Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Bursae and Bursitis
There are some small fluid filled sacs in our body that cushion the bones, tendons and muscles near the joints. They are called Bursae. Bursitis occurs when these bursae become inflamed. It is a painful condition. Though bursae are present all over the body, bursitis chiefly occurs around the major joints including shoulder, elbow, hip or knee.
Which are the common locations in which bursitis occur?
Bursitis commonly occurs in the shoulder, elbow and hip. It can also occur in the knee, heel or base of the big toe. It also occurs near the joints wherein repetitive motion occurs.
Resting the affected joint and also protecting it from further trauma are the mainstays of bursitis treatment. Pain of bursitis goes away within a few weeks in most cases with proper treatment. On the other hand, recurrent flare-ups of bursitis are common.
Causes of Bursitis
Bursitis is common in adults. It is mainly seen to occur in persons above 40 years of age.
Most common causes of bursitis include repetitive motions or positions which would impart pressure on the bursae around a joint. Examples include repeatedly throwing a ball or lifting something overhead. It also occurs when one leans on elbows repeatedly for long periods or kneels on knees repeatedly for doing activities like scrubbing the floors or laying carpets.
Injury or trauma to the affected area could cause bursitis.
Bursitis may also be caused by inflammatory arthritis such as rheumatoid arthritis.
Gout and infection to the joint / bursa are the other causes for bursitis.
Tendons connect muscles to the bones. With ageing they will get tired and will not be able to handle stress. They lose elasticity and get prone to get torn easily. Bursitis may also be caused when there is more stress on bursa from a problem with bone or joint structure. Examples – legs of different lengths or arthritis of a joint.
Risk Factors for Bursitis
Below mentioned are the risk factors for bursitis –
Ageing – With ageing, bursitis becomes common.
Occupations / hobbies – works and hobbies involving repetitive motion or pressure on bursae would increase the risk of developing bursitis. Examples of such occupations include gardening, painting, tile setting, playing musical instruments, laying carpets etc.
High risk activities – carpentry, gardening, painting, scrubbing, playing golf, tennis, skiing and throwing. Wrongly standing or sitting for a long time, be it at home or work, not stretching enough before exercise, sudden injury – can also cause bursitis.
Other medical conditions – Rheumatoid arthritis, diabetes, gout, being overweight / obese are also risk factors for bursitis.
Risk for bursitis may increase with presence of inflammatory conditions like rheumatoid or psoriatic arthritis, gout or thyroid disorders, stress or reactions to medications.
Bursitis may at times be caused by an infection, especially with Staphylococcus aureus bacteria.
Triggers of Bursitis
Below mentioned are the triggers of bursitis –
– Injury or bump to one of the bursas
– Leaning on a joint for long periods
– Making the same motions over and over
– Kneeling on the ground while gardening or fixing cars
– Running, biking etc. exercises which can put pressure on the joints
– Some kinds of surgeries
– Older adults
– Those having arthritis, gout, diabetes or other chronic health issues
– Low immunity which predisposes one to frequent infections
Symptoms of Bursitis
Pain – It is the most common symptom of bursitis. It may be a slow building one or of severe type. Stretching or extending the joint might make the pain evident. There may also be limitation of range of motion in the joint in spite of pain being absent. Stiffness, swelling or redness of the joint will also be present.
Those suffering from bursitis would have the below mentioned symptoms related to the joints –
– Aches and pains in the affected joint
– Stiffness of the affected joint
– Pain increases when the affected joint is moved or pressed upon
– Swelling of the affected joint
– Redness of the affected joint
Types of Bursitis
Bursae are small fluid filled sacs. They help in cushioning the joints, bones and muscles. Inflammation can happen in any bursa but bursitis commonly occurs in shoulders, elbow, hip, knee or foot.
1. Classification of bursitis as per their manifestation
Acute and chronic bursitis
– Sudden and acute bursitis – When bursitis occurs suddenly it hurts when one tries to move the affected joint.
– Chronic or ongoing bursitis – When bursitis becomes chronic, slow swelling occurs in the bursa. One may or may not experience pain in these conditions.
