joint is not necessarily the movements permitted
with the particular structure of that joint.
• Certain voluntary movements can be performed by the joint if resistance is encountered
to the active movements, they are considered as Type 1 accessory movements. eg:its only
when the solid object (a cricket ball) is grasped in the hand, that the fingers can be rotated
at metacarpophalangeal joints.
• Certain movements can be performed by the joint if the muscles acting on the joint are
fully relaxed,ie; performed passively, they are considered as Type 2 accessory
movements.


eg;when the supported arm is partially abducted at the shoulder joint, a distractive force can
draw the humerus away from the glenoid cavity
• Based on these resistance factors the movements can be classified as –Active & Passive.
• Characteristic of many joints when they are in loose packed position is that they can
perform “passive movements”(ie;the movements can be performed passively when the
concerned muscles are relaxed) And Active movements are that which can be performed
actively in the presence of resistance
Joint Positions:
• In close packed position-the surfaces fit together precisely.
-in all other positions-surfaces are a poor fit.
(loose-packed position)
The closely packed position or perfectly congruent position of the mating pair of
articular surfaces occurs at one extreme of the most habitual movement of the joint ie;at
the full congruent state.
• At the final position of close packing joint surfaces become fully congruent,their area of
contact is maximal ,they are tightly compressed,fibrous capsule & ligaments are
maximally spiralized & tense & no further movement is possible.Surfaces cant be
seperated by distractive forces, 2 articulating bones can be regarded as temporarily
locked together (as if they had no joint between them)
• Such an extreme position is only assumed when “a special effort is to be undertaken”
• And the articular surfaces are maximally liable to trauma because of the rigidity of the
position & enormously generated stresses.
• Any force which tends to further change the position is actively resisted by reflex
contraction of the appropriate musculature.
• In this “actual position” taken up by joint ,the elastically deformable tissues (ligaments &
articular cartilages)are in equilibrium & is balanced by its resistance to further
deformation of joint .
• Maintenece of erect posture with minimal expenditure of muscular energy – is in
symmetrical easy standing (when the knee & hip joints approach their close packed
positions.)

The loose packed position-the articular surfaces of joint are not congruent & the
articular capsule is lax.
• The laxity of articular capsule-allows a separation of articular surfaces (when applied
external distractive force) near the mid-range of joint movements.
• Ill fitting articular surfaces-is advantageous in number of ways (particularly if Male
surface has a smaller radius of curvature than the Female)
(i) it allows combined elements of spin, roll & slide.
(ii) the contact area between 2 surfaces is greatly reduced & frequent change in
the articular surface contact area.
(iii) if the wedge shaped intervals seperating the surfaces around contact area are
filled with small volume of synovial fluid.
Range Of Movement:
• More when male surface have smaller radius than the female surface
• The combined elements of spin,roll & slide increases the effective range of joint
movement.
• The reduced & frequently changing contact area diminishes the frictional & erosive
effects.
• The shape & fluid around the contact area maintain efficient joint lubrication & nutrition
of the avascular articular cartilages.
• Less with factors limiting the movement.
• The tension of ligaments limits the habitual movements.
• The tension of antagonistic muscles by its passive elasticity & reflex contraction acts
against the movement.
• Approximation of soft parts concerned limits further movement.eg;in flexion of knee &
elbow & elevation of mandible is limited when it is in contact with the teeth.
• When externally applied compressive or tensile forces including gravity causes a final
compressive force between the articular surfaces.

• And specially in synovial joints,when the fine film of synovial fluid between the surfaces
which maintains the apposition & thus helps in various postures & during movement, if
deficient.
• Joint close packed position.

• Shoulder joint Abduction & Lateral rotation
• Ulno humeral joint Extension
• Radiohumeral joint Semi flexion & pronation.
• Wrist joint Dorsi flexion
• Metacarpo phalangeal Full flexion
(2-5)
• Interphalangeal jt Extension
• 1 carpo metacarpal Full opposition
• Hip jt Extension & medial rotation
• Knee jt Full extension
• Ankle jt Dorsi flexion
• Tarsal jts Full supination
• Metatarso phalangeal jts Dorsi flexion
• Interphalangeal jts (toes) Dorsi flexion.
• Vertebral jts Dorsi flexion.
Table No: 16 shows Joint Positions Of Principal Joints
General changes with disease,Injury,Immobilization,Exercise & Overuse :

• DiseaseÆdisease process hampers the normal functioning of synovial membrane & fluid &
the stress caused erosions & splitting of articular cartilage occurs.
• InjuryÆlike tearing of the ligaments causes joint instability & articular cartilages becomes
thicker & shows fibrillation,& osteophytes are present,synovial fluid content also in the
joint is increased & seen subchondral thickening of the bone.
• Immobilization (stress deprivation)Æreferred to as position of comfort as pain is decreased
in this position.An injured joint or joint subjected to inflammation & swelling will assume


a loose-packed position to accommodate the increased volume of fluid within the joint
space,which is the position of minimum pressure.Immobilization for a few weeks helps in
adaptation of joint capsule & for development of contractures in the soft tissue.
• ExerciseÆinorder to tackle the deleterious effects of immobilization (like weakening of
bone,shrinking of capsule,decreased tensile strength of ligaments & tendons,loss of
sacromeres in the muscle,swelling in the cartilage) passive excerceises are mentioned.
Excercises influences the cell shape & physiology & can have a direct mechanical effect
on matrix alignment.It exactly help the tissues to gradually & progressilvely adapt to the
new loading conditions.
• Over useÆcauses repeated or sustained load adaptation of the tissues in its deformed
state.cell death may occur & permeability will be decreased leading to permanent
deformation.
• The health & strenght of joint structures & joint functions depend on the threshold amount
of stress & strain.
• The full range of motion of the joint ensures the nutritional supply to the soft
tissues(cartilages particularly)
• Controlled loading & motion applied early in rehabilitation process stimulate collagen
synthesis & helps in collagen fibril alignment.
• Bone density & strength increase following the stress & strain created by muscle & joint
activity.
• Therefore micromotion & compression recommended to promote body union & healing of
fractures.
• Controlled mobilization ,rather than complete immobilization is preferred.
• Tissues have a movable threshold ,below which they atrophy & above which they become
injured.
• The therapist must skilfully load the tissues with the appropriate direction, magnitude &
frequency to prevent weakening or to induce adaptation.

Mode Of Action Of Bhujangasana

Bhujangasana is advised in kati graha, where there is slow extension of vertebral column
bending the back bone backwards(in the complete extension of the lumbosacral joints for about
one minute) and again there is slowly relaxation
These movements increases the stress & strain created by muscle & joint activity in the
Lumbosacral region & joint in its movable threshold, influences the cell shape & physiology
& can have a direct mechanical effect on matrix alignment.
It exactly help the tissues to gradually & progressively adapt to the new loading
conditions.It loads the tissues with the appropriate direction, magnitude & frequency to prevent
weakening or to induce adaptation.
The full range of motion of the joint ensures the nutritional supply to the soft
tissues(cartilages particularly). The combined elements of spin,roll & slide increases the
effective range of joint movement.
The reduced & frequently changing contact area diminishes the frictional & erosive
effects.The shape & fluid around the contact area maintain efficient joint lubrication & nutrition
of the avascular articular cartilages. Less with factors limiting the movement.
In this “actual position” closed-pack position taken up by joint ; which here is during the
Dorsiflexion of the spine,the elastically deformable tissues (ligaments & articular cartilages)are
in equilibrium & is balanced by its resistance to further deformation of joint .
Gradually Supporting the tissue healing process of the Reaction phase, by optimized
Regenerative phase ,by influencing the remodeling phase, reaching to a Painfree R O M with
increase in Tensile strength & decrease in Muscle spasm towards the management of pain &
reduced reliance on medicine to restore ability to manage functional stress demands
Ultimately preventing Chronicity & Reaggravation.

(Fig No: 21 ) shows Examination of the profile of a longtitudinal section through an ovoid
surface

(Fig No :22 )shows ovoid of motion in the articular surface & change in the mechanical axis

NIDAANA
S
A AGNIVIKRITIKARAKA MARMAABHIGATA DOSHAPRAKOPA
N
C
H MANDAGNI OR VATASANCHAYA
A VISAMAGNI
Y
A
AMA KAPHA SANCHAYA
P
R
A VATAKAPHA PRAKOPA VATAPRAKOPA VATAPRAKOPA
K
O
P
A
P DOOSHYA SAMAVATAKAPHA SAMAVATA

R DUSTI, RASA,
A RAKTA, MAMSA,
S ASTHI,SIRA,SNAAYU,
A KANDARA,SANDHI
R
A
SS
TA DOSA DOOSHYA SAMMURCHANA
AM SPHIK, KATI, PRISTA,
NS TRIKA
AH
R
A
Y
A
SPHIK, KATI, PRISTA,
V
TRIKA ASTHI SANDHI
Y
A
K
T
A KATIGRAHA
Chart No:01 SCHEMATIC REPRESENTATION OF SAMPRAAPTI

Rachana anusara Samprapti
Nidana Sevana
Vata Prakopa
Stanasamsryaya in Kati-Trika Pradesha
Incresed Ruksha, kara, daruna Guna of Vata Dosha in this pradesha
Decreased Jaleeya & Snigda Guna of Tarunasti
Tarunasti Stana Cyuti due to Chalaguna of Vata
Sandhi Rachana Vikruti
Vata Dosha Prakruta Karma are hampared once again in this region
Pain from low back and grahana,sthabdhatha in gamana karma
Kati graha
Chart No :02 Tarunasthigata Vikruti

Nidana Sevana
Vata Prakopa
Stanasamsryaya in Kati- trika prishtha pradesha
Incresed Ruksha, Kara Guna of Vata Dosha in this region
Decreases Jaleeya & Snigda Guna of Sleshmadhara Kala & Sleshaka kapha
Vikruti of the kati-trika prishthavamshagata asthi sandhi
Compression of Sandhi Related structures
Vata Dosha Prakruta Karma are hampered once again in this region
Pain in low back & grahana, sthabdhata in gamana karma
Katigraha
Chart No : 03 Sleshmadhara Kala & Sleshaka kapha Vikruti

Nidana Sevana
Vata Prakopa
Stanasamshryaya in Kati-trika prishthavamshagata asthi sandhi Pradesha
Incresed Ruksha Kara Guna of Vata Dosha
Decreased Jaleeya & Snigda Guna of Asti
Degenerative Changes of Asthi
Asthi Kshaya
Vikruti of sandhi related rachana
Vata Dosha Prakruta Karma are hampared once again in this region
Pain in the low back & grahana, sthabdhata in gamana Karma
Katigraha
Chart No : 04 Ashti Vikruti:

Methodology 125
METHODOLOGY
SOURCE & METHOD OF DATA COLLECTION:

The subject of thesis is both conceptual and observational study.
MATERIALS:
SOURCE OF DATA :
Literary source : Data related to Kati-Trika sandhi shareera and kati-graha was
collected from the Brihatrayi’s, Laghutrayi’s and other classical texts including
journals, presented papers, previous thesis work done and correlated and analysed
with the knowledge of contemporary science on the subject and were discussed
emphatically.
Cadaver dissection : Kati-Trika region of 5 cadavers were dissected and various
ligaments muscles and their attachments were observed in this region.
Clinical source: A special case proforma was prepared with all points of kati-graha
and observation done on 20 selected patients with age group between 35 to 50
years who practiced Bhujangasana for 6 months. Patients were selected from IPD
and OPD of SDM Hospital Udupi & S.D.M.Y.N.C.H pareeka. Structural
abnormalities were observed with the help of X-rays (lat). Ayurvedic concepts of
Kati-graha were given importance for the study of the applied anatomy of this joint.
METHODS:
OBJECTIVES OF STUDY:
The present work is being taken up with an idea of updating early concept of Kati-
Trika sandhi Shareera in view of Modern anatomy. The main objective of this study is
aimed at
To make the comprehensive study and conceptual study on kati-trika sandhi
shaareera as mentioned in the classics, in view of regional and applied anatomy
described in the contemporary science.
To study anatomical features in abnormal conditions which may cause kati-graha
and various structural changes in Kati-Trika sandhi pradesha, thereby in this
disease.
To analyse the effect of Bhujangasana in Kati-trika sandhi shareera in relieving
katigraha in selected 20 patients.

