Sindhuja BS et al.

Musculoskeletal Disorders and Siddha Medicine

Case Report
Utilization of Varmam Therapy in Improving Quality of Life (QoL) in
patients with Cervical Dystonia- A case study
Bhuvanagiri Satya Sindhuja1, Injarapu Sankar2, Ram Mohan Reddy3, Shweta Tiwari3

From, 1Patron, 2Chief Healer, 3, 4Consultant, Department of Siddha Medicine, Chakrasiddh health centre, Hyderabad, India

ABSTRACT

Cervical Dystonia commonly called 'Spasmodic Torticollis' is a neurological disorder that causes involuntary muscle
contractions, spasms, pain and tremors in the neck region. Sagana Vatham is one among 80 vatha disease mentioned in the
Siddha text book of Siddhar Yugi. This disease affects the neck & upper extremities with some of its signs and symptoms bearing
a resemblance to cervical dystonia symptoms. It is seen that different Complementary and Alternative Medicines (CAMs) have
provided relief in cases of CD. Siddha vaidyam is another alternative therapy used in such disorders. A 56-year-old male from
Hyderabad a K/C/O Cervical Dystonia reported to the Chakrasiddh with chief complaints of pain and involuntary movements to
the right side of the neck since 2 1/2 yrs. He was given Varma therapy like Varma Elakku Muraigal (Varma Relieving Methods)
and Varma Thadavu Muraigal (Varma Massage Methods) to decrease pain and spasms, myofascial release and stretching, to
decrease dyskinesia. The total treatment was given for 25 sessions in 6 months span with gaps in between. This study aimed to
examine the effects of Siddha therapy on pain, spasms, and dyskinesia and to identify possible improvements in the quality of
life (HRQoL) of the patient. NRS was used for pain at each session. Disease-specific HRQoL was assessed by using the Cervical
Dystonia Impact Profile-58 questionnaire (CDIP-58). Positive outcomes were exhibited after 25 sessions in the frequency of
pain and spasms and holding the neck in the centre for 1 hour which was just <5 mins earlier. The pain (NRS) was markedly
reduced from a 7/10 score to 2/10. CDIP-58 scores, disease-specific HRQoL, showed a significant improvement in all parameters
after 25 sessions of treatment.

Key words: Cervical dystonia, health-related quality of life (QoL), Cervical Dystonia Impact Profile-58 questionnaire (CDPI-
58), Siddha vaidyam, Varmam therapy

In Western countries, CD is found in every 5.4 patients

C
ervical Dystonia commonly called 'Spasmodic
Torticollis' is a neurological disorder that causes the 100,000 persons and is most commonly found in Caucasian
involuntary muscle contractions, spasms, pain and women. Generally, the onset is estimated when the patients
tremors. This results in repetitive or twisting movements and are in their mid-30s to 40’s [3]. The typical symptoms of CD
dyskinesia- an abnormal turning of the head on one side [1]. include pain, abnormal posture, spasms, tremors, and
It also results in abnormal posturing of the head, shoulders dyskinesia. Pain is experienced in almost all patients due to
and neck. The CD is the most common focal dystonia, the presence of muscle contractions and head deviations [4,
affecting the social life and decreasing the quality of life for 5]. The symptoms are the cause of significant disability and
most patients [2]. The causes of Primary CD may or may not impaired quality of life among patients [6]. CD is thought to
be identifiable but it is believed to be secondary to other increase psychiatric issues like anxiety and depression in
neurological diseases such as post-brain stroke, post- patients [2, 5]. Interventions to reduce psychiatric issues and
encephalitis syndrome, and other degenerative diseases that pain play a more prominent role in treating Dystonia patients
cause a damage to the basal ganglia [2]. in order to improve disability levels. Researchers believe
there is no complete treatment for Dystonia and all treatments
Access this article online
are aimed at restoring function and managing symptoms [7].
Received – 31st August 2023 Quick Response Code ________________________________________
Initial Review – 17th September 2023
Corresponding to: Shweta Tiwari, Patron, Department of
Accepted – 08 October 2023
th Siddha Medicine, Chakrasiddh health centre, Hyderabad,
India. Email: shweta11_in@yahoo.com

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Sindhuja BS et al. Musculoskeletal Disorders and Siddha Medicine

