Bursitis: Symptoms, Causes, Risk Factors, Pathophysiology, Healing Cycle & Treatment

What Is Bursitis?

 A bursa is a small fluid-containing sac that is present near joints and bony structures to prevent friction during the movement and allow bones and other structures like ligaments and tendons to slide over the bone surface with ease.

Bursitis is, essentially, an inflammation of the bursa that is very painful and limits mobility. This can result from excessive pressure on the bursa. (1)

What Are The Causes And Risk Factors of Bursitis?

The causes and risk factors that may lead to the development of bursitis are: 

●  Aging: Bursitis becomes more common with advancing age.

●  Repetitive motion: Repetitive motions like throwing, such as in basketball or baseball, etc, if done without a proper warm-up, can lead to bursitis resulting from overuse injury.

●  Excessive kneeling: This may be a professional requirement for some people, like carpenters, for example, or maybe due to a hobby such as gardening, painting, or playing a musical instrument, etc. for long durations without taking breaks or resting in between.

●  Systemic diseases: These include the likes of rheumatoid arthritis, diabetes, gout, etc.

●  Injury: Such as from a fall or heavy blow on the joint. (2) 

The types of bursitis that most commonly occur include prepatellar bursitis in the knee region, olecranon bursitis in the elbow, trochanteric bursitis in the hip joint, and retrocalcaneal bursitis in the bursa of the ankle joint. (3)

What Are The Symptoms Of Bursitis?

Common symptoms of bursitis include:

●  Extreme pain in the affected joint.

●  Swelling or redness of the joint due to inflammation.

●  Pain on movement or touch.

●  Fever may also develop in case the affected bursa gets infected additionally. (4)

Pathophysiology Of Bursitis 

Before jumping on how to treat bursitis, we need to understand what is the pathogenesis of this painful inflammatory condition. 

Excessive pressure or movement can cause the synovial membrane of the bursa to become irritated due to micro-injuries and get inflamed. When such an inflamed bursa comes in contact with bones or tendons and gets compressed against their surfaces, it can lead to shooting pain in the region of the joint. (5)

An injury to the tissue, such as that occurs in bursitis potentiates the wound healing mechanism of our body. In general, the body’s normal response to injury involves the following phases:

1.     염증: As a result of injury to the tissue, our immune system invites a number of inflammatory cells to the site of damage. This initial phase causes the release of cytokines and other mediators of inflammation that lead to the development of pain, redness, and swelling in the area, as well as cause a localized rise in temperature of the tissue. (6)

2.     분아 증식:  Responding to the injury of tissue, our body attempts to heal and recover it by producing collagen, and other components of the extracellular matrix. Blood supply to the region also increases. This leads to the production of scar tissue, muscle spasms, and trigger points at the site of injury. (7)

3.     성숙: In an ideal scenario, this is the last stage of wound healing in which the body removes excessive scar tissue and fibrosis in an attempt to return the injured tissue to as close to its original form as possible. (8)

However, if the injurious stimulus is not removed, the body produces an excessive amount of scar tissue without it reaching the stage of remodeling. This results in fibrosis and the formation of adhesions between the various layers of the fascia. 

This is what happens in bursitis. In acute bursitis, it is the inflammation and accumulation of excess synovial fluid that leads to pain. However, when bursitis becomes chronic, pain is often absent, but the limitation of movement exists. Fibrosis causes restriction of the stretching ability of the bursa between the surfaces it is compressed against. Additionally, the muscles, tendons, and ligaments related to the affected bursa get weakened and lose functionality. (9).Therefore, too much scar tissue limits the range of motion and causes pain in the movement of the affected joint.

효과가 없는 치료법:

●  Heat and Ice: These may temporarily relieve the pain in the joint, but do not solve the underlying problem.

●  ESTIM: Electronic stimulation of the muscle is a physiotherapeutic approach that may temporarily help in the management of pain, but does not aid the process of healing of the injured bursa. (10)

●  Foam Roller and Massage: Both of these methods employ the application of pressure to the already inflamed bursa. Pressure causes aggravation of the inflammatory process but increasing the compression of the bursa between adjacent structures and surfaces.

●  Stretching and Strength Exercises: These are necessary for regaining the range of motion and movement at the affected joint, but must be done at the right time after inflammation has been dealt with. Undue stretching and movement can cause further injury and even the rupture of muscle tendons.

효과가 있는 치료법: 

To achieve long-term improvement and heel bursitis, we need to individually and often simultaneously target the inflammatory and proliferation phases involved in its pathogenesis.

염증 단계:

●  Rest well and avoid excessive and repetitive motion of the affected joint as it can cause and aggravate the pain of bursitis.

●  Magna Heal is a tool that is used to apply a magnetic field to the inflamed tissue. This magnetic field penetrates 3 inches deep into the tissue and helps to heal inflammation from within. It further aids in breaking the adhesions formed and regaining motility.

●  An anti-inflammatory diet, such as that including food sources like ginger and turmeric, is a necessary component required to support and maintain the treatment process.

●  Nutrient deficiency must be covered to aid the process of healing. AskASTR website provides free evaluation and treatment suggestions regarding particular deficiencies. 

증식 단계:

●  A3 및 A5 도구는 흉터 조직과 통증유발점을 해제하는 데 도움이 됩니다.

●  이 목적을 위해 특별히 설계된 A1 및 A5 도구를 사용하여 근막 층 사이에 형성된 접착을 끊을 수 있습니다.

By keeping these processes and tools in mind, you can be pain-free!

 참고문헌

1. Bursitis: Overview. In: InformedHealth.org [Internet]. Institute for Quality and Efficiency in Health Care (IQWiG); 2018.

2. Aaron DL, Patel A, Kayiaros S, Calfee R. Four common types of bursitis: diagnosis and management. J Am Acad Orthop Surg [Internet]. 2011 Jun [cited 2021 Sep 24];19(6). Available from: https://pubmed.ncbi.nlm.nih.gov/21628647/

3. Bursitis [Internet]. [cited 2021 Sep 24]. Available from: 

4. Williams CH, Jamal Z, Sternard BT. Bursitis. In: StatPearls [Internet]. StatPearls Publishing; 2021.

5. 마이클 H. 아스케나제 LHS. 뇌내출혈 후 병리 및 조직 복구에서 염증 반응의 단계. 세미 뉴롤. 2016년 6월;36(3):288.

6. 올리베이라 곤잘레스 AC, 코스타 TF, 아라우호 안드라데 Z, 메드라도 ARA. 상처 치유 – 문헌 검토. 브라스 더마톨. 2016;91(5):614.

7. What is the pathophysiology of bursitis? [Internet]. 2020 [cited 2021 Sep 24]. Available from: https://www.medscape.com/answers/2145588-103050/what-is-the-pathophysiology-of-bursitis#:~:text=During%20the%20acute%20phase%20of,ultimately%2C%20rupture%20of%20the%20tendons.

8. 호수 DA. 신경근 전기 자극. 스포츠 부상 치료에 대한 개요 및 적용. 스포츠메드[인터넷]. 1992년 5월 [2021년 9월 24일 인용];13(5). 사용 가능: https://pubmed.ncbi.nlm.nih.gov/1565927/