2. Types of Bursitis based on the location of manifestation –
The common types of bursitis are as below mentioned –
a. Shoulder Bursitis – In this condition there is painful swelling in the shoulder joint, caused either by an injury or bump. Some shapes of shoulder bones put more pressure on the bursa and hence cause bursitis. If the swelling is bad, it may also result in a frozen shoulder which makes it difficult to move the shoulder. If too much pain is limiting the shoulder movements, one should see the doctor.
b. Elbow Bursitis – The pointed part of the elbow is one of the commonest places for bursitis. There will be swelling, redness and pain at the bottom of the elbow in this condition. Pain worsens when one bends his elbow joint. One feels as if there is a small ball under the skin, due to the swelling. Movements at the elbow become harder when this ball (swelling) gets bigger.
One of the main causes of this condition is leaning on one’s elbow. People who have to crawl into tight work spaces are more likely to put pressure on their elbows while at work. Example – plumbers, electricians etc. This kind of bursitis is also called ‘students’ elbow’. This is because the students lean on their elbows when they sit for writing at a desk or when they use a computer. Elbow bursitis is also caused due to bumps or injuries. To help ease the pain of this condition, one can wrap an elastic bandage or wear elbow pads. Wearing elbow pads or using padded mat would help in avoiding bursitis if his or her work demands putting pressure on one’s elbow.
c. Knee Bursitis – Bursitis may occur near the kneecap or inside of the knee. Infection is the usual cause in the former (kneecap bursitis). The bursitis may hurt to move the joint or put pressure on the knee. It also hurts on touch. There may be increased warmth, swelling and redness at the place of bursitis. Sometimes it follows an injury or bump to the knee. Many times, it is caused due to the pressure on knee joints over a period of time. When it does, the pain comes on slowly. Knee bursitis is common in people who run or kneel on the ground for work. Examples – gardeners, plumbers, landscapers etc. These people should wear knee pads or use padded cushions or boards beneath the knees while at work. They also should take frequent breaks from their work. They should not squat or bend the knee joints for too long. Knee bursitis can be prevented by stretching the hamstrings and other muscles before one takes on to exercise. It is also common in wrestlers and footballers because these people are more likely to bump or land on their knees. To protect the knee from further damage and aid better healing one might have to wear a knee brace or wrap. Sometimes the swelling will reduce when you put your knee up on a pillow.
d. Hip Bursitis – The bony part of the hip that sticks out near one’s waist is where bursitis often occurs. It may present with hip or outer thigh pain. Bursitis may also occur on the inside of the hip. When this occurs, there is pain in the hip, crotch or groin. Though swelling might not be evident, one might experience pain. Initially the pain is sharp in nature and later turns into an ache that spreads out across the hip joint. When one lay on the hip, it would cause immense pain. Similarly, it would extremely hurt when one walks upstairs, squat or stands up from sitting position.
Hip bursitis is common in those having problems with the back or hips, those who have had hip replacement surgery or if one is born with one leg that is shorter than the other leg. One might experience irritation in the hip while doing exercises including running, bike riding or climbing stairs. Those indulged in jobs wherein one has to move heavy things or keep standing up for long periods of time are more at risk of getting hip bursitis. Example – jobs like being a cashier, server, warehouse worker etc. Using crutches or cane will help in healing the hip bursitis.
e. Foot Bursitis – Many of the joints in the feet will have bursa sacs. Bursitis may be caused if any of these bursa sacs get irritated. The common places of occurrence of bursitis are – around the Achilles tendon, near the heel, in the ball of the foot, at the base of the toes or in between the outside of the little toe and ankle joint. Swelling, stiffness or pain in the foot are present in foot bursitis. The pain worsens when one walks, runs or stands on his tip-toes. It is usually caused by high heels and shoes that squish the feet or ill-fitting shoes. This type of bursitis affects runners, dancers and athletes. This bursitis can be prevented by wearing well-fitting supportive shoes and also by stretching the feet and legs before exercising. A Podiatrist i.e. doctor who treats feet and ankles might prescribe an orthotic i.e. a piece of foam or plastic. When it is put into the shoe, it cushions the foot.
3. Other types of Bursitis
Bursitis might affect any bursa in the body, there are about 150 of them throughout the body.
