Tendinitis and Bursitis

Tendinitis and
Bursitis

Treatments for Tender Joints

We've all heard the expression "too little, too late." But the opposite--doing too much too soon, or too often--is what brings on tendinitis and bursitis.

Tendinitis develops when tendons, which connect muscle to bone, become inflamed. Similarly, bursitis occurs when bursa, the fluid-filled sacs designed to decrease friction in joints throughout the body, become irritated. Both problems are caused by overuse or misuse, either from athletic activity, workplace tasks or hobbies that require repetitive motions.

When Exercise Is the Cause

There are two ways to develop tendinitis and bursitis from exercise, says Edward G. McFarland, M.D., director of the Section for Sports Medicine at Johns Hopkins University in Baltimore. The first can happen when you go from relative inactivity to a new activity. "You make a quantum leap from doing nothing to something. Instead of doing it in gradual increments, you do a real sudden burst of activity that's larger than what you're use to," he says. The second can occur "if you are in shape and you decide to increase your activity, but you make too big a jump," he says. "The big key to prevention is a gradual increase in the intensity of your workouts," says Dr. McFarland.

How Women Are Affected

No one can say whether women get more or less exercise-induced tendinitis and bursitis than men do. But doctors do know that in women, the three most common forms of sports-related tendinitis occur in the shoulder, knee and Achilles tendon, says Dr. McFarland. Women also develop tendinitis in the elbow, commonly known as tennis elbow. Areas where women commonly get bursitis include the shoulder, knee and hip, doctors say.

Preliminary research at Ohio State University in Columbus indicates that bursitis and tendinitis show up frequently in people with fibromyalgia, a condition characterized by fatigue and joint and muscle pain. Early results, based on research on 40 factory workers, showed that people with fibromyalgia were three times more likely to have bursitis and tendinitis than people who didn't have it. Fibromyalgia affects more women than men.

Trouble Spot: Shoulders

Shoulder pain is often called swimmer's shoulder, a combination of tendinitis and bursitis that can develop from doing the backstroke, crawl and butterfly strokes, says Cheryl Rubin, M.D., an orthopedic surgeon in Suffern, New York. More female swimmers tend to develop the problem than male swimmers, says Dr. Rubin. One theory is that we have to do more strokes to cover the same distance and therefore place more stress on our shoulders. Another theory says it's due to greater laxity in women's shoulders. Since our shoulder joints are looser than men's, the joint is more unstable, or more likely to move out of normal alignment. Such deviation can cause trauma to structures in the joint.

Women in their thirties and forties also develop bursitis in their shoulders from tennis. "Tennis is a major culprit," says George Waylonis, M.D., clinical professor of physical medicine and rehabilitation at Ohio State University in Columbus.

Trouble Spots: Hips, Knees and Feet

Women develop hip bursitis and knee tendinitis from doing step aerobics or high-impact aerobics, says Lynn Van Ost, R.N., clinical specialist at Jefferson Sports Medicine Center in Philadelphia.

Aerobics can also cause Achilles tendinitis and heel bursitis. So can running. The Achilles tendon can become aggravated when women have poor foot alignment or exercise on improper surfaces such as banked roads or gym floors not suited for aerobics. Training errors, such as doing too much exercise before you're in proper shape or exercising at too high an intensity, can also cause Achilles problems. It's unclear why, but women runners appear to be less susceptible to Achilles tendinitis than men.

Problems from Everyday Activities

Tendinitis and bursitis can also develop when a woman's work at home or in the office requires tasks involving repetitive motions.

Activities that can cause tendinitis in the wrists and hands include working at computer terminals or performing repetitive motions required in factory work, says Janet Edmunson, immediate past president of the Association for Worksite Health Promotion in Northbrook, Illinois. Assembly-line workers and postal workers--male and female--who use their wrists a lot can also get it.

Housework can also result in overuse injury. Kneeling for long periods of time, for instance, can irritate the bursa between the skin and the kneecap. This type of bursitis is less common than it used to be, says Dr. McFarland, but at one time it was commonly known as housemaid's knee.

Activities such as gardening and sewing can also cause tendinitis, says Carla DeWald, a physical therapist at the Physical Therapy Center of Blue Bell in Pennsylvania.

"You have to watch repetitive motion, whether it's in your hobby or your job, or a combination of the two," says DeWald.

Fending Off Pain

Tendinitis and bursitis can be prevented. Here are some tips for keeping yourself pain-free.

