Bursitis

Definition

Acute or chronic bursitis: inflammation of a bursa (a fluid-filled cavity, especially common where tendons pass near bones).


Symptoms

Pain, tenderness, reduced mobility, swelling, redness, possible fever, muscle weakness.


Etiologic Considerations — Primary

Direct trauma
Microtrauma (overuse)

• Sports • Work • Housework

Poor diet

• Excess meat • Lack of green vegetables • Excess alcohol • Excess coffee

Stress

Etiologic Considerations — Secondary

Metabolic disturbance • Toxemia • Infection • Gout • Allergy


Discussion

Although most people think of the shoulder (subdeltoid) when bursitis is mentioned, bursitis may affect a number of joints throughout the body. Other fairly common sites are the hip (iliopsoas), ischia (so-called tailor’s or weaver’s bottom), prepatellar (housemaid’s knee), retrocalcaneal (Achilles), olecranon (miner’s elbow), semimembranosus (behind knee), trochanteric (bunion), or radiohumeral (tennis elbow). Bursae exist at areas of friction in the body, usually between tendon and bone, acting as cushioning barriers to tissue damage. The two most common causes of bursitis are direct trauma and microtrauma. Direct trauma, such as a severe blow to the shoulder, causes the bursa to swell, leading to pain on motion and reduced mobility. This type of bursitis, if well rested after the initial injury, will usually resolve easily within a short period of time. If aggravated and used too soon after the initial injury, this acute bursitis may become chronic, lingering for years.

Microtrauma, as a cause of bursitis, is the repeated and frequent use of the joint and muscles in an “ordinary” activity, such as found in the action of tennis or using a screwdriver, with rotation (supination) of the forearm against resistance. A similar trauma may occur to the shoulder with repeated hammering. All these actions are within the normal range of expected activity for the body, but many repetitions over a prolonged period of time ultimately cause irritation and inflammation of the bursa and later of the joint itself if the bursa communicates directly with the joint, as it does in the shoulder. Repeated small blows in the area of the bursa, such as the pushing or stamping on a lever, as in some industrial occupations, or repeated kneeling, as in cases of housemaid’s knee, will also cause bursitis. Even prolonged or repeated carrying of a heavy purse or shopping bag can initiate bursitis.

Once bursitis has developed there is a tendency for the periarticular structures to become thickened and fibrotic. If the effusion or swelling has been severe, adhesions may form to limit mobility further, causing pain and recurrent swelling.

Much confusion exists regarding bursitis among patients, since many physicians use the term fairly loosely. The label of “bursitis” of the shoulder may be used to mean arthritis, a tear in the periosteum at the insertion of the supraspinatus muscle, calcification of the supraspinatus muscle, pain from the third costovertebral joint, partial muscle tears, or true subacromial/subdeltoid bursitis.

One commonly neglected aspect of bursitis is the possibility that if the nutritional state had been more adequate, the same amount of trauma may not have resulted in any symptoms whatsoever. Certainly, high levels of vitamin C are known to help protect against connective tissue injuries. Outside of the athletic injuries resulting in bursitis, the average person we see with bursitis is on a poor, vitamin-deficient diet. Not surprisingly, then, we find the nutritional approach to therapy essential to allow other local therapies to function best.

An interesting consideration with bursitis and other inflammatory conditions is that some people are particularly prone to inflammatory reactions. Two people of similar age and build will respond quite differently to an episode of trauma or repeated microtraumas. One may show only minor symptoms lasting a short period of time, while the other may develop a bursitis that causes discomfort for years, perhaps decades. The difference in these two is that the latter is an inflammatory condition, even before the traumatic incident. We believe the causes of this predisposition are usually dietary or stress related. We find cases of bursitis very rare among those who are on a highly nutritious, alkaline (more vegetarian) diet with few obvious irritants, such as coffee, alcohol, refined sugars, salt, and strong spices. This applies to all diseases but particularly to such inflammatory conditions as bursitis, arthritis, gastritis, colitis, and others. Stress plays an obvious role in such conditions, working along a variety of negative pathways.


