Bursitis Naturopathic Protocol

Bursitis Naturopathic Protocol

This Bursitis Naturopathic Protocol is provided as information for patients of HealthMasters Naturopath Kevin Tresize ND as part of a treatment plan to assist patients with understanding of their treatment plan and should not be substituted for medical advise, diagnosis or treatment. It is important to note that this is a summary only and is intended to assist discussion between practitioner and patient as part of consultations and should not be substituted for medical advise, diagnosis or treatment. This Bursitis Naturopathic Protocol may be changed to suit the individual requirements of the patient and should not be substituted for medical advice, diagnosis or treatment.

HealthMasters Naturopath Kevin Tresize ND

 

Definition: Bursitis

Bursitis is inflammation of a bursa (Figure 1) caused by repetitive use, trauma, infection, or systemic inflammatory disease. Bursa are flattened sacs that serve as a protective buffer between bones and overlapping muscles (deep bursa) or between bones and tendons/skin (superficial bursa). Humans have approximately 160 bursa. Bursitis most commonly affects the subacromial (shoulder), olecranon (elbow), trochanteric (hip), prepatellar (knee), and infrapatellar (knee) bursa. Symptoms of bursitis may include localised tenderness, oedema, erythema, and/or reduced movement.

Inflammation causes synovial cells to multiply and thereby increases collagen formation and fluid production. A more permeable capillary membrane allows entrance of high protein fluid. The bursal lining may be replaced by granulation tissue followed by fibrous tissue. Haemorrhage may occur. One study suggests this process may be mediated by cytokines, metalloproteases, and cyclooxygenases. In septic arthritis, local trauma usually causes inoculation of bacteria into the bursa, which triggers the inflammatory process.

Bursitis Figure 1 

Aetiology (Cause) / Risk factors: Bursitis

  • Chronic overuse or repetitive use
  • Traumatic injury
  • Bacterial infection
  • Gout, pseudogout
  • Rheumatoid arthritis
  • May need to have a differential diagnosis with septic arthritis, ligamentous injury, fracture or osteoarthritis.

Signs and Symptoms: Bursitis

  • Localised pain aggravated by movement
  • Abrupt onset of pain in acute bursitis
  • Localised swelling
  • Localised tenderness
  • Erythema
  • Fever, swelling, and increased temperature of the overlying skin (septic bursitis)

Core Treatment: Bursitis

Assess the cause, whether:

  • Repetitive bursa irritation (from a repetitive movement or excessive pressure)
  • Traumatic injury, leading to inflammation
  • Systemic disease

Manage inflammation - pain, redness, swelling and promote resolution

Acute relief of pain, swelling, flares of autoimmunity

If pain is chronic:

If bursitis is caused by infection

Antimicrobial to address systemic or unidentified infection:

Additional support for joint repair – optional if with other chronic joint problems

OR

Management of chronic systemic inflammation

  • Metagenics Clinical Detoxification Program
OR

 

Alphabetical Reference of Nutritional Support: Bursitis

Formula Catch Phrase Key benefits
BCM– 95 Turmeric and Devil’s Claw to Treat Chronic Inflammation A combination of herbs to provide powerful synergistic anti-inflammatory and analgesic effects by inhibiting RAGE, COX-2 expression, TNF-α and NFkB. This herbal combination is safe for long-term use.
Connective Tissue Maintenance A combination of nutrients to provide long term protection against joint degeneration. Contains therapeutic doses of glucosamine.
Cordyceps, Coriolus and Reishi for Immune Stimulation These four clinically proven medicinal mushroom extracts have demonstrated potency to enhance immunity whilst modulating inflammation. Supports the resolution of chronic, latent and/or recurrent infectious conditions, and safe for use in autoimmune diseases, such as RA
Gelatin Complete Joint Restore Powder This formula contains glucosamine, MSM and gelatin plus nutritional co-factors, is clinically trialled to help reduce pain and inflammation in conditions such as osteoarthritis, and to promote the healing of joint tissues.
High Bioavailability Zinc with Vitamin C Zinc and vitamin C are amongst the most critical nutrients in healthy immunity, as both are involved in wound healing, immune balance and to boost resistance to infection.
Highly Bioavailable Palmitoylethanolamide (PEA) With Endocannabinoid Action PEA is a bioactive lipid that directly modulates endocannabinoid signalling, indirectly increasing cannabinoid receptor activity throughout the nervous system, including microglial cells and astrocytes, as well as receptor activity in immune cells. PEA’s actions enhance anti-neuroinflammatory, analgesic and neuroprotective pathways, benefiting chronic pain, including neuropathic pain, in addition to neurodegenerative conditions.
High Potency Anti-inflammatory Herbs Powerful anti-inflammatory herbs and nutrients, including BCM-95 turmeric, BosPure boswellia, willow bark, ginger and quercetin are designed to rapidly reduce acute inflammation.
Meta Mag Magnesium Bisglycinate, Corydalis and California Poppy for Pain A magnesium and herbal formula for acute or chronic pain management. Magnesium has been shown to block glutamate via inhibition of the NMDA receptor, thereby reducing excitatory neurotransmission. Corydalis is an effective analgesic in both inflammatory and neuropathic pain.
Small Intestinal Bacterial Control A combination of phellodendron with potent essential oils targets overgrowth of flora in the small intestines, which is associated with chronic fatigue, irritable bowel syndrome and systemic inflammation.
Specialised Pro-Resolving Mediators SPMs are lipid mediators that promote resolution, reduce pain, encourage clearance of pathogens and mitigate pathological inflammation, without immunosuppression. SPMs regulate macrophage polarisation; triggering the switch from M1 (proinflammatory) to the M2 (anti-inflammatory) phenotype, therefore promoting resolution.


