Taylor Paganini, LMT
Approximately 1 in 31 people in the United States alone, which is equivalent to 8.7 million people, are suffering from a condition called Bursitis. It is most common among adults ages 40 and older. As we age, our tendons aren’t able to handle the same amount of stress as well as they used to. They’re less elastic and easier to tear. That is why is seems easier and much more common for us as adults to become sore, achy, and prone to injury.
What is Bursitis? The word Bursitis comes from two Latin phrases, “bursa” meaning sac or pouch that facilitates motion as between a tendon and a bone and “itis” meaning disease or inflammation of. Bursitis is inflammation or irritation of a bursa sac which acts as a cushion between bone and tissue such as muscles or tendons. Bursitis is most common around major joints like our shoulder, hip, elbow, knee, ankle and foot. This condition is usually caused by repetitive movements, compression, direct injury, infection, crystal deposits, and in some cases an autoimmune or systemic disease. If there’s a problem with the structure of a bone or joint (such as legs that are different lengths or arthritis of a particular joint), that can also put more stress on a bursa, causing Bursitis. Funny enough, Bursitis most of the time is caused by daily high risk activities such as gardening, raking, shoveling, painting, scrubbing, tennis, golf, skiing and throwing. You can also get it by sitting or standing with poor posture for long periods of time.
How to know if you have Bursitis? Most people with Bursitis at first assume it must be muscular. They are experiencing symptoms such as pain, stiffness and swelling. But how to do we distinguish between muscular pain and joint pain? All forms of Bursitis are an inflammation and/or degradation of the bursa of the joint. However, depending upon which joint is afflicted the symptoms will vary in forms of sensation and comfortability. When it comes to Bursitis there are many ways we can test for it.
Here are some of the most common types of Bursitis and there symptoms.
1) Trochanteric bursitis (hip): inflammation of one or both bursae in the hip joint. Usually a history of repetitive hip flexion or direct trauma; lateral (outside) hip pain with hip flexion or extension. There are usually no visual signs such as redness or swelling. Palpation (direct pressure) at the greater trochanter is painful.
2) Subacromial Bursitis (shoulder): inflammation of the bursa in the shoulder. The usual causes are pressure (acute or chronic) on the bursa but can also be infection, autoimmune disease or crystal deposits. The symptoms and pain are very similar to impingement such as dull shoulder pain and weakness with certain movements due to repetitive motion or trauma; visual altered movement; surrounding muscles of the shoulder are hypertonic (stuck in flexion); pain with active or passive range of motion such as flexion or abduction (away from the body). MRT (muscle resistance test) may or may not produce pain.
3) Olecranon Bursitis (elbow): inflammation of the bursa that is superficial to the olecranon process of the ulna. Usually caused by external compression (acute or chronic), it might also be from infection, systemic disorders or
medical procedures. Trauma or activities that place pressure on the posterior (in back of) elbow. A major indicator of bursitis of the elbow is a visible large lump on the posterior elbow that may or may not be red. Painful and tender to the touch with palpation. May have pain with flexion and extension of elbow. Your doctor may order antibiotics and or anti- inflammatories. As with all cases of bursitis, the source of compression needs to be removed or resolved. Contraindication: massage is avoided until the condition is healed.
4) Prepatellar Bursitis (knee): The most common inflamed bursa in the knee joint is the prepatellar bursa. It is usually a chronic non-septic bursitis caused by frequent mechanical compression from activities like gardening or lay out a carpet. Symptoms are pain to anterior (front) of the knee, redness, swelling, local heat (inflammation) and difficulty walking. Visible prominent enlargement over the patellar region. Pressure to the patellar is painful and may be able to feel for heat, fluid and/or crepitus. There will be pain with knee flexion. MRT (muscle resistance testing) will produce no pain.
