A Simple Protocol for Relieving Bursitis

Fish oil is profoundly useful for relieving many conditions caused by inflammation. Bursitis, however, is not a condition caused by the inflammatory processes that are corrected by fish oil. Another common supplement can help.

What is Bursitis?

Bursitis is a condition of acute or chronic pain in the bursa. These are tiny sacs filled with a slimy fluid that provide a cushion in joints between bones and in the space between bones and the tendons that connect them to muscles.

The best explanation of bursitis I've ever heard was shared with me by Dr. Jonathan Cluett. Dr. Cluett compares a bursa to zip-lock bag. If the zip-lock bag is flat and tight, it is easy to pull out of the box. It allows other objects to slide over it easily. If the zip-lock bag is filled with air, it can get stuck in the box, and it is not easy for other objects to slide over it easily.

Bursitis is a condition in which the proteins that make the "bag" weaken and the bursa deforms. It is not so much caused by inflammation as it is caused by degeneration of the collagen fibers that make up the tissue. To support recovery from bursitis you need to encourage protein synthesis, not to fight inflammation.

Tissue Changes in Bursitis

Bursitis can be caused by infection, injury, gout, or rheumatoid arthritis, but most commonly the problem is overuse of the joint causing the protein of the bursa to break down. Housemaid's knee, from scrubbing floors, and miner's elbow, from swinging a pick, were the classical forms of the condition.

Nowadays, bursitis is most common in landscapers, roofers, carpet layers, and janitors, all of whom do repetitive motions all day long. People who work at desk jobs are most likely to develop bursitis as "weekend warriors," when they work out too hard at the gym or they play too hard at a weekend athletic event.

At a microscopic level, stress and strain breaks down the fibers of collagen that hold the bursa together. The immune system generates inflammation to fill the sac with fluid, but this actually prevents even further damage. Inflammation holds the collagen fibers in place until they can heal. Fighting inflammation with too much pain reliever and too much fish oil actually can make the problem worse.

Beginning the Healing Process for Bursitis

The first step to recovery is resting the affected joint. Sometimes the joint is so swollen that it is best to go to the doctor to have the excess fluid aspirated by a very long needle stuck directly into the bursa. I've had this procedure myself, and the "little shot" to anesthetize the muscle hurts more than the "big shot" to draw off fluid. There is no additional pain from the procedure, and relief can be immediate.

While you don't want to put pressure on the joint, you do want to continue to use the muscles around it. If you can get to a warm-water pool, try to do "water-cise" to move muscles without stressing the joint. Professional massage can be helpful, as can a hand massager if you can't afford to see a massage therapist. At the same time you are getting these treatments for your joint, you can also start supportive nutrition.

Vitamin B12 for Bursitis

Researchers have known for about sixty years that vitamin B12 injections accelerate healing of bursitis. The way B12 works is by binding to proteins that otherwise would help white blood cells known as neutrophils attach themselves to the bursa. Neutrophils secrete the chemicals that cause the bursa to fill up with fluid. They also release chemicals that cause pain and tissue swelling.

There is no standard protocol for B12 treatment. If you go to a nutritionally oriented physician, you may be offered a vitamin B12 injection. If you want to take vitamin B12 on your own, the most effective dose seems to be about 1,000 mg a day. I would take a B12 supplement along with a

"complete B" supplement to make sure all the B vitamins stayed in balance. The cost of vitamin B supplements is quite low. If you take B12, don't take a separate folic acid supplement, because excess folic acid can mask symptoms of B12 deficiency.

If you are on any prescription diuretic, such as Lasix (furosemide), which nearly everyone who has had a heart attack is given, you may need to take vitamin B indefinitely to help you deal with bursitis pain.

Other Supplements That Can Help Heal Bursitis

The pineapple extract bromelain can help relieve swelling caused by bursitis. This enzyme helps the immune system (a group of white blood cells not involved in the production of inflammatory chemicals) break down damaged collagen fibers so they can be replaced.