Some relief can be gained by conventional treatments limbs and headache on/off for the past 2 years. Since the
including pain relievers, Botox injections, or sometimes patient has been on homoeopathic medications for the last 1
surgical treatment. Currently, the evidence shows best year, the intensity of pain was moderate in nature but the
treatment option is to inject the dystonic neck muscles with severity used to increase if he pulled his neck on the left side,
botulinum toxin but for a temporary period [8]. Many CAM numbness and tingling sensation had reduced but the problem
therapies such as physical therapy, acupressure, Kerala was still persistent.
massages, homeopathy, and chiropractic adjustments are
utilized by dystonia patients to manage symptoms. It is seen On turning the neck towards the left side, he had cramps
dystonia patients could benefit from alternative therapies but and tremors. He found difficulty on sleeping to his left side
these treatments are not well documented [8]. and while walking, he felt pain as he had to keep his body
tilted due to neck stiffness. He noticed that after sleeping he
Siddha vaidyam is another alternative therapy which is an didn't experienced any pain in the morning but it would get
ancient and traditional therapy used in the Indian aggravated as the day passess by. The patient had difficulty
subcontinent, especially in Southern India. This therapy while driving the car and so completely stopped driving.
works on Varma points where the vital energy of our body is
concentrated and has proved to be beneficial in managing the The concerned patient had an office job with sitting duty
symptoms of disorders like dystonia. It focuses on removing for 9 hours and had to attend meetings throughout the day.
blockages, improving energy flow and activating the body’s The patient noticed that anxiety and stress were aggravating
internal healing mechanisms. Thus, resulting in a cure and an the condition and he would get tremors often. He was
improved lifestyle with no medications and no surgical embarrassed due to his present condition so his social life was
intervention [9, 10]. According to varma theory, to stimulate
also getting affected. As the only sole earning member of the
the Varma points; pressure should be applied to these points
family responsibility was on his shoulders, he had immense
at a particular and given strength [11]. As mentioned in
psychological stress which led to depression and deterioration
Varma literature, stimulation of Varma points consist of five
in his quality of life [6].
main aspects: saving life (Physiological aspect), cause of
disease (Pathological aspect), curing disease (Therapeutic
History of Past Medical Illness: The patient is Non-diabetic
aspect) and giving longevity (Preventive aspect) [12, 13].
but has age-related Hypertensive. He has an H/o Vasectomy
Sagana Vatham (cervical spondylosis) is one among 80 vatha
and Haemorrhoidectomy 20 years back. In 2020, he had a
diseases mentioned in the Siddha textbook of Siddhar Yugi.
brain stroke and was admitted for a week in hospital for same.
This disease affects the neck & upper extremities with some
After 10 days of stroke, patient started feeling acute pain and
of its signs and symptoms bearing a resemblance to cervical
neck deviation to right with continuous shaking movements
dystonia symptoms.
of neck. It was associated with severe stiffness in neck and
This study aimed to identify possible improvements in eyes pain. On increase in eye pain, the patient consulted an
quality of life (HRQoL) after multiple sessions of pressure ophthalmologist, who advised him to visit a neurologist
therapy in an adult dystonia patient. The patient was given terming the issue as neuro problem. The neurologist
treatment for a total of 25 sessions with gaps in between confirmed it as Dystonia and started Baclofen and lateron, he
depending upon his improvement. A Numeric Rating scale was also injected with Botox but he could get only mild relief.
(NRS) was used for pain at each session. Disease-specific The condition deteoriated after he had covid in 2021. Over
HRQoL was assessed by using the CDIP-58. The assessments the past year, the patient managed his symptoms with
were performed before and after the 25 sessions in a span of homeopathic medications and physio exercise three times a
6 month treatment period. week. His colleague advised him to visit Chakrasiddh for
consultation and for permanent treatment.
CASE PRESENTATION
Assessment Measures: Before start of treatment, all videos
A 56-year-old male from Hyderabad a K/C/O CD reported to of patients walking style, range of movement of neck, level
the Chakrasiddh OPD on Jan, 22 with chief complaints of of dyskinesia was recorded as pre-treatment assessment. It is
pain and involuntary movements to the right side of his neck essential, as it will affect the final outcomes and the
for 2 1/2 years. He had neck deviation to the right side and improvement can be identified.
was unable to hold his neck in the centre even for a few
minutes (<5 mins) and was having intense pain if he tried 1. Numeric Rating Scale for Pain: Pre and post-treatment
taking the neck on the left side. His complaints also included pain severity measurement were assessed using the NRS
severe neck pain, swelling over the left side with cervical (Numeric Rating Scale) at each treatment session where 0
stiffness, tingling sensation and numbness in both upper refers to no pain and 10 refers to worst possible,