Methodology 126
STUDY DESIGN: Before –After Non experimental design

.All the patients were treated for a period of six months by Bhujangasana,
SAMPLING TECHNIQUE : Convenient sampling.
Inclusion Criteria
Patients Aged between 35-50 years of either sex.
Patients having pratyatma lakshanas of Kati-graha.
Diagnosed patients of Kati-graha
Exclusion Criteria
Pregnancy.
Infective and neoplasmic conditions of Spine.
Any surgical intervention.
Who are unfit to undergo Yogasana.
Metabolic & congenital abnormalities.
Fibrosis condition.
IVDP
POPULATION:All Katigraha patients. (age 35 to age 50 year)
HYPOTHESIS: There will be changes in the Anatomical Structures in Kati trika sandhi
after the Intervention(Bhujangasana) in Katigraha patients.
ASSUMPTION: An Increased Lumbo Sacral angle suggests a mechanical factor in
producing LBP by increasing the shearing & compressive forces on the Articular facets at
the Lumbosacral junction
DATA GATHERING METHOD: On the day of admission of Kati-graha patients in
the age group of 35-50yr.will be interviewed & socio-demographic & Clinical data were
collected. .They were asked to take Lat view of Lumbosacral joint X-ray & the
observations were done, they were instructed to do Bhujangasana for 6 months & after 6
months again Clinical data like Grading of Pain, Stiffness, Range of Movement, SLRT,
X-Ray findings & Goniometric readings were taken, these two Observations (Pre-Post)
were compared .
The outcomes(prognosis) measurements were analysed

Methodology 127
METHOD OF BHUJANGASANA :
TECHNIQUE
1. Lie on the floor in prone position,with the legs straight, soles facing up.
2. The chin should touch the ground.
3. Bring the arms to the level of last ribs with the palms on the ground.
4. The hand should bend at the elbows touching the body.
5. Inhale & lift the upper portion of the trunk slowly, till the Navel portion is about to
leave the ground.
6. The rest of the body should be in contact with the ground.
7. Maintain this position as long as possible & with slow exhalation lower the body &
come back to position number one.
Step by step adoption of procedure & the complete lumbosacral extension when
achieved (during the headed cobra pose) will be maintained for about 1 minute & slowly
coming to the prone position.
Duration:,practicing daily morning & evening for about 10 times,Pathyapathya: Along
with the intervention, dietic restriction & codes of conducts were advised to be followed.
(Fig No : 23) shows Lumbosacral angle & Goniometer

Methodology 128
Fergusons Method of Lumbosacral Measurement & Goniometer

INSTRUMENTS:
Goniometer.
Measurement of Lumbosacral angle in the X-rays(lat) done with the help of
Goniometer, Using Fergusons Method of Lumbosacral angle measurement.ie; Angle
formed between the plane of superior surface of S1 to the horizontal plane.
LUMBOSACRAL ANGLE IN NORMAL ADULTS :
Frequently used method of measurement is Fergusons method, it is the angle formed
between the plane of Superior surface of S1 to the horizontal plane.
Measured in Lateral spot radiological images of L5-S1 intervertebral space, with 40 inch
focal spot film distance,focusing 1 inch below the Iliac crest.
Normal accepted range of Lumbosacral angle in Lateral Recumbent position is 20-800
NORMAL X-RAY FINDINGS OF LUMBOSACRAL JOINT LAT VIEW.
(Fig No : 24 )shows normal Lumbosacral Vertebra

Bone Density are Normal Joint space Normal
Posterior elements appear Normal No evidence of Local lesion
No evidence of Listhesis End plates of Vertebra appear Normal

Methodology 129
Sample size 20
Sample Type Katigraha patients (CLBP Not radiating
below gluteal region.)
Procedure Bhujangasana
Duration of Procedure 20 – 30 minutes
Duration of Lumbosacral Extension 1-2 minutes
Duration of Treatment 6 months
Table No : 17 Method of Intervention
ASSESSMENT CRITERIA:
Diagnosed cases of kati-graha were clinically examined for signs and symptoms,
structural changes were observed in radiological examination & lumbosacral
angle measured with goniometer in lateral spot radiographs before & after the
intervention of Bhujangasana and correlated with anatomical features.
The subjective symptoms were assessed by giving grades.
Clinical examinations to assess the Range of Motion (SLR) done both pre & post
operatively.
Assessment of Subject:
• Acute & Chronic LBP Acute-Duration if < One month
Subacute- from 1-3 months
Chronic-Duration more than three months,& episodic
• LBP disability index
Based on % of Disability
0-20% - Minimal
20-40%- Moderate
40-60%-Severe
60-80%-Crippled
80-100%-Bed bound

Methodology 130
Assessment of Subjective parameters:

G1-Normal
G2-Mild
G3-Moderate
G4-Severe
Assessment of Objective Parameters :
Radiological changes
SLRT
Range Of Movement at Lumbosacral joint
Goniometric measurement of Lumbosacral angle
OBSERVATIONS
Normal Anatomy
Cadaveric dissection.
Radiological Anatomy
Basic screening procedure for bone deformities is X-ray
All the patients were having structural changes in the lumbo-sacral spine in the
form of degenerative changes, like changes in the shape of vertebral bodies,
increase in the intervertebral space, thinning of the vertebrae, Osteophytes,etc.
PLAN OF ANALYSIS :
Data will be analysed by Descriptive & Inferential statistical methods.
Observational Analysis :Based on Normal anatomy & Radiological changes observed
Pre & Post Intervention.
Statistical Analysis:
The data were collected from the patients, before & after the Intervention &
statistically analyzed by using Student’s ‘t’ test in consultation with the Bio-statistician.

Observation & Analysis 136
OBSERVATION & RESULTS
ANALYSIS AND INTERPRETATIONS

Data Analysis
This was a study conducted in 20 patients ranging from age 35 to Age 51 years.
All were suffering from KATIGRAHA. All patients were treated with Bhujangasana for
a period of Six months and the outcomes were (prognosis) measured after the completion
of the treatment by both objective and subjective criteria.
Data analysis consisted of two parts, first part to describe the characteristic of the study
subjects by using descriptive methods viz mean, median, S.D. and percentage. Second
part consisted of comparisons of pre treatment measurements of the outcome with that of
post treatment measurements where we used inferential methods and statistics. In the
descriptive part, we used frequency tables and appropriate diagrams. In the inferential
part, we used appropriate test procedure and data interpreted using the value of the test
statistic and the corresponding probability (p) value.
Because of the small number of patients, for comparisons, we use Non-parametric

methods. The patient’s characteristics were shown in the following tables

Descriptive Part
I.
Age No. %
35-39 8 40.0
40-44 5 25.0
45-49 4 20.0
50 > 3 15.0
Total 20 100.0
Table No : 18 The distribution of age of the patients.
Graph No : 1 Age wise distribution of the patient.
Minimum age was 35 years and Maximum age was 51 years with mean age 42.4 and
S.D. of age 5.49 years.

II.
Gender No. %
Male 13 65.0
Female 7 35.0
Total 20 100.0
Table No : 19 Distribution of patients according to Gender
Graph No : 2 Genderwise Distribution of Patients.

Majority of the patients in this series were males

III.
Religion No %
Hindu 17 85.0
Christian 2 10.0
Muslim 1 5.0
Total 20 100.0
Table No : 20 Distribution according to Religion
Graph No : 3 Community wise Distribution of Patients.
Majority (85%) of the patients were Hindus

IV.
Education No. %
Post Graduate 7 35.0
Graduate 10 50.0
Higher Secondary 2 10.0
PUC 1 5.0
Total 20 100.0
Table No : 21 Distribution according to Educational Qualification
Graph No :04 Education wise Distribution of Patients
17 out of 20(85%) patients were having their educational qualification either graduation
or post graduation.

V.
Marital Status No. %
Married 18 90.0
Unmarried 2 10.0
Total 20 100.0
Table No : 22 Distribution according to Marital Status
Graph No :05 Marital Status of the Patients.

90 percent of the patients were married

VI.
Status No. %
Middle 12 60.0
High 8 40.0
Total 20 100.0
Table No :23 Distribution according to Social Status
Graph No : 06 Social Status of the patients.

VII. Occupation No. %
Business 3 15.0
House wife 3 15.0
Doctor 2 10.0
Engineer 2 10.0
Teacher 2 10.0
Bank Manager 1 5.0
Advocate 1 5.0
Hotel Manager 1 5.0
Physiotherapist 1 5.0
Police 1 5.0
Athlete 1 5.0
Taxi Driver 1 5.0
Labour 1 5.0
Total 20 100.0
Table No: 24 Distribution according to occupation
Graph No : 07 Occupational Status of the patients.

According to occupation, patients were from all walks of life

VIII.
Habits No. %
Smoking 6 30.0
Alcohol 3 15.0
Smoking + Alcohol 1 5.0
Tobacco 1 5.0
None 9 45.0
Total 20 100.0
Table No : 25 Distribution according to Habits
Graph No : 08 Habit wise Distribution of the patients.

9 patients did not have any habit at all. 7 patients were smokers and 4 patients were
alcoholics

IX.
Trauma No. %
Present 10 50.0
Absent 10 50.0
Total 20 100.0
Table No : 26 Distribution according to history of trauma
Graph No : 09 Distribution of the patients according to History of Trauma.

10 patients (50%) had history of trauma
X. DIET : All patients were using mixed dietary habits.

XI.
Nature of Work No. %
Standing 5 25.0
Sedentary 4 20.0
Manual 4 20.0
Travelling 2 10.0
Sedentary + Travel 1 5.0
Standing + Travel 1 5.0
Sitting + Travel 1 5.0
Walking 1 5.0
Sitting 1 5.0
Total 20 100.0
Table No : 27 Distribution according to their nature of work
Graph No : 10 Distribution of the patients according to the Types of Work

Patients were from various types of work

XII.
Vishrama No. %
Proper 6 30.0
Less 14 70.0
Total 20 100.0
Table No : 28 Distribution according to nature of Vishrama
Graph No : 11 Distribution of the patients according to Vishrama.
Majority of the patients (70%) did not have proper vishrama.

XIII.
Vyayama No. %
Proper 3 15.0
Less 8 40.0
No 9 45.0
Total 20 100.0
Table No : 29 Distribution according to vyayama
Graph No : 12 Distribution of the patients according to Vyayama.
Only 3 (15%) patients had proper vyayama

XIV.
Nidra No. %
Sound 8 40.0
Disturbed 7 35.0
Jagaran 5 25.0
Total 20 100.0
Table No : 30 Distribution according to Nidra
Graph No : 13 Distribution of the patients according toNidra.
Only 8 (40%) patients had sound Nidra

XV.
Vegadharan No. %
Positive 12 60.0
Negative 8 40.0
Total 20 100.0
Table No : 31 Distribution according to Vegadharana
Graph No : 14 Distribution of the patients according to Vegadharana.
60% of the patients had positive Vegadharan

XVI.
Prakrithi No. %
Vatha Kapha 7 35.0
Vatha Pitha 7 35.0
Vatha Pitha Kapha 5 25.0
Kapha Pitha 1 5.0
Total 20 100.0
Table No : 32 Distribution according to Prakrithi
Graph No : 16 Distribution of the patients according to Prakruthi.
Maximum number of patients had Vata predominance .

XVII.
Samhanana No. %
P 12 60.0
M 8 40.0
Total 20 100.0
Table No : 33 Distribution according to Samhanana
Graph No : 17 Distribution of the patients according toSamhanana.
Sixty percent of the patients had “P” Samhanana

XVIII.
Ahara Shakthi No. %
P 12 60.0
M 8 40.0
Total 20 100.0
Table No : 34 Distribution according to Ahara “Shakthi”
Graph No : 18 Distribution of the patients according to Ahara Shakti

Sixty percent of the patients had “P” Ahara Shakthi.

XIX. Outcome Assessments

RUK
In the pre treatment period all the patients had Grade 4 (severe) from RUK. But
after the treatment 5 (25%) patients had improvement to Grade 1, (normal), 12 (60%) had
improvement to mild form (Grade 2) and remaining 3 (15%) patients had improvement to
Grade 3 (Moderate)
Pre Intervention Post Intervention
Grade No. %
Pre-treatment No. %
Normal (G1) 5 25.0
G4 (Severe) 20 100.0
Mild (G2) 12 60.0
Total 20 100.00
Moderate (G3) 3 15.0
Total 20 100.0
Table No : 35 Distribution of RUK Pre & Post therapy
Graph No : 19 Distribution of the patients according to Gradings of Pain Post

intervention.
There were marked improvement Post intervention for all the patients.

XX. STHAMBHA
Grade No. %
Normal (G1) 3 15.0
Mild (G2) 4 20.0
Severe (G4) 5 25.0
Total 20 100.0
Table No : 36 Distribution of Sthambha Pre intervention
Graph No : 20 Distribution of the patients according to Gradings of Sthambha Pre

intervention.

Grade No. %
Normal (G1) 11 55.0
Mild (G2) 7 35.0
Total 20 100.0
Table No : 37 Distribution of Sthambha Post intervention.
Graph No : 21 Distribution of the patients according to Gradings of Sthambha

Post intervention.
Before the treatment 13 (65%) patients had moderate to severe grade of Sthamba and
after the treatment 18 (90%) patients improved to normal to mild grade and none had
severe grade of Sthamba.

XXI. GRAHANA
Pre Treatment
Grade No. %
Severe (G4) 14 70.0
Total 20 100.0
Table No : 38 Distribution of Grahana Pre intervention
Graph No : 22 Distribution of the patients according to Gradings of Grahana Pre

intervention.

Grade No. %
Normal (G1) 7 35.0
Mild (G2) 6 30.0
Total 20 100.0
Table No : 39 Distribution of Grahana Post intervention.
Graph No : 23 Distribution of the patients according to Gradings of Grahana Post

intervention.
We could see from the above table that every patient had moderate to severe
grade of Grahana. But after the treatment all the patients had excellent improvement and
13 (65%) of patients had improvement to grade 1 to grade 2 Grahana. Noticeably no
patient had severe grade of grahana.