Treatment

Since the average case of bursitis is caused by trauma or repeated use as in tennis, angling, baseball, cricket, hammering, or other activities with repeated actions, these are strictly forbidden until full healing is complete. The only cause of chronic bursitis is improper care of acute bursitis, and the best part of this cure is rest. All cases of slow-to-heal bursitis need careful dietary evaluation to find areas that cause inflammation within the system. A strict vegetarian—and preferably vegan—diet is very helpful in stubborn cases. When the patient is unwilling to comply with such a drastic change, we suggest four glasses of carrot juice per day and at least one solely salad meal per day. Periodic fasting or all vegetable days will also help speed recovery. Alcohol is a main offender, as is coffee, and these need to be eliminated until all pain and inflammation are gone for at least two months.

Acute
  • Ice compress: Just as soon as the first symptoms appear, apply cold compresses, leaving them on for 20 to 40 minutes. Repeat this application every 3 waking hours for the first 2 days.
  • Restraint: Fix the joint in a resting position and do not use actively. In the case of a shoulder, use a sling, if this is necessary to prevent the shoulder’s use.
  • Passive mobilization (see below under Exercises): Mobilization is necessary several times daily.
  • Ultrasound: After the first 48 hours, get ultrasound treatments daily for 1 week, then four times per week the second week.
  • Alternate hot and cold compresses: After 48 hours of ice-cold applications, use ultrasound and alternate hot and cold applications, or use heat, followed by joint mobilization, ending with a cold application.
Chronic
  • Hot compresses.
  • Alternate hot and cold compresses.
  • Ultrasound four to five times weekly.

Exercises

Passive mobilization*: Movement of the injured joint with the help of another person should be done after the first 48 hours, two to six times each day, to the full range of motion without the assistance of the patient’s muscles. This speeds healing and reduces the possibility of adhesions forming. New machines for this purpose, to mobilize without muscle assistance, have had success in healing joint and soft tissue injuries.

Once all or most of the pain and swelling has subsided, non-muscle-assisted exercises can begin. The following are exercises aimed at bursitis in the shoulder. For patients with bursitis elsewhere (e.g., hip or knee), use these examples to devise movements to exercise the joint in question. For instance, for bursitis in the knee, sit on the edge of a table and gently swing the lower leg.

  1. Arm swing (1)*: Stoop to 90° angle from waist and let arms hang freely, then gently swing arms front and back and then side to side. Do not use shoulder muscles in this action. Then gently swing arms in small circles in both directions, gradually increasing the diameter of the circle as each day progresses.
  2. Toe touch*: Bend forward at waist and touch toes repeatedly.
  3. Bed exercise*: Lie in bed and slowly raise arm from the shoulder out from side to point of pain, then lower arm.

Begin the following muscle-assisted exercises once the previous two exercises are easily performed without much pain.

  1. Wall creep*: Stand 1 foot from wall with hands on wall at whatever level is comfortable, say, waist high. Slowly creep your hands up the wall by pulling your fingers forward and back like a spider. Stop when you reach the level where pain increases. Repeat exercises four to five times per day. Mark this level on the wall and over the next few weeks try to exceed this level progressively, going higher until arms can go completely overhead.
  2. Arm swing (2)*: Stand erect and swing arms across body repeatedly in a gentle action. Swing arms in gradually larger swings front to back until full-circle swings can be easily and painlessly made.
  3. Apron tie*: Repeated by tying and untying an apron behind your back.
  4. Collar button-up*: Attempt to button and unbutton a real or imaginary button behind the collar at the back of your neck, repeatedly.
  5. The pickpocket*: Repeatedly attempt to remove a billfold from the back pocket.
  6. Pulley exercises*: Arrange a pulley on the wall with a strong 8- to 10-ft rope running through it. Attach a handle to both ends, or attach through a firm rubber ball with a large knot. If possible, arrange the pulley so that its height from the floor may be freely adjusted. Sit on the floor or on a stool with back to pulley. Begin with pulley close to floor and pull with the injured arm on the rope against the resistance provided from the good arm, which is holding onto the opposite end of the rope. Two-pound weights may be used instead. Repeat several times and then raise the pulley 6 inches. Repeat these exercises until a height is reached that evokes mild to moderate pain. Do not overdo. The object is to increase both the strength and mobility of the shoulder slowly. Repeat, sitting facing the pulley. Ready-made pulley exercise units are also available at most sports departments. Increase weights slowly.
  7. Stick, rope, ball, and door techniques*: This simple technique replaces the previous one and is more portable. Attach a wooden handle to one end of a 4- to 6-ft rope and attach the other end through a firm rubber ball with a large knot. The ball end is then slipped behind the door and the door closed so that the rope may be secured at any position along the door’s perimeter. Stand with back to door, with rope in the near-floor level. Gradually pull the rope against the resistance for 3 to 6 seconds, and relax. Repeat two to three times, then repeat at higher levels along the door frame. Stop at the level you feel pain. Then repeat, this time facing the door.

