Question
What is the causes of Bursitis, my chiropractor said that I have Bursitis in my shoulder. I am now wondering if that is what has been causing my hip pain that has happening. How would I know if bursitis is the cause of my hip pain. How is bursitis treated, and how can I prevent it from returning again? So far I have had adjustment and he said to ice my shoulder every hour for two days. It hasn抰 really helped much. Thanks for any help.

Answer
Dear B. Greene,

Bursitis is inflammation of the bursa.  The bursa is a fluid filled sac that cushions the tendon and aids in the reduction of friction between the tendon and the bone.

Microtrauma (repetitive friction and small injury) creates excessive rubbing of the tendon over the bone.  This occurs due to high amounts of repetitive arm, shoulder, hip, knee and ankle motion, leading  to increased friction of the bursa itself to cause the inflammation and irritation of the bursa. Bursitis can also occur with compression of the bursa, such as a side sleeper who places a lot of shoulder or hip pressure when they lay down for long periods.  In this case it would not take too much movement of this already compressed area to cause friction of the bursa. Examples of bursitis motions would be improper golf swings, pitching, racquet sports, or repetitive work related duties.    

Symptoms vary from an achy pain and stiffness to the local area of the joint, to a burning that surrounds the whole joint capsule. Pain is usually worse during and after activity, and the bursa and surrounding joint area can become stiffer the following day.

With proper care for the area, the pain in the bursa should lessen over three weeks, but it should be noted that the healing of the area continues and doesn't even peak until at least six weeks following the initial injury, and there will be some level of scar formation. The scar formation may take as long as a year in severe cases due to the type of collagen formation (type II fibers, and the reduced blood supply to the area.  If you continue to have problems after 6 months, it is considered chronic and much more difficult to treat.

The initial approach to treating a bursitis is to support and protect the bursa by bracing any areas of the tendon that are being pulled on during use, as this will help stop bursa friction from occurring. It is important to loosen up the tendons, lessen the pain, minimize any bursa inflammation, and reduce the compression that can occur with lying down or sitting.

Reducing inflammation and soothing pain can be done topically if a pain reliever has the ability to penetrate the skin barrier and contains anti-inflammatory agents. A topical formula that contains natural menthol will not only relieve pain, but dilate the blood vessels. This allows for relief of the bursitis, without causing any stiffening of the tissue..(such as biofreeze or cryoderm...you can get this from your chiropractor).

MSM, also known as Methyl Sulfonyl Methane is a natural supplement that is getting a lot of attention due to its role in tissue healing at a cellular level.  It is a natural organic sulfur that comes from rain fall and is found naturally in the human body.  It has been shown to have anti-inflammatory effects on the tissues...this is also in cryoderm, or can be supplemented along with chondroitin sulfate and glucosamine sulfate.  Ice can relieve inflammation, but will constrict the blood vessels and further stiffen the joint area.  Medically, cortisone injections can reduce inflammation, but unfortunately are very caustic and can cause a weakening of the tissue structure and a create more scar tissue...if you get any injections, they should be done sparingly!

After the scar tissue has begun to accumulate, it will be important to perform procedures which help break down the scar tissue in the tendon tissue, so as to let the tendon and muscle regain it's normal flexibility and lessen the chance of further injury.  Soft tissue mobilization techniques such as Graston technique or Active release technique are beneficial.

www.grastontechnique.com
www.activerelase.com

While exercise is appropriate for breaking down scar tissue once the area has healed, it may further irritate the area during the initial stages.  Therefore, other methods that can be performed by your healthcare provider, such as ultrasound and massage, may be safely used to accomplish this early on in the injury. Ultrasound uses sound waves that vibrate a such a fast level, that it cannot be felt with normal use.  Ultrasound will cause an increase in circulation to the tissue and soften the scar tissue to allow it to further break down.  Ultrasound can also be used as phonophoresis to help topical pain and nutrient solutions reach further down into the tissue....ultrasound should only be performed by a licensed therapist or doctor though as it does create heat in the tissue, and there is the potential for tissue burns if not utilized by a qualified professional.  

Lastly, bursitis is often a blanket diagnosis given whenever there is inflammation in the joint, and some doctors utilize the term when tendonitis is actually the problem, or when other joint problems such as capsulitis are the cause.  The only true way to determine if bursitis is being diagnosed correctly is with the use of multiple orthopedic tests to differentiate the tissue involved, and ultimately an MRI if the condition is chronic or resistant to treatment.

Hope this helps!
Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net