ISSN: 2322 - 0902 (P)

ISSN: 2322 - 0910 (O)

International Journal of Ayurveda
and Pharma Research

Review Article

VARMAM THERAPY FOR COMMON SHOULDER JOINT PATHOLOGICAL CONDITIONS - A REVIEW

Kavitha.S1*, Magudapathi.S2, Suguna.M3, Manjula.V4, Dhinesh Raman.G5
*1Siddha Consultant, Magizh Siddha and Varma Center, Rajapalaiyam.
2PG Scholar, Govt. Siddha Medical College, Chennai.
3Assistant Professor, National Institute of Siddha, Chennai.
4Lecturer, Nandha Siddha Medical College, Erode.
5Assistant Professor, JSA Siddha Medical College, Kallakuruchi, India.

Article info ABSTRACT

Article History: Varmam- a discrete medical science and a great contribution of Siddhars to Tamil Nadu. It
Received: 11-01-2023 encompases Varma martial arts, Varma therapy, internal and external medicines. Varma
Revised: 08-02-2023
therapy and medicines effectively treat neuro musculoskeletal conditions which is
Accepted: 19-02-2023 admirable. Shoulder pain is most common orthopaedic condition. It is the third common
KEYWORDS: cause of musculoskeletal consultations in primary care. Approximately 1% of adult develops
Varma therapy, new shoulder pain annually. Common pathological conditions of shoulder like rotator cuff
Rotator cuff disorders and adhesive capsulitis etc exhibits similar clinical features like pain and stiffness
disorders, Acromio-
of shoulder joint and restricted movements. Varma therapy rearranges and regulates the
clavicular joint
diseases, “Vaasi” and consequently helps to maintain the equilibrium of trihumours (Vatham, Pitham,
Glenohumeral Kapham). This review article explicates the Varma points for the treatment of shoulder
disorders (Adhesive pathological conditions, the exact anatomical location of Varma points and the appropriate
Capsulitis). method of its manipulation, certainly a key to further research articles.

INTRODUCTION
Varmam – “A discrete Medical science and a The rotator cuff and its adjacent structures are
great contribution of Siddhar’s to Tamil Nadu.” In the more prone to inflammatory and degenerative
Siddha system, Varmam is predominantly used as a changes. Varmam treatment effectively reduces the
Therapy for a long time in southern parts of symptoms and improves the quality of life in common
Tamilnadu, especially in Kanyakumari. shoulder pathological conditions.
Varma points are vital spots that connect the Pathological Conditions of the Shoulder Joint
physical and subtle body. These Varma points traverse The Three Pathological Conditions of the Shoulder
the vital energy through particular channels and Joint[8]
streams known as ‘Saram” and ‘Vaasi[1]. Any
 Rotator cuff disorders
derangement in these channels can cause diseases in
the human body.  Acromioclavicular joint diseases
By proper method of stimulation, these Varma  Glenohumeral disorders (adhesive capsulitis)
points regulate and rearrange the vital energy channel Rotator Cuff Disorders[7]
(Vaasi suzharchi) which helps to maintain the It is a group of conditions related to
equilibrium of tri humours (Vatham, Pitham and supraspinatus tendon and rotator cuff. It includes
Kabham) to treat diseases. Among many orthopaedic supraspinatus tendinitis, supraspinatus calcification.
problems shoulder pain is the most common condition. Subdeltoid bursitis and rotator cuff tear.
Access this article online Supraspinatus Tendinitis- Acute pain in the shoulder
Quick Response Code and inability to abduct the shoulder and tenderness
https://doi.org/10.47070/ijapr.v11iSuppl1.2694
just below the acromion laterally and anteriorly above
the greater tuberosity.
Published by Mahadev Publications (Regd.)
publication licensed under a Creative The painful arc of abduction is diagnostic criteria of
Commons Attribution-NonCommercial- supraspinatus tendinitis.
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Pain on abduction with thumb down and worse against
resistance.

