International Journal of Science and Research (IJSR)

ISSN: 2319-7064
SJIF (2022): 7.942

Role of Siddha in Management of Duchenne

Muscular Dystrophy to Reinforce the Quality of
Life - A Pediatric Case Report
Dr. Bhuvanagiri Sathya Sindhuja1, Injarapu Sankar2, Dr. Ram Mohan Reddy3, Dr. Shweta Tiwari4*
1
Patron, Department of Siddha Medicine, Chakrasiddh health centre, Hyderabad, India
2
Chief Healer, Department of Siddha Medicine, Chakrasiddh health centre, Hyderabad, India
3, 4
Consultant Dr, Department of Siddha Medicine, Chakrasiddh health centre, Hyderabad, India
4
Corresponding Author Email: shweta11_in[at]yahoo.com

Abstract: Duchenne muscular dystrophy (DMD) is a progressive muscular disorder characterized by muscle weakness, motor delays,
respiratory impairment, and if left untreated can cause loss of ambulation. It is the most typical X-linked disorder of muscular dystrophy
primarily affecting male children, with proximal muscle weakness and calf hypertrophy in affected boys. In Siddha literature, DMD
symptoms bears a resemblance to Thasaivatham (Muscular Dystrophy) and is explained by increased Vatham. Siddha is an ancient
traditional therapy which believes in treating the disease from its root cause from within. Here, we present a case study of a ten-year-old
male diagnosed with DMD. From the age of four and half, the patient had difficulty walking for long distances, needed support while
climbing stairs, frequent falls, muscle spasms, and had lower extremity weakness on both sides with a reduced range of motion (ROM).
Since last one month, the patient is having increased muscle pains & difficulty in breathing, is unable to balance while walking and has
decreased strength, stamina, in both lower limbs. Gowers sign was positive which suggested DMD. The main objective of this case is to
determine the role of Siddha therapy in management of DMD and is focused mostly on maintaining the range of motion (ROM), and to
improve the quality of life of the child. The patient was treated with Siddha therapy utilizing stimulation of Varmam Maruthuvam by
pressing (Amartthal) technique and Thokkanam (Massage manipulation) on OPD basis for 45 sessions in two phases. The treatment
also included the support of physiotherapy in different sittings for three months for mobility assistance along with yogasanam. A diet
designed specially for strengthening the muscles and stamina was advised for further improvement. His CPK-creatinine kinase was 9021
U/L (NV= 25 to 200U/L) which became 5200 U/L post-treatment. The assessment was done on North Star Ambulatory Assessment. He is
able to walk long distances (>1km) with faster pase and is able to stand without support for 15 minutes on his own. There is lot of
improvement in hand strength & increased range of motions in both legs measured by the goniometer. The child had no frequent falls
and strength in lower limbs is seen better. DMD has no permanent cure but by adopting a multi-dimensional treatment approach,
including Siddha therapy with dietary modifications, physiotherapy, family support and counselling of patient; the quality of life can be
reinforced to much extent. This study presents Siddha therapy as a new treatment option to manage symptoms of DMD, install a
confidence in patient and increased stamina to perform his daily life activities thus improving quality of life.

Keywords: Duchenne’s Muscular dystrophy, Muscle weakness, Creatine kinase, Gower sign, Siddha therapy, Thasaivatham

Abbreviations: Duchenne’s Muscular dystrophy (DMD), Range of motion (ROM)