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Sindhuja BS et al. Musculoskeletal Disorders and Siddha Medicine

excruciating, and unbearable pain. The pain was evaluated shoulders), Kaichulukki varmam (above the clavicle bone
on different symptoms like during bending, walking, both side) and Chippi Varmam (below the clavicle bone both
sleeping, working, lifting, exertion, movements of head, sides)
neck, shoulder, arms etc As spasms occurred in the same
areas of pain, no separate measure was taken. The patient In initial 5-8 sessions, patient felt no difference in spasms
was asked to keep a daily record of overnight pain and but he could feel the neck stiffness release and was able to
spasm frequency over the next 6 months period. move it much freely. Pain was recorded on NRS after every
2. Cervical Dystonia Impact Profile-58 for Quality of life: gap. The intensity of muscle twitching and dyskinesia was
The quality of life in patients of CD was assessed by using noted to visualize the difference. Pain on daily activities like
the CD Impact Profile-58 questionnaire (CDIP-58). The walking, sleeping, lifting and other symptoms were
centre had developed a simple questionnaire on basis of maintained. The patient was advised to notice the intensity
CDIP-58 which covered all aspects of symptoms to assess and frequency of tremors and spasms along with neck
quality of life. It is composed of fifty-eight 5-point items stiffness and swelling in left neck region.
grouped into eight subscales that measure symptoms
(head and neck movements, pain and discomfort in neck RESULT
and shoulders, sleep disturbance), activity limitations in
upper limb activities and walking, psychosocial features Positive outcomes were exhibited in the frequency of pain and
(annoyance, mood, psychosocial functioning). Eight spasms and holding the neck in centre for 1 hour which was
summary scale scores are generated by summing items just 2-3 mins earlier. Muscle twitching and dyskinesia
and then transformed to a 0–100 score. All following reduced to only times when he was stressed. Walking had
measures were evaluated once before the start of treatment become easier and even improvement was seen in sleeping on
and at every 5th treatment session to see gradual left side. Now, the patient could sleep for 20-25 mins facing
improvement. the left side of body and the pain in lower back and hands is
totally reduced. Intensity of tremors and spasms has reduced
Treatment Plan: The treatment was started on 5th Jan, 2022; tremendously from throughout day to only 4-5 times. Neck
it was planned to conduct 25 sessions with gaps in between, stiffness and swelling in left neck region is absent now.
spread out in 6 months. The treatment included pressure at
different varmam points at the neck and thoracolumbar After 25 sessions, the pain (NRS) in Neck region was
region. Following the initial assessment, 5 sessions were markedly reduced from severe too mild in severity. CDIP-58
administered after every 3 days. Each session began with a which assess disease-specific HRQoL, also showed a
discussion to involve the patient in the treatment process, and significant improvement after 25 sessions of treatment. The
feedback of previous treatment was obtained. Record was clinical score taken at beginning of treatment for various
maintained of severity of pain and spasms release with parameters of quality of life showed score as 83/100 which
improvement in daily activities. 30-min were allotted for each after treatment was only 22.5/100. The mean score of all eight
treatment session with 10 mins of physiotherapy to strengthen domains of CDIP-58 including head and neck symptoms,
the neck muscles. pain and discomfort, upper limb activities, walking, sleep,
annoyance, mood, and psychosocial functioning were
He was given Varma therapy like Varma Elakku Muraigal significantly improved (Table 1).
(Varma Relieving Methods) and Varma Thadavu Muraigal
(Varma Massage Methods) with the main focus to relax After seeing the vast improvements in patient’s
myofascial muscles to decrease dyskinesia and decrease pain symptoms, pre and post x-rays were compared and the case
and spasms. The following 6 Varmam points are stimulated was closed on 12th july, 2022. The patient was given
to achieve a therapeutic effect in the treatment of patient: instructions to follow up every 2 months, do regular exercises
Muddichu varmam (near C7), Kakkatai Kalam (on b/l and to follow a good diet to strengthen the muscles.

Table-1 (Cervical dystonia outcome parameters pre and post treatment) Clinical Score before start of treatment (zero
week) and after 25 sessions as measured by CDIP-58

Outcome Parameters Pre-treatment (out of 10 each) Post treatment (out of 10 each)

Head and Neck symptoms 9 3
Pain and discomfort 9.5 4
Swelling 7.5 2
Tremors 9 2

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Sindhuja BS et al. Musculoskeletal Disorders and Siddha Medicine

Sleep 10 2.5
Daily activities (Walking, Driving) 9 2
Annoyance 7 1
Mood swings 7 2
Psychological functioning 8 2
Social and family life 7 2
Total 83/100 22.5/100

DISCUSSION in reducing and lowering the involuntary muscle contractions,

spasms, pain and tremors. By aligning body energies (mind,
The results of this study demonstrate positive effects on body and spirit), which empowers and activates the body’s
symptoms of dystonia through the application of siddha internal healing mechanisms; the varmam technique of
Varmam therapy like Varma Elakku Muraigal (Varma Siddha provides positive result in curing and an improved
Relieving Methods) and Varma Thadavu Muraigal (Varma lifestyle. Siddha therapy along with diet and physiotherapy
Massage Methods) which resembles the massage therapy in rehabilitation played a vital role in this case in reducing pain
clinical settings [11]. Post-treatment intensity & frequency of and stiffness in neck; reducing symptoms related to tremors
pain, spasms, and dyskinesia were all seen improved meeting functional independence, and quality of life in patients.
the patient’s goals for treatment [5].
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