Remember to stretch. Warm up and stretch before you exercise. This will loosen up your muscles and joints and prevent them from sudden overload during physical exertion. "Stretching shouldn't be bouncy. It should be a long, steady stretch," says Dr. McFarland. For whatever stretch you do, a good rule of thumb is to hold the stretch for 15 to 30 seconds, relax, then stretch again. Stretch for about five to ten minutes before you exercise, says Dr. McFarland, and again at cool-down. For tendinitis of the wrist or hand related to work activities, stretch your fingers and arms periodically, says Edmunson.

Go gradual. Whatever the exercise you choose, begin gradually. "First start out doing the activity for only 10 to 15 minutes maximum," says Dr. McFarland. Then increase initially every other day, with rest in between, until you are at the level that you want to achieve.

Ease into aerobics. If you're a beginner and haven't been getting any exercise, take it easy at those first couple of aerobics classes. "Go to the first class with the intention of not completing the class," says Dr. McFarland. "Participate until you are fatigued, but don't force yourself to finish the workout."

Women doing step aerobics can develop tendinitis of the knee, just below the kneecap, says DeWald. "Progress gradually," she says. And consider staying at a lower step height, says Dr. Rubin.

Vary your activity. Try different types of activities instead of the same exercise every day. Mix swimming with running or aerobics with cycling, for instance. "Cross-training allows you to exercise every day but not stress the same muscles and joints," says Dr. McFarland. Also, try variety within your sport. If you're having trouble with your shoulders while swimming, try a kickboard workout. Or if you're having difficulty with those overhead tennis shots, hit ground strokes.

Lay off the hand-weights. If you're experiencing shoulder or elbow pain, it may be caused by the hand-weights you're using during aerobics or while you're running, so consider giving them a rest.

"When people use heavier weights (more than one pound), they can stress the joints, especially the elbows, back and shoulders," says Carol Garber, Ph.D., clinical professor of medicine at Brown University in Providence and director of the Human Performance Laboratory at Memorial Hospital of Rhode Island in Pawtucket. Laying off the weights probably won't affect your workout too much. Studies show that the aerobic benefit of hand-weights is pretty minimal, says Dr. Garber. "People can get the same aerobic benefit by doing vigorous arm motions without the weights," she says.

Get some guidance. Get good instruction from someone who knows the new sport you plan to try, says Dr. McFarland. This will help you avoid mistakes that can lead to injury.

Heed posture and position. Prevent tendinitis from work-related tasks by paying attention to your posture and chair position, says Edmunson. "Make sure you are doing the movement properly. Your seat needs to be the right height," she says. Adjust your seat so your wrists aren't cocked up but instead are in the neutral position, she says.

Also talk to your company's medical or safety department for advice on how to position your chair or perform a work task properly, she says. If there is no one to consult where you work, try calling the occupational health department of your local hospital. Many hospitals conduct community health workshops.

Pay attention to pain. If you feel pain, don't ignore it. If you have continuous pain without activity, pain that prevents you from doing other activities, pain that wakes you up at night or pain that is not relieved with ice or aspirin, see your doctor--you may have tendinitis, bursitis or another problem, says Dr. McFarland. Beginners in particular should consult a physician, because they often can't distinguish the good pain of muscle soreness from the bad pain of injury, while more experienced athletes usually can.

Ice it. When you feel pain, use ice, not heat, says Dr. McFarland. One technique is called ice massage. Put water in a paper cup and freeze it, then peel away the top part of the cup and rub the ice on the area for 10 to 15 minutes or until it's numb. It's okay to massage ice directly on skin, but ice packs should have a protective cloth between the pack and your skin. If you have diabetes or poor blood flow to an extremity, however, do not use ice.

Let yourself rest. If you have tendinitis pain, resting the part of your body that hurts will help. "People underestimate the value of rest," says Dr. McFarland. "People are afraid to rest. Rest is very beneficial. By and large most of us can afford to take a day or two off," he says. The rest recommendation applies to work, too. "Take a break from what you are doing," says Edmunson.

Give your body relief. Pay attention to the pain that you feel. If it's tendinitis or bursitis, you can treat it with anti-inflammatories like aspirin or ibuprofen combined with ice therapy for a brief period, says Dr. McFarland. If that doesn't work, then cut back on your activities, he says. If the pain doesn't subside with rest, see your doctor.