Overview 

Bursitis affects more than 8.5 million people in the US, or roughly 1 in 30 adults. Bursitis usually occurs as the result of repetitive motion or stress on a joint over a long period of time. However, bursitis can also be caused by injury, infection, or a previously existing condition, such as arthritis. 

Bursitis is characterized by inflammation of one or more of the body’s 150 bursae, small sacs filled with synovial fluid that surround and cushion the areas between joints and muscles and tendons. When the bursae become inflamed, movement of the joint and surrounding muscle becomes painful. However, dull pain may also be experienced when the affected joint is at rest. 

For most people, bursitis can be successfully treated to reduce symptoms and prevent further deterioration. However, it is not uncommon for symptoms to reappear at a later date if the appropriate self-care is not maintained. 

Common Types of Bursitis

Following are the most common areas of the body that bursitis may affect and its relative cause: 

Shoulder  Also known as subacromial bursitis, inflammation of the bursae of the shoulder is usually caused by injury to the rotator cuff due to repeated use of the arms overhead, heavy lifting, or even a fall. 

Knee  Prepatellar bursitis, commonly referred to as ‘housemaid’s knee,’ involves the bursae just above the kneecap, or patella. This form of bursitis is frequently seen in people who have endured repeated stress and pressure on their knees, perhaps while gardening, laying carpeting, or scrubbing floors (hence, the common name). Bursitis of the knee is also commonly found in people who are overweight. 

Elbow  Olecranon bursitis impacts the elbow and its cause may be due to a variety of activities, including certain sports (baseball, tennis, etc.), occupational tasks (painting, for example), and just about any other form of repetitive movement that extends the elbow. Even frequent leaning on your elbows can eventually result in this form of bursitis. 

Hip  People who stand for long periods of time may become susceptible to this form of the condition, also known by the medical term of trochanteric bursitis. However, injury to the hip or arthritis may also be a contributing factor. 

Other areas of the body can be affected as well. The bursae over the tail bone, for instance, can encourage bursitis of the buttocks. Repeated use of inappropriate or Improperly fitted footwear can cause bursitis of the ankle, or even the big toe. 

Risk Factors 

Occupation  If your occupation requires repetitive motion of one or more joints, you are at risk for developing bursitis 

Sports  Playing sports professionally or for recreation may precipitate bursitis. 

Age  Bursitis most commonly appears during middle age. 

Medical  Certain conditions may predispose a person to bursitis, including gout, arthritis and osteoporosis, as well as staph infections. 

Symptoms and Diagnosis

Typical warning signs of bursitis include: 

Stiffness in one or more joints.

Swelling or redness around the affected area.

Decreased range of motion.

Pain upon movement or pressure (i.e., standing, walking, etc.). 

Diagnosis 

Simple screening for bursitis usually consists of a review of symptoms, followed by a physical exam. In some cases, X-rays may be taken, or synovial fluid may be extracted and analyzed. In addition, blood tests may help rule out other conditions with similar symptoms. 

Natural Treatment and Management of Bursitis 

Applying ice packs to the inflamed area for 15-minute intervals may bring relief, especially if the inflamed region appears red or feel warm to the touch. 

Moist heat may be applied to the affected area for 20-minute intervals providing there is no sign of redness. 

Gentle stretching can help to reduce stiffness and restore mobility. Stretching is even more important to ‘warm up’ muscles before engaging in any activity to help prevent injury. 

Elevating the affected area can be helpful to relieve pain and inflammation when the hip, knee, or elbow is involved. 

Short-term use of NSAIDs, such as aspirin or ibuprofen, can help to relieve pain until inflammation subsides. 

Recommended Supplements in the Treatment of Bursitis 

Vitamin C 

Vitamin C can be helpful in the treatment of bursitis since it provides antioxidant properties and helps to speed tissue healing. This vitamin also plays a role in repairing damaged bursal and connective tissue. 

Omega-3 

Studies have shown that omega-3 fatty acids play a role in reducing pain and swelling by interfering with certain mediators that signal cells to commence an inflammatory response. In addition, omega-3 fatty acids disrupt the action of certain enzymes that cause joint damage. 

Glucosamine sulfate 

Glucosamine promotes the synthesis of proteoglycans and glycosaminoglycans (GAGs), protein molecules that are involved in joint repair and connective tissue support. 

S-adenosylmethionine (SAMe) 

SAMe is naturally produced in the body from adenosine triphosphate and methionine.

