Bursitis: Impact on Runner’s

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If bursitis hasn’t happened to you yet, it will- bursitis joint pain. It hits us all at different points in our athletic career. For some of us it will come shortly after we log our first 100 miles, and for other it will come once our running logs boast a cool 100,000 miles finished. But it always comes.  One common cause of joint pain? Runner’s Bursitis.

 

Running is unique in that it relies so heavily on one part of the body. Our legs and feet absorb the shock of 2x our body weight every time we take a stride. Running even a single mile involves thousands of footfalls, and forces our joints to bear double the weight of our bodies thousands of times. This sort of repetitive movement has the ability to wear our joints down and bring on an injury. Particularly injury in the form of Runner’s Bursitis. This article takes a look at Runner’s Bursitis: what it is, how to treat it, and how to prevent it. Read on to be more informed about the body and to gain tools for a longer, less painful running career.

What is Runner’s Bursitis?

Runner’s Bursitis is an umbrella term for a condition that affects the small, fluid-filled sacs that act as cushions between the bones, tendons, and muscles of all of the body’s major joints. When working correctly, these small sacs, called bursa, help the joints glide smoothly, and keep the tendons, ligaments, and muscles from scraping on the bones. But when subjected to continuous, repetitive motion, like the glide and stride of our legs as we log mile after mile, the bursa can become swollen and tender, which causes the area around the joint to look red and swollen and to feel stiff or sore.

Via: Vimeo.com

Bursitis is most common in the shoulder, hip and elbow, but it can also happen in the knee, heel and the base of the big toe (or the ball of the foot). Most runners experience bursitis pain in their legs (hip, knee, heel, and ball of the foot) as our legs take most of the pounding and endure a more aggravating repetitive motion than our arms. However, runners can also experience bursitis in their arms (shoulder and elbow) if they have a jerky or inconsistent arm swing.

Symptoms

Swelling and redness of the joint, as well as pain (sharp and stabbing initially, followed by a dull, aching pain as time goes on) beginning at the joint, are two of the major signs of Runner’s Bursitis. Pain and swelling will initially begin directly on the joint, but, because of the body’s interconnectedness, can spread out along the limbs if left untreated. Bursitis pain often feels worse if the joint has been held in a singular position for too long. For example, you might notice it more after getting out of a chair, rising from bed in the morning, or after holding the phone to your ear for a long conversation.

Via: Vimeo.com

In short, some of the tell-tale signs of bursitis are:

  • Swelling and redness of the joint
  • Warmth around the joint, or painful area
  • An initial sharp or stabbing pain, followed by a duller, aching pain
  • Increase in discomfort after keeping a joint stationary for a long period of time

And occasionally:

  • Weakness in the muscles surrounding the joint
  • Loss of motion (especially in shoulder and elbow bursitis)

Causes of Runner’s Bursitis

There are two types of Bursitis that runners can experience: acute and chronic.

Acute bursitis, or short-lived bursitis, is often brought on by some sort of accident or by another injury. For example, if a runner falls on a trail, and his elbow lands on a rock, the collision with the rock could cause the bursa in the elbow to swell. The runner could then experience acute bursitis that will last only for a day or two until the swelling goes away.

Acute bursitis can also be caused by other injuries, like fractures, pulled muscles, or even surgery on the joint. All of which cause excess stress on the joint as the body works to overcompensate for the injury. Overcompensation happens when the body uses tendons, ligaments, and muscles to pull more on a joint than it normally would.

Acute bursitis for runners is brought on by:

  • Running accidents (slips, trips and falls that bang major joints)
  • Other injuries (like fractures and pulled muscles)

Chronic bursitis is much longer lasting and can stick around for months or years if not treated correctly. This type of bursitis is most often caused by overuse. When we run we move our legs and arms the same exact way hundreds or thousands of times per workout. This causes the bursa in our joints (especially those in the legs) to endure constant and continuous stress and aggravation. Which then causes inflammation and irritation. Chronic bursitis can also be caused by pre-existing conditions like arthritis, gout, and diabetes.

Chronic bursitis for runners is brought on by:

  • Overuse (continuous stress and aggravation on the bursa of a joint due to repetitive motion and stress)
  • Pre-existing conditions (arthritis, gout, and diabetes can all cause the bursa of the joints to swell and initiate pain)

Women are also more prone to bursitis in the hip (Greater Trochanteric Bursitis) than men, because they rotate their hips more when walking and running than their male counterparts.

Risk Factors

Any and all runners are at risk of developing bursitis. This is especially true of those with a jerking or pounding stride that causes extra stress to the joints. But there are other various factors that make one more inclined to develop Runner’s Bursitis, including:

Here is a more in-depth look at each of these risk factors.