1. Introduction In most of the cases DMD is clinically diagnosed at 4-5

years of age, progression of disease may lead to wheelchair
Duchenne muscular dystrophy (DMD) is a progressive dependency by the age of 11-12 year and finally death by
neuromuscular genetic disorder and one of the most severe 20-25 years [6]. Typically, muscle weakness affects the
types of muscular dystrophy [1]. It is an atypical inherited proximal muscles in DMD and hence begins in the lower
disorder which primarily affects boys between age group 5- limbs first. Proximal-distal weakness is a confirmatory sign
25 years [2]. The prevalence of DMD is estimated 1 in every at the time of clinical manifestation of DMD [7]. It is
7500 males [3]. It is an X-linked recessive muscular characterized by motor impairments, muscle weakness,
dystrophy caused by a mutation in the dystrophin gene, walking difficulty, waddling, toe-walking, difficulty in
which leads to the absence or decrease in dystrophin. The climbing stairs and running. Patients use their hands to lift
levels of Serum creatinine kinase are drastically raised than from the floor, is illustrated by Gowers’ sign, and is
normal laboratory values [4]. 78% cases of DMD are usually considered a confirmatory sign of having DMD [8] Pseudo-
inherited from the mother, whereas approximately 22% muscular hypertrophy another sign of DMD, is characterized
occurs due to a mutation in the gene for dystrophin [1,5]. by enlarged calf muscles leading to muscle fiber
DMD patients produce very little or no dystrophin at all in hypertrophy [9]. Mild to moderate lordosis is very common
their muscles, and due to its absence, even everyday activity in DMD along with other signs [10].
can cause huge damage to the muscle cells. Although it is a
genetic disorder, sometimes DMD can be seen in individuals Progressive decrease in muscle strength and stamina leads to
who do not even have a family history of it suggesting the limited physical activity. Frequent falls, the need of help to
genes are mutated on their own [5]. stand up develops fear among patients and further reduces
leg activities, resulting in disuse of the musculoskeletal and
Volume 13 Issue 1, January 2024
Fully Refereed | Open Access | Double Blind Peer Reviewed Journal
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 International Journal of Science and Research (IJSR)
ISSN: 2319-7064
SJIF (2022): 7.942
cardio-respiratory systems [8,9]. The main cause for patients difficulty in breathing. The parents reported a history of
death is confirmed to be either by respiratory failure or repeated falls, excessive fatigue, progressive muscle
cardiac failure, as it is noted that 95% of patients having weakness, and inability to climb stairs. He had difficulty
DMD progresses to cardio-myopathies [11]. Limited walking for long distances, needed support while climbing
physical activity arising due to loss of ambulation hurdles stairs, muscle spasms, and had lower extremity weakness on
daily life activities leading to a decrease in health-related both sides with a reduced range of motion (ROM). Since last
quality of life (HRQOL) and increase in economic one month, the patient is having increased muscle pain &
burden.[12]. For prolong life expectancy and slow fatique in vigrous physical activities, is unable to balance
progression of disease, a high-quality multidisciplinary care while walking and has decreased strength, stamina, in both
is needed [13]. lower limbs. He was unable to keep up with peers during
sports and was also C/O pain in hand while writing. This
Ongoing studies shows positive effects of many therapies was causing poor performance in school and his self
that initiates the relief but there is still no curative therapy confidence was getting down. Family history details showed
available thus, treatment remains symptomatic. All therapy no one of his family members having DMD, his parents did
aims to manage DMD by providing an aid to preserve not have consanguineous marriage and his one elder brother
functional abilities for as long as possible [14]. In Siddha is healthy.
literature, DMD symptoms bears a resemblance to
Thasaivatham (Muscular Dystrophy) and is explained by On examination, Gowers sign was positive which suggested
increased Vatham in the body [15]. Siddha is an ancient DMD (Fig 1). He was having difficulty while getting up
traditional therapy which believes in treating the disease and from floor, a waddling gait with enlarged calf muscles were
ailments holistically; aiming not just to prevent pain but to noticed. According to Siddha Manual, DMD is primarily
remove the root cause of the disease. It involves healing caused when Vatham in body is disturbed or increased and
using a combination of Siddha deep tissue Therapies, this affects the seven udalthathukal Saaram, Senneer, Oon
mobility exercises, and lifestyle changes along with spiritual and kozhuppu. We performed various laboratory
healing to completely relieve pain, restore mobility, and help investigations. His Vit D levels were lower than normal,
in leading a better life [15]. The spiritual aspect refers to MLPA taken out in 2015 showed Deletion of Axon 10-17.
spiritual energy working at a deep level on our spiritual CBC reported normal range but, biochemistry analysis
being. The healing involves the transfer of energy; in other showed significantly elevated levels of Creatine kinase,
words, it is not from the healer him or herself, but the healer alanine aminotransferase, aspartate aminotransferase, and
links with ‘Universal’ or Divine energy to channel healing lactate dehydrogenase (9021 U/L, 223 U/L, 195.4 U/L and
for the mind, body and spirit [16]. 674 µg/dl, respectively) (Table 1). Muscle biopsy results
revealed an extensive loss of skeletal muscle fibers that are
Among the deep tissue therapies is Varmam therapy; it is the replaced by fat tissue, and extensive fibrosis noted. ECG and
therapeutic manipulation of Varmam points in which the EEG were essentially normal. Therefore, based on history,
pranic energy remains concentrated. Manipulation over clinical examination, and investigations, the diagnosis of
these points with a particular force for the specified time will DMD was established. The motor nerve conduction studies
release the pranic energy from these points and bring relief revealed low amplitude compound muscle action potentials
to the affected individual by regulating the flow of pranic throughout, with normal conduction velocities. The history,
energy which is obstructed due to assault on specific points physical examination findings and elevated creatine kinase/
(Varmam points) or due to other causes [17]. levels strongly suggested a case for DMD. North Star
Ambulatory Assessment (NSAA), a functional scale
2. Case Presentation specifically developed for assessing motor function in DMD,
and validated in ambulant DMD children older than 5 years,
A ten-year-old male diagnosed with DMD presented in the was used for this patient to access the improvement pre and
Chakrasiddh in May-2022 with severe muscular pain and post treatment.

