Elakizhi, Pizhichil and Abhyanga: Ayurvedic Therapies Used in Shoulder Care

Elakizhi, Pizhichil, and Abhyanga are the three main external Ayurvedic therapies used in Ayurvedic shoulder care therapies. Abhyanga uses the application of warm medicated oils. In Elakizhi, warm herbal leaf boluses are used. In Pizhichil, a continuous stream of warm medicated oil is poured on the region. After a detailed examination, the Ayurvedic physician determines the therapy sequence and therapies to be administered.

How Ayurveda Approaches Shoulder Stiffness

References to adhesive capsulitis (also known as “frozen shoulder”) in classical Ayurvedic texts are made under the topic of Apabahuka (“restricted and painful shoulder movement”). Other clinical scenarios dealing with restricted shoulder movement and pain may involve rotator cuff strain, cervical spondylosis with referred pain, or stiffness following prolonged immobilization.

In Ayurveda, assessment of restricted shoulder movement is done through the constitution and dosha affecting the Amsa sandhi (the shoulder joint) and snayu (the ligaments and tendons). Because there may be more than one etiology behind similar presentations, the treatment offered to an individual will more often than not be unique to that individual. Whereas in other systems of medicine, treatment may be similar or the same for many patients with a particular condition, in Ayurveda, individualization of treatment is essential to a consultation, and not an addendum.

Abhyanga: Warm Medicated Oil Massage

Abhyanga is a full or partial body massage using warm, herb-infused oil (taila), applied using strokes suited for the joint, in a certain direction. Different types of oil used for musculoskeletal problems include Ksheerabala, Mahanarayana, Dhanwantharam, Murivenna, and Sahacharadi taila, and the choice of oil is not such a choice, the choice belongs to the practitioner.

In a shoulder program, Abhyanga typically forms the snehana (oleation) base. In this case the tissues are prepared before any heat therapy is applied, and a session usually lasts 30 to 45 minutes, after which some form of swedana (fomentation) is applied.

Elakizhi: Herbal Leaf Bolus Fomentation

Elakizhi or Patra Potali Sweda is a therapy that involves the application of leaves that have been sautéed in oil over the affected region. The leaves are tied in cloth bundles and kept over the heavily medicated oil.

The bundles, inter alia, usually contain Nirgundi (Vitex negundo), Eranda (castor), Arka (Calotropis), tamarind, with coconut, lemon, and rock salt. The therapy provides both contact and moisture application to the herbal in one go.

Elakizhi therapy is opted for where symptoms of stiffness, reduced range of motion, and discomfort in a localized area are prevalent. The therapy lasts for about 45 minutes, and several sessions are recommended.

Pizhichil: Continuous Warm Oil Stream

During Pizhichil, the body is massaged while receiving warm medicated oil. This medicated oil is applied by oil squeezing from cloth sachets by trained therapists. Oleation and fomentation are achieved in a single step by this procedure.

Pizhichil requires the most amount of resources out of the three processes. This is due to the need for trained therapists, close temperature control systems and constant physician supervision. This service is almost always recommended for a fixed number of sessions with each session being supervised with therapists monitoring patient comfort levels and vital signs at each session.

Comparing the Three Therapies

Therapy	Classical name	Method	Typically considered when
Abhyanga	Snehana	Hand-applied warm medicated oil	Preparation, general Vata management, maintenance
Elakizhi	Patra Potali Sweda	Heated herbal leaf boluses	Localised stiffness with reduced range of movement
Pizhichil	Kaya Seka	Continuous warm oil stream + massage	Longstanding presentations needing supervised oleation

These therapies are complementary rather than competing. A supervised program often adds layers — Abhyanga as the base therapy, Elakizhi added for stiffness of localised joints, and Pizhichil as a therapy for a defined period of time, under the doctor’s evaluation. Internal medicines, dietary advices and complementary therapies such as Nasya or Greeva Basti may also be included.

Programs typically last for 7, 14 or 21 days. Responses differ according to the individual patient and may include chronicity, activities of daily living, and the presence of other conditions such as diabetes. Diabetes is well known to contribute to adhesive capsulitis and is openly discussed during the assessment.

What Happens at Consultation

An initial consultation at Kottakkal Ayurvedic Treatment Centre covers the history, a physical examination to assess movement of the shoulder joint, and a review of any imaging or reports from a shoulder specialist that you may carry along.

There are some cases where a traditional medical condition needs to be ruled out first: recent trauma, fracture, suspected dislocation, infection, neurological concerns with progressive weakness or weight loss of unexplained origin. We make the referral wherever it is appropriate. Ayurvedic therapy will be provided alongside your medical care, and should not be considered a replacement for medical care. In case there are is a need to alter your medication, kindly consult the doctor who prescribed the medicine.

Consultations are available at our clinics in Ajman, Deira Dubai, Satwa Dubai and Sharjah.

Frequently Asked Questions