Submitted Aug 22, 2003   Updated Sep 26, 2010
By Ray Fosterrlf@mt-rushmore.net


This is one of the most exciting and useful topics that we could discuss. If you know of any friends or family that have bursitis, give them a quick call and tell them to tune in and learn about what they can do to help themselves with one of the most painful and sometimes the most chronic condition that can cause not only pain and misery - but loss of time from work.

What is exciting is that there are some very simple things you can do right at home that can take the edge off the pain and even make the pain and the bursitis go away in short order. So stay tuned!

Q1 In order to know what we are talking about when we use the word "bursitis" -  what is "Bursitis".

  1. Let me give you a tip that will help in understanding medicalese. When a medical word ends in "it is" - think "pain" and think "inflammation". "Itis" means inflammation. The part of the word that goes before the "itis" tells you what is inflamed. "Tendonitis" means that it is a tendon that is inflamed. "Bursitis" means that it is a bursa that is inflamed.

Q2 So now that we know what "itis" means - what is a bursa?

  1. Any place where lots of movement between parts of the body takes place, the body will facilitate the movement by making a nice slippery, lubricated pouch that will let the parts move freely without friction or irritation or expenditure of much energy loss in the movement. This slippery movement pouch is called a bursa.

Q3 So where in the body do we find bursa?

A Anywhere that there is a lot of movement between parts the body makes a bursa. For example - the skin over the front of your knee cap needs to move a lot over the knee cap because people are always bending their knees. So the body makes it easy for the skin to move over the knee cap or patella by making a pre-patellar bursa. If that bursa gets swollen or inflamed it is called "housemaids knee" because in the old days when maids cleaned the floors in houses they used to do so on their knees and could get this bursa inflamed.

There is an exactly same situation behind your elbow as there is in front of your knee.

If you get a sore shoulder and the doctor tells you that you have an "impingement syndrome" what you have is a bursitis of the subachromial space. On top of your shoulder joint, between the bone above called the achromion and the bone below called the humorous, is a space that has a soft lining with slipper fluid inside called the subachromial bursa. In English we would call it the "under top of the shoulder bone bag of fluid" If the motion between the arm bone and the bone that covers the top of the shoulder exceeds the comfort zone of that space, it gets inflamed and sends you messages that you call pain.

Q4 What is the difference between a bursitis and a tendonitis?

A There is no real difference in terms of what is going on. Whether it is a tendon and the sheath or other parts around the tendon that are irritating each other, which is called a tendonitis, or whether it is the skin over a bone as occurs in front of the knee or behind the elbow - the mechanism is the same. The parts become inflamed and it hurts right where it is inflamed. The causes and the sure for tendonitis and bursitis is the same.

Q5 What bursa or tendon in the body is most often involved in a bursitis or a tendonitis?

A It is the bursa or tendon that gets the most mechanical stress. If you are an assembly worker and have to do a repetitive motion in the same direction over and over and have not gotten used to it yet, the part of the body being mechanically stressed is what gets inflamed. If you spend a lot of time on your knees without special protective devices, you may irritate the bursa in front of the knee cap or the bone that you can feel as a bump that your patella tendon attaches to in front below your knee.

A Baker's cyst is a bursitis behind the knee. The medial or lateral ligaments of the knee and the bursa associated with them can become inflamed. The tendons that attach on the inner side of the knee below the knee joint can become inflamed. This is a called a pes anserinus bursitis.

If you are a mechanic or an assembly worker and do a lot of twisting wrenches over and over and are not used to doing that work, not only will your muscles that are used more than they are used to being used, get sore, but the tendon or the muscle where it attaches to the bone may become inflamed usually on the outer side, but sometimes on the inner side of the elbow.

If you do a lot of overhead work, the shoulder may become sore in one of several places such as around the tendon that goes through the shoulder joint to attach above the shoulder joint. This is called a bicipital tendonitis or a bicipital bursitis. If it is the bursa on top of the shoulder joint, it is called a subachromial bursitis.

If it is the tendons that go to the thumb - it has a fancy name. It is called DeQuevain"s disease. If it is the fascia that attaches to the front of the heel bone, it is called a "heel spur" which comes from the xray picture that is often seen with this condition.

