A REVIEW OF MARMA MANIPULATION AS A THERAPEUTIC MODALITY IN JANU SANDHIGATA VATA (KNEE OSTEOARTHRITIS)

Abstract

Background: Janu Sandhigatavata Vata, clinically correlated with Knee Osteoarthritis, is a chronic degenerative musculoskeletal disorder characterised by Shoola (pain), Shotha (swelling), Stabdhata (stiffness), Atopa (crepitus), and progressive functional disability of the knee joint. Ayurveda describes Janu Sandhigata Vata as a Vatavyadhi predominantly involving the degeneration of Sandhi (joints) due to aggravated Vata Dosha and leading to deterioration of knee joint function. The increasing prevalence of Janu Sandhigata Vata among the ageing population has created a growing demand for safe, cost-effective, and non-invasive therapeutic interventions. Among various Ayurvedic therapeutic modalities, Marma Chikitsa has gained attention for its holistic approach to musculoskeletal disorders. Objective: To review the therapeutic role of Marma Manipulation in the management of Janu Sandhigata Vata (Knee Osteoarthritis) by critically evaluating classical Ayurvedic concepts, contemporary scientific evidence, and the proposed mechanisms underlying its clinical effects. Methods: A review was conducted using classical Ayurvedic texts, including the Sushruta Samhita, Charaka Samhita, and Ashtanga Hridaya, as well as peer-reviewed scientific literature retrieved from databases such as PubMed, Google Scholar, and the AYUSH Research Portal. Relevant evidence on Marma therapy, knee osteoarthritis, manual therapy, and pain modulation was critically reviewed and synthesised. Results: Classical Ayurvedic literature describes Marma as vital anatomical and physiological sites where muscles, vessels, ligaments, bones, and joints converge and where Prana and Tridosha are predominantly established. Therapeutic stimulation of these points is believed to regulate Vata Dosha, improve tissue nourishment, and restore joint function. Contemporary evidence suggests that Marma Manipulation may exert its therapeutic effects through multiple mechanisms, including modulation of pain via the Gate Control Theory, activation of endogenous analgesic pathways, enhancement of local circulation, reduction of inflammatory mediators, relaxation of muscles, and enhancement of functional mobility and improvement in quality of life (QOL). Clinical studies reviewed consistently demonstrate improvements in pain, stiffness, range of motion, WOMAC scores, and overall functional outcomes in patients with Janu Sandhigata Vata. Conclusion: Marma Manipulation represents a promising integrative therapeutic approach whose proposed mechanisms are supported by both classical Ayurvedic concepts and contemporary biomedical evidence. Further large-sample-size randomised controlled trials are required to strengthen the current evidence and facilitate the incorporation of Marma Manipulation into evidence-based management of Janu Sandhigata Vata (Knee Osteoarthritis). Overall, Marma Manipulation appears to be a safe, promising, non- invasive, cost–effective and clinically relevant therapeutic approach for the management of Janu Sandhigata Vata (Knee Osteoarthritis).