I would start with 250 mg of bromelain a day and work up 1,500 mg a day over about a week if there were no allergic reactions. Very few people are allergic to bromelain, but sometimes people who are allergic to pineapple get an allergic reaction to the supplement. Start with a low dose to make sure any reaction you have is mild.

The herb devil's claw is useful if aspirin upsets your stomach. You take either devil's claw or other over-the-counter products, not both. Don't use the herb if you have any kind gastric or duodenal ulcer.

Feverfew is an herb more often offered for migraine, but it can also relieve bursitis pain. One study found that women who took 70 to 86 mg of feverfew per day recovered grip strength. Like devil's claw, feverfew is an either-or pain treatment. Either you take feverfew, or you take aspirin or other NSAIDs, but you don't take both. Don't use feverfew if you have gastric or duodenal ulcers.

Fresh ginger, up to two full tablespoons per day, relieves bursitis pain if you eat it often. Frankly, eating that much ginger is an acquired taste. Personally, I put apple, lemon, and ginger in the juice and drink the blend. To me, "straight up" ginger is just too much for my taste buds to handle.

Raisins soaked in gin are a popular American remedy for bursitis. Some people soak raisins in gin and then eat the raisins. Actually, researchers have found, if you just drink the gin you will get a greater benefit. The alcohol in the gin slows the action of neutrophils that break down fibers and fill the bursa with fluid.

Willow bark is the herb from which aspirin was first extracted. It is a gentler form of pain relief, but if you have problems with aspirin, you will just have them in lesser degree with willow bark.

Simple Home Care for Bursitis

In addition to resting affected joints, many people get relief from TENS, or transcutaneous electrical nerve stimulation. TENS is a method of pain relief that has been around for over 2,000 years, since the ancient Greek physician Scribonius Largus discovered that standing on an electrical fish relieved joint pain. American Founding Father Benjamin Franklin developed his own device for relieving joint pain based on the same principle.

The way TENS works is by activating opioid receptors in the nerves around a joint. Opioid receptors respond to opium-based pain relievers. TENS activatest the receptors without the use of a drug. The treatment also slows down the transmission of nerve impulses from the joint so that much of the pain that is not blocked by the stimulation of opioid receptors is not conducted back to the brain.

If there is anything that users of TENS agree on, it is that "turning up the juice" on a TENS unit is not necessarily a good idea. You don't need to replace an aching sensation with a burning sensation. Used as directed, however, TENS offers low-cost relief that only requires a single, initial investment.

Acupuncture for Bursitis

There is a form of bursitis that is especially amenable to acupuncture treatment, frozen shoulder. In this form of bursitis moving the shoulders becomes extremely painful. People avoid exercise, and muscles weaken so that the shoulder is subject to different kinds of injury after recovery from bursitis.

It may take 5 to 10 acupuncture treatments to begin to relieve frozen shoulder. Acupuncture plus acupressure massage, however, usually cuts recovery time in half. The points to treat with acupressure are the indentation in the back just below the shoulder and the inside crease of the arm at the elbow. Gentle pressure generates pain relief. You can massage the inside crease of the arm at the elbow yourself, but you need a partner for acupressure to the back. It may also help to apply light pressure to the shoulder where it joins the arm. Always stop acupressure if it begins to hurt.

And What About Fish Oil for Bursitis?

There are no clinical trials of fish oil as a bursitis treatment, and the single clinical trial of fish oil as a treatment for carpal tunnel syndrome suggests that the dosage of fish oil that works would be very, very high. When people take about 7,000 mg of DHA + EPA essential fatty acids a day (which requires taking 7 to 70 capsules of fish oil a day, depending on the brand), the immune system generates fewer neutrophils, which would cause less tissue break down in the bursa. But since interfering with the immune system can cause other problems, and there are other methods that work, I don't recommend fish oil as a treatment for bursitis.

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