Armonk PTST’s John Connolly was quoted in an article on the Salonpas Blog on bursitis and tendinitis

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Taming Bursitis and Tendinitis Inflammation, 3/21/16

Bursitis and tendinitis are conditions that cause swelling around muscles and bones.  How do people get bursitis and tendinitis?  What can people do to treat the pain of bursitis and tendinitis? What parts of the body are most affected?  What exercises are recommended to treat it?  Salonpas® interviewed leading doctors and physical therapists to learn about treatment options.

“Tendons are ropes of touch tissue that connect muscle to bone,” said Dr. Nathan Wei, founder of the Arthritis Treatment Center.  “They are surrounded by a sheath of synovium (much like a knife inside a sheath).  Syndovium is the same material that lines the inside of the joints.  Tendons help muscles move bones.  When muscles contract and relax, a bone moves because it is connected to the muscle via a tendon.  Bursae are small ‘sacks’ that are lined with synovial tissue which are located near joints, serving a protective function.”

“Both bursitis and tendinitis can develop through trauma, overuse and even aging,” says Dr. Wei.  “Inflammation of the synovial tissue is what causes the pain of both bursitis and tendinitis.”

Carolyn Dean, MD ND, Medical Advisory Board Member, Nutritional Magnesium Association.

“Medical conditions such as diabetes, arthritis and thyroid diseases can also cause these conditions,” says Dr. Carolyn Dean, a medical doctor and author of “The Complete Natural Medicine Guide to Women’s Health.”

“However as people get older, the term ‘tendonitis’ may become a misnomer as the tendons themselves may degenerate,” says Dr. Wei.  “The term used here is ‘tendonopathy.’  The pain is the same, but the treatment changes.”
What can people do to reduce the pain of bursitis and tendonitis? “The treatment depends on the severity,” says Dr. Wei. “With mild disease, rest, ice and physical therapy may help.  Non-steroidal anti-inflammatory drugs may be useful for pain relief but their use should be short-term and with the lowest possible dose to avoid side effects.”

“They can use an anti-inflammatory mineral such as magnesium which relaxes muscles and lowers inflammation.  Not all forms of magnesium or easily absorbed by the body. Magnesium citrate powder mixed with hot or cold water and sipped throughout the day is a highly absorbable form that is easy to take,” says Dr. Dean.

“They could get physical therapy or sports massage to lengthen the muscles that have shortened with overuse and reduce scar tissue which also hampers range of motion and affects joint and tendon health,” adds Dr. Dean.

“With severe chronic conditions, injections of glucocorticoid using ultrasound guidance can be employed,” says Dr. Wei.  “For more serious disease, some patients may require injections of platelet rich plasma (PRP).  These injections must be administered using ultrasound guidance. Often, needle tenotomy – peppering the injured area with small holes is performed- in order to induce injury, which paradoxically causes more rapid healing. This is particularly true for tendonopathy where PRP may be used earlier in the treatment cycle. Since many of my patients are Boomers, we use PRP more often since tendinopathy is more common than tendonitis in this population.”

John Connolly, PT

Does exercising make the condition worse?  “It is possible to continue exercising, however one should consider that the type of exercise they are performing may be exacerbating the condition,” says John Connolly, a licensed physical therapist with a Board Certification as an Orthopedic Specialist in Physical Therapy at Armonk Physical Therapy and Sports Training.

“Exercising is not an ‘all or nothing’ approach,” says Connolly. “There are so many means of exercise that exist, so an individual can work around injuries or substitute different exercises to avoid aggravating an injury. There are even exercises that would be recommended to help address and correct the condition. The trouble is that some individuals may not know which exercises are safe to continue and which exercises to avoid. In that event, consulting a credentialed exercise professional or a Physical Therapist may be the best option to answer those questions.”

What types of exercise are recommended for bursitis and tendinitis suffers?  “I am a firm believer of, if you cannot move your body well, you should not add any extra weight to a movement as this cause most injuries,” said Patrick Lerouge, a restorative therapist at Evolve Restorative Therapy.   “So begin with body weight movements under the supervision of someone that knows you as a person not as injury, and a person that knows about regressive movement patterns, so they can find where your movement problem is coming from.”

Patrick Lerouge, founder of Evolve Restorative Therapy.

“Eccentric exercises have been proven to be the most beneficial in the rehabilitation of tendinitis and bursitis,” says  Sridhar Yalamanchili, a physical therapist with the Atlantic Spine Center.  “Several clinical studies investigating these exercises show the helpful role of them. Eccentric means lengthening contractions of the muscles. To help understand this, consider the following example. An eccentric exercise for the biceps muscle would be to slowly straighten the elbow, thus lengthening the biceps. A customized exercise program which is designed by rehabilitation professionals to help the inflamed structures, as well as address the surrounding joints, will help alleviate pain.”

“An exercise prescription will be based on what we feel will NOT aggravate the condition, and also to attempt to correct the biomechanical dysfunction,” says Connolly.  “An individual suffering from a shoulder tendonitis or bursitis should be good to run and bike for a cardiovascular means, however, swimming would not be a great alternative due to the constant overhead patterns that are seen with most swimming strokes. On the other hand, a runner suffering from Achilles Tendonitis would benefit from biking and swimming due to the non-impact nature of these activities. Stretching muscle groups that are tight and short and strengthening weak stabilizing muscle groups would be beneficial to promote optimal biomechanical patterns at any given joint, which in turn can reduce the risk of a tendonitis or bursitis.”

Is there a way to avoid future bouts of tendinitis and bursitis?  “Until an individual has eliminated their pain and corrected their biomechanical faults, I typically advise against continuing any activating that had contributed to the condition in the first place,” says Connolly. “This gives the body the opportunity to allow its healing process to take place. I also encourage my patients to continue to work on a Maintenance Routine’ perhaps 1-2 times per week, despite feeling better, as this will continue to keep their risk for re-injury low. For instance, I personally like to use a lot of body weight exercises in my routines. However, these large compound exercises typically will strengthen larger muscle groups. My ‘Maintenance Routine’ will consist of small single joint exercises that target small joint stabilizing muscles and stretches for tight and shortened muscle groups. By targeting these areas 1-2 times a week, my goal is that my biomechanics are correct during other modes of exercise such as weightlifting and running. This is just an example of how I might advise someone, but ultimately every person is different, and exercise prescription MUST be individualized to best fit that person.”

Many people suffering bursitis and tendinitis report that the Salonpas® Pain Relief Patch and theSalonpas® Arthritis Pain Patch, the first and only FDA-approved OTC topical pain patches for the temporary relief of mild to moderate muscles and joints aches and pains associated with arthritis, helps ease their pain and enable them to continue to exercise.  Other pain sufferers find pain relief fromSalonpas Jet Spray and DEEP Relieving Gel.