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Soothing the Pain of Bursitis and Tendinopathy

by Jeff Siegel

Whether you work out on a regular basis, are a weekend warrior, or have just gone a little too far with home activities you know that overdoing it can lead to unhappiness. Activities that are repetitive or too intense can cause minor tears and strains which cause pain that can slow you down. If you've ever mentioned you had an achy joint, you may have heard the term tendonitis or bursitis. Is this really what you have? And more importantly, how do you get rid of it?

Birth of Bursitis and Tendonitis

Tendons and bursae help support movement at your joints. Bursa are fluid filled sacs that help your tendons glide over bony areas of your joints. Tendons are connective tissues that bind muscles to bones. When these structures become injured, they can make joint movement painful. Overuse or stress injuries can easily cause the following injuries:

  • Bursitis—swelling and irritation of the bursa
  • Tendinopathy—problems in the tendon including
    • Tendonitis—swelling and irritation of the tendon
    • Tendinosis—chronic tearing of the tendon

These injuries may be caused by something as simple as housecleaning or your everyday job, to something more complex like sports. It may also be caused by an imbalance in the muscles around your joint. It may be difficult to tell if the problems is with the tendon or bursa.

The pain may not always be due to an obvious injury. It may slowly develop or intensify over time. It is important to know your body to help distinguish between normal soreness from some workouts and soreness that indicates a problem.

Listen to Your Body, Avoid the Problem

Pain is a communication tool. It is the way your brain tells you that you need to pay attention because something is wrong. If you are feeling pain, you need to assess why, especially if the pain continues or recurs often. Ignoring the pain may simply force you to be unnecessarily uncomfortable. It can also lead to long term problems.

Note what activities may be causing the pain. Find ways to change the activity to reduce stress on your joints. Some adaptations that may help include:

  • Check your technique. A small correction in how you do an activity can make a big difference.
  • Lower the intensity. You may have gone too hard, too fast. Lower your intensity level and gradually increase your intensity as you get stronger.
  • Be aware of activites that have repetitve actions.
    • For tasks like shoveling or sweeping, take small breaks to give your joints a break.
    • For sport activites like tennis, check your technique. Allow other types of exercise to give your body a break from the repetitive motions of one sport.

Not all injuries can be prevented. Fortunately most tendon and bursa problems can be relieved with some basic at home care.

You Have Pain, Now What?

The Basics

Bursitis and tendinopathy need time and attention to heal. Most of the time, the pain will go away with home care. Here are some tips on what you can do at home:

  • Rest—avoid the activity that is causing the pain
  • Ice—can help reduce swelling, so pack it on for a short time, a few times a day.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)—pain relievers like ibuprofen. If you have any medical problems, or take other medications, check with your doctor before starting this medicine.
    • Keep in mind there are many choices for NSAIDs. You may take it by mouth or rub it on the skin.
    • NSAIDs can irritate the stomach. It can cause bleeding in the intestine if taken for a long period of time.
  • Investigate what action may have caused the pain. Look for ways to prevent it from happening again.

These steps will help relieve discomfort but may not solve the underlying problem. Talk to your doctor if the pain does not go away. Your doctor may recommend other treatment options such as joint injections and physical therapy.

Injections

In some cases, cortisone may be injected into the bursa or around tendons. This medicine may help to reduce swelling and irritation.. These injections may make the pain may go away temporarily. The cause of the bursitis or tendonitis will still need to be addressed.

Physical Therapy

Physical therapy may help relieve the cause of the tendonitis or bursitis. A physical therapist may help to:

  • Improve balance of muscles around a joint—imbalances can increase your risk of injury
  • Strengthen muscles around the joint—to relieve pressure on the tendons and bursa
  • Identify improper techniques that may be causing problem

Other treatments like ice or heat therapy, braces, or wraps may help to manage the pain while you heal.

You may never know for sure if your ache is from tendinopathy or bursitis. Rest is the most important step for either injury. Give your body the chance it needs to heal before jumping back in to action. A few days of frustration are much easier to deal with than long term pain.

RESOURCES::

American Orthopaedic Society for Sports Medicine
http://www.sportsmed.org/patient/intro

American Society of Exercise Physiologists
http://www.asep.org/

CANADIAN RESOURCES::

Canadian Society for Exercise Physiology
http://www.csep.ca/english/view.asp?x=1

Healthy Living Unit
http://www.phac-aspc.gc.ca/pau-uap/fitness/

REFERENCES::

Achilles Teninopathy. EBSCO DynaMed website. Available at http://www.ebscohost.com/dynamed/what.php. Updated February 9, 2012. Accessed November 8, 2012.

Anterior Tibialis and Extensor Teninopathy. EBSCO DynaMed website. Available at http:http://www.ebscohost.com/dynamed/what.php. Updated November 3, 2012. Accessed November 8, 2012.

Andres BM, Murrell GA: Treatment of tendinopathy: what works, what does not, and what is on the horizon. Clin Orthop Relat rEs. 2008;466:1539-54.

Mayor, RB. Treatment of Athletic Tendinopathy. Connecticut Medicine 2012;76(8):471-5. http://www.ncbi.nlm.nih.gov/pubmed/23061212. Accessed November 7, 2012.

Patellar Teninopathy. EBSCO DynaMed website. Available at http://www.ebscohost.com/dynamed/what.php. Updated November 3, 2012. Accessed November 8, 2012.

Peroneal Tendinopathy. EBSCO DynaMed website. Available at http://www.ebscohost.com/dynamed/what.php. Updated November 3, 2012. Accessed November 8, 2012.

Pes Anserine Bursitis. EBSCO DynaMed website. Available at http://www.ebscohost.com/dynamed/what.php. Updated September 20, 2012. Accessed November 8, 2012.

Posterior Tibialis Teninopathy. EBSCO DynaMed website. Available athttp://www.ebscohost.com/dynamed/what.php. Updated November 3, 2012. Accessed November 8, 2012.

Wasielewski NJ, Kotsko KM: Does eccentric exercise reduce pain and improve strength in physically active adults with symptomatic lower extremity tendinosis? A systematic review. J Athl Train. 2007;42:409-21.


Last reviewed November 2012 by Brian P. Randall, MD
Last Updated: 11/15/2012

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