IJAPR | February 2023 | Vol 11 | Suppl 1 36

 Kavitha.S et al. Varmam Therapy for Common Shoulder Joint Pathological Conditions
Movement up to 60° is painless. The range between Stages of Adhesive Capsulitis
60° to 120° is acutely painful. The range beyond 120° is Freezing: Painful and Inflammatory Stage
painless. This stage lasts between 3 and 9 months and is
Subdeltoid Bursitis- Inflammation of subdeltoid characterized by acute synovitis of the glenohumeral
bursa as a result of excessive friction. joint. The pain worsens and affects both active and
Rotator cuff Tear passive range of motion.
With advancing age the supraspinatus tendon Frozen: Transitional Stage
and musculotendinous cuff undergoes degenerative Because of pain at the end of the range of
changes which leads to tendinitis and attrition. At this motion, arm movement may be limited, causing
stage, any jerky violence may result rupture of the muscular disuse can last between 4 to 12 months.
tendon it may be partial or complete. Owing to deposition of advanced glycogen end product
The stage of rupture of rotator cuff tendon due to in capsules and glenoidal labrum. Primarily it affects
degeneration is classified by Neer as follows the external rotation of shoulder followed by flexion
Stage-1- Oedema and haemorrhage and internal rotation eventually compromise with
Stage-2- Fibrosis and tendinitis reduced ROM.
Stage-3 - Bone spur and tendon rupture Thawing Stage: It lasts from 1 year to 3 years when
the stiffness, pain, inflammation, restrictions were
In partial tear the patient present with the complaints
spontaneously downfall and the ROM started to getting
of painful arc. In complete ruptures there is inability to
better.
initiate the abduction. If the shoulder is passively
abducted initially the further abduction is possible. The prevalence of adhesive capsulitis
frequently seen in patients with diabetes mellitus,
Acromioclavicular Disease[7,8]
hypothyroidsm, Trauma, Parkinson’s disease, stroke,
Secondary to trauma and osteoarthritis. shoulder dislocation, humerus fracture, malunion etc.
Restriction of passive horizontal adduction of the
Varma Therapy for the Treatment Of Shoulder
shoulder with elbow extension. Subacromial
Pathological Conditions
impingement is also caused by acromioclavicular joint
arthritis Varma literatures denotes 108 main Varma points
situated in human body, through this points the life
Glenohumeral Disorder (Adhesive Capsulitis)[9]
energy (Vaasi) cumulates and circulates in a specific
Adhesive capsulitis (AC), often referred to as frozen manner (Saram).
shoulder, is characterized by global restriction of
These 108 Varma points classified into two types:
movements in all planes. Initially, the pain is a dull
insidious persistent pattern that later progressively Thoduvarmam- 96
restricts the active and passive range of motion of the Padu varmam- 12
glenohumeral joint. These restricted movements Padu Varmam - Padu varma spots are 12 in numbers
would spontaneously recover completely or nearly is situated deeply inside the internal organs, bones and
complete recovery over a period of time. muscles. To make any damage to these Varma points
Painful stiffness of the shoulder can adversely the potency of a dint must be strong. Each Padu
affect activities of daily living and consequently impair varmam is connected with a Naadi. Each Padu Varma
quality of life. Simon-Emmanuel Duplay is widely points are connected with 8 Thodu varmas. If one
recognized as the first physician to describe this Varma point gets affected, it will affect the 8 Thodu
pathology, which he called ‘scapulohumeral varma points. The forceful trauma to this Paduvarma
periarthritis’. ‘Periarthritis’ describes a painful sites are more dangerous and it can lead to death.
shoulder syndrome that is distinct from arthritis with Thodu varmam: Thodu varma spots are 96 in
general radiographic preservation of the joint. numbers. Situated superficial to the muscles and bones
The shoulder clinic census revealed the and in between the junctions of muscles, nerves and
incidence rate of frozen shoulder, Range from 2-5%. bones. Thodu varma spots can stimulated by fingers.
Women aged between 40 and 60 years are the most Mathirai- A Unit.
commonly affected by frozen shoulders. However, in The amount of pressure applied during the stimulation
their long-term (averaging 7 and 4 years, respectively) of Varma point is called “Mathirai”.[1,6]
follow-up studies, found that 40% to 50% of non- If exceeds the Varma points will get affected
operatively managed frozen shoulder patients did not and exhibits adverse effects like chills, fever,
regain their baseline function and still had ongoing unconsciousness etc.
residual pain.
Avathi: If a Varma points get affected due to any
trauma and shows adverse effects one can normalize it
within a period of time known as Avathi.