Some other types of bursitis are –
Buttock Bursitis – This is caused due to the inflammation of bursa near the main muscle of the buttock. It is also called by the names ‘tailor’s bottom’ or ‘weaver’s bottom’. It is common in those who sit on hard surfaces, like chairs or floors which are not padded. It causes pain and aching in the butts and upper thighs. Pain worsens usually after sitting for a long time, stretching or exercising, or even when you flex, extend or move your hips. One can sit comfortably by using a donut shaped pillow. One can also apply cold compress on the bursitis.
Septic Bursitis – This type of bursitis is caused by infection and it is not common.
Diagnosis of Bursitis
Bursitis is diagnosed on the basis of thorough medical history and interrogation and physical examination conducted on the patient by the doctor.
The below mentioned tests might be advised if needed –
– Imaging tests – X-rays help in excluding other causes of discomfort. Ultrasound or MRI also helps as diagnostic tools.
– Laboratory tests – To find out the exact cause of pain and inflammation of your joint, your doctor might advise you to get some blood tests or analysis of fluid from the inflamed bursa.
Does bursitis go away all by itself?
Often, bursitis goes away all by itself. It usually gets better by resting and using home remedies. One should see the doctor if rest doesn’t make the pain better or avoid activities which worsen the pain. Bursitis usually doesn’t go away on its own if it is caused by infection. Having fever, increased warmth, redness or rash or bruises in the affected part should alert you to see the doctor immediately.
Right time to see the doctor
One should consult the doctor immediately if he or she has –
– Joint pain which is disabling
– If you have trouble in moving the joint, sudden inability to move a joint
– Manifestation of excessive swelling, redness, excessive warmth, bruising or rash in the afflicted joint or area
– Sharp or shooting pain, mainly experienced following exercise or exertion
– Presence of high fever – more than 102-degree F or 38.89 degree C
– If you have pain in more than one area of the body
– If you have general illness
– If the pain has persisted longer than 2 weeks’ time
Prevention of Bursitis
It is not always possible to prevent bursitis. Also, all types of bursitis cannot be prevented.
When you change the methods in which you do certain tasks and also take up some measures which might lower the risk of getting bursitis, you may reduce your risk and severity of flare-ups of bursitis. Examples include the below mentioned –
Keep away – Keeping away from any activity which hurts or worsens pain and other symptoms in and around any joint, in the region of bursae.
Breaks – When you are amidst repeated activities or jobs which demand so i.e. making motions again and again, take frequent breaks in between the activities. This will help to a great extent. Rest or doing other activities between repetitive tasks shall be planned.
Exercise – The affected joint can be protected if one plans exercises to strengthen muscles.
Postures – Monitor your postures and maintain good posture throughout the day.
Sitting – Avoid sitting still at a place for a long time and be active.
Be slow with starting any exercise or activity – While experimenting with a new exercise, sport or activity, make sure you are starting them slowly and easily. You can do the motion often and also use more force as and when you build up strength.
Mix up the motions and try variety – without making the same motions at all times while playing sports or indulging in activities which demand the same range of movements.
Body weight – One should maintain healthy body weight. Excessive weight of the body shall place more stress on the joints. Therefore, it is important to keep a check on one’s body weight and maintain it at desired levels.
Lifting – One needs to be cautious while lifting himself. The knees shall be bent while one tries to lift. If not, it would transfer extra stress on the bursae in the hips.
Warm ups – To protect the joints from injury one should do warm ups and stretches before taking on to any strenuous activities. Also, warm up and do stretching before playing. Use proper form always.
Kneeling pads – One shall use padding to reduce the pressure on his or her knees especially so if your job or hobby demands plenty of kneeling. While resting your joint on a hard surface as in kneeling or sitting, make sure that you use cushions or pads.
Wheeling – One should use a wheeled cart for carrying heavy loads. This is because carrying heavy loads can put enormous stress on the shoulder bursae.
Orthotic Shoe Insert – Use an orthotic shoe insert when you have hip bursitis caused due to one leg being longer than the other.
Home remedies for Bursitis
Bursitis and its symptoms may get better with some remedies done at home but one should not venture into overdoing them by ignoring the magnitude of the problem. It is always good to take a doctor’s opinion. Some things which might help you are –
Rest – the affected area to the best of your capacity. Avoid doing anything that worsens the pain and other symptoms of bursitis.
