Bursitis and Tendinitis
Bursitis and Tendinitis
Easing Those Overworked Joints
You're on the stair climber for an hour. You shovel snow all afternoon. You wallpaper the kitchen over the weekend.
What do these things have in common? They're all terrific ways to get a raging case of bursitis or tendinitis. These painful conditions overlap so often that doctors frequently diagnose them as bursitis/tendinitis, because it can be hard to tell where one leaves off and the other begins.
And they can happen most often to people in their forties, particularly those who haven't worked to maintain their flexibility. Without regular stretching, muscles and tendons get tighter and rub together more, increasing the risk of inflammation.
Once you have bursitis and tendinitis, you move around with the caution of a much older person. And you can forget the joys of your favorite sport, because a sudden motion can feel as though you've just been jabbed with a red-hot poker.
Here's why it hurts.
The No-Use Syndrome
Your bursae are tiny fluid-filled sacs that cushion the spaces where muscle passes over bone and where two muscles rub together. In your kneecaps and elbows, they form cushions between skin and bone. They can get inflamed when you injure or overuse a joint or when you accelerate your workout beyond what you're used to, says Pekka Mooar, M.D., director of the Delaware Valley Sports Medicine Center in Philadelphia.
If you have tendinitis, it is not really your tendon but a ring of tissue around the tendon where it attaches to a bone or muscle that hurts. The pain is caused by overuse of the tendon, which produces inflammation.
"We all get more aches and pains with age; there's no controversy about that," says Phillip E. Higgs, M.D., a reconstructive surgeon at Washington University School of Medicine in St. Louis. But if you stay limber over the years, a burst of effort is much less likely to bring on bursitis and tendinitis, he says.
It is too little exercise, not aging itself, that increases your risk of these painful ailments. That's what Dr. Higgs and his colleagues concluded after counting cases of bursitis and tendinitis in a study of 157 poultry workers and 118 data processors. Although the workers ranged in age from 20 to 71, the younger workers who got little exercise had nearly the same number of inflammations as older workers who didn't exercise much.
Bursitis and tendinitis vary a great deal from person to person, Dr. Higgs says. For example, one day of all-out sports may cause symptoms in one person, while another may not have trouble until after many years of work on an assembly line.
Where It Hurts Most
Shoulders, elbows, hips, knees and ankles are especially vulnerable to bursitis and tendinitis. Women tend to get inflammations in the hips more than men do because our hips are set at a wider angle from the pelvis, putting greater stress on the hip joints. For men, shoulders are the usual problem area, because they tend to do more throwing or to have jobs that require a lot of overhead lifting.
Back when we were the only ones scrubbing floors, an inflamed knee bursa was called housemaid's knee. And one form of tendinitis rarely seen in anyone these days used to occur almost exclusively in women's wrists. The cause? Wringing out cloth diapers and cleaning rags. These days, many of us still get other forms of tendinitis from activities such as typing, doctors say. Any job or hobby that requires repetitive motion, from working on an assembly line to sewing, increases the risk.
Bursitis and tendinitis are also caused by overdoing a favorite sport. Tennis can do in elbows and wrists; swimming can irritate the shoulder bursae; running can aggravate ankles and Achilles tendons, particularly if you run on hard surfaces in the wrong shoes. And aerobics, particularly step aerobics, can cause hips and knees to flare up.
Bursitis is often missed as a cause of lower back pain, experts say. And it often accompanies the disorder called fibromyalgia, which causes muscle pain and stiffness throughout the body.
Fortunately, bursitis and tendinitis are very treatable. And you can do a lot to prevent them.
Safeguarding Your Joints
The most important thing is to get into condition gradually and to ease into vigorous exercise gently, says Stephen Campbell, M.D., a rheumatologist at Oregon Health Sciences University in Portland. Here are some suggestions.
