Bursitis
WHAT IS BURSITIS?
The prefix "itis" means inflammation, so the word "bursitis" simply means inflammation of a bursa. A bursa is a fluid filled sack which cushions various parts of our joints so they do not rub on each other. For example, bursae are found between tendons and bones. You will soon learn what causes a chronic bursitis condition and how it can be resolved.
WHAT CAUSES BURSITIS?
When someone does a physical activity to excess they can strain the muscle that was overused. This can happen to a well-trained athlete who is striving to excel or a retired person who overdoes it working in their garden. This scenario is often seen in the "weekend warrior" athlete who sits at a desk all week and then plays softball or tennis all day on the weekend. A regimen that builds one athlete may be ill prescribed for another resulting in them breaking down to an injured state. For a tender back entering rehabilitation the difference between the exercise dose that builds tissue is only slightly less than the dose that will cause further injury. The resultant muscle strain (mild tear) creates inflammation and pain. This strain usually occurs near the end of the muscle where it attaches to a bone or blends into its tendon. This creates a condition known as acute tendinitis. This condition could also be created if the muscle is strained from trauma such as a fall. Keep reading, this really is about bursitis.
The usual treatment for acute tendinitis is to rest the area, apply ice periodically for the first 24 to 72 hours and then to use moist heat. Rest prevents further muscle injury, the ice reduces the initial inflammation and swelling and the moist heat circulates blood through the area to speed the healing process. Now, if you added proper Chiropractic care and low load exercises to this treatment plan the muscle would probably heal totally back to normal.
However, this is not what the average person usually does. They may ice once or twice and rest a bit, but most often they just take an over-the-counter pain medication and continue on with their normal activities. If the strain was minor, their body may be able to heal the muscle fibers normally. Unfortunately, this is not the usual result because the injured muscle is being used instead of rested. Because of the stress on the muscle, their body heals the injured muscle fibers by binding them together with fibrotic adhesions or scar tissue. This is done in an attempt to prevent further damage to the injured area. It is a normal protective response of their body.
Formation of scar tissue in an injured muscle causes it to become shorter and tighter than normal. This places more tension and stress on the muscle making it easier to strain during future physical activities. If the muscle is over-stressed or re-injured further, eventually enough scar tissue will form to shorten the muscle to the degree that it can pull the bone it is attached to out of normal alignment. The result is a joint misalignment which causes a chronic condition to develop. If a tendon receives most of the stress from the joint misalignment then chronic tendinitis develops. If a nerve is stretched or has excess pressure on it from abnormal swelling caused by the joint misalignment then a chronic neuritis condition will develop. This happens most often when the spinal vertebrae are pulled out of their normal alignment (subluxated). If the cartilage of a joint is receiving abnormally high pressure on it because of the joint misalignment then a chronic arthritis condition will develop. Now, last but not least, if the bursae around the joint receives excess pressure and stress because of the misalignment then a chronic bursitis develops.
FACTORS AFFECTING BURSITIS SEVERITY
You now know the cause of bursitis, but there are five primary factors that determine the severity of the condition.
The first is simply the degree of misalignment in the joint. Obviously, the worse the misalignment the greater the stress on the bursa and the more inflammation and pain normally created. I will need to examine you to feel the degree of joint misalignment.
The second factor is time. Usually, the longer a misalignment is present the more stress and increased scar tissue the muscle and tendon accumulates. This is why bursitis will often get progressively worse. As people live, work and play they accumulate muscle damage leading to joint misalignments. As time passes, more damage accumulates. Since many of these imbalances are minor the person doesn't notice a problem until they are 40 or 50 years old. At that time, they begin to have stiffness and pain in whatever joints have been misaligned. Most just assume that it's a natural part of aging and are unaware that a successful treatment exists, so they just live with the pain or use drugs or other treatments that just cover up their symptoms. Unfortunately, as the condition progressively worsens, stronger drugs and more radical treatments are required to deal with the pain.
A third factor influencing the severity of bursitis is the amount of use the affected joint receives. If someone is physically active in their job, sports, exercising or other activities, more inflammation and pain will be created than if they are physically inactive.
The fourth factor is weight. It should be easy to see that weight-bearing joints such as feet, ankles, knees, hips and spine are going to receive more stress in a 250 pound person than in a 125 pound person. Reducing and maintaining a more normal body weight will usually reduce the pain of many bursitis conditions.
The fifth factor comes from the bodies power of adaptation. When a joint is imbalanced the body actually creates other joint imbalances to compensate and reduce stress to the original imbalanced joint. This can often result in pain relief in the original injured area and explains why a lot of therapies appear to have resolved a problem when they really haven't. Unfortunately, the compensating area will usually develop a problem of its own after a period of time because of the excessive stress it then receives.
TREATMENT FOR CHRONIC BURSITIS
If you have a chronic bursitis condition it can most likely be resolved by receiving the Progressive Body Movement explained elsewhere in this web page. The misaligned joint directly causing the bursitis must be aligned properly and any other joint imbalances which could cause the problem to return must also be aligned. Then we must determine what caused the muscle damage leading to the joint imbalance. If it is an activity that you are doing using incorrect body movements or poor posture, then you must be educated in how to do it in such a way that you won't over-stress your muscles.
SYMPTOMATIC RELIEF
The symptoms of bursitis can be treated in various ways. Some relieve the pressure on a bursa temporarily while others help reduce the inflammation caused by the joint imbalance. In my experience, none of these treatments remove the primary cause as Progressive Body Movements and Total Health treatments do, but they are helpful to varying degrees.