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 Int. J. Ayur. Pharma Research, 2023;11(Suppl 1):36-40
Each Varma points are having specific period of Amarthal, Pathukkal, Karakkal, Pinnal[5]. With proper
time to get revive. By this time one should stimulate therapeutic manipulation techniques of Varma points
Varma points in specific therapeutic manipulation one can treat diseases. According to modern science
techniques called Ilakku muraigal. This shows the the exact mechanism of action is still unexplored. It can
diverse action and significance of traumatic and be related to touch therapy.
therapeutic aspect a Varma point. According to GATE control theory by Melzark
According to Varma science when a Varma and Wall[8] pressure given at a certain points transmits
point is affected it will consequently derange the pleasurable impulses to the brain and blocks the pain
circulation of life energy (Vaasi)[1], which leads to impulse conducted by afferent sensory fiber that is
pathological conditions due to derangement of alpha, delta and c fiber to reach the brain. Thus the
homeostasis between Vatham, Pitham and Kabam. Varma points situated around the shoulder joint
In therapeutic aspect each Varma points can be reduces the pain and restricted movement of shoulder
stimulated in 12 different ways - Anukkal, Asaiththal, joint and diminish the recurrence of diseases.
Thattal, Thadaval, Yenthal Oondral, Pidithal Nazhukkal,
Table 1: Varma Points – Location – Method of Manipulation
S.No Varma points Anatomical Locations Method of Manipulation
1. Kaakattai kaalam Shoulder pole Varma point Press and hold with the middle
Situated at the center of the descending three fingers[2]
point of the trapezius muscle
2. Netti varmam 4 finger breadth lateral to Spinous Press by thumb finger, this Varma
process of C7 vertebrae point stimulated in Kazhuthu
thadaval murai.[2,3,4]
3. Puja varmam Situated at acromioclavicular joint Press with thumb finger
intermittently 3-5 times.[3]
4. Kai kuzhi varmam Situated at the posterior axillary fold Press with thumb finger and hold
upward.[3]
5. Kai puja poruthu Situated at the anterior axillary fold Press by thumb finger and hold
varmam upward
6. Aththi kanthari 2.5 finger breadth superolateral to Clockwise rotation by middle 3
varmam nipple fingers
7. Agaththu varmam Situated at the center of armpit Press with the ring finger and hold
it upwards
8. Nenju nadukku maru Situated 6 finger breadth below the Clockwise rotation middle 3
varmam spinous process fingers
9. Sippi varmam Situated at the center of medial border Upward and downward pressure
of the scapula by thumb finger
10. Sippi thongu thasai Situated at the muscle below the inferior Upward and downward pressure
varmam angle of the scapula by thumb finger
11. Mun puya nadukku Situated anteriorly at the center of arm Press with thumb finger
varmam intermittently
12. Mulangai mun Situated anteriorly at the center point of Press with thumb finger
nadukku varmam forearm intermittently
13 Kai kavali varmam Web surface between thumb and index Press with thumb and index finger
finger and hold for 3-5 counts. 2, 3, 5

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Kavitha.S et al. Varmam Therapy for Common Shoulder Joint Pathological Conditions

3
6
5
6

77
11

12
2

Figure 1

8
4

10

Figure 2

13

Figure 3

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 Int. J. Ayur. Pharma Research, 2023;11(Suppl 1):36-40
CONCLUSION Varma Medicine and Research, Revised 2nd edition
Varmam treatment is drugless non- invasive 2015.
pain management therapy, show admirable effect in 4. Dr. Kannan Rajaram T, Viral Alavai Adipadaiyil
the treatment of musculoskeletal conditions. This Varma Pulligal Matrum Ilaku Muraigal Adangiya
review article illustrates the common pathological Varma, Maruthuvam, Centre for Varma Medicine
conditions of the shoulder joint and the Varma points and Research, Revised Second Edition 2015.
for effective treatment. The anatomical locations of 5. Dr.Chidambarathanupillai S, Varma Saari,
Varma points are also the manipulating methods. This International Institute of Thanuology, 1st edition,
will definitely upgrade the insight into Varmam September 1999.
therapy and initiative for further research. 6. Chidambarathanupillai S. (1993) Varma Soodi,
REFERENCES International Institute of Thanuology.
7. Dr Mayilvahanan Natarajan Natarajan’s Textbook of
1. Dr.Kannan rajaram.T, Dr. Mohanraj.T, (2017) A
Orthopaedics and Traumatology, eighth edition
textbook of varmam 2nd edition.
2018. wolters Kluwer (India) Pvt. Ltd., New Delhi.
2. Dr.Kannan Rajaram T. (2007) Varma Pulligalin
8. Shoulder Pain Diagnosis and Management in
Iruppidam. Atsvs Siddha Medical College and
Primary Care
Hospital.
9. Melzak R., Wall P. Pain mechanism: a new theory.
3. Dr.Kannan Rajaram T, Noolalavai Nutpangal
Sciences. 1965; 150: 971–978. [Google Scholar] [Ref
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Muraigal Adangiya Varma Maruthuvam, Center for
*Address for correspondence
Cite this article as:
Kavitha.S, Magudapathi.S, Suguna.M, Manjula.V, Dhinesh Raman.G. Varmam Therapy Dr. Kavitha.S
for Common Shoulder Joint Pathological Conditions- A Review. International Siddha Consultant,
Magizh Siddha and Varma center,
Journal of Ayurveda and Pharma Research. 2023;11(Suppl 1):36-40.
Rajapalaiyam.
https://doi.org/10.47070/ijapr.v11iSuppl1.2694
Email: [email protected]
Source of support: Nil, Conflict of interest: None Declared
Ph.no: 9445816706

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