5) Retrocalcaneal Bursitis (foot/ankle): Inflammation of the bursa surrounding your heel. The bursae near your heels are behind your Achilles tendon. It is usually caused by overuse of the heel and ankle area. This can be due to lack of stretching before exercise such as walking, running or jumping as well as wearing poor fitting shoes and high heels. It’s most common in athletes and is sometimes misdiagnosed as Achilles tendonitis. Unfortunately these two conditions can happen at the same time. The most common symptom is heel pain and tenderness when applying pressure such as standing. Swelling, redness, local heat (inflammation) to the heel, loss of movement and pain to muscles of the gastrocnemius (calves) are also symptoms of this condition.
The reason in performing tests such as range of motion and muscle resistance is because it helps the practitioner have a better understanding of the condition which therefore gives the patient much more accurate diagnoses. For example, pain with any resistance indicates to the practitioner that it is NOT bursitis. Any pain with muscle resistance is a clear indication of a muscle or tendon pathology.
Treatments for Bursitis: Bursitis treatment depends on the specific type of bursitis, as there are subtle differences in the treatment of the different conditions. However, there are some general themes in treatment to allow the inflamed bursa to rest, allow the inflammation to subside, and prevent the condition from becoming persistent or recurrent. Like we had mentioned earlier, as with ALL cases of bursitis, the source of the compression needs to removed or resolved. I have found professionally that alternative therapies in order to successfully treat bursitis is the best path to take both long term and preventatively. Some of the best ways to treat Bursitis are: Chiropractic medicine holds promise for most people with musculoskeletal disorders such as bursitis. Performing adjustments or manipulations with the hands, the chiropractor directs treatment not just toward the injured joint but toward the whole body, unblocking any nerve interference that may be caused by a misaligned vertebra. The treatment goals are to reduce inflammation in the joint, restore proper posture and movement, and bring the body back to its healthy state, preventing the bursitis from occurring again. Acupuncture can relieve the pain of bursitis and restore function to the joint. But perhaps more important, this therapy can address the underlying imbalance in energy, or qi, that predisposed the person to bursitis in the first place. Massage Therapy can be very helpful for people with bursitis. Massage therapy can reduce the pain of bursitis and increase blood supply to the tissues, allowing the body to recovery faster and heal itself. The treatment goal is to reduce compression and relieve pressure on the bursa. In most cases of bursitis, excluding prepatellar bursitis, direct massage or pressure is contraindicated directly over the bursa. Instead, massage therapy will reduce the compression caused by muscle tension above and below the joint. Nutritional Therapy for bursitis may be very helpful in reducing systemic inflammation and preventing inflammation to begin with. A poor, vitamin deficient diet may predispose someone to bursitis. Besides making sure that we are eliminating and avoiding the causative factors and activities that had caused this condition, some other common ways to go about treating and managing your bursitis include ice application, oral anti-inflammatory medications, and cortisone injections.
Prevention The best treatment for any condition first and foremost is prevention. We can’t always prevent a condition from happening but why wait until you no longer have mobility and are experiencing real pain. Prevention of this condition requires routine stretching and myofascial release to the surrounding muscle groups, above and below, the afflicted joint on a regular basis. This will allow less friction between the bone, tendon and bursa. Other preventative measures we can all take in order to avoid bursitis are:
If something hurts, stop IMMEDIATELY what you are doing
Use cushions or pads when resting a joint on a hard surface
Always use proper form and body mechanics when exercising and making sure you are stretching before all physical activity
Do not sit or stand in one place for long periods of time
Keep a healthy body weight
Take breaks often when using repetitive movements
With every new exercise routine, ALWAYS begin slowly. As you begin to build strength, you can use more force.
“An ounce of prevention is worth a pound of a cure.” – Benjamin Franklin
Taylor Paganini L.M.T, O.T is certified in Myofascial Release Technique, Trigger Point Therapy, AMMA, and Prenatal massage. Also certified in flame Cupping. Her techniques are to help unblock energy in the body and bring better mobility and functionality to the muscular and nervous systems in order to reconnect the mind/body experience.