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Bursitis

 

Bursitis Introduction

Part of the reason that we are able to move so freely is due to the flexibility of our joints. Bursas are small, fluid filled sack-like structures that serve to diminish friction between two moving structures, to allow them to move over one another with more fluidity. There are over 150 bursas throughout your body, found where tendons meet bones to cushion their movement and reduce rubbing; if we didn’t have bursas the lack of lubrication would limit our range of motion, significantly increase wear and tear, and be very painful.

When a bursa is inflamed it results in a condition called bursitis. This usually occurs with repetitive use of a joint or constant pressure; occasionally an infection within the bursa will be responsible for the inflammation. Due to this inflammatory process, the bursa loses its lubricating ability, becoming more swollen, painful and inflamed as it is moved. Due to its diminished function, the joint itself will become painful and hard to move. Normally, it is the major joints that are more susceptible to bursitis such as the knee, hip or shoulder, but it can also occur in the smaller joints such as the big toe. Sometimes, small calcifications can form on tendons were they meet joints, causing the development of new bursas in these areas.

Symptoms of bursitis can appear similar to tendonitis or arthritis and can be mistaken for these other conditions. Bursitis is unlike other conditions involving bones and joints and does not lead to deformity and is usually short lived, but can flare up chronically. Symptoms can be more noticeable at night or after periods of use. Similar to other musculoskeletal conditions, bursitis can be very painful and limit motion. As stated earlier, the most common reason for bursitis is over-use or injury, but it can also be associated with other conditions such as arthritis, gout, bacterial infection, and rarely, tuberculosis.

There a few different types of bursitis, mainly named after the type of occupation that can cause the condition:

  • Weaver’s bottom. This type of bursitis gets its name from an inflamed bursa resulting from sitting on a hard surface and swaying back and forth, such as sitting at a loom. The bursa affected sits over the bone in your buttocks.
  • Housemaid’s knee. In this type of bursitis a soft, egg-shaped bump forms on the front of your knee, due to kneeling while scrubbing a floor, gardening or doing other activities that place pressure on your knees.
  • Miners’ elbow. This form results from swinging a pick. You may get a similar inflammation by pushing a vacuum cleaner back and forth. Constant hammering and swinging a tennis racket are other examples of repeated physical activities that may lead to bursitis of the elbow or shoulder. In addition, repeated leaning on your elbows could lead to bursitis over the tip of your elbow.

Bursitis Symptoms

  • Dull ache in your hip, shoulder or elbow or smaller affect joint
  • Heat or swelling in area with inflamed bursa
  • Limited range of motion in affected joint
  • Pain and stiffness with movement or pressure to inflamed bursa

With hip bursitis, there will be no noticeable redness at the hip, due to the fact that the bursa lies deep to major muscles. The pain with this type of bursitis will manifest over the greater trochanter, the part of your thighbone that juts out just below your hip.

Bursitis Symptoms

  • 32 people per 1000 experience bursitis
  • 8.7 million people in USA suffer from bursitis

Bursitis Treatment

NSAIDS: For pain and swelling, nonsteroidal anti-inflammatory medications (NSAIDs) such as Ibuprofen, Celebrex, can be helpful. NSAIDs inhibit the enzymes Cox-1 and Cox-2 (cyclooxygenase), which participate in a pro-inflammatory pathway. Efficacy varies between the different NSAIDS due to their variation in mechanism of action.

COX-2 Inhibitors: A relatively new sub-class of NSAID, known as Cox-2 inhibitors, work by blocking cyclooxygenase 2 enzyme which is involved in the inflammation pathway. By sparing cyclooxygenase 1 (Cox-1) enzyme, gastrointestinal toxicity is supposedly reduced. Due to this claim, some prefer using Cox-2 inhibitors to other NSAIDs.

Corticosteroids: If the symptoms of bursitis are persistent, corticosteroid injections may be considered. This very powerful anti-inflammatory medication can be injected directly to the site of inflammation. This can be extremely helpful for situations that are not improved with rest, and can provide immediate relief for a swollen tender joint. Long-term use of steroids degrades cartilage and demineralize bone and should be used sparingly.

Supplements helpful for Bursitis

Nutritional supplements and herbs for bursitis revolve around reducing the pain and swelling of inflammation. Most supplements that have been found effective for inflammation associated with arthritis, strains, sprains and sports injuries are also effective for reducing symptoms of bursitis.

MSM

MSM (methyl sulfonyl methane) is a natural sulfur compound found in all living things. It has been shown to add flexibility to cell walls, allowing fluids to pass through the tissue more easily. While MSM is normally found in many common foods, such as meat, fish and a variety of fruits, vegetables, and grains, it is inactivated in our food by processes such as heating, storage, processing, and cooking. It is an odorless, water-soluble material that provides a bioavailable source of dietary sulfur.