XXII
Pre-Intervention (X-ray)
X-ray findings No. %
Degenerative changes 20 100.0
Post -Intervention
X-ray No. %
Slight Regenerative 20 100.0

changes
Table No : 40 Radiological Assessment – by X-ray of Lumbo Sacral region

(Lateral View) Pre & Post intervention.
Before treatment everybody had degenerative changes and after treatment none had
degeneration. Everybody had improved and had slight Regenerative changes after
treatment

XXIII SLRT Pre-Intervention
Positive 20 100.0
Post-Intervention
Negative 11 55.0
Positive (Increased angle) 8 40.0
Positive 1 5.0
Total 20 100.0
Table No : 41 SLRT changes Pre & Post Intervention
Graph No : 24 Distribution of the patients based on SLRT changes Post

intervention.
Before the treatment every patient had positive SLRT but after the treatment 11 (55%)
patients had negative SLRT and 8 (40%) patients had positive but increased angle
improvement. That is 95% of the patients had improvement and only 1 (5%) patient had
no improvement.

XXIV GONIOMETER READING

Pre-Intervention
Reading (in degree)
Mean 35.75
Standard Deviation 8.74
Median 33.0
Average reduction 0.95
Standard deviation of reduction 0.60
Median Reduction 1
Post Intervation
Reading (in degree)
Mean 34.80
Standard Deviation 8.88
Median 32.00
Table No : 42 Goniometer Reading Pre & Post intervention
There were very high significant reduction in the lumbo - sacral angle reading
Wilcoxon’s matched pairs signed rank test was used because of the pre-post treatment
reading of the same patients.
Wilcoxcon’s Z=3.71 and P = 0.0001
From all those outcome measurements (both subjective and objective), it was
observed that there were tremendous improvement of all the patients after treatment.

Observations & Analysis 134
L4 vertebra
L5 vertebra
Lumbosacral joint
X-ray 1 shows Preintervention & Post intervention changes
Marked reduction in the goniometric measurement of lumbosacral angle and slight regenerative
changes at the vertebral margins.
L4
L5
Lumbosacral joint
X-ray 2 shows Preintervention & Post intervention changes

L4
L5
Sacralization
X-ray 3 shows pre intervention & post intervention changes
changes at the vertebral margins .
L4
L5
Lumbosacral jt
X-ray 4 shows preintervention & post intervention changes

DISSECTION PHOTOS

Fig No: 25 shows Psoas Minor Muscle

Fig No: 26 shows Ilio Hypogastric Nerve

Fig No: 27 shows Ilio Inguinal Nerve
Fig No: 28 shows Psoas Major Muscle

Fig No: 29 shows Sympathetic Trunk

Fig No: 30 shows Lumbo Sacral Trunk

Discussion 162
DISCUSSION
DISCUSSION ON CONCEPTUAL STUDY
Kati
Kati is described as the region present below the naabhi pradesha, and above the
Medra & Mushka region .In the present context it should be understood as Shroni
pradesha ie; Hip region.Kati kapala, Nitamba & Shroni Phalaka all these indicates the
Ileal part of Hip bone.While mentioning the Pramana of kati by Charaka & Susruta it
refers to the Vistara/diameter of Pelvic cavity (pelvic inlet) & Parinaha mentioned by
vagbhata refers to the circumference of Pelvis.In these contexts Kati have been
considered along with the Bhagasthi & Shroni Phalakaasthi.
Kati is the lowback region along with the Ileal part of hipbone & sacrum.Thus the
region of L5 have to be inferred in the present context.
Trika
Trika is considered as the region, where the union of three structures takes place.
Trika is mentioned as the region present in the posterior aspect of Kati. It is considered as
the Shroni Kanda bhaaga, stem part of Hip bone.Sacral region is considered as the Trika
pradesha with the union of three structures, namely,
¾ Sacrum
¾ Two hip bones (Ilium)
¾ Fifth lumbar vertebra
Anatomical structures in the joint:
Anatomical features of Kati-Trika sandhis mentioned in Ayurveda can be correlated
upto certain extent with the help of the contemporary science. Kati-trika asthi sandhi are
pratara variety of sandhis. They are alpa cheshtavanta. These type of joints are
responsible for the slippery and gliding type of movements. It can be correlated to
Cartilaginous & Synovial joints.
Acharya Sushruta has mentioned 30 asthis in the prushtha vamsha. According to
modern anatomy, five lumbar vertebrae are present in the low back
region.Ayurvedic classics also mentions “Shronyasthi panchakam” which includes
one Asthi each in Guda, Bhaga &both Nitamba pradesha & One Trikasthi.

Discussion 163
Definite number of Sandhi sankhya in Kati-Trika pradesha is not explained.But
Trika is explained as the place of Sanghata which lies at the base of

Prushtavamsha.,Therefore these Sandhis have been counted under the
Prushtavamsha Sandhis only & can be correlated to Inter vertebral joints
ie;Lumbosacral joint
Shleshmadhara kala may be correlated with synovial membrane, which are situated
in the joints, which secretes the synovial fluid and supports it.
Shleshma may be correlated with synovial fluid. The synovial fluid acts as a
lubricant which increases the joint efficiency and reduce joint erosion of articular
surfaces similar to that of a wheel which moves smoothly, lubricated at its axis.
Kaphavaha, Raktavaha, Vaatavaha siras and Adhoga dhamanis of the Kati-Trika
pradesha may be correlated with the arterial blood supply, venous drainage and
nerve supply to these sandhis.
About 60 snayus are mentioned in the Kati-Trika pradesha. These snayus are of
Pruthula and Pratanavati variety. There is no reference for exact number of snayus
in the Kati-Trika prushtha in our classics. Based on the knowledge of dissection we
can correlate these snayus with,
¾ Anterior longitudinal ligament
¾ Posterior longitudinal ligament
¾ Ligamentum flava
¾ Supraspinous ligament
¾ Interspinous ligament
¾ Intertransverse ligament
¾ Iliolumbar ligament
¾ Sacroiliac ligament
¾ Sacrotuberous ligament
¾ Ventral sacrococcygeal ligament
¾ Dorsal sacrococcygeal ligament
¾ Lateral sacrococcygeal ligament

Discussion 164
In Kati-Trika prushtha pradesha the number of peshi is not mentioned in the

classics. But, the peshis which are present in the parshva pradesha (6),
prushtordhva (10) and sphik (10) supports the sandhis in this region.
These peshis could be correlated upto certain extent with superficial and deep
muscles of the back. And some muscles which act on this region like, Quadratus
lumboeum, Psoas major and Psoas minor.
Four maamsa rajju are present on either side of the prushthavamsha which bind
the peshis with the bones. Among them two are present inside and two outside the
prushtha vamsha. These could be correlated with the deep muscles of the back in
particular with Erector spinae which gives out three slips, i.e. lateral, intermediate
and medial slips, which further gives out three slips each i.e. Iliocostalis,
Longissimus and Spinalis muscle.
KANDARA
Kandaras are mahasnayus or vrutta type of snayus and are sixteen in number. Out
of them four are present in prushtha and four in adhashakha.
Kandaras of shakhas spreads upto the nakhagra praroha. Four kandaras help in
binding shroni with the prushtha. The above explanation gives an idea about the
sacral plexus and the sciatic nerve, the largest nerve in the body which extend
from low back till the tip of the toes of lower limb.
The chief functions attributed to kandara are utkshepana etc. the kandara present
in the adhashakha helps in the gamana karma. Here, we can see that, the Sciatica
nerve is the chief nerve supply to the lower limb and helps in functions like
Flexion and extension etc.
DISCUSSION ON THE DISEASE

The kandaras present in the tala and pratyanguli which are connected to shroni
and prushtha, when gets affected by vaata dosha, leads to loss of movement and
manifestation of symptoms in the Kati-Trika pradesha
Katigraha refers to pain & stiffness in the Kati-trika prushta pradesha.

Discussion 165
It may be caused due to degenerative conditions such as herniated disc,

osteophytic bone spur which press the spinal nerves exiting from the spinal cord.
In either case, there may be partial or total loss of sensory, motor or both.
The functions attributed to the sakthi as utkshepana, apakshepana and gamana
karma etc. Kati graham can lead to loss of the above said functions.
Sandhigata vaata can also be considered as one of the etiological factor in the
manifestation of Kati-graha vyadhi, since its symptoms are also observed here.
The pathology leads to structural and functional changes in the Kati-trika prushtha
vamsha gata sandhi resulting in the production of local symptoms leading to the
manifestationof katigraha vyadhi.
Ruk : This is the cardinal symptom of the vaata dosha. Vitiated vaata dosha
causes the shoshana of the structures present in the kati and trika sandhi pradesha
like, maamsa, snayu, kandara etc due to its khara and ruksha guna. When these
structures are affected by vaata dosha pain is felt throughout its course of extent.
According to western science, the anatomical entities leading to the pain are,
Source Mechanism involved
1) Synovium Inflammation
2) Osteophytes Stretching of Periosteal Nerve Endings.
3) Ligaments Stretch
4) Capsule Inflammation and Distension
5) Muscle Spasm
Table No - 43: Pathological Changes in Joints:

Stambha : When vitiated vaata dosha affects the kati-trika sandhi, the shoshana
of maamsa, snayu, kandara, kurcha etc takes place because of its khara, kathina
and ruksha guna. Main function of kandara i.e. utkshepana etc are hampered when
kandara is affected by vaata dosha, and person feels stabdhata in the sakthi
pradesha.
Grahana : When vitiated vaata dosha affects the kati-trika sandhi, the shoshana
of maamsa, snayu, kandara, kurcha etc takes place because of its khara, kathina

Discussion 166
and ruksha guna. Main function of kandara i.e. utkshepana etc are hampered when
kandara is affected by vaata dosha, and person feels stabdhata in the sakthi
pradesha which gradually causes reduction in the Range of Movement of the
Joint.
Sandhivishlesha or sandhi chyuti: Snayus are responsible for the
sandhibandana. Shleshmadhara kala and shleshaka kapha helps in maintaining
sthiratva of the sandhi. When aggravated vaata lodges in the kati-trika prushtha
vamsha sandhi it does the shoshana of dhaatus which sustain the sandhi. It leads
to shleshma kshaya, snayuvikruti, subsequently resulting in sandhivishlesha or
sandhivichyuti like utpishta of vishlishta.
According to western science, the degenerative disorders of spine leading to disc
herniation due to weakness of the ligaments or because of the dehydration of the disc.
This leads to the compression of spinal nerve roots.
Samprapti: Aggravated vaata dosha when gets sthanasamshraya in the kati-trika
prushtha vamsha gata sandhi, affects the structures like shleshma, shleshmadhara
kala, snayu, maamsa etc leading to sandhi vishlesha. The sandhi vishlesha affects
the surrounding structures especially compression of nerve roots present in the
kati-trika pradesha leading to the manifestation of signs and symptoms resulting
in katigraha vyadhi.
Here, the nerve roots which are present in the kati-trika prushthavamsha gata
sandhi, which forms the sacral plexus are compressed. When these nerve roots are
compressed, the sciatic nerve which is the main nerve of sacral plexus also gets affected
resulting in radiating pain throughout its extent resulting in Katigraha, And its later
outcome can be Gridhrasee.
Here some of the sandhigata vaata lakshanas should be considered as local
symptoms of degenerative changes in the lumbosacral spine are present. Due to
sandhigata vaata and sandhi vishlesha etc, symptoms leads to nerve root
compression which leads to pain from the root to its distribution. This condition is
called as Katigraha.

Discussion 167
Some pathological events are correlated as follows.

On the lines of Ayurvedic classics, Katigraha can be best compared with that of
the Low Back Pain in modern parlance resulting due to compression of nerve
roots. So, in accordance with the symptomatolgy of the disease and the cadaveric
dissection,the structures present in the kati-trika sandhi pradesha when
compressed or undergoes pathological or degenerative changes,it results in
different symptomatologies of katigraha disease..
Dysfunction of Synovial Membrane

When the vitiated vaata gets localized in the Kati-trika prushthavamsha sandhi it
diminishes the Slesaka Kapha by its Ruksa Guna. When the amount of Kapha is
less in the joint, adjacent bony parts comes nearer and leads to friction between
them during the movement. Quite often they may adhere to each other and cause
fusion. This leads to shoshana of sthayi asthi dhatu and hence hampers the
function of asthi and sandhi.
Dehydration of Intervertebral Disc

The vitiated Vaata localizes in the Kati-trika Prusta Vamsha Gata tarunasthi with
their Khara and Ruksha qualities in dominating. Tarunasthis are Snigdha & pre
predominant in jaleeyaguna. Sthanasamsraya of Ruksha & Kara Guna of Vaata
dosha leads to loss of jaleeya mahabhuta i.e. dehydration, and due to chala
gunavikruti displacement of tarunasthi occurs resulting in the impairment of the
joint structure.
Osteoporosis & Formation of Osteophytes

Sthanasamsraya of ruksha and khara Guna of vaata dosha in asthi leads to asthi
Vruddhi & Kshaya Laxana due to degenerative changes leading to structural and
functional impairment of Kati-trika prushthavamsha gata sandhi. Adhiasthi is the
pathological formation of Osteophytes and asthi Kshaya is nothing but
osteoporosis.