In supplement form, it is primarily used to inflammatory disorders, including osteoarthritis, fibromyalgia and tendonitis. SAMe is involved in a number of processes, including the synthesis and neurotransmission of serotonin and dopamine. Initial studies have shown that this substance also exhibits anti-inflammatory activity. 

Herbs Used in the Treatment of Bursitis 

Pineapple 

Bromelain, an enzyme obtained from the pineapple plant, has demonstrated proteinase activity that yields anti-inflammatory and analgesic properties in several studies involving subjects with arthritis, trauma-induced inflammation, or post-operative swelling. 

Turmeric 

Curcumin, the active constituent of turmeric that lends its yellow pigment, exhibits potent antioxidant and anti-inflammatory qualities that have been compared to cortisone in efficacy, but without producing side effects or toxicity. In addition, curcumin also protects against oxidative damage to tissues. 

Safety Precautions 

Vitamin C 

Do not take if you have a history of kidney stones or are undergoing chemotherapy treatments. 

Excessive consumption of chewable tablets can erode tooth enamel. 

Glucosamine sulfate 

Avoid if you are allergic to shellfish since some products are obtained from the exoskeleton of shellfish (chitin). 

SAMe 

Only use under the advise of a physician if you are taking one or more of the following: 

Tricyclic antidepressants

Clomipramine

Monoamine oxidase inhibitors (MAO-Is)

Selective serotonin reuptake inhibitors (SSRIs) 

Pineapple (Bromelain) 

Do not supplement with bromelain if you are also taking warfarin or other blood thinners. 

Turmeric (Curcumin) 

Do not take if you have a history of gallstones, stomach disorders or bile duct obstruction. 

Do not take if you are undergoing chemotherapy. 

Avoid if taking one or more of the following drugs: 

Warfarin or other blood thinners

Reserpine

References

Kremer JM. N-3 fatty acid supplements in rheumatoid arthritis. Am J Clin Nutr. 2000;(suppl 1):349S-351S.

Simopoulos AP. Omega-3 fatty acids in inflammation and autoimmune diseases. J Am Coll Nutr. 2002 Dec;21(6):495-505. 

Klein G, Kullich W, Schnitker J, et al. Efficacy and tolerance of an oral enzyme combination in painful osteoarthritis of the hip. A double-blind, randomised study comparing oral enzymes with non-steroidal anti-inflammatory drugs. Clin Exp Rheumatol. 2006 Jan-Feb;24(1):25-30.

Hale LP, Greer PK, Trinh CT, et al. Proteinase activity and stability of natural bromelain preparations. Int Immunopharmacol. 2005 Apr;5(4):783-93.

Kamenícek V, Holán P, Franĕk P. [Systemic enzyme therapy in the treatment and prevention of post-traumatic and postoperative swelling] Acta Chir Orthop Traumatol Cech. 2001;68(1):45-9. Czech.

Rovenská E, Svík K, Stancíková M, et al. Inhibitory effect of enzyme therapy and combination therapy with cyclosporin A on collagen-induced arthritis. Clin Exp Rheumatol. 2001 May-Jun;19(3):303-9.

Jacob A, Wu R, Zhou M, et al. Mechanism of the Anti-inflammatory Effect of Curcumin: PPAR-gamma Activation. PPAR Res. 2007;2007:89369.

Biswas S, Rahman I. Modulation of steroid activity in chronic inflammation: A novel anti-inflammatory role for curcumin. Mol Nutr Food Res. 2008 Mar 10

Garg R, Gupta S, Maru G. Dietary curcumin modulates transcriptional regulator(s) of phase I and phase II enzymes in benzo(a)pyrene-treated mice: mechanism of its anti-initiating action. Carcinogenesis. 2008 Mar 4

Osteoarthritis: the clinical picture, pathogenesis, and management with studies on a new therapeutic agent, S-adenosylmethionine. Proceedings of a symposium. Am J Med 1987;83:1-110.

Bradley JD, et al. A randomized, double blind, placebo controlled trial of intravenous loading with S-adenosylmethionine (SAM) followed by oral SAM therapy in patients with knee osteoarthritis. J Rheumatol 1994;21:905-11.

Maccagno A. Double-blind controlled clinical trial of oral S-adenosylmethionine versus piroxicam in knee osteoarthritis. Am J Med 1987;83:72-7.