 

Diet, Lifestyle and Specific Natural Treatments: Bursitis

Diet and Lifestyle

  • Avoid HARM factors: Heat, Alcohol, Running (or exercise), Massage (contraindicated with bursitis)
  • In acute situations, apply ice pack for 20-30 minutes.
  • Chiropractic, osteopathy or physiotherapy helps with the assessment management and treatment of bursitis.
  • Massage is contraindicated in septic bursitis. Otherwise, massage (especially myofascial release therapy) can be used for general relaxation and to reduce discomfort from holding patterns secondary to pain and compensating for an injured part.
  • Most acute and chronic bursitis can be prevented by avoiding overuse of the joint, by resting between periods of activity, and by adequately warming up and stretching before strenuous activity.

Diet:

  • Reduce pro-inflammatory foods in the diet including saturated fats (meats, especially poultry, and dairy), refined foods, and sugar.
  • A small percentage of people respond dramatically to a diet free of nightshades. They include peppers, eggplant, tomatoes, and white potatoes. A month-long trial is recommended.
  • Emphasise foods high in essential fatty acids such as oily fish and nuts / seeds

 

Supportive Lifestyle Programs: Bursitis 

Supportive Lifestyle Program Description

Metagenics Clinical Detoxification Program

Neurological and gut health is highly dependent on effective liver and bowel detoxification and clearance of endogenous and environmental toxins. The Metagenics Clinical Detoxification Programs are designed to address the primary source of toxicity in patients, and encourage elimination of and protection against these toxins. A questionnaire is available for patients to complete which assist the Practitioner in determining the most appropriate program. There are three programs available:

  • Health Reset
  • Gut Pathogen Elimination
  • Liver Chemical Clearance

Wellness and Healthy Ageing Program

Recommending a low glycaemic, alkalising diet with lifestyle with exercise and effective stress management, are all factors associated with healthy musculoskeletal function and disease prevention. Scientifically shown to improve health, quality of life and to reduce the biomarkers associated with ageing.

 

Pathology Tests: Bursitis

Pathology Test Interpretation Guidlines

WBC

Elevated in septic/infectious bursitis

Bursal fluid culture

Positive in septic/infectious bursitis

Crystal examination

Presence of crystals in bursal fluid indicative of gout

ESR

(to exclude autoimmune disease)

Child: 2-15 mm/hr

Adult female

17-50 years: 3-19 mm/hr

51-70 years: <20 mm/hr

>70 years: <35 mm/hr

Adult male

17-50 years: 1-10 mm/hr

51-70 years: <14 mm/hr

>70 years: <30 mm/hr

Rheumatoid factor

<30 IU/L.  Elevated in RA and other chronic autoimmune conditions

Omega-3 Index Test

A validated test that measures red-blood cell (RBC) EPA and DHA status to personalise supplemental and diet prescriptions, as well as identifying those at risk of health conditions associated with omega-3 deficiency. An Omega-3 Index in the desirable range of 8%-12% is an indicator of better overall health.

 

Pharmaceutical Treatments: Bursitis

 

Acute bursitis:

  • Rest the joint, and elevate if possible
  • Ice application
  • Immobilisation and/or compression of the joint
  • Ultrasound therapy helpful in some cases
  • NSAIDs for pain
  • In more severe cases, local anaesthetic and corticosteroid injected into the bursa
  • Oral corticosteroids
  • Rarely, aspiration is indicated

Septic bursitis:

  • Drain bursal fluid
  • Antibiotics

Chronic bursitis:

  • Repeated corticosteroid injections with physical therapy to restore joint function

 

Pharmaceuticals

Nonsteroidal anti-inflammatory agents -- Most commonly used for relief of mild to moderately severe pain. Although pain-relieving effects tend to be patient specific, ibuprofen is usually used for initial therapy.

Antibiotics -- Therapy must cover all likely pathogens in the context of the clinical setting

Corticosteroids -- These agents have anti-inflammatory properties and cause profound and varied metabolic effects. In addition, they modify the body's immune response to diverse stimuli.


Footnotes: Bursitis

[1] Ensuring patients maintain an omega 3 index above 8% is essential to SPM production. Omega-3 status can be evaluated/monitored using the Omega-3 Index Test (refer to pathology testing section). In the instance of deficiency, consider co-prescribing an omega-3 essential fatty acid supplement.

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