First, what is a bursa (bursae)? A bursa is any small pouch or sac between tendons, muscles or bony joints at points of friction or stress which contains a very slippery synovial fluid which allows the two sides of the sac to slide freely. http://en.wikipedia.org/wiki/Synovial_bursa
The term “bursitis” is a combination of “bursa” and “itis,” a word termination meaning inflammation of the bursa. Bursitis is an inflammation of the lubricating membrane. The classic signs of inflammation are pain, heat, redness and swelling.
The most common bursae sites involved in bursitis are at the shoulder, elbow, hip joint, knee and heel.
Here’s an image of the shoulder bursa:
Bursitis can be caused by trauma, infection or crystal deposits. Trauma is the most common type; it usually develops from mechanical stress due to overuse, direct injury or muscle/joint misalignment.
Bursitis caused by trauma is usually what a doctor of chiropractic who uses applied kinesiology and neurokinetic therapy will see so I will confine my discussion to that type.
Repetitive activities as in sports or washing a floor on your knees are examples of overuse. Falling or hitting a joint can cause inflammation to the bursa.
Muscle/joint misalignment is often an overlooked but very common cause of bursitis; joints depend on the contraction of certain muscles that move the joint in the desired direction and the relaxation of opposing muscles.
Improper contraction or using the wrong set of muscles or the joint not being in the correct position to allow the correct contraction can cause a misalignment problem and stress the bursa and cause inflammation.
When a patient comes in with a bursitis problem, one of the first things that I do is test the surrounding muscles for any weaknesses or spasms as a muscle imbalance will affect the joint and the bursa.
In the case of shoulder bursitis, I ask is there a dysfunction in the coordination of muscles working in patterns. Is the biceps or pectoralis major or trapezius compensating (facilitating) for weak or inhibited muscles like the deltoid or rotator cuff muscles , for example. or vice versa. Muscle imbalance can cause uneven pull or misalignment of the joints that surround the bursa; causing inflammation of the bursa.
Weak muscles are strengthened and muscle spasms or compensating muscles are relaxed via spindle and golgi tendon work. Blood flow to the muscles is improved by working on neuro-vascular points and lymphatic flow.
The joint alignment is checked and any misalignment is corrected by adjustment of the joint.
For information on specific techniques, please read:
Adequate nutrition for repair and health of the bursa is discussed with the patient.
Sometimes chronic systemic inflammation in a patient requires improving the gut digestion as this can affect one’s joint.
Applications of ice decreases swelling and use of wet heat increases blood and lymph flow to promote healing.
Lifestyle changes are recommended; for example if one has to kneel for work, heel pads are suggested. And proper stretching and exercises are recommended to support the joint and the muscles crossing the bursa.
© 2015-Dr. Vittoria Repetto/revised – 2016
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