Beware the Itis of Bursa

By

Victoria L. Magown, CMTPT, LMT and George S. Pellegrino, LMT, CMTPT

Shakespeare has warned "Beware the Ides of March". At MyoRehab, we have chosen March to focus on a common pain syndrome that shows itself in many forms. We know this malady as bursitis. Although it causes pain for many, few suffers really understand its cause.  First, "Itis" is the Latin word meaning inflammation and a bursa is a pad like sac that reduces friction between a muscle tendon and a bone. It is similar to a small plastic bag filled with Jell-O. Therefore, burs-itis is inflammation of the bursa sac.

How often have we observed someone point to their hip or shoulder in pain and say, "My bursitis is really painful today"? The pain of an inflamed bursa can persist for years at a low level and become aggravated by "a wrong move" from time to time. Sufferers of bursitis may believe that the only way to get relief is to rest, or perhaps have a steroid injected into the bursa. This “cure” may not be as long lasting as we would like.

The question we should ask ourselves is why does a bursa become inflamed in the first place? It is of the bursa can be the result of direct trauma or from the tendon of a tight muscle repeatedly rubs over it. Muscles can become shortened as the result of trauma, sport injuries, car accidents, and work related repetitive motion.

When muscles are traumatized they develop Myofascial Trigger Points. A Myofascial Trigger Point is a hypersensitive spot in a muscle that when stimulated, usually produces pain referred in a predictable pattern away from the Trigger Point. These points also trigger contractions in muscles that are called taut bands.

Shortened, painful muscles play a big part in the underlying cause of bursitis.  Sometimes a diagnosis of bursitis is not bursitis at all. Since Trigger Points refer pain to a location that often mimics bursitis, the pain at the site of the bursa may not be from the bursa but pain triggered from a point in the muscle.

In the illustrations below, the location of the Trigger Point is indicated by an "x" and the pain patterns they produce by the shaded area. In illustration A, the tensor fasciae latae produces pain that mimics bursitis of the trochanter (hip bone). Landing on the feet from a high jump or walking or running on a surface that is sloped to one side can establish Trigger Points in this muscle.

Another common site of “bursitis” is found in the rectus femoris shown in illustration B.  Trigger Points in the rectus femoris produce pain over the knee. This is often misdiagnosed as bursitis of the patella (knee cap). Trigger Points can be established in this muscle by a fall as in a ski accident or while running.  Sitting for a long time with a heavy weight on the lap, such as holding a heavy child during a long car trip, can also activate Trigger Points in this muscle.

Heel pain has many causes. One cause of heel pain is often misinterpreted as calcaneal (heel) bursitis when in fact, the pain may originate in a Trigger Point found in the soleus (Illustration C). Trigger Points in the soleus develop when runners repeatedly land on the forefoot (toes or ball of the foot) causing an overload in the soleus. The soleus is also overloaded when skiing or ice skating without proper ankle support.

Pain in the front of the shoulder can mimic inflammation of the bursa under the tendon of the bicep muscle. When the infraspinatus muscle found on the back of the shoulder blade (Illustration D) harbors Trigger Points, its pain pattern is in the front of the shoulder similar to the pain produced by it is of the biceps bursa. Trigger Points are activated in this muscle by reaching backward to break a fall or reaching behind while pulling a wagon or walking a reluctant pet.

As we mentioned above, muscles with Trigger Points become shortened and painful. It is possible that the shortened, painful muscle has indeed irritated the bursa causing it to become inflamed. Just treating the inflamed bursa, however, will probably give only temporary relief.  This is due to the fact that the Trigger Points are still shortening the muscle which will continue to irritate the bursa, it inflamed.

Is there an "Itis of Bursa" to be aware of in your life? Give us a call at MyoRehab.