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 International Journal of Science and Research (IJSR)
ISSN: 2319-7064
SJIF (2022): 7.942

Figure 1: Depicting mild Scoliosis and Gower’ s Sign (DMD)

Table 1: Investigation Reports

Parameters Patients Value Parameters Patients Value
CPK 9021 Alanine aminotransferase 223 U/L
Vit D 14.21 Aspartate aminotransferase 195.4 U/L
MLPA Deletion of Axon 10-17 lactate dehydrogenase 674 U/L

3. Treatment Protocol weight and muscle loss or gain was done along with
Physiotherapist who worked on strengthening core muscles.
After proper history and examination, 40 sessions of Special therapies of points advised are mentioned in Table 3.
Varmam therapy were planned, each with 20 days and at an The chief healer of Chakrasiddh did 4 special sessions of the
interval of 45 days. Siddha procedures like Thokannam patient in relation to energy sessions as she is a firm believer
(pressure manipulation) and Varmam Maruthuvam along that people carry around unhelpful energetic burdens (past or
with Yoga Maruthuvam & Physio exercises were performed carriers from parents) which can be alleviated by healing
for all 40 days [19]. Parents of patient were counseled from [16]. Whenever such sessions were conducted, the feedback
time to time to monitor and help child to understand the from patient was very positive and he could feel more fresh
condition. Regular monitoring by a Nutritionist regarding his and light.

Table 3: Special Therapies

Therapy Different Varmam points Location Duration
Varmam
Ayulkaala pinnal On both sides of C7 vertebra 3 mins
Maruthuvam
Poovadangal At The Junction Of The Thigh And Gluteus 4 mins
UllthodaiVarmam Middle Of Medial Aspect Of Thigh 5-7 mins
Ullankalvellai varmam Meeting Point Of Two Balls Of Sole 4-5 mins
Komberikalam Middle of the leg along the medial border of tibia 3 mins
Kaalkavuli varmam At junction of big and second toe in plantar region 5 mins
Anna kaalam One Finger Above The Umblicus 1-2 mins
Mannai varmam Lower end of the calf muscle (posterior aspect) 2-3 min
Puja varmam In The Shoulder Pit Lateral To Acromian Process 3 mins
Dhanurasanam, Pachimothasanam,
Every day for
Yoga Maruthuvam Halasanam, Sarvangasanam Matsyasanam,
30 mins with
Sirasanam, Padmasanam,Savasanam,Naadi
each for 3 mins
suthi Pranay

In initial week, patient had lots of pain as he had capped his After break, his treatment focused mainly on improving his
steroids but could see difference in his stiffness. He could quality of life. Work was started on strengthening his hands
notice the level of strength in his legs was improved and he and legs. There was stiffness in his back due to
was able to walk for 20 mins without any help. He was able hyperlordosis which was a hurdle in sleeping but there was
to take steps and his confidence boosted up. Since, the vast improvement in pain intensity while performing
treatment included a break time for 2 months for working on activities from 9 (severe) to 6 (moderate) on VAS. The
muscular strength, he was temporarily given break. treatment was given to him for 20 days in 2nd phase.

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4. Observation and Results
CPK level was reduced noticeably from 9021 U/L to 5200
U/L, mentioned in Table 2. Along with improvement in
CPK levels, improvement in symptoms was also appreciated
by the patient. The assessment was done on NSSA on
different symptoms (Table 3) .After 1st sitting, patient
reported mild relief in generalized weakness and walking
was mildly improved. Though the patient was still unable to
sit in squatting position, but his H/O frequent falls decreased
and on completion he had no falls. Patient also appreciated
relief in calf muscle pain and tightness. Mild improvement
was also seen in picking up weights and sleeping straight
with no disturbance. Walking was improved, and he is able
to walk long distances (>1km) with faster pase and is able to
stand without support for 15 minutes on his own. Patient
could walk or run without falling. Patient reported
improvement in being able to stand from sitting position.
There is lot of improvement in hand strength & increased Figure 2: X-Ray (Pre and Post treatment)
range of motions in both legs measured by the goniometer.
Especially power in left hand (patient is left hander) was Table 2: Investigation Reports
improved as parents told about his exam in which he wrote Parameters Value Before treatment After treatment
for 3 hours while earlier he could barely write for 15 mins. CPK 9021 U/L 5200 U/L
His self confidence and speech was improved.