MSM appears to inhibit pain and inflammation, and research suggests that MSM may have a variety of benefits for people with all types of arthritis.[1] In addition to its role in reducing inflammation, MSM plays a beneficial role in immune health, osteoporosis, hair, skin, nails, athletic injuries, acne, wrinkles and allergies. MSM can be taken orally or applied topically, and is well tolerated when using proper dosing guidelines.

Curcuma longa (turmeric)

Curcuma longa, known as turmeric, has been used in Ayurvedic medicine for centuries. Its many uses make it a very versatile remedy, but its anti-inflammatory properties are what help bursitis. The most active constituent of turmeric is curcumin, and most research revolves around this component. When used orally, curcumin exhibits many direct anti-inflammatory effects such as inhibiting the formation of blood clots, stabilizing cell membranes thereby preventing the release of inflammatory mediators.[2, 3] In one study, curcumin was found to be a more potent anti-inflammatory than phenylbutazone and cortisone in a rats suffering from acute inflammation.[4] However, curcumin was only half as effective as these other agents in diminishing chronic inflammation. The topical application of turmeric is also helpful in reducing inflammation as well as acting as a counter-irritant thereby reducing pain.[5]

Turmeric is very well tolerated. Because of its safety, efficacy and excellent tolerability compared to other standard drug treatments it provides a great alternative to reducing inflammation of bursitis.

Bromelain

Bromelain refers to a group of sulphur-containing enzymes derived from the pineapple plant that digest protein. Taken away from food, bromelain helps to reduce inflammation by traveling to the site of injury and breaking down the factors that promote swelling, pain and inflammation. Because of its ability to impact many aspects of inflammation, it is used often in sports injuries, arthritis and strains including bursitis. In one study, the combined effect of curcumin and bromelain reduced the need for corticosteroids in those suffering from rheumatoid arthritis.[6]

Vitamin C

Commonly known as one of the most potent anti-oxidants, vitamin C is also very important to the repair of injuries. It accelerates cellular growth and repair and is important in the production of collagen, which the body uses to create connective tissue. Those suffering from chronic bursitis could benefit from taking vitamin C regularly, to strengthen the body and make it less susceptible to repeated injury.

Vitamin C’s role in decreasing inflammation is due to its ability to inhibit the secretion of prostaglandins, chemical mediators that contribute to symptoms such as pain and swelling.[7] However, its role as a powerful antioxidant must be discounted, as it scavenges free radicals that also contribute to the inflammation process

White Willow Extract (Salix Species)

The Salix species of trees (namely the white willow tree) contains constituents that are very effective in reducing pain and inflammation. The components salicin and salicyl glycosides inhibit cyclooxygenase, the enzyme involved in the pathways of inflammation, making it an excellent herb for diminishing the discomfort of bursitis. In fact, the modern day aspirin is derived from the one type of willow bark. The pain reducing effect of this herb takes a bit of time to take action, but once it does, the effect is maintained for several hours.

Omega 3 Fatty Acids

When it comes to inflammation, omega 3 fatty acids found in cold-water fish, nuts, and seeds are extremely effective in interrupting pathways. These fatty acids are essential to the body but not produced by the body, and so must be obtained from our diet and supplementation. Omega 3 fatty acids have two main functions: they are involved in the integrity and fluidity of cell membranes and are also converted to a number of important substances called prostaglandins, some of which are anti-inflammatory and others that are pro-inflammatory.

Some studies show a reduction of pain and inflammation in those suffering from osteoarthritis and rheumatoid arthritis, ulcerative colitis and other inflammatory conditions when supplementing with omega 3 fatty acids.[8] Omega 3 fatty acids work by promoting pathways that decrease arachidonic acid, a precursor to pro-inflammatory prostaglandins.

References

[1] Jacob SW, et al. The Miracle of MSM: The Natural Solution for Pain. New York: G.P. Putnam’s Sons; 1999:57-58.

[2] Mukhopadhyay A, et al, Agents and Actions, 12, 1982: 508-515

[3] Srivastava KC, Bordia A and Verma SK, Prostaglandins Leukotrienes and Essential Fatty Acids, 52 1995: 223-227

[4] Mukhopadhyay A, et al, Agents and Actions, 12, 1982: 508-515

[5] Patacchini R, Maggi CA and Meli A, Arch Pharmacol, 342, 1990: 72-7

[6] Izaka k, Yamada M, Kawano T and Suyama T: Gastrointestinal absorption and anti-inflammatory effects of bromelain. Exp Med Surg 22, 277-280, 1964

[7] Eberhard Kronhausen and Phyllis Kronhausen with Harry B. Demopoulos, M.D., Formula for Life, William Morrow and Co., New York, 1989, p. 95.

[8] Gil A. Polyunsaturated fatty acids and inflammatory diseases. Biomed Pharmacother. 2002 Oct;56(8):388-96.