Tendinitis & Bursitis

TENDINITIS AND BURSITIS are two common disorders of the musculoskeletal system that are usually the result of repetitive activity. Tennis elbow is one of the most common types of tendinitis. While painful, annoying, and sometimes immobilizing, with proper care and prevention tendinitis and bursitis are nor ultimately serious. I discuss them together because their treatment is identical.

Tendinitis is essentially an inflammation of the tendon, a band of tough, white fibrous tissue that connects the muscle to the bone. Muscle fibers merge at one end into a tendon while the opposite end is attached to bone. When the tendon becomes inflamed, usually from a strain-overexertion, tearing, stretching, and twisting-it swells and causes soreness and impaired motion. This is tendinitis. A tendon can actually tear away from the bone, resulting in a ruptured tendon. The tendons most commonly injured include the Achilles (at the back of the ankle), the biceps (at the front of the shoulder), the pollicis brevis and longus (the thumb), the upper patella (the knee), the posterior tibial (the inside of the foot), the elbow, and the rotator cuff (shoulder).

Bursitis is caused when the bursa-a sac or pouch filled with lubricating fluid that surrounds and protects joints such as the shoulders-becomes inflamed. Bursitis can be caused by trauma, strain, infection, or arthritis. The most common sites of bursitis include the shoulder, hip, elbow, and lower knee.

The most common cause of both tendinitis and bursitis is excessive tension on the tendon or bursa. Repeated movements, such as are common to sports, can cause both disorders. One way to prevent development of both these problems is to warm up sufficiently before exercising or engaging in a sport. This allows the tendons and muscles to become more flexible, thus making strains less likely. If you’re just beginning an exercise routine, it’s essential that you work into it at a gentle pace. I most commonly see bursitis of the shoulder, tendinitis of the elbow, and knee problems. Most of these complaints are sports or exercise related. I tell my patients that they can eliminate chronic problems by modifying or changing their movements, using the RICE technique and ensuring that their nutritional status is up to par.

Modifying or changing your movements means that you can’t keep repeating a movement that’s causing pain and disability. If you run and your knees give you trouble, you need to do an alternative exercise until your knees are better and, even then, you’ll have to regularly alternate exercises so as not to aggravate your condition. For example, if you are running and the pain is acute, stop running. When the pain lessens, after a period of time, you can begin to run again, but alternate running with another exercise like swimming or cycling. If you have a tennis elbow you’ll probably need some expert instruction to help you modify your stroke so that the joint won’t be constantly stressed. Whatever you do, if you feel pain-either new pain or a recurrence of a chronic pain-while exercising, don’t try to “work through it.” You can rupture a tendon, making surgery necessary or putting a permanent halt to your activity.

Many knee problems caused by running are actually due to a condition called pronation of the feet. This means that your weight is not distributed evenly on your feet; running aggravates the problem, causing irritation of the knee. In most cases, this is helped by orthotic supports in your running shoes.

The RICE technique (Rest, Ice, Compress, Elevate), described below, is important if you’ve just injured yourself in order to minimize inflammation. But it can also be useful if you have a chronic problem. Say your ankle regularly develops tendinitis. To minimize the problem, use the RICE technique after every exercise session or whenever your ankle begins to bother you. This will help to keep your tendinitis or bursitis under control.

THE R.I.C.E. RECOMMENDATIONS:

• Rest the injured part immediately.
• Ice the injured area to minimize swelling and inflammation.
• Compress the injured area to limit swelling and bleeding.
• Elevate the injured area to a level that’s above the heart to increase drainage of fluids from the affected area.

Remember when you put ice on an injury not to apply it directly to the skin-cover the area with a clean cloth or towel. Also, when you “compress” the injured area, be sure not to wrap it so tightly that you limit circulation. The best way to apply ice and compression is to use both on the injured area for a half hour and then remove them both for fifteen minutes to allow full circulation.

The acute, painful stage of tendinitis and bursitis can last from one to five days, sometimes longer. During this period you can use the RICE technique for gradually diminishing amounts of time. You might use it constantly for the first few hours of pain and then five or six times on the second day of pain, three or four times the next day, and so on. In between compression and ice, it’s best to keep the area immobilized to minimize pain and inflammation. You can fashion a homemade sling if your arm is affected; if your foot or knee is the problem, stay off it.

Once the inflammation has subsided, which can take from three to five days or sometimes more, you need to gradually begin to exercise the affected area. This is critical. If you keep the area immobilized, it will take far longer to heal and it may heal less completely. As you reach the point where you can begin movement exercise, the inflammation will be gone and the affected area will no longer be warm to the touch. Then, in addition to the exercise, you can apply warm heat, using a heating pad or warm, moist cloths.

The important thing to remember about postinflammation exercise is that when you begin to exercise an injured shoulder, knee, or ankle you’re not trying to build muscle strength at first by working it harder and harder: You’re merely trying to maintain mobility and enhance your range of motion. This means you need only gently move the injured part in ever-larger circles for just a few minutes, three or four times a day. Only when all pain is gone and the range of movement seems normal should you consider resuming regular exercise.

Adequate nutrition can play a role in preventing and easing the effects of tendinitis and bursitis. The following nutrients, used also for wound healing, are important.

Vitamin C is critical to the repair of injuries. It speeds cellular growth and repair and is important in the production of collagen, which the body uses to create connective tissue. I suggest that patients who suffer regularly from tendinitis and bursitis take regular vitamin C supplementation. Vitamin A in the form of beta-carotene is also critical to tissue repair. It’s best taken with zinc, which works in conjunction with vitamin A to repair tissue and reduce inflammation.

Vitamin E and selenium work together to limit inflammation and speed healing.

NATURAL PRESCRIPTION FOR TENDINITIS AND BURSITIS

FOR ACUTE PAIN:

• Immediately after injury, for up to five days, and sometimes longer, use the: RICE technique as described above. Use with decreasing frequency until the pain and inflammation have subsided.
• During acute pain, immobilize the joint either, with a sling or keep off the joint if it’s a foot or knee.
• When acute pain has subsided, gradually exercise joint with increasingly large movements made very gently, and without any kind of bouncing.
• As you begin to exercise, use warm heat either in the form of a heating pad or warm, moist compresses.

FOR CHRONIC PAIN

• Never exercise without warming up, and begin all, new activities gradually. Stretch, without bouncing, before all exercise.
• If you have chronic tendinitis or bursitis, use the RICE techniques immediately after exercise even if you don’t feel pain.
• Never “work through the pain.” If you feel pain during an, activity, stop and use the RICE technique; to continue your activity is to risk rupture and surgery.
• Modify year movements. Try to avoid regular, repetitive movements with any Joint that’s vulnerable to, tendinitis or bursitis. If a particular exercise causes your problem, alternate that exercise with another and/or get professional instruction on how to modify your movements, for instance those that cause tennis elbow, so as to avoid stressing the joint.

IN ADDITION TO YOUR DAILY BASIC VITAMIN/MINERAL SUPPLEMENT, TAKE THE FOLLOWING UNTIL YOUR INJURY IS HEALED:

• Vitamin C: 1,000 mg. daily
• Beta-carotene: 10,000 I.U. daily.
• Zinc: 22.5 mg, daily.
• Vitamin E: 400 I. U. daily.
• Selenium: 50 mos. daily

IN ADDITION: Acupuncture can be very helpful for people who suffer from acute and chronic tendinitis and bursitis.