Discussion 168
DISCUSSION ON CLINICAL STUDY:

The data available from the observations made in this study of 20 patients are being
discussed below.
Regarding Demographic Data Discussion was like this:
Age
In this study it was found that the incidence was highest in the age group of 35-39
years constituting 40% of total number of patients in the series. It was followed by 25%
in 40-44 years age group, 20% in 45-49 years age group and 15% in 50> years age
group . All patients had abnormal X-ray findings.
In spondylosis degenerative changes in the intervertebral joints start after 30 years of
age, which become most common around 45 years of age. Here the present data signifies
age factor in spondylosis in accordance with textual references.
Sex
In the sample taken for the study, 65% were males in comparison to 35% of females.
All had abnormal X-ray findings.
Here, the study reveals that males were more susceptible for the disease, Owing to
their straneous activities & inadequate rest pattern.
Religion
About 85% of the patients were belonging to Hindu religion and 10% were
belonging to Christianity and 5% belonged to Muslim community. This may be because
of large number of Hindu population in the area.
Socio-Economic Status:
Maximum number of patients were from Middle class (60%) and 40% from High
class,. All had abnormal X-ray findings.
Both Observations of Religion & Socio economic status were having no support from
other studies as LBP can affect the people of all castes & all classes.
Education:
Maximum number of patients were graduates (85%), followed by 10% up to high
school level, 20% upto PUC level and none were uneducated. All had abnormal X-ray
findings. This shows that pattern of education with Katigraha has no relation at all.

Discussion 169
Marital Status:
Maximum number of patients (90%) were married in this study. It may be a factor
that the strenous workload which demands in all the spheres may be a causative factor in
inducing this disease. All had abnormal X-ray findings.
Occupation:
In the present case 15% of the patients were housewives and 15% of them were
businessmen.Patients were from all walks of life,. By this we can say that housewives
were more prone for the disease due to continuous standing and irregular kind of work
they do. It included the businessmen who were more into continuous sitting nature of
work which may lead to the aggravation of vaata leading to katigraha. All had abnormal
X-ray findings.
Dietary Habits:
All patients (100%) were following mixed food habits,. All had abnormal X-ray
findings.
Ahara shakti
60% of the patients had Pravara Ahara shakti ,which shows not much significant
contribution of food intake & digestion in LBP.
Habits:
About 45% were having no addiction and about 35% had Smoking habit, 20% each
had alcohol and 5 % had tobacco habit. This shows that the addiction habits might not
have any influence over the etiology of Katigraha, as more number of patients were not
addicted to any above said habits. All had abnormal X-ray findings.
Prakruti
About 35% of the patients belonged to vaatakapha prakruti and 35% to vaatapitta
Prakruti, and 25% belonged to vata pitta kapha prakruti. All had abnormal X-ray
findings. Maximum number of patients Prakruti had Vata Dosha involvement i.e.80%
(Vaatapitta & Vaata kapha) and are more susceptible to disorders of Vata.
Samhanana
60% of the patients were pravara, 40% were madhyama,. All had abnormal X-ray
findings.

Discussion 170
Duration of Illness
All the patients were belonging to the group of >3 months chronicity with localized
LBP, not radiating below the Gluteal region.. All the patients in the study had the
samanya lakshanas like, ruk,sthambha,grahana etc. All had abnormal X-ray findings.
Trauma
50% of the patients had history of Trauma which shows Trauma as a significant
causative as well as contributing factor.
Nature of Work
Patients were from various types of works.25% had Standing pattern of works,
20% had sedentary pattern, 20% manual work,10% had Travelling work pattern.As LBP
is the commonest Work related Problem in the present day.The prolonged sitting &
standing in same posture/ awkward posture is causing LBP in such occupations which is
being supported in the study.
Vishrama
70% of the patients had Less vishrama,signifying its contribution in LBP,Stressful
atmosphere also a contributing factor as it compels Man to do continuously works
without adequate Rest or change in Posture.
Vyayama
Only 15% of the patient had Proper Vyayama,45% of the patient had less
excercises & 40% had no vyayama..The study shows that persons with less excercises are
more susceptible for LBP.
Nidra
40% of the patients had sound sleep, 35% had disturbed sleep, 25% had irregular
sleeping patterns,which shows improper sleep as a contributing factor for LBP,as it is
Vataprakopa kara.
Vegadharana
60% of the patient had history of Vegadharana,showing significance as a
contributing factor,as it is Vata prakopakara.

Discussion 171
Regarding Out Come Parameters Discussion was like this

Out of Clinical features Ruk, Sthambha, Grahana all were present in all patients
Ruk
100% of patients had G4 grade (severe) pain,which after intervention came to G2
grade(mild) in 60%,G1 grade (normal) in 25% and G3 grade (moderate) in 15% of the
patients.
Sthambha
65% patients had moderate to severe grade of Sthambha & after intervention 90% of the
patients came to Normal – Mild grade & None had Severe grade of stiffness.
Grahana
Every patient had Moderate to Severe grade of Grahana,& after intervention 65% of
patients had improvement to grade 1 – grade 2 grahana,no patient had Severe grading in
the range of movement.
Discussion on Outcome Parameters
Ruk, Sthambha & Grahana were present in all the patients which after
Intervention were observed to be considerably relieved showing the effectiveness of the
Therapy.
SLRT which was positive before the intervention became negative in 55% of the
patients & 40% had positive SLRT but with an increased angle improvement.That is 95%
of the patients had improvement & only 5% had no improvement showing the
effectiveness of Therapy.
Repetetive movements changes the forces which the Disc Nucleus exerts on the
wall of the discs, the Annulus Fibrosis,which enable the ability of the vertebral elements
to sustain the pressure effects .As an increase in pressure against the Posterior disc wall
can worsten symptoms while a decrease can improve pain.
Repeated movements in 0ne plane establish a directional preference, a direction of
movements which improves the presenting symptoms.

Discussion 172
X-Ray Findings:
• All the patient were having structural changes in Kati-trika prushtha vamsha gata
asthi sandhi in the form of Spondylolysis, Lordosis, Lumbarization, Sacralization,
osteophytes formation, and. These pathological changes were observed mainly in
L4,L5and S1 vertebrae.
• Different patients presented with the different type of findings. In some patient
only minor changes were present whereas in others, the patient presented with
multiple changes in the Lumbosacral spine.
• 100 % patients had joint space narrowing at the level of L5-S1. Space narrowing
was observed between the vertebral bodies. Pain occurring in the low back were
due to degenerative changes at this level.
• Only about 25% of patients had Osteophytes. These osteophytes irritate the roots
sacral plexus. According to involment of nerves, pain occurs.
• 40% of the patients had fused vertebra(sacralization 35% & Lumbarization 5%)
• 100% of the patients had degenerative changes .
• Maximum structural changes (80%) were observed in the, L5 –S1 joint level.
After Intervention all the patients in the Radiological Examination revealed slight
regenerative changes, with very highly significant reduction in the Lumbosacral
angle reading with a Median reduction of 1degree from the Preintervention
measurement showing the effectiveness of therapy.
DISCUSSION ON RADIOLOGICAL STUDY:

Structural changes or pathological changes in the Lumbosacral vertebrae including
Intervertibral disc and ligaments etc. are the causative factors for the manifestation of
Katigraha. These changes are well defined with the help of radiological investigations .
According to Ashraya-ashrayi bhava, Vata dosha is Ashrita in Asthi. Whenever Vata
vruddhi takes place it results in the Asthi kshaya, unlike others where the vruddhi of
ashrita leads to vruddhi of ashraya. Hence the magnitude of pathology in vaata dosha can
be identified through the pathology in the sandhi pradesha.
Some of the pathologic changes that could be observed are,

Discussion 173
Pathological Events: Asthikshaya Lakshana

• Asthishoola - Pain in the lumbosacral region.
• Rookshata - Sclerosis of lumbosacral vertebra due to degenerative changes.
• Sandhishaithilya –Structural changes in the joints of lumbosacral vertebra.
1]Spondylolysis – Asthi kshaya
Due to Vata vruddhi in Lumbosacral spine Asthikshaya takes place. It leads to
manifestation of Asthiksaya lakshana,& Asthi vikruti, leading to decrease in the bone
density & other degenerative changes like increase in the intervertebral space, local
lesions, End plates of Vertebra will appear abnormal.
2]Spondylolisthesis – Sandhi vishlesha
When aggravated vaata lodges in the kati-trika prushtha vamsha sandhi it does the
shoshana of dhaatus which sustain the sandhi. It leads to shleshma kshaya, snayuvikruti,
subsequently resulting in sandhivishlesha or sandhivichyuti like utpishta of vishlishta,
leading to displacement of the Vertebral bodies.
3] Lordosis – Asthi chyuti
Due to vata vruddhi & kapha Kshaya the normal alignment of the Vertebral
column is lost pertaining to continous stress & strain factors in the Lumbosacral joint
leading to abnormal curvatures, resulting in fusion of the Vertebral bodies due to the
abnormal calcification.
4] Osteophytes – Adhyasthi
Due to Vata vruddhi in Lumbosacral spine Asthikshaya takes place. It leads to
manifestation of Asthiksaya lakshana. If these osteophytes are near to the vertebral
foramina they irritate the nerves as a result of which pathological signs and symptoms of
Kati graha will manifest in patients.
Mainly pathological changes were seen in the Articular cartilages & adjacent Bones
& Synovium. Regressive changes were marked in weight bearing regions of the articular
cartilages & loss of cartilaginous matrix were evident ,followed by flaking & fissuring of
articular cartilages resulting in breaking off of pieces of cartilages exposing the
subchondral bone. Where in the increased Osteoclastic activity causing remodeling of the
bone resulting in change in shape of the bony surface.

Discussion 174
Damaged Cartilage,resulted in cartilaginous outgrowths at the joint margins which

got ossified forming Osteophytes or spur.
Progressive loss of cartilage & synovial membrane were apparent as radiologically
Jointspace narrowing was observed.
After Intervention:
All the patients had slight regenerative changes in the X-ray,
The osteophytic regressive changes were observed,
Thickening of the vertebral margins & remodelling of the bone shape were seen, &
increase in the Intervertebral space seen.
Which could be inferred as Osteogenesis & Realignment in the bones.
DISCUSSION ON GONIOMETRIC READING ON LUMBOSACRAL ANGLE:

An increased angle suggests a mechanical factor in producing low back pain. This angle
increase from an average of 20 degree at birth to an average of 70 degree at the age of
five years, it remains at that level thereafter. The formation of lumbosacral angle is
related to the progressive acquisition of erect posture and the ontogeny of bipedal
locomotion.
The impact of increasing joint activity and paraspinal muscle activity helps in
stature recovery
Any postural changes to compensate the stress and strain in the lumbosacral joints
results in the changes in the lumbar curvature which results in an increased lumbosacral
angle and by the intervention of Bhugangasana we have observed that there was a median
reduction of one degree in the lumbosacral angle from the measurement taken before
intervention. Which signifies the anatomical changes at the joint, showing the efficacy of
the therapy.
To Conclude :
The movements in the Lumbo-sacral joint brought about by Bhujangasana causes
the structural changes in the joint which helps in the regeneration & realignment of the
bones & cartilages which can be classified into these different stages.

Discussion 175
Reaction Phase( >4 days)

Supports Tissue Healing Process
Where Range of motion is within the Pain-free range without resistance.
Regenerative Phase(0-6 week)
Optimize the Normal regenerative phase (Elimination of the Debris,
Revascularization, Fibroblast proliferation)
Minimize Inflammation, protect Neurovascularization, limit duration of
Inflammatory response, stimulate Protein production.
Remodelling Phase(1-3+ months)
Influence the Remodelling phase (Contraction of Scarr tissue, Maturation of
Collagen, Increase in Tensile strength, Re-establishes Range of movement, enhance
Proprioception.
Ultimately
Restore R O M & Joint mobility.
From all those outcome measurements (both subjective & objective),it was observed that
the treatment modality were found effective in relieving Signs & Symptoms of LBP.

Conclusion 176
CONCLUSION
• Kati is considered as the low back region along with the Sacrum and Ileal part of
hip bone which refers here to L5 vertebra.
• Trika is the region of asthi sanghata,which forms the Shroni kanda bhaga, which can
be taken as the sacral region.
• The number of Asthi, Pesi, Snayu and Kandara explained by Acharya Sushruta are
more proximal to the modern view of regional anatomy of Kati-Trika prushtha
vamshagata asthi sandhi shareera.
• Adhoga dhamanis, vaata vaha siras, Kaphavaha siras and Raktavaha siras can be
correlated with the arterial blood supply, venous drainage and nerve supply to the
Kati- Trika prushthavamsha gata sandhis.
• Vaata dosha has ashraya-ashrayi bhava sambandha with asthi. Vaata vruddhi leads to
asthi kshaya and the changes can be correlated with the degenerative disorders of the
lumbosacral spine.
• Signs and symptoms of sandhigata vaata can be correlated with the pathology of
degenerative disorders of lumbosacral spine. Signs and symptoms of Katigraha can
be correlated with that of the low back pain
• The pain , stiffness and decrease in the range of movement at the lumbosacral spine is
due to structural changes in the L5-S1 joint. The pathology is due to the compression
of nerve roots of Sacral plexus.
• The lumbosacral angle plays an important role in determining the posture and degree
of spinal curvature and an increase in angle suggests a mechanical factor in producing
low back pain. The development of lumbosacral angle is related to the progressive
acquisition of erect posture and the ontogeny of bipedal locomotion.
• Bhujangasana involves different steps, At the stage of complete lumbosacral
extension( which will be maintained for about one minute), the lumbosacral spine is
in its close- packed position which influences the cell shape & physiology & can have
a direct mechanical effect on matrix alignment.It exactly help the tissues to gradually
& progressilvely adapt to the new loading conditions.