Ice and heat – Icing in the form of ice packs or cold compresses will help in reducing the swelling of bursitis when applied on it. You may also use a heating pad or pack or hot water bottle following 2 days of icing. Alternatively, you may take a hot shower / bath.
Elevation – make sure to elevate the affected joint and place it on a pillow.
Exercise – make sure to stretch the limb / body before exercising. Learn and practice those exercises which help in strengthening your core muscles and also make you more flexible.
Posture check – Keep a check on your postures and always use good posture and body mechanics. Take help of a physical therapist or your doctor who can help you to do right kinds of motions and movements, sit right, and lift right things that go easy on your body, without irritating your joints or worsening your bursitis symptoms.
Avoid – Those suffering from bursitis should avoid lifting heavy weights, repetitive movements and pressure.
Breaks – Take as many breaks as possible from your work which demand repetitive movements and cause pressure on the joints.
Changes – Make essential changes at workplace and in working patterns. Example – sitting on a padded chair instead of standing.
Cushioning – The affected area should be padded. The hard surfaces shall be avoided. To kneel down, one should use knee pads or padded mat. One can sit on a donut-shaped pillow or padded cushion instead of sitting on the floor.
Massage – Massaging can help but one needs to do it after taking the doctor’s opinion and consent and the infection shall be ruled out.
Joint support – One should cushion the joint and support it by using a brace, ace bandage, splint or elastic band.
Lifestyle changes
The below mentioned measures could relieve the bursitis pain –
– Take good rest
– Do not overuse the affected area
– Ice application would relieve swelling if administered within 48 hours after occurrence of symptoms
– Application of dry or moist heat (heating pad, warm bath etc.)
– Over the counter medication to relieve pain and inflammation
– Cushioning your knees (like keeping a small pillow between your legs if you are used to sleep on your side)
Treatment of Bursitis
Usually, bursitis gets better on its own. Discomfort can be relieved using conservative measures like rest, ice or pain reliever. If these things do not
Rest – Rest is very important in the treatment of bursitis. The condition goes away all by itself after resting in the affected area for a few weeks. One should try not to put pressure on it and should also avoid the activities which worsen the pain.
If the pain doesn’t ease after rest, one should see the doctor, especially if one cannot move the joint or if the area around the bursitis is red and swollen and also if there is a rash or bruise around. These signs indicate an infection being the cause of bursitis.
Medicines – Ibuprofen or Naproxen sodium may help in reducing pain and swelling. Antibiotics may be prescribed if there is infection. Steroids may be given to quickly bring down inflammation and pain.
Injections – Pain and inflammation can be reduced if a corticosteroid is injected into the bursa. It is quick acting.
Use of cane etc. – Doctors may advise you to use cane, crutches, brace, split or elastic bandage depending on the location of bursitis.
Physical therapy – This would help in strengthening your muscles and would also increase the range of motion at the affected joint. Physical therapist might guide you to do exercises for your core (back and belly muscles). You may also be guided with correct ways of sitting, standing and moving. This will help in better healing of bursitis or prevent its recurrence.
Surgery – may be recommended in rare cases if other treatments are not helping in recovery. Surgical drainage of bursa or surgical removal of affected bursa may be required in some cases.
Therapy – the muscles in the affected area are strengthened by physical therapy or exercises. This in turn helps in easing pain and preventing recurrence.
Assistive Device – use of walking cane or other devices would help in relieving the pressure on the affected area.
Bursitis: Ayurveda Understanding
The anatomical description of bursa / bursae puts it into ‘shleshaka kapha zone’. Shleshaka Kapha lubricates the joints and supports them, it is the chief buffer against the destructive action of pathologically increased vata or pitta afflicting the joints.
Affliction of the joints and bursae of the body by increased vata and pitta and consequent depletion of protective kapha would cause inflammation and degeneration therein leading to bursitis.
Treatment principles of bursitis include combating aggravated pitta and vata and reducing the swelling and symptoms of bursitis through suitable interventions.
Related Reading – Bursitis, Ayurveda Perspective