The X-rays taken out after 3 months post treatment showed

improved hyperlordosis condition (Fig 2)

Table 3: North Star Ambulatory Assessment (NSAA)

Evaluation before the of treatment after the treatment
S.NO Parameters Value Details Value Details
1 Stand 1 Able to stand with legs abducted for 4sec 1 Able to stand but for about 10 mins
Toe walking but can walk for 30
2 Walking 11 ++++ 2
mins with faster speed
With support from thighs and holding chair &
3 Rise from chair 1 2 With support
bending
4 Stand on 1 leg (Rt) 1 Stand but imbalance 2 Can stand for 2-3 min
5 Stand on 1 leg (Lt) 1 Cannot Stand without support but imbalance 2 Can stand for 2-3 min
6 Climb box step (Rt) 1 Able to climb up with support of railing 2 Better speed is seen
7 Climb box step (Lt) 1 Able to climb up with support of Knee 2 Better speed
8 Desend box step (Rt) 1 Support required 2 Was able to do it without support
9 Desend box step (Lt) 1 Support required 2 Was able to do it without support
10 Gets to sitting position 1 Self assistance pull on legs & turn with hands 2 Takes no time now
Strength in lower limbs inc, can do
11 Rise from floor 0 No strength, requires help 1
without any help
12 Lifts Head 1 Able to lift head and touch till chin 2 Improved with ease
Few steps on heels, the angulation of
13 Stands on heel 0 Cannot stand on heels 1
floor and heel is also less
14 Jumping 0 No strength 1 Can jump at least 2-3 times
0= Unable to perform 1= Perform with difficulty 2= Can Perform