Summary 177
SUMMARY
The dissertation entitled ‘A study on Kati-Trika Sandhi Shareera w.s.r. to the effect of
Bhujangasana in Katigraha’ comprises of 8 chapters namely Introduction, Objectives, Review
of literature, Methodology, Observation, Discussion, Conclusion and Summary.
• Chapter 1: A brief introduction, which gives compact idea of the subject, is given in the
beginning. It emphasizes on importance of study on Kati-Trika asthi sandhi shareera and
necessity of understanding the human body. Short description of Katigraha & Bhujangasana
is explained here.
• Chapter 2: Gives an idea about Aims & Objectives of the study.
• Chapter 3: Review of literature is sub divided into Historical review, Ayurvedic review,
Modern review, Yogic Review & Bhujangasana Review
In Historical review there are Historical references of Kati-Trika prushthavamsha and
Katigraha in Vedic period, Pauranika period, Samhita period and Sangraha Kala.
In first part of Ayurvedic review there is detail description of Kati, Trika, and Prishtavamsha
sandhi shareera in these regions, description about sandhi, its Sankhya, Prakara and Pramana in
Kati-Trika region is explained. Asthi, Snayu, Peshi, Kala, Sleshma, Sira, Dhamani present in
Kati-Trika region are explained. In the second part of Ayurvedic review there is detail
description of Nidana Panchaka of Katigraha. In third part of Ayurvedic review Katigraha
related Shaareera is explained in detail.
In first part of Modern review, detail Anatomy of Lumbo-sacral spine is explained. In second
part, Definition, Etiology, Pathology, Signs & Symptoms of Katigraha is described. And in third
part of Modern review, functional anatomy and detail description of anatomy related to Low
Back Pain & Bhujangasana related Anatomy & Mode of action of Bhujangasana is explained.
• Chapter 4: Methodology explains Materials & Methods of Data collection, Inclusion
criteria, Exclusion criteria, Assessment criteria, Analysis (Statistical, Radiological, Cadaveric
dissection) and also the brief understanding about the normal X-rayfindings & Normal
Lumbosacral angle in Adults.
• Chapter 5: Observations of Cadaver dissection, Observations & Analysis of clinical study of
patients of Katigraha, Pre intervention & Post intervention X-ray photographs are presented
in this chapter.


Summary 178
• Chapter 6: Discussion is subdivided into Discussion of Conceptual study, Discussion on

disease and Discussion of Clinical study. In the first part Anatomical features of Ayurveda
literature were correlated with Modern science. In the second part the structures involved in
the manifestation of Katigraha vyadhi are discussed. In third part of discussion X-ray
findings of the 20 Patients were discussed, Goniometric measurement of Lumbosacral angle
& Clinical data are discussed.
• Chapter 7: Conclusion drawn from various sections of the work are given.
• Chapter 8: Summarizes the entire work.

Shloka References 179
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30. §ÉrÉÉhÉÉÇ xÉXçaÉÈ || || vÉ.Mü.SìÓ ||
31. mÉ×¸uÉÇvÉÉkÉÉUã Ì§ÉMüqÉç ||
mÉ×¸uÉÇvÉxrÉÉkÉÉãpÉÉaÉã | §ÉrÉÉhÉÉÇ xÉXçaÉÈ || || A.MüÉã 2/6/76 ||
32 . rÉ±ÌmÉ ´ÉÉåÍhÉ MüÉhQû pÉÉaÉå Ì§ÉMÇü mÉëÍxÉ®Ç || ||xÉÑ.zÉÉ.5/16 ||
33 . Ì§ÉMüÇ ²ÉSvÉÉXçaÉÑsÉÉãixÉãkÉqÉç || ||cÉ.ÌuÉ 8/117 ||
cÉ¢ümÉÉÍhÉ- Ì§ÉMüÍqÉÌiÉ aÉÑSÉxjlÉ mÉëpÉ×ÌiÉ MüOûÏMümÉsÉÉãkuÉïmÉrÉïliÉqÉç ||
34. mÉ×wjÉÉÎxjÉ iÉÑ MüxÉãÂ xrÉÉiÉç...|| || UÉ.ÌlÉ qÉ 11 111 ||
35. mÉgcÉcÉiuÉÉËUÇvÉiÉç mÉ×¸aÉiÉÉlrÉxjÉÏÌlÉ. . . . .|| || cÉ.vÉÉ 7/6 ||

36 . pÉÉaÉïuÉÉxjÉÏlÉÏ mÉ×¸ÉÌlÉ cÉiuÉÉËUÇvÉccÉ mÉgcÉMüqÉç || || MüÉ.xÉ.ÌuÉ.vÉÉ 7 ||
37 . mÉ×¸ã Ì§ÉÇvÉiÉç || || xÉÑ.vÉÉ 5/19 ||
38 . Ì§ÉÇvÉiÉç mÉ×¸ã || || A.WØû.vÉÉ 3/16 ||
39 . iÉãwÉÉÇ aÉÑSpÉaÉ ÌlÉiÉqoÉãwÉÑ cÉiuÉÉËU, Ì§ÉMüxÉÇÍ´ÉiÉqÉãMüqÉç || ||xÉÑ.vÉÉ 5/19 ||
40 . ²ã ´ÉÉãÍhÉTüsÉMãü, LãMüÇ pÉaÉÉÎxjÉ || || cÉ.vÉÉ 7/6 ||
41 . vÉÉZÉÉxiÉÑ WûluÉÉã MüOèrÉÉÇ cÉ cÉã¹ÉuÉliÉxiÉÑ xÉlkÉrÉÈ || || xÉÑ.vÉÉ 5/25 ||
42 . §ÉrÉÈ MüOûÏ MümÉÉsÉãwÉÑ. . || || xÉÑ.vÉÉ 5/26 ||
43 . §ÉrÉÈ MüOûÏ MümÉÉsÉãwÉÑ || || A.xÉ vÉÉ 5/97 ||
44 . ÍvÉUÈ MüOûÏ MümÉÉsÉãwÉÑ iÉÑ³ÉxÉãuÉlrÉÈ || || xÉÑ.vÉÉ 5/26 ||
45 . AÇxÉmÉÏPûaÉÑSpÉaÉÌlÉiÉqoÉãwÉÑ xÉÉqÉÑª, aÉëÏuÉÉmÉ×¸uÉÇvÉrÉÉãÈ mÉëiÉUÉÈ, ÍvÉUÈ MüOûÏMümÉÉsÉãwÉÑ iÉÑ³ÉxÉãuÉlrÉÈ....||
|| xÉÑ.vÉÉ 5/27 ||
46 . AÇxÉmÉÏPû aÉÑS pÉaÉ ÌlÉiÉqoÉãwÉÑ xÉÉqÉÑª,.........iÉÑ³ÉxÉãuÉlÉÏxÉ¥É || || A.xÉÇ vÉÉ 5/99 ||
47 . cÉiÉÑSïvÉÉxjlÉÉÇ xÉXçbÉÉiÉÉÈ, ......... Ì§ÉMüÍvÉUxÉÉãUãMæüMüÈ|| || xÉÑ.vÉÉ 5/16 ||
48 . ²ÉÌ§ÉÇvÉiÉç ´ÉÉãhrÉÉÈ aÉÑSqÉãRíûÉ´ÉrÉÉÈ || || A.xÉÇ vÉÉ 6/5 ||
49 . iÉ§É uÉÉiÉuÉÉÌWûlrÉ. . . . . .iÉÉxÉÉÇ aÉÑSqÉãRíûÉÍ´ÉiÉÉÈ ´ÉÉãhrÉÉqÉ¹Éæ . . .|| || xÉÑ.vÉÉ 7/7 ||
50 . LãiÉÉÍpÉUkÉÉãlÉÉpÉã mÉYuÉÉvÉrÉ MüOûÏ qÉÔ§É mÉÑUÏwÉ aÉÑSoÉÎxiÉ qÉãRíû xÉYjÉÏÌlÉ kÉÉrÉïliÉã rÉÉmrÉliÉã cÉ ||
|| xÉÑ.vÉÉ 9/7 ||
51 . xlÉÉrÉÑËUÌiÉ vÉhÉÉMüÉU EmkÉÉiÉÑÌuÉvÉãwÉÉã, rÉãlÉ kÉlÉÔÇwÉÏrÉliÉã || || QûsWûhÉ- xÉÑ.xÉÔ 25/21||
52 . lÉuÉ xlÉÉrÉÑ vÉiÉÉÌlÉ | iÉÉxÉÉÇ vÉÉZÉÉxÉÑ wÉOèvÉiÉÉÌlÉ, ²ã vÉiÉã Ì§ÉÇvÉccÉ MüÉã¸ã. . wÉ¸ã MüOèrÉÉÇ . . . ||
|| xÉÑ.vÉÉ 5/29 ||
53 . MühQûUÉ qÉWûÉxlÉÉrÉÑÈ || ||QûsWûhÉ- xÉÑ.vÉÉ 5/11 ||
54 . qÉWûirÉÈ xlÉÉrÉuÉÈ mÉëÉã£üÈ MühQûUÉxiÉÉxiÉÑ wÉÉåQûvÉ |
mÉëxÉUhÉÉMÑügcÉlÉrÉÉãSØï¹Ç iÉÉxÉÉÇ mÉërÉÉãeÉlÉqÉç || || pÉÉ.mÉë mÉÔ 3/269||
55 . iÉ§É WûxiÉ mÉÉSaÉiÉÉlÉÉÇ MühQûUÉhÉÉÇ lÉZÉÉÈ mÉëUÉãWûÉÈ |
mÉ×¸ÌlÉoÉlkÉlÉÉlÉÉÇ mÉëUÉãWûÉ ÌlÉiÉqoÉqÉÔkÉÉãïÂuÉ¤ÉÉãÅÍ¤ÉxiÉlÉÌmÉhQûÉÈ || ||pÉÉ.mÉë.mÉÔ 3/268||
56 . wÉÉåQûvÉ MühQûUÉ . . . . . . . ´ÉÉãÍhÉmÉ×¹ÌlÉoÉÎlkÉlÉÏlÉÉqÉkÉÉãpÉÉaÉaÉiÉÉlÉÉÇ ÌoÉqoÉÇ || || xÉÑ.vÉÉ 5/11 ||
57 . MüÌuÉUÉeÉç WûÉUhÉcÉlSì cÉYëuÉÌiÉï - ÌoÉqoÉÇ xÉÎcNûSìÇ Ì§ÉMüÉÎxjÉ CirÉÑcrÉiÉã || ||xÉÑ.vÉÉ 5/11 ||

58 . iÉ§É mÉ×¸uÉÇvÉqÉÑpÉrÉiÉÈ mÉëÌiÉ´ÉÉåÍhÉMüÉhQûqÉÎxjÉlÉÏ MüÌOûMüiÉÂhÉã. . |
mÉÉμÉïrÉÉãeÉïbÉlÉoÉÌWûpÉÉïaÉã mÉ×¸uÉÇvÉqÉÑpÉrÉiÉÉã MÑüMÑülSUã. . . . . ||
´ÉÉãÍhÉMüÉhQûrÉÉãÂmÉrÉÉïvÉrÉÉcNûÉSlÉÉæ mÉÉμÉÉïliÉUmÉëÌiÉoÉ®Éæ ÌlÉiÉqoÉÉæ . . ||
|| xÉÑ.vÉÉ 6||
59 . mÉ×¸uÉÇvÉqÉÑpÉrÉiÉÈ mÉëÌiÉ´ÉÉãÍhÉMühÉÉïuÉÎxjÉlÉÏ MüÌOûMüiÉÂhÉã |
. . . ´ÉÉãÍhÉ MühÉïrÉÉãÂmÉrÉÉïvÉrÉÉcNûÉSlÉÉæ mÉÉμÉÉïliÉUmÉëÌiÉoÉ®Éæ ÌlÉiÉqoÉÉæ || A.xÉÇ.vÉÉ 7/7
60 . eÉbÉlÉÇ MüOèrÉÉÇ AÌaÉëqÉpÉÉaÉÈ | || QûsWûhÉ - xÉÑ.E 64/26 ||
61 . iÉiÉÈ xjÉÉlÉÎxjÉiÉã. . . . . . . . || || xÉÑ.ÍcÉ 3/28 ||
62 . aÉÑS qÉÑwMürÉÉãqÉïkrÉã rÉÉã pÉÉaÉÈ xÉ pÉaÉÈ xqÉ×iÉÈ || || UÉ.ÌlÉ 69 ||
63 . lÉÉÍpÉ mÉ×¸ MüÌOû qÉÑwMü aÉÑS uÉÇ¤ÉhÉ zÉåTüxÉÉÇ |
LMü²ÉUxiÉlÉÑiuÉMçü MüÉå qÉkrÉå oÉÎxiÉUkÉÉåqÉÑZÉ: || xÉÑ.ÌlÉ.3/18||
64 . xÉÇkÉÉlÉqÉç |
kÉÉgÉç ' EmÉxÉaÉãï kÉÉã ÌMüÈ || || A.MüÉã. 3/2/11 ||
65 . xÉÇkÉrÉ¶É AXçaÉ xÉlkÉÉlÉÉiÉç SãWãû mÉëÉã£üÉ MüTüÉÎluÉiÉÉ || || vÉÉ.mÉÔ 5/57 ||
66 . xÉÇÍkÉ xÉÇvsÉãwÉhÉ xlÉãWûlÉ UÉãmÉhÉmÉÔUhÉ oÉsÉxjÉærÉïM×ücdsÉãvqÉÉ mÉgcÉkÉÉ mÉëÌuÉpÉ£ü...|
QûsWûhÉ - xÉÇÍkÉxÉÇvsÉãwÉhÉÉM×üiÉç xÉÇÍkÉoÉlkÉlÉÇ MüUÉãÌiÉ || || xÉÑ.xÉÔ 15/4 ||
67 . AxjlÉÉÇ iÉÑ xÉlkÉrÉÉã ½ãiÉã MãüuÉsÉÉÈ mÉËUMüÐÌiÉïiÉÉÈ |
mÉãvÉÏxlÉÉrÉÑÍxÉUÉhÉÉÇ iÉÑ xÉÎlkÉxÉÇZrÉÉÇ lÉ ÌuÉ±iÉã || || xÉÑ.vÉÉ 5/28 ||
68. ÍxÉUÉxlÉÉruÉÎxjÉmÉuÉÉïÍhÉ xÉlkÉrÉ¶É vÉUÏËUhÉÉqÉç |
mÉãvÉÏÍpÉÈ xÉÇuÉ×iÉÉlrÉ§É oÉsÉuÉÎliÉ pÉlirÉiÉÈ || || xÉÑ.vÉÉ 5/38 ||
69 . UxÉÉxÉ×XçqÉÉÇxÉqÉãSÉãÅÎxjÉqÉeeÉvÉÑ¢üÉÍhÉ kÉÉiÉuÉÈ || || A.WØû.xÉÔ 1/13 ||
70 . AmÉÉlÉÉãÅmÉÉlÉaÉÈ ´ÉÉãÍhÉoÉÎxiÉqÉãRíûÉãÂaÉÉãcÉUÈ |
vÉÑ¢üÉiÉïuÉvÉM×ülqÉÔ§É aÉpÉïÌlÉw¢üqÉhÉÉ Ì¢ürÉÉ || || A.WØû.xÉÔ 12/9 ||
71 . iÉÇ ÌlÉaÉ×ºûÉÌS | xÉYjlÉÉåÌlÉï¶ÉsÉiuÉÇ AÉmÉÉSrÉÌiÉ || ||A.S¨É-A.WØû.ÌlÉ.15/54||
72 . AÇxÉmÉÏPûaÉÑSpÉaÉÌlÉiÉqoÉãwÉÑ xÉÉqÉÑª, aÉëÏuÉÉmÉ×¸uÉÇvÉrÉÉãÈ mÉëiÉUÉÈ, ÍvÉUÈ MüOûÏMümÉÉsÉãwÉÑ iÉÑ³ÉxÉãuÉlrÉÈ....||
|| xÉÑ.vÉÉ 5/27 ||