The ones we have mentioned are the most common, but it could happen just about anywhere around any joint.

At the hip it is a trochanteric bursitis that is the common one.

Q6 So it sounds as though we want to increase our activity level little by little to avoid getting a bursitis. Is that true?

A Doing too much too soon is the usual and common way that a bursitis or a tendonitis develops.

Q7 Some people seem to be able to do as much as they like as rapidly as they like with never developing a bursitis or a tendonitis. Other people are suffering with sore tendons and bursa often. Why is this so?

A First of all we do not know all there is to know about this subject. Certainly, if you have arthritis in the family, you are more at risk for bursitis and tendonitis. It you have arthritis, you are much more at risk to develop a bursitis as compared to a person who has no arthritis.

How loose your joints are has a relationship between the ease of getting an inflamed bursa or tendon. The more laxity the less danger of getting an inflamed tendon or bursa. The tighter a person's tendons and ligaments are, the more danger of getting an inflamed tendon or bursa. If your joints and tendons tend to be tight, stretching exercises are especially important for you before doing aerobic exercises or doing more than your body is physically used to doing.

Q8 Is every pain around a joint caused by bursitis or tendonitis?

A No, there are some other important causes of pains around a joint. The most common pain around a joint is a bursitis or a tendonitis. But it will require you to see your medical provider to diagnose conditions that can imitate a tendonitis or a bursitis.

Q9 What are the names of some of these other conditions that may look like a tendonitis or a bursitis?

A Gout, osteoarthritis, deep vein thrombosis or a blood clot can all mimic a tendonitis or a bursitis. So it is good to have a proper diagnosis before going too far with a pain about a joint.

Q10 Why can a bursitis or a tendonitis be such a problem?

A Any time you treat a pain symptomatically, without getting to the cause of the problem, it runs the risk of become symptomatic again as soon as you stop the treatment.

Q11 Explain what you mean by symptomatic treatment?

A The usual and customary treatment that your doctor will give you for bursitis or tendonitis is an powerful anti-inflammatory medication. In fact aches and pains about the joints are so common that the pill makers make it easy for you to get an anti-inflammatory over the counter without needing a prescription from your doctor. Symptomatic treatment means that the symptoms are treated. If it hurts - don't find out why it hurts - just take a pain pill! If it is inflamed - don't find out why it is inflamed take an anti-inflammatory drug. That is what I mean by symptomatic treatment.

Q12 Is there anything better than symptomatic treatment?

A Yes there is. Find out why you hurt and deal with that problem. Then the hurt will be cured if the cause of the hurt is dealt with.

Q13 Can you give me a practical example of what you mean?

A Yes, Joe Blow has been unable to work because his knees, arms, elbows, shoulders, feet or whatever part it is that has the bursitis or tendonitis. He has had a stomach bleed because he took so much anti-inflammatory medication, that now he is afraid to take any more. But he is still left with the bursitis or tendonitis as soon as he stopped taking the medication that suppressed the inflammation.

Q14 So what can Jo Blow do to get rid of the cause of his bursitis or tendonitis?

A The first step is to find the cause of the bursitis or tendonitis? Inflammation is the body's effort at repair of damaged tissues. Simply turning off the repair process with strong drugs is clearly not the best answer even though it will make it feel better for a time.

Q15 What in your experience is the most common cause of the bursitis or tendonitis?

A It is difficult to generalize. Each cause is specific for each patient. Most people do not have any trouble telling the doctor what the cause is. The problem comes in when one of two things happens - either the inflammation does not go away when the cause of the inflammation is removed - such as a specific repetitive work motion, or else your livelihood requires that repetitive work which you have been able to do for years, and now you can't do it anymore without hurting.

Q16 That sounds like common problems. Can anything be done besides keeping on with the symptomatic treatment using drugs?

A Yes, there are a number of things that can be done.

At the most simple level, natural symptomatic treatments can be used to replace the drug treatments with their potentially dangerous side effects. In other words, if there is no question as to what is irritating your body part, and the irritation can not easily be removed, there are simple, gentle treatments that can be done on a long term basis that do not have the side effects of the non-steroidal anit inflammatories.

