Summer is finally here. That too means the weekend warrior season is upon us. Many of us take advantage of the warm sunny weather to engage in outdoor sports. Whether it is climbing, biking, hiking or team sports, we are more apt to push our bodies to the limits of physical exertion. Such exertion if we are not careful can lead to acute or chronic injuries. This summer, we at legitmassage.com will examine different injuries that we are all susceptible to and explain what we can do to avoid injury and what measures to take if we encounter an injury. We will address self-care (the kind of care that aids the healing process between massage sessions) as well as different massage techniques to address specific muscle and tendon injuries. This week we take a look at bursitis.
What is bursitis and what causes it?
Bursitis, not unlike most “itis” is an inflammatory state of the bursa. Which begs the next question, what is a bursa? Bursa actually means purse. They are small, flat sacs that are lined with synovium or synovial fluid, the lubrication surrounding our joints that enable us to move like a well-oiled machine. Essentially, the bursa around our joints helps to reduce friction between our tendons and our bones. They cannot be palpated or felt unless they are inflamed. In this state, heat and swelling may be present and deep burning pain is experienced and in some extreme cases nocturnal pain which disturbs sleep. Range of motion is limited in areas where bursitis is located and constant pain is experienced when the bursa are compressed.
Among the causes of bursitis is overuse coupled with poor posture and biomechanics. When surrounding muscles and structures are over or poorly used then friction can easily result in inflammation of the bursa. Secondary to existing tendonitis, bursitis can sometimes be caused by muscle imbalances and postural dysfunctions such as scoliosis or hyperkyphosis, an increase in the normal thoracic curve marked by rounded shoulder and forward head posture. Direct trauma can also cause bursitis as well as osteoarthritis, rheumatoid arthritis, gout and infection.
Where can I get bursitis?
There are many places in the body where bursitis can occur. Some of the more common areas are around the shoulder, elbow, hip, knee, and ankle.
- Shoulder – results from overuse such as working for long periods of time with your arm overhead like painters do. With shoulder bursitis, pain is noticeably different and increased with movement.
- Elbow – repetitive weight bearing such as can occur with plumbers or heating and air conditioning mechanics that crawl around on their knees in tight spaces and lean on their elbows for prolonged periods of time on hard surfaces which may cause the bursa to swell insidiously or over several months.
- Hip – Some symptoms of hip bursitis is experiencing pain getting out of a car or climbing stairs. Pain is felt at the outside of the upper thigh at the hip bone. Any athletes who run a lot, soccer players and basketball players, are susceptible. Some people with hip bursitis complain of discomfort or pain while sleeping on their side.
- Knee – There are several places in the knee to contract bursitis. The most common being the kneecap, but the bursae below the kneecap and on the inside of the kneecap can become inflamed. Knee bursitis may result from prolonged wear and tear on the knee and again athletes, particularly baseball/softball catchers are more vulnerable. However, any profession that requires prolonged kneeling or repetitive standing from the kneeling position such as carpet laying is considered at risk for knee bursitis.
- Ankle – The Achilles tendon is prone to ankle bursitis. Symptoms may include heel pain and ankle pain that causes swelling and tenderness around the Achilles. Again athletes are more susceptible as ankle bursitis can be caused by too much running or jumping but walkers are vulnerable as are anyone with an aggressive workout regimen whereas activity level is increased without proper conditioning.
Treatment of bursitis and how regular massage helps?
In the initial stages of bursitis, as with any tendonitis, rest and ice are recommended and if necessary, anti-inflammatories. As the bursa heals, a regimen of stretching and gradual return to strength for any surrounding structures is advised. Your licensed massage therapist may treat you with a non-heavy cold application so as to avoid compressing the bursa or use heat or both in the later stages of injury or healing. In any case, the massage therapist worth his or her salt will elevate the affected limbs and treat any edema or swelling with manual lymphatic drainage. Another treatment option is to treat any surrounding trigger points to proximal muscles or muscles above the injury site. As the bursitis begins to clear, the therapist can introduce joint play and active and/or passive stretching of the surrounding structures.
As with tendonitis injuries, be mindful of stretching and strengthening and try not to do too much too soon. While you are taking your time to heal, this is a good time to alter any biomechanics that contributed to the initial injury. Changed biomechanics combined with your massage treatments will get you back in the game and more importantly keep you in the game.
Kip Yates, LMT was trained at the Swedish Institute in New York City and is New York State and Texas State licensed. He is owner and operator of Massage Refresh in New York City where he provides Swedish wellness and recuperative Deep Tissue massage that encompasses myofascial release and trigger point therapy. Kip lives in Brooklyn with his wife and three children and also practices at Physiofitness Physical Therapy in Soho.