Katigraha is Vataja nanatmaja vyadhi which mainly presents with pain in the low back region varying from mild to severe in nature. Low back ache can be because of any acute or chronic causes which affects day to day activities of any individual. Marma Chikitsa and Agnikarma are two specialised parasurgical protocols of Shalyatantra those can be effectively used in acute management of painful conditions. A case study of a male patient presented with acute pain in the lumbosacral region and pain was assessed with VAS and Oswestry’s low back pain disability scale. Patient was given treatment with Marma stimulation and manipulation, Agnikarma on tender points with Pancha loha shalaka, and Shamanaoushadis like Rasnasapthaka kwatha, Trayodashanga guggulu, Alva’s Painex balm and Avipattikara churna were given for the period of 7 days. Patient was assessed for every 2nd day for pain, disability and tenderness.On 7th day patient had almost complete relief from the pain. Marma chikitsa is less explored area of ayurveda, which can help in economical and quick management of acute conditions when used as primary treatment tool or as an adjuvant therapy.