Tendinitis and Bursitis

When you do something over and over again, you expect your body to get used to it. You don't expect it to rebel.

But that's more or less what happens when you develop tendinitis or bursitis. By performing some repetitive motion-swatting tennis balls, weeding your garden, or painting the rooms of your home-you can irritate and inflame tendons or small fluidfilled sacs called bursae. And that hurts.

Medically, tendinitis and bursitis are two distinct conditions. But they affect the same body parts, and they are treated in very similar ways.

Both involve inflammation. That's your body's natural response to an injury. When you see the redness and swelling characteristic of inflammation, you know that your immune system is working hard to help you heal. But severe or prolonged inflammation can do more harm than good. In the case of tendinitis or bursitis, it causes sharp, achy, often burning pain in the affected body part. Here's how each condition develops.

Tendinitis. Tendons are the fibrous, elastic bands that connect your muscles to your bones. If a tendon somehow becomes injured, it can partially tear. And that causes inflammation and pain.

You develop tendinitis not because your tendons are weak or abnormal but because the muscles that support them are out of shape. When your muscles can't handle their workload, your tendons become stressed. And that makes them vulnerable to tearing.

Bursitis. As your tendons slide across bone, they are lubricated by your bursae. Your bursae protect your tendons from damage. If you repeatedly move a body part in a certain way, your bursae have to keep relubricating the tendons in that area. Over time, this can cause the bursae to become inflamed. That's bursitis. Along with the inflammation, you can count on pain. And you may find that you can't move the joint as much as you could in the past.

The best way to avoid tendinitis and bursitis is to get in shape. The stronger your muscles, the lower your risk of injuring a tendon or bursa. Be sure to include some sort of resistance training in your exercise routine. Or consider joining a health club, where you can combine aerobic exercise with resistance training.

If you already have tendinitis or bursitis, you may be able to relieve your pain and speed your recovery with a combination of natural remedies, alternative remedies, and over-the-counter drugs. (Many of these remedies also work for sprains.) Here's what works, according to the experts.

Best Choices

Exercise

Change your ways. To prevent a repeat episode of tendinitis or bursitis, you'll need to pinpoint the activity that first caused problems. Then change the way you perform that activity. You may want to consult with a personal trainer, physical therapist, or sports-medicine physician, who can help you adjust your form and technique so that you're not overusing the joint that's in trouble.

Gradually add intensity. Tendinitis and bursitis often set in when you suddenly increase the intensity of your workout-say, extending your daily walks from 1 mile to 5 miles or playing tennis for 2 hours instead of 1/2 hour. Make small, gradual changes as you move toward a higher level of activity.

Herbal Medicine

Bet on willow bark. Drinking willow bark tea may help relieve the pain of tendinitis and bursitis, says James A. Duke, Ph.D. To make the tea, simmer about 2 teaspoons of powdered bark in 1 cup of boiling water for 10 minutes. Then strain and allow to cool. Drink two or three cupfuls of tea a day.

Feel better with bromelain. An enzyme found in pineapple, bromelain has anti-inflammatory properties. Research has shown that it can help heal musculoskeletal injuries, including tendinitis and bursitis, says Alan Gaby, M.D.

If you want to try bromelain yourself, Joseph Pizzorno Jr., N.D., recommends taking 450 milligrams of the enzyme before each meal. Or you can simply eat lots of pineapple, as Dr. Duke does when he's nursing an injury.

Heal faster with hawthorn. Hawthorn contains compounds that help stabilize the protein called collagen. This protein reinforces the structure of tendons, so they heal faster and are less vulnerable to reinjury.

Until your tendinitis subsides, Dr. Pizzorno recommends taking 2 teaspoons of standardized hawthorn tincture three times a day. You can take hawthorn for 3 to 4 weeks.

Home Remedies

At first, treat your injury with RICE. RICE stands for rest, ice, compression, and elevation. These four measures are considered standard first-aid for tendinitis and bursitis, says Steven Subotnick, D.P.M., a sports-medicine specialist in San Leandro, California, and author of Sports and Exercise Injuries.

Later, add some heat. Once the swelling from bursitis or tendinitis has started to subside, you may want to switch from cold treatments to heat. Soak the injured body part in warm to tolerably hot water, use a heated gel pack, or take contrast baths.