73 . ÌuÉzsÉåwÉ CuÉ xÉlkÉÏlÉÉÇ xÉÉS FuÉÏï: MüOûÏ aÉëWû:| mÉ×¸Ç ¤ÉÉåSÍqÉuÉÉmlÉÉåÌiÉ ÌlÉwmÉÏŽiÉ CuÉÉåSUÇ ||
|| A.WØû.ÌlÉ.2/11||
74 . xÉYjÉlÉÉååaÉëïWûÉå uÉ…¤ÉhÉrÉÉåuÉ×ïMürÉÉå: MüÌOû mÉ×¸rÉÉå:| || A.¾Òû.ÌlÉ.11/15 ||
75 . iÉ§É mÉYuÉÉzÉrÉå ¢Ñü®: zÉÔsÉ AÉlÉÉWû AÉl§É MÔüeÉlÉÇ | qÉsÉUÉåkÉÉzqÉuÉkqÉÉïzÉïÎx§ÉMü mÉ×¸ MüOûÏaÉëWûqÉç ||
||A.WØû.ÌlÉ.15/7 ||
76 . Al§ÉMÔüeÉlÉÇ AÉsÉxrÉÇ SÉæoÉïsrÉÇ xÉSlÉÇ iÉjÉÉ |
SìuÉÇ zÉÏiÉÇ bÉlÉÇ ÎxlÉakÉÇ xÉMüOûÏ uÉåSlÉÇ zÉM×üiÉç || || qÉ.ÌlÉ.aÉëWûÍhÉ.18||
77 . eÉÉlÉÑ eÉç…bÉÉåÂMüšÇ xÉWûxiÉmÉÉSÉ…xÉÎlkÉwÉÑ |
ÌlÉxiÉÉåS: xTÑüUhÉÇ pÉåSÉå aÉÑÂiuÉÇ xÉÑÎmiÉUåuÉ cÉ || || qÉ.ÌlÉ.uÉÉiÉ U£ü.6||
78 . lÉÉÍpÉqÉl§ÉÇ cÉ ÌuÉ¹qpÉ uÉåaÉÇ M×üiuÉÉ mÉëhÉzrÉÌiÉ | qÉÉÂiÉÉå WØûiÉç MüOûÏ lÉÉÍpÉ mÉÉrÉÑ uÉ…¤ÉhÉ uÉåSlÉÉ: ||
||A.WØû.ÌlÉ.12/10||
79 . iÉ§É uÉÉiÉÉåSUå zÉÉåTü: mÉÉhÉÏmÉÉlqÉÑwMüMÑüÍ¤ÉwÉÑ |
MÑüÍ¤É mÉÉμÉÉåïSU MüOûÏ mÉ×¸ ÂMçü mÉuÉï pÉåSlÉÇ|| ||A.¾Òû.ÌlÉ.12/12||
80 . iÉåwÉÉÇ iÉÑ mÉÔuÉïÃmÉÉÍhÉ MüOûÏ MümÉÉsÉ uÉåSlÉÉ
MühQÕûSÉïWû: zÉÉåTü¶É aÉÑSxrÉ pÉuÉÌiÉ || ||xÉÑ.ÌlÉ.4/4||
81 . qÉåSÉålÉÉQûÏxiÉ×iÉÏrÉMåü | aÉëÉWûÏ ÌmÉ¨ÉÉÌlÉsÉÉlqÉÔklÉïç Îx§ÉMüxrÉ MüTüÌmÉ¨ÉiÉ:|
xÉ mÉ×¸xrÉ AÌlÉsÉ MüTüÉixÉ cÉæMüÉWûÉliÉU: xqÉëÑiÉ:|| ||A.WØû.ÌlÉ.2/70-71||
82 . ÍzÉU: mÉμÉÉïÎxjÉ ÂMçü MüqmÉÉå qÉqÉïpÉåSÎx§ÉMüaÉëWû: EUÉå ÌuÉoÉlkÉÎxiÉÍqÉUÇ MüÉxÉ: μÉÉxÉ: mÉëeÉÉaÉU: ||
||A.WØû.ÌlÉ.6/16||
83 . iÉ§É mÉYuÉÉzÉrÉå ¢Ñü®: zÉÔsÉ AÉlÉÉWû AÉl§É MÔüeÉlÉÇ | qÉsÉUÉåkÉÉzqÉuÉkqÉÉïzÉïÎx§ÉMü mÉ×¸ MüOûÏaÉëWûqÉç ||
||A.WØû.ÌlÉ.15/7 ||
84 . mÉYuÉÉzÉrÉxiÉÉå AÉl§ÉMÔüeÉÇ zÉÔsÉÉOûÉåmÉÉæ MüUÉåÌiÉ cÉ |
M×ücNíû qÉÔ§É mÉÑUÏwÉiuÉqÉÉlÉÉWÇû Ì§ÉMü uÉåSlÉÉÇ || ||qÉÉ.ÌlÉ.uÉÉiÉurÉÉÍkÉ.14||
85 .rÉÑaÉmÉiÉçMÑüÌmÉiÉÉuÉliÉÎx§ÉMüxÉÎlkÉ mÉëuÉåzÉMüÉæ |
xiÉokÉÇ cÉ MÑüÂiÉÉå aÉÉ§ÉqÉÉqÉuÉÉiÉ: xÉ EcrÉiÉå || ||qÉÉ.ÌlÉ.AÉqÉuÉÉiÉ.5||
85 . .aÉëWûÉå ÌuÉhÉç qÉÔ§É uÉÉiÉÉlÉÉÇ zÉÔsÉ AÉkqÉÉlÉÉzqÉzÉMïüUÉ: |
eÉç…bÉÉåÂÌ§ÉMümÉÉimÉ×¸UÉåaÉzÉÉåwÉæ aÉÑSå ÎxjÉiÉå || ||qÉÉ.ÌlÉ.uÉÉiÉurÉÉÍkÉ.12||

87 . mÉÉÎwhÉï mÉëirÉ…;sÉÏlÉÉÇMühQûUÉ qÉÉÂiÉÉÌSìïiÉÉ |
xÉYjrÉÑi¤ÉåmÉÇ ÌlÉaÉ×ºûÉÌiÉ aÉ×kêxÉÏÇ iÉÉÇ mÉëcÉ¤ÉiÉå || ||A.WØû.ÌlÉ.15/54||
88 . ÎxTüaÉxjlÉÉå: mÉ×¸uÉÇzÉÉxjlÉÉårÉï: xÉÎlkÉxiÉÌiÉç§ÉMÇüü qÉiÉÇ |
iÉ§É uÉiÉålÉ rÉÉ mÉÏQûÉ Ì§ÉMü zÉÔsÉÇ iÉSÒcrÉiÉå || ||pÉÉ.mÉë.210||
89 . uÉÉrÉÑ: MüšÉÍ´ÉiÉÉ: zÉÑ®É: xÉÉqÉÉå uÉÉ eÉlÉrÉåiÉç ÂeÉÇ|
MüÌOû aÉëWû: xÉ ÌuÉ¥ÉårÉ: mÉ…; xÉÎYjÉ ²rÉÉÍ´ÉiÉ || ||aÉSÌlÉaÉëWû.19/160||
90. ÌlÉSÉlÉÇ mÉÔuÉïÃmÉÉÍhÉ ÃmÉÉÍhÉ EmÉzÉrÉxiÉjÉÉ | xÉÇmÉëÉÎmiÉ¶ÉåÌiÉ ÌuÉelÉÉlÉÇ UÉåaÉÉhÉÉÇ mÉleÉiÉÉ xqÉ×iÉÇ ||
||A.WØû.ÌlÉ.1/2||
91 . ÌiÉ£üÉåwhÉ MüwÉÉrÉ AsmÉ Ã¤É mÉëÍqÉiÉ pÉÉåeÉlÉæ:| kÉÉUhÉ ESÏUhÉ ÌlÉzÉÉ eÉÉaÉUÉirÉÑŠ pÉÉwÉhÉæ: ||
Ì¢ürÉÉÌiÉrÉÉåaÉpÉÏ zÉÉåMü ÍcÉliÉÉ urÉÉrÉÉqÉ qÉæjÉÑlÉæ: | aÉëÏwqÉ AWûÉåUÉÌ§É pÉÑ£üÉliÉå mÉëMÑmrÉÌiÉ xÉqÉÏUhÉ: ||
||A.WØû.ÌlÉ.1/14||
92 . Ã¤É vÉÏiÉ AsmÉ sÉbÉÑ A³É urÉuÉÉrÉ AÌiÉmÉëeÉÉaÉUæÈ l
ÌuÉwÉqÉÉSÒmÉcÉÉUÉ¶É SÉãwÉÉxÉ×Mç xÉëuÉhÉÉSÌiÉ ll
sÉÇbÉlÉ msÉuÉlÉ AirÉkuÉurÉÉrÉÉqÉ AÌiÉ ÌuÉcÉãÌ¸iÉæÈl
kÉÉiÉÔlÉÉÇ xÉÇ¤ÉrÉÉÍ¶ÉliÉÉ vÉÉãMüUÉãaÉ AÌiÉ MüwÉïhÉÉiÉç ll
SÒÈZÉvÉrrÉÉxÉlÉÉiÉç ¢üÉãkÉÉÌ¬uÉÉxuÉmlÉÉ°rÉÉSÌmÉ l
uÉãaÉxÉÇkÉÉUhÉÉSè AÉqÉÉSè AÍpÉbÉÉiÉÉiÉç ApÉÉãeÉlÉÉiÉç ll
qÉqÉÉïbÉÉiÉÉiÉç aÉeÉ F·íé AμÉvÉÏbÉërÉÉlÉÉmÉiÉÇxÉlÉÉiÉç l ||cÉ.ÍcÉ.28/15-18||
93. mÉÔuÉïÃmÉÍqÉÌiÉ mÉëÉaÉÑimÉÍ¨É sÉ¤ÉhÉÇ urÉÉkÉãÈ || || cÉ.ÌlÉ 1/8 ||
94 . AurÉ£üÇ sÉ¤ÉhÉÇ iÉãwÉÉÇ mÉÔuÉïÃmÉÍqÉÌiÉ xqÉ×iÉqÉç |
AÉiqÉÃmÉÇ iÉÑ iÉSèurÉ£üqÉmÉÉrÉÉã sÉbÉÑiÉÉ mÉÑlÉÈ || || cÉ.ÍcÉ 28/19-20||
95 . cÉ¢ümÉÉÍhÉ- AurÉ£üÍqÉÌiÉ AsmÉiuÉãlÉ rÉjÉÉã£üsÉ¤ÉhÉiÉÉãÅxÉÇmÉÔhÉïqÉç || || cÉ.ÍcÉ 11/12 ||
96 . mÉëÉSÒpÉÑïiÉ sÉ¤ÉhÉÇ mÉÑlÉÍsÉïXçaÉqÉç || || cÉ.ÌlÉ 1/9 ||
97 . uÉÉrÉÑ: MüšÉÍ´ÉiÉÉ: zÉÑ®É: xÉÉqÉÉå uÉÉ eÉlÉrÉåiÉç ÂeÉÇ|
MüÌOû aÉëWû: xÉ ÌuÉ¥ÉårÉ: mÉ…; xÉÎYjÉ ²rÉÉÍ´ÉiÉ || ||aÉSÌlÉaÉëWû.19/160||
98 . xÉçÇMüÉåcÉ: mÉuÉïhÉÉÇ xiÉqpÉÉå pÉåSÉå AxjlÉÉÇ mÉuÉïhÉÉqÉÌmÉ |
sÉÉåqÉ WûzÉï: mÉësÉÉmÉ¶É mÉÉÍhÉ mÉ×¸ ÍzÉU aÉëWåû || ||cÉ.ÍcÉ.28/20-21||