Poultices

  • Green cabbage leaf poultice*: Apply to tender, swollen bursa nightly.
  • Comfrey leaf poultice*
  • Apple cider vinegar and salt compress*: Prepare a saturated solution of iodized salt dissolved in a 50/50 mix of hot water and apple cider vinegar. Saturate a compress and apply hot for 10 to 15 minutes two times per day. Helps with tissue damage, fibrositis, and calcification.
  • Castor oil packs
  • Hot Epsom salts packs: If there is no swelling.
  • Ice compress: If there is swelling.

Physiotherapy

  • Peanut oil massage* to area.
  • Ultrasound therapy* daily for first 2 weeks; reduce to three times per week for the next 2 weeks.
  • Positive galvanism* to bursa with magnesium sulfate or oil of wintergreen.
  • Shoulder mobilization and manipulation* to break adhesions in chronic cases.

Therapeutic Agents

Vitamins and Minerals—Primary
  • Vitamin A*: 10,000 to 25,000 IU two to three times per day. To aid tissue repair and immune function.
  • Vitamin B12*: Intramuscular injection of 1,000 mcg one time per week.
  • Vitamin C with bioflavonoids*: 1,000 mg six to twelve times per day, or to bowel tolerance. Reduces inflammation.
  • Vitamin E*: 400 IU two times per day. Anti-inflammatory
  • Zinc*: 50 mg per day. Aids tissue repair.
  • Calcium*: 800 to 1,000 mg per day. For proper connective tissue repair.
  • Magnesium*: 400 to 500 mg per day. For proper connective tissue repair.
Vitamins and Minerals—Secondary
  • Vitamin B complex: 50 mg three times per day.
  • Vitamin B6: 250 to 500 mg per day.
  • Pantothenic acid: 250 to 500 mg two times daily.
  • Selenium: 200 mcg per day.
Other—Primary
  • Bromelain*: 2 to 4 tablets three to four times per day, taken only on an empty stomach. Anti-inflammatory. Very effective with bursitis. These high doses may cause some gastrointestinal upset in some people. Use with care in history of ulcers.
  • Glucosamine and Chondroitin*: One teaspoon of powder or two capsules three times daily. Helps to heal connective tissue.
Other—Secondary
  • Atomodine or other iodine source.
  • Raw adrenal tablets.
  • DL-Phenylalanine: 500 to 1,000 mg two to three times per day. For pain relief.
  • Coenzyme Q10: 60 mg per day. To improve circulation.
Botanicals
  • White bryony (Bryonia alba): 5 drops tincture two to three times per day, or used as homeopathic dilution. Pain with motion. (Highly toxic; use only with professional supervision.)
  • Comfrey (Symphytum officinale): Use as strong infusion, decoction, or tincture, two to three times daily for one to three months as therapeutic trial.
Excerpts from Better Health Through Natural Healing 3rd Edition

First published in 1985, Better Health through Natural Healing has become one of the most successful and authoritative resources of its type, with more than 1.5 million copies sold worldwide. Since the original publication of this comprehensive guide, alternative therapies have become more and more accepted by the mainstream, and patients and practitioners of the wider medical community are embracing complementary medicine as an effective treatment option for a range of medical conditions.

The book is available at the West End clinic, exclusively in Australia.


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