Exercise to strengthen certain muscles can sometimes create a counter pull against the tight, damaged muscle. This can help realign the joint in some cases, thereby relieving some of the stress on the inflamed bursa. However, if not done properly it could cause increased pressure on the bursa instead. Unfortunately, since most joint imbalances vary, a generic exercise program can't be designed for bursitis conditions. Specific exercises would be designed for someone who received some Progressive Body Movements treatments but could not stay long enough to get their joint totally realigned. Those who get their joints realigned totally would be taught exercises to keep their muscles strong and more resistant to over-stress. This helps prevent the problem from returning once the muscles have healed from the treatments.
I recommend that home stretches or active lengthening of short muscles comes last in the treatment program. Stretching may aggravate the misalignment at the site of the tendon bone junction if done in the presence of tendonitis or bursitis. Stretching can also be helpful if done at the right time and the right way. It is most effective when the tight damaged muscles causing the misalignments are gently stretched. Stretching muscles will help relieve the pressure temporarily. Sometimes for a few moments and sometimes for a few hours. I design specific stretches for a patient who could not receive enough treatments to get their damaged muscles restored to normal length. A balanced stretching program would be taught to those who were able to get enough treatments to restore their joints back into total alignment. Stretching also helps prevent more muscle damage from accumulating.
A lot of bursitis therapies use heat in some form. Applying heat to short, damaged muscles causes them to lengthen temporarily, thereby relieving some of the pressure on the bursa. This provides some relief, however heat also increases inflammation and makes the problem worse. Using heat to treat bursitis is a two-edged sword. It helps a little in one way but hurts in another. Whatever you do, never apply dry heat to your muscles. Since muscles are around 70 percent water, the dry heat dehydrates them causing them to become shorter. This creates a greater imbalance in the joint making your problem worse. I have seen and experienced that myofascial therapy massage and joint mobilization will relieve the pressure and pain as much as moist heat without the negative effect of increasing the inflammation.
Nutrition doesn't remove the cause of bursitis, but can be very helpful at treating the inflammation and pain. It is one important part of treating any inflammatory condition.
A great deal has been written about treating inflammatory conditions with nutrition so I'm not going to go into a lot of detail here. The best foundation is to increase your intake of fruits and vegetables and decrease your intake of fats, grain products and meats. Since most fruits and vegetables leave an alkaline ash after being digested they have an anti-inflammatory effect. They also help reduce excess body fat so you should also become leaner and therefore place less stress on any weight-bearing joint affected with bursitis. There are also many other health benefits from eating more fruits and vegetables, so explore and enjoy the many varieties available.
A number of nutritional supplements have an anti-inflammatory effect. Bromelain, an enzyme from pineapples, and curcumin herb are both good natural anti-inflammatories but must be taken between meals instead of with meals as usually stated on the label. These should be safe for anyone to use 2-3 times a day. Consult a good herb book or nutritionist for other good natural products that decrease inflammation. Even though herbs are natural products and can be used quite a bit without any side effects, I feel it is best to cycle their use. In other words, get three or four products and use one on Monday, another on Tuesday, the next on Wednesday, and the last one on Thursday. Then begin again with the first one on Friday. This should prevent any negative effects that may occur using herbs to excess. Some herbs are quite powerful and should only be used long enough to re-establish balance when an imbalanced situation is present. Always consult a physician knowledgeable in nutrition before starting any supplementation program. This is especially important if you are taking any medication.
PREVENTION OF BURSITIS
You now know that the cause of bursitis is a joint misalignment placing excessive stress on the bursae of a joint. You also know that muscle damage causing the muscle to shorten due to scar tissue is what creates the joint misalignment. Knowing this, you should have an idea about how bursitis can be prevented. It is actually quite simple. Any time you have muscle damage from a trauma, the torn muscle must be treated correctly so very little, if any, scar tissue will form. (For treatment guidelines see TREATMENT FOR ACUTE TENDINITIS in the tendinitis section.)
You must also learn how to do repetitive activities in such a way that you will not over-stress your muscles and gradually accumulate scar tissue over a long period of time. You should also learn how to avoid poor postural and body usage habits that can cause muscle damage to slowly accumulate. Learning Progressive Body Movement is one of the best ways to learn how to use your body without over-stressing your muscles. This is very important because many problems are created by the slow accumulation of muscle damage rather than from a trauma of some kind.
Another way to prevent muscle damage is to warm up properly before sports participation or other physical stress. Also, cycling your work, recreational activities or physical training allows your body time to properly heal any areas that have been stressed. For example, if you are training for baseball, don't run three or four days in a row and then throw three or four days in a row. Doing this could easily cause some muscle damage and scar tissue buildup. Instead, alternate running and throwing every other day. This way the muscles around your knees and shoulders will have time to recuperate properly after each training session.
Everyone will benefit from a regular strength-building exercise program for their entire body. This will make all of their muscles more resistant to muscle damage and help prevent not only bursitis, but also tendinitis, arthritis and neuritis. When done efficiently it only takes a few hours each week. If you are a weekend athlete it is especially important to do a regular exercise program during the week. This way you will be less likely to strain a muscle on the weekend while doing a sport you enjoy. Keeping in shape will also make you better at your activity or sport and provide many other health benefits.
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