For a contrast bath, soak the injury site first in hot water for 5 minutes, then in cold water for 30 seconds. Repeat for three to five cycles.

Over-The-Counter Drugs

Pick the right product. To relieve the pain and inflammation of tendinitis or bursitis, take aspirin or ibuprofen instead of acetaminophen. While acetaminophen can also ease pain, it has no anti-inflammatory action.

If aspirin bothers your stomach, look for enteric-coated tablets or capsules that dissolve in your intestines rather than in your stomach.

Other Good Choices

Massage

Stimulate your circulation. Once your pain has subsided, gently massage the injured body part for 10 minutes twice a day. This enhances blood flow through the injury site, which supports the healing process, Dr. Subotnick says.

Aromatherapy

Try a scented massage. Certain essential oils can help treat musculoskeletal injuries, including tendinitis and bursitis. Kathi Keville and Mindy Green, coauthors of Aromatherapy: A Complete Guide to the Healing Art, suggest making your own massage lotion or oil from a blend of essential oils: To 2 ounces of unscented skin lotion or vegetable oil, add 6 drops of helichrysum, 4 drops of marjoram, 4 drops of birch, 3 drops of chamomile, 3 drops of lavender, 3 drops of ginger, and 2 drops of juniper. Rub in the scented lotion or oil as part of your self-massage.

Homeopathy

Maximize relief with a microdose medicine. For tendinitis and bursitis, Dr. Subotnick suggests trying one of the following homeopathic medicines. Choose the one that most closely matches your symptoms.

• Arnica, if your injured body part feels achy and sore
• Sulfuricum acidum, if Arnica doesn't help within 2 hours
• Ruta graveolens, if you feel stiff and sore
• Rhus toxicodendron, if you feel better with heat treatment and motion

Take the medicine in the 6th, 12th, or 30th potency-four pellets four times a day. You can buy homeopathic medicines in many health food stores.

Chinese Medicine

Unblock Blood. To treat tendinitis and bursitis, Chinese physicians recommend alternating ice and heat treatments right from the onset of pain.

In addition, Efrem Korngold, O.M.D., L.Ac., prescribes herbs such as clematis root, gentian root, chaenomeles fruit, and dried ginger. He also prescribes herbs that "open channels" and get Blood moving, including cinnamon twig, peppermint oil, camphor, and red pepper.

Visit an acupuncturist. Research has shown acupuncture to be an effective treatment for tendinitis and bursitis. During an acupuncture session, which points are stimulated depends on which body part is injured. For example, if you have tennis elbow, your acupuncturist is likely to insert needles in the opposite elbow and burn moxa (mugwort) over the affected elbow. This technique, called moxibustion, is intended to draw out Wind, Damp, and Cold and to activate Blood, Dr. Korngold explains.

Look into cupping and bleeding. Acupuncturists sometimes use two other techniques to draw out Wind, Cold, and Damp. One, called cupping, involves burning alcohol-soaked cotton in small jars. When the flames die out, the practitioner places a jar mouth-down over the affected body part. Because the fire has reduced the air pressure in the jar, some of your skin gets sucked up inside.

The other technique, called bleeding, involves only tiny pinpricks, which draw out only a minute amount of blood. Just like acupuncture and moxibustion, cupping and bleeding should be administered only by qualilled Chinese medicine doctors.

Medical Measures

For an especially severe case of tendinitis or bursitis, your doctor may inject the inflamed area with corticosteroids and an anesthetic. This combination provides rapid relief, but the effects are only temporary. Some physicians are willing to reinject corticosteroids many times, but some research suggests that steroids weaken tendons and impede healing.

There is another treatment option for severe bursitis. To reduce swelling, your doctor may use a syringe to draw off the excess fluid in the affected bursa.

If you experience recurrent knee, ankle, or foot problems, consult a podiatrist. You may have a foot abnormality that can easily be corrected with custom shoe inserts, called orthotics.

Red Flags

Call your doctor if your pain persists or gets worse after 2 weeks of home care or if the affected body part appears discolored or deformed. Your doctor will probably take x-rays to rule out a fracture, then prescribe a short course of a nonsteroidal anti-inflammatory drug (NSAID). You may also be referred to a physical therapist.

Also, consult your doctor promptly if your joint pain is accompanied by fever, chills, or night sweats or is near a break in your skin. You may have an infection.