99 . ÎxTüMçü mÉÔuÉïÇ MüÌOû mÉ×¸Éå ÂeÉÉlÉÑeÉ…bÉÉmÉSÇ ¢üqÉÉiÉç |
aÉ×kÉëxÉÏ xiÉqpÉ Â£üÉåSæaÉ×ïºûÉÌiÉ xmÉlSiÉå qÉÑWÒû: || ||rÉÉå.U¦ÉÉ.uÉÉiÉurÉÉÍkÉ ÌlÉSÉlÉ. ||
100 . xÉgcÉrÉÇ cÉ mÉëMüÉãmÉÇ cÉ mÉëxÉiÉÇ xjÉÉlÉxÉÇ´ÉrÉqÉç |
urÉÌ£üÇ pÉãSÇ cÉ rÉÉã uÉãÍ¨É SÉãwÉÉhÉÉÇ xÉ pÉuÉãÌ°wÉMç || || xÉÑ.xÉÔ 21/36 ||
101 . iÉãwÉÉÇ uÉÉrÉÑaÉïÌiÉqÉiuÉÉiÉç mÉëxÉUhÉWãûiÉÑÈ xÉirÉmrÉcÉæiÉlrÉã xÉÌWû UeÉÉãpÉÔÌrÉ¸ UeÉ¶É mÉëuÉiÉïMãü xÉuÉïpÉuÉÉlÉÉqÉç ||
|| xÉÑ. xÉÔ 21/28 ||
102 . mÉÔuÉïÃmÉqÉãuÉ xjÉÉlÉxÉÇ´ÉrÉ ÍsÉXçaÉqÉç |
iÉ§É mÉÔuÉïÃmÉaÉiÉãwÉÑ cÉiÉÑjÉï Ì¢ürÉÉMüÉsÉÈ || ||xÉÑ.xÉÔ21/33 ||
103 . uÉÉrÉÑÈ MüOèrÉÉÇ ÎxjÉiÉÈ xÉYjlÉ MühQûUÉqÉÉÍ¤ÉmÉã±SÉ |
iÉSÉ ZÉgeÉÉã pÉuÉãeeÉliÉÑÈ mÉXçaÉÑÈ xÉYjlÉÉã²ïrÉÉãUÌmÉ || || A.WØû.ÌlÉ 15/45 ||
104 . MüqmÉiÉã aÉqÉlÉÉUqpÉã ZÉgeÉÌ³ÉuÉ cÉ rÉÉÌiÉ rÉÈ |
MüsÉÉrÉZÉgeÉÇ iÉÇ ÌuÉ±ÉlqÉÑ£ü xÉÎlkÉmÉëoÉlkÉlÉqÉç || || A.WØû.ÌlÉ 15/46 ||
105 . aÉëWûÉã ÌuÉhqÉÔ§ÉuÉÉiÉÉlÉÉÇ vÉÔsÉkqÉÉlÉvqÉ vÉMïüUÉÈ |
eÉXçbÉÉãÂÌ§ÉMümÉÉimÉ×¸UÉãaÉvÉÉãwÉÉæ aÉÑSÎxjÉiÉã || || cÉ.ÍcÉ 28/26,27 ||
106 . oÉÉ½ÉprÉliÉUÉrÉÉqÉÇ ZÉÎssÉÇ MÑüoeÉiuÉqÉãuÉ cÉ |
xÉuÉÉïXçaÉæMüÉXçaÉ UÉãaÉÉÇ¶É MÑürÉÉïiÉç xlÉÉrÉÑaÉiÉÉãÅÌlÉsÉÈ || || cÉ.ÍcÉ 28/35 ||
107 . mÉYuÉÉvÉrÉxrÉÉãÅl§ÉMÔüeÉÇ vÉÑsÉÉOûÉæmÉÉæ MüUÉãÌiÉ cÉ |
M×ücdqÉÔ§ÉmÉÑUÏwÉiuÉqÉÉlÉÉWûÇ Ì§ÉMüuÉãSlÉÉqÉç || || cÉ.ÍcÉ 28/28 ||
108 . mÉÉμÉïrÉÉãeÉïbÉlÉoÉÌWûpÉÉïaÉã mÉ×¸uÉÇvÉqÉÑpÉrÉiÉÉã MÑüMÑülSUã, iÉ§É xmÉvÉÉï¥ÉÉlÉqÉkÉÈ MüÉrÉã cÉã¹ÉãmÉbÉÉiÉ¶É ||
|| xÉÑ. vÉÉ 6/26 ||
109 . ÎxTüYmÉÔuÉÉï MüOûÏmÉ×¸ÉãÂeÉÉlÉÑeÉXçaÉÉmÉSÇ ¢üqÉÉiÉç | || cÉ.ÍcÉ 28/56 ||
43. MüÌOûuÉÇ¤ÉhÉWØûimÉÉμÉï´ÉÉãÍhÉwÉÑ qÉÉÂiÉÈ |
MÑüÂiÉã uÉãSlÉÉÇ. . . . . . . . . . . . .|| || cÉ.ÍcÉ 30/213 ||
44. iÉãwÉÉqÉrÉÉÇ ÌuÉvÉãwÉÈ. . . . . . . .FÂMüOûÏmÉ×¸Ì§ÉMümÉÉμÉïMÑüÍ¤ÉoÉÎxiÉvÉÔsÉÈ || || cÉ.ÍcÉ.14/11 ||
45. iÉ§É SuÉÏïMüU ÌuÉwÉãhÉ. . . . . .MüOûÏmÉ×¸aÉëÏuÉÉSÉæoÉïsrÉÇ || || xÉÑ.Mü.4/37 ||
46. wÉ¸ã mÉëhÉÉvÉvÉ¶É pÉ×vÉÇ cÉÉmrÉÌiÉxÉÉrÉïiÉã |
xMülkÉmÉ×¸MüOûÏpÉXçaÉ xÉÌ³ÉUÉãkÉ¶É xÉmiÉqÉã || || xÉÑ. Mü 2/39 ||

48 . . . iÉxrÉ ÍsÉXçaÉqÉeÉÏhÉïxrÉ ÌuÉ¹qpÉÉÈ xÉSlÉÇ iÉjÉÉ |
. . . . . . . . . . . . . . .mÉ×¸MüOûÏaÉëWûÈ || || cÉ.ÍcÉ 15/45 ||
49. iÉ§É EmÉÎxjÉiÉ mÉëxÉuÉÉrÉÉÈ MüOûÏmÉ×¸Ç mÉëÌiÉ xÉqÉliÉÉiÉç uÉãSlÉÉ || || xÉÑ.vÉÉ. 10/7 ||
50. rÉxrÉÉÈ mÉÑlÉuÉÉïiÉÉãmÉxÉ×¹ xÉëÉãiÉÍxÉ sÉÏlÉÉã aÉpÉïÈ. . . . .iÉæsÉãlÉ cÉÉpÉÏ¤hÉqÉÑSUuÉÇ¤ÉhÉÉãÂMüOûÏmÉÉμÉïmÉ×¸ÉlrÉprÉgeÉlÉÉiÉç ||
|| A.xÉ.vÉÉ 4/23 ||
51. §ÉrÉÉhÉÉÇ xÉXçaÉÈ || || vÉ.Mü.SìÓ ||
52. mÉ×¸uÉÇvÉÉkÉÉUã Ì§ÉMüqÉç ||
mÉ×¸uÉÇvÉxrÉÉkÉÉãpÉÉaÉã | §ÉrÉÉhÉÉÇ xÉXçaÉÈ || || A.MüÉã 2/6/76 ||
53. Ì§ÉMüÇ ²ÉSvÉÉXçaÉÑsÉÉãixÉãkÉqÉç || ||cÉ.ÌuÉ 8/117 ||
cÉ¢ümÉÉÍhÉ- Ì§ÉMüÍqÉÌiÉ aÉÑSÉxjlÉ mÉëpÉ×ÌiÉ MüOûÏMümÉsÉÉãkuÉïmÉrÉïliÉqÉç ||
54. AÇxÉmÉÏPûaÉÑSpÉaÉÌlÉiÉqoÉãwÉÑ xÉÉqÉÑª, aÉëÏuÉÉmÉ×¸uÉÇvÉrÉÉãÈ mÉëiÉUÉÈ, ÍvÉUÈ MüOûÏMümÉÉsÉãwÉÑ iÉÑ³ÉxÉãuÉlrÉÈ....||
|| xÉÑ.vÉÉ 5/27 ||
55. cÉiÉÑSïvÉÉxjlÉÉÇ xÉXçbÉÉiÉÉÈ, ......... Ì§ÉMüÍvÉUxÉÉãUãMæüMüÈ|| || xÉÑ.vÉÉ 5/16 ||
56. mÉ×wjÉÉÎxjÉ iÉÑ MüxÉãÂ xrÉÉiÉç...|| || UÉ.ÌlÉ qÉ 11 111 ||
57. mÉgcÉcÉiuÉÉËUÇvÉiÉç mÉ×¸aÉiÉÉlrÉxjÉÏÌlÉ. . . . .|| || cÉ.vÉÉ 7/6 ||
58. pÉÉaÉïuÉÉxjÉÏlÉÏ mÉ×¸ÉÌlÉ cÉiuÉÉËUÇvÉccÉ mÉgcÉMüqÉç || || MüÉ.xÉ.ÌuÉ.vÉÉ 7 ||
59. mÉ×¸ã Ì§ÉÇvÉiÉç || || xÉÑ.vÉÉ 5/19 ||
60. Ì§ÉÇvÉiÉç mÉ×¸ã || || A.WØû.vÉÉ 3/16 ||
61. xÉÇkÉÉlÉqÉç |
kÉÉgÉç ' EmÉxÉaÉãï kÉÉã ÌMüÈ || || A.MüÉã. 3/2/11 ||
62. xÉÇkÉrÉ¶É AXçaÉ xÉlkÉÉlÉÉiÉç SãWãû mÉëÉã£üÉ MüTüÉÎluÉiÉÉ || || vÉÉ.mÉÔ 5/57 ||
63. xÉÇÍkÉ xÉÇvsÉãwÉhÉ xlÉãWûlÉ UÉãmÉhÉmÉÔUhÉ oÉsÉxjÉærÉïM×ücdsÉãvqÉÉ mÉgcÉkÉÉ mÉëÌuÉpÉ£ü...|
QûsWûhÉ - xÉÇÍkÉxÉÇvsÉãwÉhÉÉM×üiÉç xÉÇÍkÉoÉlkÉlÉÇ MüUÉãÌiÉ || || xÉÑ.xÉÔ 15/4 ||
64. AxjlÉÉÇ iÉÑ xÉlkÉrÉÉã ½ãiÉã MãüuÉsÉÉÈ mÉËUMüÐÌiÉïiÉÉÈ |
mÉãvÉÏxlÉÉrÉÑÍxÉUÉhÉÉÇ iÉÑ xÉÎlkÉxÉÇZrÉÉÇ lÉ ÌuÉ±iÉã || || xÉÑ.vÉÉ 5/28 ||
mÉãvÉÏÍpÉÈ xÉÇuÉ×iÉÉlrÉ§É oÉsÉuÉÎliÉ pÉlirÉiÉÈ || || xÉÑ.vÉÉ 5/38 ||