Q17 What is one of these anti-inflammatory symptomatic treatments that can be used long-term with no side effects?

A Hydrotherapy in the form of alternate hot and cold is one of the most powerful anti-inflammatories that does not turn off the inflammation but co-operates with the body's efforts to overcome the irritation making the body part stronger to put up with the irritation.

Q18 How would a hydrotherapy treatment be given at home - say for a painful shoulder?

A Whatever the body part is, the principle is to get the part warm for 3 minutes and then cool it for 1 minute or even 30 seconds.

Q19 What does alternating heating and cooling a part of the body do?

A When the part is hot, the muscles relax, including the muscles of the blood vessels and blood flows into the part. When the part is cooled, the muscles contract, and blood is squeezed out of the part.

Q20 What is the advantage of that?

A It acts as a blood pump and the blood flow is greatly increased which means healing elements from the blood are increased, and the pain chemicals and waste products from the inflammation are taken away more rapidly and the inflammation is able to do its job and heal and strengthen the part so it can take more movement and more mechanical stress.

Q21 That is exciting! So it is more than simply making the part feel good! How long should the hot and cold treatments last and how do you get the body part hot and cold with water?

A A shower is the best way to get a shoulder or back or any part of the body hot and cold. Let hot water run on the part for 3 minutes and then turn the water to cold for 30 seconds, and then back to hot for 3 minutes. Start with the hot and have three changes and end with the cold. This can be done for weeks or days, as long as it takes to heal the inflammation.

Q22 I thought you said that this was a symptomatic treatment, it sounds curative to me?

A It is symptomatic from the standpoint that it deals with the inflammation - not the cause of the inflammation. But it is true that it is also curative because instead of turning off the inflammation like drugs do, it assists the body to let the inflammation do the job it was intended to do and strengthen the body part.

Q23 Is there another symptomatic-curative natural remedy for bursitis/tendonitis?

A In the acute stages, when it first begins, the use of charcoal can be very beneficial.

Q24 Charcoal as for barbequing bisquettes?

A No, no - charcoal as for the universal antidote that is used in emergency rooms across the nation.

Q25 Does drinking charcoal as for antidote help with bursitis?

A I might, but that is not the recommended way to take charcoal for a bursitis or a tendonitis. More and more it is being generally appreciated that the skin is a great way of getting medication into the body. Charcoal applied wet to the skin draws out the inflammation without stopping it as the anti-inflammatory drugs do. Charcoal used on the skin where the pain will make the body part feel better almost immediately and it will also help the body heal because it is the inflammatory toxins and pain chemicals that is taken out through the skin by the charcoal.

Q26 How is charcoal applied to the skin?

A Use the powder that can be obtained from a drug store. Mix equal parts of powdered charcoal with finely ground flax seed. Then mix with water until it is a gooey paste. Spear that onto the painful part and cover with plastic to keep it moist and tape on to keep it from making a mess. Leave it on all night and repeat as necessary. A chuck that is cut to size is a good way to go.

Q27 Are there any other natural anti-inflammatory treatments?

A Sleep is a great anti-inflammatory treatment because anything that boosts your immune system helps overcome inflammatory conditions naturally. Water - 8 glasses of water drunk a day helps the immune system. A diet rich in phytochemicals is a great antiinflammatory treatment. Diet is one of the most important ways to strengthen the immune system. A plant based diet help is avoiding the toxins that concentrate in the fat of animals as well as being rich in anti-oxidant and other protective phytochemicals. Exercise - walking 2 miles a day, 5 days a week is an immune system booster.

Q28 Are there any other local treatments that can help a bursitis - like a chronic tennis elbow?

A Tennis elbow can be helped by local massage. This works the same way as the hot and cold, but the blood flow is increased locally by simple mechanical means massaging the vessels which increases the local blood flow.

Q29 Are there any things that can be avoided that would help prevent or overcome bursitis or tendonitis?

A Anything that decreases the blood flow will increase the likelihood of local inflammations - such as smoking, rich diet with high fat or high sugar contents. Inactivity in terms of physical exercise. Anything that decreases the free flow of blood.