Stretch before exercise. "In preparation for vigorous activity, you need to do more stretches of the muscles you'll be using," says Dr. Mooar. "Hold a slow, sustained stretch for ten seconds, and don't bounce. Repeat the stretch three to five times before exercising." And don't do high-speed stretches, or you risk tearing muscle fibers or ligaments, he says. If you're unsure which stretching exercise is best for you, check with a trainer.
Start new activities slowly. If you take up a new sport, work at gradually increasing the strength and flexibility of the muscles you'll be using, says Dr. Mooar. If you choose tennis, for example, take it one set at a time at first. "Don't pick up a racket and play lots of sets at once, because your shoulder is going to feel like it's falling off," he says.
Prepare for work or play. If your job or hobby calls for repetitive motion, ask a trainer to recommend strengthening and endurance exercises targeted for that motion, Dr. Mooar says. "If you do this," he says, "you can stop bursitis and tendinitis from happening over and over." Many people develop chronic inflammation from reinjuring their joints, he says.
Support yourself. Typing and filing can trigger problems in your wrists and back. Use a keyboard wrist rest for typing, says Dr. Campbell. And check that your chair is well adjusted so that your back is supported and your arms and wrists are level with each other.
Have mercy on your knees. There is little but a tiny bursa between your kneecap and the skin over it, says Dr. Mooar. So if you're doing housework or gardening on your knees, kneel on a piece of foam rubber or wear knee pads to cushion them. Many garden centers, sporting goods stores and hardware stores carry foam rubber or knee pads.
Lie flat on your back with your knees bent and your feet resting flat on the floor (top). Clasp your hands behind your head. Cross your right leg over your left leg, placing your right foot on the outside of your left leg just below the left knee (center). Do a gentle pelvic tilt (that is, gently press the curve of your back toward the floor). Keeping your shoulders and upper back stationary, use your right foot to steadily pull your left knee toward the floor on your right side (bottom). You should feel a stretch in your left lower back or outer thigh as you try to touch your left knee to the door. Hold the stretch for six seconds. Return to the starting position. Relax. Repeat the exercise using your left foot on the outside of your right leg (just below the right knee) to pull your right knee toward the floor on your left side. Repeat three to five times, twice daily.
Pain-Free Workouts
There's no need to let bursitis or tendinitis spoil your participation in your favorite sport. Gradual conditioning is the key to prevention--or to staging a careful comeback if bursitis or tendinitis has already hit. Here's some advice for various activities. Aerobics. Learn the routines at your own pace; don't push yourself. Always warm up and stretch before you exercise and cool down after, says Robert L. Swezey, M.D., medical director of the Arthritis and Back Pain Center in Santa Monica, California. Tennis. To avoid serving up wrist pain or tennis elbow, choose a large-handled racquet, decrease the string tension and wear an elastic band around your forearm to support the muscles, says Stephen Campbell, M.D., a rheumatologist at Oregon Health Sciences University in Portland. If your shoulder is the problem, modify your serve to avoid vigorously swinging your arm over your head. Running. Condition yourself very gradually before running longer distances, says Dr. Campbell. Don't run too vigorously if you're just starting, avoid hard surfaces and wear shoes with soft soles and high-quality insoles and arch supports. Swimming. Although swimming is very gentle on most joints, the shoulder can get too much of a workout, Dr. Campbell says. To prevent or heal shoulder bursitis or tendinitis, avoid the freestyle, or crawl, and butterfly strokes, he says. Use the breaststroke or sidestroke or a kickboard instead. Returning to training. After a bout of bursitis or tendinitis, it's crucial to wait until all the pain has gone for restarting vigorous workouts, says Dr. Campbell. When you have your doctor's okay to start again, exercise at a lower frequency and intensity and recondition your injured joint over weeks or months, he says. |
Tips for a Quick Recovery
Ouch. You already have bursitis or tendinitis, and you want relief--quick. The first question to ask yourself is, what have you done differently? "You're overdoing whatever it is," says Dr. Campbell. "First, stop doing it." Then:
Give yourself an ice massage. "Apply a paper cup full of ice to the painful area," says Robert L. Swezey, M.D., medical director of the Arthritis and Back Pain Center in Santa Monica, California. Rub the icy bottom of the cup into the sore spot for two to five minutes, three or four times a day, to control the inflammation, he says.
