Bursitis

Bursitis Causes, symptoms and treatment

Bursitis occurs when one or more bursae become inflamed as a result of irritation or infection. Bursae are small sacs filled with synovial fluid located between bones and tendons or muscles. They function to create a smooth, frictionless gliding surface, making normal movement painless. Bursitis mainly affects the bursae of the elbows, knees, shoulder or hip, and may be acute or chronic. It seldom occurs before adulthood and is more common in middle and old age.

Tendinopathy is generally a result of injury to or overuse of a tendon and involves both inflammation of the tendon as well as tiny tears in the connective tissue. Tendinopathies can be degenerative, although the degeneration can be reversible.

Causes / Risk Factors of Bursitis

• Chronic overuse or repetitive use
• Traumatic injury
• Excessive pressure
• Bacterial infection
• Inflammatory joint disease e.g. gout, rheumatoid arthritis

Common examples

• Pre-patellar bursitis (housemaid‘s knee)
• Infrapatellar bursitis (clergyman‘s knee)
• Trochanteric bursitis: causes hip pain
• Olecranon bursitis (student‘s elbow): causes pain and swelling in elbow
• Subacromial bursitis: causes shoulder pain
• Achilles tenidopathy: common injury in sports that involve jumping
• Patellar tendinopathy: common in sports that involve jumping and landing e.g. basketball, volleyball
• Rotator cuff injury: tendinopathy occurring in the shoulder; common in sports involving repetitive throws
• Tennis elbow: tendinopathy occurring in sports that involve repetitive movements of the elbow
• Plantar fasciitis: similar to a tendinopathy but involving the plantar fascia

Signs and symptoms of Bursitis

• Local joint pain, swelling and stiffness
• Pain is worse during movement of the joint

Differential Diagnosis

• Osteoarthritis
• Gout
• Sprain or strain

TREATMENT STRATEGY FOR BURSITIS

• Identify and address underlying cause
• Protect tissues from further injury
• Reduce pain and inflammation
• Promote healing of tissue (once acute phase has resolved)

Diet plan guidelines for Bursitis

• Minimise pro-inflammatory foods: sugar, refined carbohydrates, trans fats, excessive red meat, saturated fats, omega-6 fatty acids, caffeine and alcohol
• Emphasise anti-inflammatory foods: in cold-water oily fish, berries, nuts and seeds, turmeric, ginger, green tea, olive oil
• Include antioxidant-rich foods to promote tissue repair: berries, green tea, turmeric, fruits and vegetables

Supplements that support Bursitis

• Reduce inflammation
  • Vitamin C
  • Bromelain
  • Omega-3 fatty acids
  • Curcumin

·    Repair connective tissue

• Vitamin C with bioflavonoids
  • Calcium and Magnesim
  • Vitamin E
  • Glucosamine sulphate and chondroitin sulphate

Herbal medicine treatment that supports Bursitis

• Reduce pain and inflammation – turmeric (potentiates effect of bromelain), ginger, boswellia, devil‘s claw, willow bark, Jamaica dogwood
• Tincture of one or more may be taken – 15 drops every 15 minutes up to four doses for acute pain relief, or 30 drops 4 x daily
• Reduce muscle spasm (if indicated) – valerian
• Repair connective tissue – gotu kola, hawthorn, grape seed
• Topical applications – arnica

Lifestyle / Physical measures to

• In acute injury, use RICE:
• Rest the injured part
• Ice the painful area
• Compress injured area with an elastic bandage
• Elevate injured part above level of heart
• After acute phase: gradually increase range-of-motion and stretching exercises to maintain and improve mobility and prevent adhesions
• Acupuncture can be helpful in resolving swelling and inflammation, especially for pain relief
• Physiotherapy
• Massage is contraindicated in septic bursitis but otherwise can be used for general relaxation and to reduce discomfort form holding patterns secondary to pain and compensating for an injured part
• Most acute and chronic bursitis can be prevented by avoiding overuse of the joint, by resting between periods of activity and by adequately warming up and stretching before strenuous activity

FUNCTIONAL MEDICINE TREATMENT OF BURSITIS

Bursitis is a form of inflammation in the joints of the body that is commonly found on scans where patients have investigations into pain through movement.  Often, changing repetitive movement patterns, stretching, massage and physio/chiropractic intervention will resolve the issue.

In cases where these manual interventions do not have success, there is often underlying inflammatory processes within the body that are driving the pain and discomfort.  There are many sources of potential inflammation in the body with food intolerance reactions, poor digestive function, intestinal permeability, impaired detoxification pathways and gut dysbiosis being common offenders. 

We see with many patients that addressing these underlying inflammatory pathways that miraculously the aches and pains, sometimes experienced for years on end have been resolved and a full range of movement is again achievable.

At our Perth clinic of Advanced Functional Medicine we receive many referrals from physiotherapists and chiropractors with patients that aren’t responding as well as they should be to treatment.  Once we address these underlying causes of inflammation, the manual treatments and manipulations hold within the body and the patients heals. 

If you of a family member are suffering from long term pain, stiffness or a limited range of motion that hasn’t been able to be cleared and maintained through massage, physio and/or chiropractic we would love to hear from you.  Have you addressed inflammatory pathways in the body?  Have you had your gut tested for intestinal permeability or bacterial overgrowth?  Did treating these areas resolve your muscular and joint pain?  Please leave a comment.

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