5. Discussion In Siddha no exact correlation can be found, however there

are certain references in classical texts which show
Duchenne muscular dystrophy is the most common and similarity to DMD. In Yugi Vaidhya Chinthamani book, he
severe form of muscular dystrophy [1]. It is a genetic or mentioned about Thasaivatham (Muscular Dystrophy) in his
inherited disorder, primarily affecting boys between age book which bears resemblance to symptoms of DMD [15].
group 5-25 years [2]. The prevalence of DMD is estimated 1 He has explained about the its cause due to increased
in every 7500 males [3]. DMD manifests as weakness Vatham. The seven udalthathukal Saaram, Senneer, Oon and
affecting proximal muscles, typically that of lower limbs kozhuppu gets affected in such cases [16]. Such cases can be
initially [6]. Gower’s sign, toe walking, waddling gait and treated by multidimentional approach involving mind, body
hyperlordosis are the later features which put an emotional and soul. The treatment involves therapies like Varmam
as well as monetary burden to patients [7]. It is seen most therapy in which there is therapeutic manipulation of
children having DMD are confined to wheelchair by the age Varmam points in which the pranic energy remains
of 12-15 years. No specific treatment for the same exists. concentrated. Manipulation over these points with a
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 International Journal of Science and Research (IJSR)
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particular force for the specified time will release the pranic evidence review. Orphanet Journal of Rare Diseases.
energy from these points and bring relief to the affected 2017;12(1).
individual by regulating the flow of pranic energy [19]. [8] Martini FH. Fundamentals of Anatomy and
Physiology. 4th edition. New Jersey; Prentice Hall Inc.
Ullthodai Varmam, Komberikalam and Mannai Varmam Simon and Schuster; 1998. 148-150p
points helped the patient in strengthening his core muscles [9] Flanigan Kevin M. the Dystrophinopathies. In: David
and helped in increasing his stamina [20]. Energy sessions in Hilton-Jones, Turber Martin R, editors. Oxford
Spiritual healing helped the patient to release unhelpful Textbook of Neuromuscular Disorders. United
energetic burdens, in other words he was relaxed by easy Kingdom: Oxford University Press; 2014; 2076-78p.
flow of energy [18]. As mentioned in observations, [10] Martini FH. Fundamentals of Anatomy and
noticeable improvement was found in patient’s gait; he Physiology. 4th edition. New Jersey; Prentice Hall Inc.
could walk or run without falls. His parents were quite Simon and Schuster; 1998. 152-155p.
satisfied with his performance in school and in his physical [11] Bushby K, Finkel R, Birnkrant DJ, Case LE, Clemens
activities which was the main aim of our treatment. PR, Cripe L, et al. Diagnosis and management of
Duchenne muscular dystrophy, part 1: diagnosis, and
6. Conclusion pharmacological and psychosocial management.
Lancet Neurology. 2010;9(1):77-93.
Duchenne muscular dystrophy is a neuromuscular disorder. [12] Ryder S, Leadley R, Armstrong N, Westwood M, de
This article is an attempt to present a case of Duchenne Kock S, Butt T, et al. The burden, epidemiology, costs
muscular dystrophy, effectively managed by Siddha and treatment for Duchenne muscular dystrophy: an
principles. DMD has no permanent cure in modern medicine evidence review. Orphanet Journal of Rare Diseases.
but by adopting a multi-dimensional treatment approach, 2017;12(1).
including traditional Siddha therapy with dietary [13] Schreiber-Katz O, Klug C, Thiele S, Schorling E,
modifications, physiotherapy, family support and Zowe J, Reilich P, et al. Comparative cost of illness
counselling of patient; the quality of life can be reinforced to analysis and assessment of health care burden of
much extent. Whether Siddha therapies can improve the Duchenne and Becker muscular dystrophies in
lifespan of patient or not, is a subject of research but, by Germany. Orphanet Journal of Rare Diseases.
reducing the intensity of symptoms, it can be a new 2014;9(1).
treatment option for DMD. The traditional therapy installed [14] Kieny P, Chollet S, Delalande P, Le Fort M, Magot A,
an impact on confidence in patient, improvement in his Pereon Y, et al. Evolution of life expectancy of
sufferings, increased stamina all indicating improved patients with Duchenne muscular dystrophy at AFM
lifestyle of the patients. Yolaine de Kepper centre between 1981 and 2011.
Annals of Physical and Rehabilitation Medicine.
References 2013;56(6):443-54.
[15] Kuppusamy Mudaliar K.N, Mookadaipu, Siddha
[1] Birnkrant DJ, Bushby K, Bann CM, et al.: Diagnosis Maruthuvam, Tamil Nadu Siddha Maruthuva variyam,
and management of Duchenne muscular dystrophy, 1987:192-200
part 1: diagnosis, and neuromuscular, rehabilitation, [16] Agnivesha. Charaka. Charaka Samhita. Sutra Sthana,
endocrine, and gastrointestinal and nutritional Mahachatushpada Adhyaya, Rajeshwardatta Shastri,
management. Lancet Neurol. 2018, 17:251-67. editor. Varanasi: Chaukhamba Bharati Academy;
10.1016/S1474-4422(18)30024-3 reprint 2008; 202p.
[2] Hoffman EP, Brown RH Jr, Kunkel LM (1987) [17] Charman R A. Placing Healers, Healees, and Healing
Dystrophin: The protein product of the Duchenne into a Wider Research Context. The Journal of
muscular dystrophy locus. Cell 51: 919-928. Alternative and Complementary Medicine. 2000;
[3] Richard A, Thompson MD, Paul JV Jr, Cleveland MD 6(2):177-180
(1959) Serum aldolase in muscle disease. AMA Arch [18] Angelo J. Your healing power. A comprehensive guide
Intern Med. 103 (4): 551-564. to channelling your healing energies. London, Piatkus
[4] Chamberlain JS, Pearlman JA, Muzny DM, Gibbs RA, Publishers, 2001
Ranier JE, et al. (1988) Expression of the murine [19] Rajendran, T., Text Book of Varmam and Massage
duchenne muscular dystrophy gene in muscle and Science, Varma Ariviyal Aayvu Maiyam,
brain. Science 239: 1416-1418. kanyakumari, 2006
[20] R. Thyagarajan, Varmavithi, Arulmigu Palani
[5] Tinsley JM, Potter AC, Phelps SR, Fisher R, Trickett
Thandayuthabahni Swamy Thirukkovil Siddha
JI, et al. (1996) Amelioration of the dystrophic
Maruthuva Nool Veliyeettu Kuzhu, Madras,1976
phenotype of mdx mice using a truncated utrophin
transgene. Nature 384: 349-353.
[6] Mah JK, Selby K, Campbell C, Nadeau A,
Tarnopolsky M, McCormick A, et al. A population-
based study of dystrophin mutations in Canada. The
Canadian journal of neurological sciences Le journal
canadien des sciences neurologiques. 2011;38(3):465.
[7] Ryder S, Leadley R, Armstrong N, Westwood M, de
Kock S, Butt T, et al. The burden, epidemiology, costs
and treatment for Duchenne muscular dystrophy: an
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