Alternate it with heat. After the ice, apply a microwavable heat pack or electric heating pad to soothe the pain, says Dr. Campbell. The microwavable packs are available at most pharmacies, he says.
Bundle up for bed. Wear a flannel shirt or a wool sweater at night to keep a painful shoulder extra warm. If you sleep sleeveless in a cool room, your morning stiffness and soreness will be greater.
Use the right pain reliever. Choose an aspirin or ibuprofen pain reliever for the pain, says Dr. Campbell. Aspirin and ibuprofen block the production of chemicals called prostaglandins, which contribute to swelling and pain in inflamed tissue. Acetaminophen won't control inflammation because it does not block prostaglandins.
Swing it. Sometimes bursitis in the shoulder progresses to a painful condition called adhesive capsulitis, or frozen shoulder. When this happens, the shoulder's range of motion is almost completely restricted, and the joint is nearly immobile. To avoid frozen shoulder, you need to start moving your shoulder as soon as the acute pain has passed, says Dr. Campbell. Lie facedown on a cushioned surface such as a bed, and hang the affected arm over the side. Gently swing your arm like a pendulum, gradually increasing the range until you can swing it in a full circle. Do this for 15 to 30 minutes, three to five times a week, to restore your range of motion, he says.
Consider chiropractic care. If your pain won't quit, a technique called friction massage may clear up the problem, says Warren Hammer, D.C., a chiropractor in private practice in Norwalk, Connecticut. When inflammation is chronic, fibrous adhesions don't allow the bursae to glide smoothly. Friction massage can break down those adhesions, says Dr. Hammer, relieving the cause of bursitis pain. "Also, an inflamed tendon becomes thicker and shorter, which creates further inflammation in the bursa it's rubbing over," Dr. Hammer says. "The deep pressure of massage across the bursa and tendon can lengthen the tendon fibers again." Use ice to calm the inflammation before chiropractic treatment, he says.
Preventing the Freeze
If bursitis or tendinitis lingers too long, you may need to see your doctor for help in battling the pain. Here are some remedies to ask her about.
Consider prescription relief. If you have no history of stomach problems, ask your doctor about prescription-strength non-steroidal anti-inflammatory drugs (NSAIDs) for pain, says Dr. Campbell. Like aspirin and ibuprofen, NSAIDs work by blocking the production of prostaglandins. But they can also irritate the stomach like aspirin does, so they are usually not prescribed for long periods.
Go slow on shots. Nearly the last resort for pain, steroids are "shortcuts, not cures," says Dr. Mooar. Most doctors recommend injecting a painful joint, tendon or bursa no more than twice a year. Frequent injections can weaken or rupture a tendon.
"Most people are overinjected with cortisone-like drugs," says Dr. Swezey. "Most doctors use 10 to 20 milligrams for bursal injections, but I've found that 2½ milligrams works quite well."
Make surgery the last resort. For extremely severe bursitis, your doctor may use a needle to draw fluid off a painful joint or recommend that an orthopedic surgeon remove an inflamed bursa entirely, says Dr. Mooar. But before consenting to surgery, you should seek a second opinion.
Lie flat on your back with your knees bent and your feet resting flat on the floor (top). Clasp your hands behind your head. Cross your right leg over your left leg, placing your right foot on the outside of your left leg just below the left knee (center). Do a gentle pelvic tilt (that is, gently press the curve of your back toward the floor). Keeping your shoulders and upper back stationary, use your right foot to steadily pull your left knee toward the floor on your right side (bottom). You should feel a stretch in your left lower back or outer thigh as you try to touch your left knee to the floor. Hold the stretch for six seconds. Return to the starting position. Relax. Repeat the exercise using your left foot on the outside of your right leg (just below the right knee) to pull your right knee toward the floor on your left side. Repeat three to five times, twice daily.
