Soothing the pain of bursitis and tendinitis

by Jeff Siegel

Tendinitis and bursitis are as painful as they are inevitable -- especially for men who believe they should play through pain and that soreness is just an excuse to work harder. But tendinitis and bursitis, though often difficult to diagnose, can be overcome. In fact, techniques as simple as an effective warmup and sound mechanics, whether you're swinging a tennis racquet or throwing a softball, can help you avoid a painful morning after.

One day, your shoulder feels fine. The next day, the pain is as sharp as anything you've ever felt -- a twisting, shooting pain that seems to have come from nowhere. Yes, you played softball over the weekend, but it's hard to equate a couple of hard throws from right field with the intense pain that you feel in your shoulder.

You know it's not arthritis, because this pain is different than the swelling and stiffening that occurs with your occasional bouts of arthritis. So you call your health care provider, who asks you what you did over the weekend. You tell him, which gives him a good idea of where to look. The pain isn't arthritis, he says, but almost certainly bursitis, tendinitis or both -- two of the most common joint problems affecting men 35 and older. One study, in fact, says two-thirds of men who complain of muscle problems are suffering from one of the two.

"What's important to keep in mind is that tendinitis and bursitis are different, although people tend to associate them as one," says Jacob Rozbruch, M.D., an orthopedist in private practice in New York City. "What they have in common is that they both cause pain, often in the same areas, like in the rotator cuff of the shoulder. But they are not the same condition."

In tendinitis, the tendons--those extensions of the muscles that attach to the bone -- become inflamed. In bursitis, the bursae--150 layers of cells that help the muscles glide smoothly over each other -- become inflamed.

Tendinitis is almost always caused by overuse or misuse of the tendons, as in tennis elbow (which actually affects the tendons in your wrist) or sore knees among serious runners. The pain of bursitis, on the other hand, is an indication that there may be a more serious problem going on in the muscles protected by the bursae, in much the same way an airbag inflates in an auto accident. The swelling and discomfort, for example, might mean that you've torn a muscle.

"What we try to find out when we see people with tendinitis or bursitis is 'Why is this person prone to these conditions?'" says Joel Press, M.D., a specialist is musculoskeletal and sports injuries at the Rehabilitation Institute of Chicago. "The muscles may not be strong enough or they may be too inflexible, which can lead to tendinitis or bursitis." Any physically active man (or woman, for that matter) is susceptible to bursitis or tendinitis, which is the more common of the two. The tendons and bursae are like other parts of the body. They wear out from constant use. The more active you are, the more likely you are to wear them out. Each case is different, and there seems to be no correlation with a family history of bursitis or tendinitis.

That's one of the differences between these two "itises" and their cousin, arthritis, in which heredity does seem to play a role. Arthritis affects a different part of the musculoskeletal system by causing a swelling in the lining of the joints.

Since physical activity is one cause of bursitis and tendinitis, the best way to avoid the inflammation and pain is to avoid doing more than you can. Says Dr. Rozbruch: "Pain is a communication tool. It's the way your brain tells your body to change the way you exercise."

Consider your sore shoulder. Baseball fans will recognize your symptoms as the dreaded rotator cuff injury so common to pitchers. One reason pitchers are susceptible is because pitching -- especially throwing so hard and throwing curve balls -- is a very unnatural action.

You can avoid the pain in one of two ways. First, warm up before you start throwing. It sounds too simple to be effective, but life usually works out that way, doesn't it? "If you make sure your tendons are loose, they are less likely to become inflamed," says Dr. Press. "Don't do anything without warming up--work up to it gradually, and you'll be better off."

Second, if you do inflame the tendons or the bursae despite warming up, the best approach is to rest. This gives the body a chance to heal itself (any anti-inflammatory over-the-counter drug like ibuprofen helps, as does icing the affected area), and then look at how you can change the way you throw to prevent the problem from happening again.

"I can inject cortisone into the bursae, and that will reduce the inflammation," says Dr. Rozbruch. But it's not going to eliminate the mechanical problem that caused the inflammation in the first place. That's what's causing the damage, and if you eliminate the mechanical problem, then you can eliminate the pain from recurring."

That approach, says Dr. Press, is the key to a successful rehabilitation. "What we've discovered," he says, "is that the best way to deal with tendinitis and bursitis is to take an almost holistic approach. We look at the biomechanical aspects. Is the bursitis or tendinitis caused by a training error? Can we change the way you do something? The key is to find out why the muscles aren't strong enough or why they are too inflexible."

Once that's under control, doctors say, you can throw as hard as you want from right field and remain pain free.