66. UxÉÉxÉ×XçqÉÉÇxÉqÉãSÉãÅÎxjÉqÉeeÉvÉÑ¢üÉÍhÉ kÉÉiÉuÉÈ || || A.WØû.xÉÔ 1/13 ||
67. AmÉÉlÉÉãÅmÉÉlÉaÉÈ ´ÉÉãÍhÉoÉÎxiÉqÉãRíûÉãÂaÉÉãcÉUÈ |
vÉÑ¢üÉiÉïuÉvÉM×ülqÉÔ§É aÉpÉïÌlÉw¢üqÉhÉÉ Ì¢ürÉÉ || || A.WØû.xÉÔ 12/9 ||
68. vsÉãwqÉÉ ÎxjÉUiuÉ ÎxlÉakÉiuÉqÉç xÉÎlkÉoÉlkÉ¤ÉqÉÉÌSÍpÉÈ | || A.WØû 11/3 ||
69. xÉÎlkÉxÉÇvsÉãwÉÉcdsÉãwÉMüÈ xÉÎlkÉwÉÑ ÎxjÉiÉÈ || || A.WØû. 12/18 ||
70. cÉiÉÑjÉÏï vsÉãwqÉkÉUÉ xÉuÉïxÉÎlkÉwÉÑ mÉëÉhÉpÉ×iÉÉÇ pÉuÉÌiÉ ||
xlÉãWûÉprÉ£ãü rÉjÉÉ ½¤Éã cÉ¢üÇ xÉÉkÉÑ mÉëuÉiÉïiÉã ||
xÉlkÉrÉ xÉÉkÉÑ uÉiÉïliÉã xÉÇÎvsÉ¹ÉÈ vsÉãwqÉhÉÉ iÉjÉÉ || ||xÉÑ.vÉÉ 4/15 ||
mÉãvÉÏÍpÉÈ xÉÇuÉ×iÉÉlrÉ§É oÉsÉuÉÎliÉ pÉuÉlirÉiÉÈ || || xÉÑ.vÉÉ 5/38 ||
72. qÉÉÇxÉmÉãvrÉÉã oÉsÉÉrÉ xrÉÑUuÉqpÉÉrÉ SãÌWûlÉÉqÉç || ||vÉÉ.xÉÇ mÉÔ 5/39 ||
73. qÉWûirÉÉã qÉÉÇxÉUeeÉuÉ¶ÉiÉxÉëÈ - mÉ×¸uÉÇvÉqÉÑpÉrÉiÉÈ mÉãÍvÉÌlÉoÉlkÉlÉÉjÉãï ²ã oÉÉ½ã, AÉprÉliÉUã cÉ ²ã ||
|| xÉÑ.vÉÉ 5/14 ||
74. mÉëxÉUhÉÉMÑügcÉlÉrÉÉãUXçaÉÉlÉÉÇ MühQûUÉ qÉiÉÉÈ || || vÉÉ.mÉÔ 5/63 ||
75. xÉUhÉÉiÉç ÍxÉUÉÈ || || cÉ.xÉÔ 30/12 ||
eÉÉlÉÑMüOèrÉÔÂ xÉlkÉÏlÉÉÇ xTÑüUhÉÇ xiÉokÉiÉÉ pÉ×vÉqÉç ||
uÉÉiÉvsÉãwqÉÉã°uÉÉrÉÉÇ iÉÑ ÌlÉÍqÉ¨ÉÇ uÉÌ»ûqÉÉSïuÉqÉç |
iÉlSìÉ qÉÑZÉmÉëxÉãMü¶É pÉ£ü²ãwÉxiÉjÉæuÉ cÉ || || qÉÉ.ÌlÉ 22/55-56 ||
89. ZÉssÉÏ iÉÑ mÉÉSeÉXçbÉÉãÂMüUqÉÔsÉÉuÉqÉÉãÌOûlÉÏ || || cÉ.ÍcÉ 28/57 ||
93. eÉXçbÉÉãÂasÉÉÌlÉUirÉjÉïÇ vÉμÉccÉSÉWûuÉãSlÉÉ |
mÉSã cÉ urÉrÉiÉã lrÉxiÉÇ vÉÏiÉxmÉvÉïÇ lÉ uÉãÍ¨É cÉ ||
xÉÇxjÉÉlÉã mÉÏQûlÉã aÉirÉÉÇ cÉÉsÉlÉã cÉÉmrÉlÉÏμÉUÈ |
AlrÉlÉãrÉÉæ ÌWû xÉÇpÉalÉÉuÉÔÂ mÉÉSÉæ cÉ qÉlrÉiÉã ||
rÉSÉ SÉWûÉÌiÉï iÉÉãSÉiÉÉæ uÉãmÉlÉÈ mÉÑÂwÉÉã pÉuÉãiÉç || || cÉ.ÍcÉ 27/17-19 ||
94. lrÉxiÉã iÉÑ ÌuÉwÉqÉÇ mÉÉSã ÂeÉÈ MÑürÉÉïiÉç xÉqÉÏUhÉÈ |

uÉÉiÉMühOûMü CirÉãwÉ ÌuÉ¥ÉãrÉÈ ZÉQÒûMüÉÍ´ÉiÉÈ || || xÉÑ. ÌlÉ 1/79 ||
95. WØûwrÉiÉ¶ÉUhÉÉæ rÉxrÉ pÉuÉiÉ¶É mÉëxÉÑmiÉuÉiÉç |
mÉÉSWûwÉïÈ xÉ ÌuÉ¥ÉãrÉÈ MüTüuÉÉiÉmÉëMüÉãmÉeÉÈ || || xÉÑ.ÌlÉ 1/81 ||

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Case proforma 206
A STUDY ON THE KATI-TRIKA SANDHI SHAAREERA W.S.R TO THE

EFFECT OF“BHUJANGASANA” IN KATI-GRAHA.
Name: Serial No.

Age: Date:
OPD/IPD:
Sex: Bed No.:
Religion: DOA/DOD:
Education: Intervention:
Marital Status: Postal Address:
Social Status:
Occupation: Desha:
I) Presenting Complaints with duration

-a) Pain(Ruk, Toda) in Buttock/ Lumbar region
b)Radiating pain-
c)Tenderness
d)Swelling
e)Restriction of movements
II) Associatedsymptoms: Deranged movements/ Fasciculations/ Parasthesia/

Numbness/ Tandra/ Gourava/ Arochaka/Spurana/Mukhapraseka/ Others:
III) History of Present Illness:

Onset- sudden / gradual / Insidious
Site of pain-L1 L2 L3 L4 L5 S1
Nature- Dragging/ Shooting/ Stabbing/ Dull/ Pulling
Course- Continuous/ Intermittant/ Progressive/ Waxing and waning
Radiation- Rt. Leg/ Lt. Leg/ Both From: To:

Case proforma 207
Aggravating Factor- Diurnal-

Seasonal-
Movement-FB/BB/Lat.Rot/Walking/Folding Legs
Anya-Activities like lifting,coughing,standing,
Sneezing,sitting.
Relieving Factor- Diurnal-

Seasonal-
Movement-FB/BB/Lat.Rot/Walking/Folding Legs/Rest
IV) History Of Past Illness:

Abhighaataja (Trauma)/ Anya Roga
V) Family History:
H/o complaints related to musculo –skeletal system. Y N
VI) Treatment History:

Ayurveda Allopathy Others
VII) Obstetric History: No of deliveries N/Cs N/Abortion
Gynaec history: M.C.___ days R IR

Menarche Yr.
Dysmenorrhoea Lucorrhoea Metrorrhagia Menorrhagia
VIII) Personal History:
Habits Duration/ Occasional/ Stopped/ Relationship to

Continued Regular Reduced Symptom

Case proforma 208
Smoking
Alcohol
Tobacco
Snuff
Others
2) Ahara:
a. Quantity- Alpa Pramitha Sama Atipramana
b. Dominant rasa in diet- M A L K T K
c. Guna- Ruksha / Sheetha / Laghu
Snigdha / Ushna / Guru
d. Dietetic habit: Samashana / Vishamashana
Adhyashana / Anashana
e. Nature of Diet: Veg Nonveg Mixed
3) Nature of work: Manual / Sedentary / Labour

Traveling / Walking / Standing / Sitting
Stooping/ Squatting.
Day Night
4) Vishram: ____hrs
Proper / Less / Excessive
5) Vyayama: No / Less / Proper / Excessive / Irregular
6) Nidra: Sound / Disturbed / Ratri jagarana / _hrs
7) Others:
a. Atimaithuna:
b. Vegadhaarana:
Pureesha pravrutti : Regular/ Irregular/ Constipation/ Loose Motion

Case proforma 209
Saama / Niraama
Mootra pravarutti : Quantity/ Smell/ Colour/ Frequency/ Urgency
Dysuria/ Burning discharge/ Others.
IX) General Examination:

1. Pulse- /min
2. Blood pressure- /mm of hg
3. Temperature- /0F
4. Respiratory rate- /min
5. Lymphadenopathy- Y N
6. Nourishment- Good / Moderate / Poor
7. Gait-
X) Dasha vidha Pareeksha:

1. Prakritatah: V / P / K / VP / VK / KP / VPK
2. Vaya: Bala Madhya Vriddha
3. Vikrititah: V P K
4. Samhanana: P M A
5. Satwa : P M A
6. Pramana: Ht wt P M A
7. Satmyata: P M A
8. Ahara Shakti:
-Abhyavarana P M A
-Jarana P M A
9. Sara: P M A
10. Desha S J A
XI) Sroto Pareeksha:

1. Pranavaha: Prakrita Vaikrita
2. Udakavaha: Prakrita Vaikrita
3. Annavaha: Prakrita Vaikrita

Case proforma 210
4. Rasavaha: Prakrita Vaikrita

5. Raktavaha: Prakrita Vaikrita
6. Mamsavaha: Prakrita Vaikrita
7. Medovaha: Prakrita Vaikrita
8. Asthivaha: Prakrita Vaikrita
9. Majjavaha: Prakrita Vaikrita
10. Sukravaha: Prakrita Vaikrita
11. Artavaha: Prakrita Vaikrita
12. Swedavaha: Prakrita Vaikrita
13. Mutravaha: Prakrita Vaikrita
14. Purishavaha: Prakrita Vaikrita
XII) Systemic Examination:

1. C.V.S-
2. R.S-
3. C.N.S-
4. P/A-
5. Loco motor system-
JOINTS Erythma Swelling Muscle Deformity Movements Tenderness Crepitus

wasting restricted
Hip- Rt
” - Lt
Examination of vertebral column :.
XIV) Investigations:
X - ray Lumbosacral joints
PA View-
Lateral View-

Case proforma 211
XV) Assessment criteria:G1G2G3G4(Normal,mild,moderate,severe)

Stambha ( Stiffness ):
Ruk ( Pain ):
Goniometer reading:
Straight Leg Raising Test :
XVI) Samprapthi Ghataka:
1. Nidana - Ahara Vihara
Sannikrista Viprakrista
2. Roopa-
3. Dosha-
4. Dooshya-
5. Srothas-
6. Srotodushti prakarana
7. Udbhava sthana-
8. Sanchara sthana-
9. Roga marga-
10. Sthana samshraya-
11. Vyakta sthana-
12. Adhishtana-
13. Swabhava-
XVII) Samprapti:
XVIII) Vyadhi vinischaya:
X1X)Chikitsa:

Case proforma 212
Asana- Bhujangasana.
Pathyapathya-
Assessment criteria-
Pain-
Stiffness-
Range of movement-
Goniometer reading-
X-ray PA & Lat view-
SLRT-
Signature of the guide Signature of the student

Thusharalal Thesis

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“A STUDY ON KATI-TRIKA SANDHI SHAAREERA W. S. R.

Dissertation submitted to the

In partial fulfillment of the requirements for the degree of

UNDER THE GUIDANCE OF

DEPARTMENT OF P. G. STUDIES IN SHAREERA RACHANA

DECLARATION BY THE CANDIDATE

I hereby declare that this dissertation entitled “A STUDY ON KATI-TRIKA

Date: Signature of the Candidate

Place: Udupi Dr. Thusharalal.S

CERTIFICATE BY THE CO-GUIDE

This is to certify that the dissertation entitled “A STUDY ON KATI-TRIKA SANDHI

ENDORSEMENT BY THE HOD, PRINCIPAL/HEAD OF THE INSTITUTION

This is to certify that the dissertation “A STUDY ON KATI-TRIKA SANDHI

Signature of H.O.D Signature of Principal

Dr. U.Govindaraju, Dr. U. N. Prasad,

Professor and Head, Principal,

Place: Udupi Place: Udupi

DECLARATION BY THE CANDIDATE

format for academic / research purpose.

Date: Signature of the Candidate

Place: Udupi Dr. Thusharalal.S

© Rajiv Gandhi University of Health Sciences, Karnataka

CERTIFICATE BY THE GUIDE

This is to certify that the dissertation entitled “A STUDY ON KATI-TRIKA SANDHI

PROFESSOR AND HEAD,

The grace of divinity so kind to place me the seedling as my parents Dr.Jyothilal

Department of Shareera Rachana, SDMCA, Udupi.

I would like to thank my Co-guide, Dr.Mohammed rafik,B.N.Y.S., M.D

Department of Shareera Rachana, SDMCA, Udupi.

Department of Shareera Rachana, SDMCA, Udupi.

Sl. No. Contents Page No.

3 Review of literature 05-124

5 Observations & Analysis 131-161

9 Reference Shlokas 179-187

12 Master chart 213

Department of Shareera Rachana, SDMCA, Udupi.

Table Description Page

1 Number of Asthi in Prushthavamsha 15

2 Divisions of the body 16

3 Marmas related with Kati-trika Pradesha 16

4 Samanya Nidana of Vatavyadhi 20

5 Marmas of Kati-Trika Prushtha and sakthi related 20

6 General symptoms present in the Katitrika 22

7 Deep Muscles of the Back & its Actions 52

8 Lumbar plexus, Branches & Distribution 68

9 Sacral plexus branches and its distribution 70

10 Main features of Low back pain from various sources 74

11 Objective signs met with following herniation of the 75

12 Causes of Back pain in relation to Age 76

13 Movements possible at Synovial joints 111

14 Movements possible at Ball & Socket joints 111

15 2 types of Articular surfaces 115

16 Joint positions of Principal joints 120

17 Method of Intervention 129

18 Distribution of patients according to Age 137

19 Distribution of patients according to Gender 138

20 Distribution of patients according to Religion 139

Department of Shareera Rachana, SDMCA, Udupi.

21 Distribution of patients according to Educational 140

22 Distribution of patients according to Marital status 141

23 Distribution of patients according to Social status 142

24 Distribution of patients according to Occupation 143

25 Distribution of patients according to Habits 144