  • Age—Mechanical and degenerative issues are more likely in older runners. While younger runners tend to develop bursitis because of underdeveloped muscle groups that pull inappropriately on the joint.
  • Weight—Runners who are overweight are more prone to bursitis, as every stride comes down with greater force on the hip, knee, heel and big toe. For athletes who come to running in an effort to lose weight, bursitis might be an initial condition that alleviates itself as pounds are shed.
  • Leg length—Runners who have different length legs, especially those with different length femur bones, are highly likely to develop bursitis. This is because the bursa in the longer leg will absorb more shock and suffer more pull in every stride, irritating the delicate sac.
  • Scoliosis—Doctors have recently drawn a connection between Scoliosis (the s-shaped twisting of the spine which can cause an uneven pelvis) and bursitis. Especially in cases of Ischiogluteal Bursitis which affects the bursa between the Ischial tuberosity (a marking on the hip bone) and the tendon of the hamstring.
  • Infection—Bursitis is also attributed to bacteria found in infections like a Staph infection (Staphylococcus Aureus) that attack and inflame the bursa. Runners who have experienced a staph infection are more inclined to develop bursitis.

Diagnosing Runner’s Bursitis

Runner’s bursitis, especially in the hip, knee, heel, and foot, can be difficult to diagnose because it shares symptoms similar to many other running injuries (Runner’s Knee, IT band syndrome, Achilles Tendonitis, etc.). Because of this, it is crucial that you get a comprehensive physical examination from a qualified doctor.

Your doctor should listen to your symptoms, and examine the painful or inflamed area. Occasionally,  an X-ray or MRI will be taken to ensure that you are properly diagnosed and to completely rule out other conditions.

False Positives For Runner’s Bursitis

Pain from bursitis can be hard to pinpoint to a single origin since it will often feel as if it’s an entire area or section of the body that’s hurt. Bursitis is also often found in areas where runners commonly experience pain from lots of different causes (i.e. pain in the knee could be prepatellar bursitis or runner’s knee). Because of these two things, Runner’s Bursitis can be hard to diagnose and there are several other injuries that can be false positives for bursitis. For example:

Here is exactly how these other injuries can sometimes be seen as false positives for Runner’s Bursitis.

  • Arthritis— Just like Runner’s Bursitis, Arthritis is actually an umbrella term for many kinds of joint disease and joint pain. There are many kinds of arthritis, each of which can affect all of the joints in the body. When dealing the joint-centered pain, it’s important to rule out arthritis in any of its forms before proceeding with treatment. Because arthritis is a chronic illness it often requires a more intensive drug treatment plan, and occasionally surgery. Image testing (x-rays, MRIs, ultrasounds, etc.) will often be used to rule out the possibility of arthritis.
  • Stress fractures—Stress fractures happen when a part of the body is overused. For example, when your legs cover a considerable amount of mileage every week for an extended period of time, your muscles will eventually tire of absorbing the shock from each footfall. So they’ll stop performing their job, and pass the task of shock absorbing along to the bones in your legs instead. Bones aren’t meant to absorb repetitive shock like that and will begin to experience small cracks as a reaction. In order to heal, these stress fractures will need complete rest for a set length of time, followed by a slow return to running and physical activity. Your doctor should rule out stress fractures as the cause of your pain by taking x-rays.
  • Tendonitis—Bursitis is also easily confusable with tendonitis. Because the bursa sacs are creating a cushion between bones and tendons or bones and ligaments, it can often feel like it’s the actual tendon that’s injured instead of the bursa that’s inflamed. Tendonitis also is caused by many of the same things (repetitive activity, sudden injury) as bursitis, making it extremely difficult to differentiate from bursitis. But, Tendonitis is a different injury—the swelling of the tendon instead of the swelling of the bursa sac. Your doctor will perform a variety of physical tests in order to determine which part of the body is swollen.

Treatment and Prevention

 Once a bursitis diagnosis has been obtained, there are several ways to ensure that the injury is treated and cared for. Additionally, there are several ways to prevent a repeat instance of bursitis or to eliminate your chances of experiencing bursitis in the first place. Below is a look at the treatment options and preventative methods (including stretches and exercises) for runner’s bursitis.

 Treatment Options

Bursitis can be a highly painful and incredibly discouraging injury. A diagnosis can sometimes seem like a death sentence for your running career. But it doesn’t have to be. Bursitis is easily treatable and just requires a little patience and perseverance to get rid of it once and for all.

There are several options for treating the various forms and cases of bursitis, most of which are completely non-surgical:

And in some cases:

  • Surgery

Below is a deeper look at the treatment options for Runner’s Bursitis.

  • Rest—The number one treatment option for bursitis is rest. Giving the aggravated joint a break from the repetitive and pounding motion of running is the quickest and simplest way to heal the bursa. Rest doesn’t have to mean giving up working out entirely. Depending on where the bursitis is located (hip vs. shoulder) there can be other, more low-impact options, like swimming or biking. Of course, there are cases where any type of motion can be aggravating, and a total rest of the body is necessary. Your doctor will let you know what the right level of activity is for you.
  • NASIDS— (Nonsteroidal anti-inflammatory drugs)—Your doctor may recommend that you begin taking an over the counter NASIDS, like Ibuprofen or Aspirin, daily. And especially after a run. These anti-inflammatory drugs will help dull the pain that bursitis brings. Over time, they will also begin to target and decrease the swelling and irritation of the bursa sacs. NASIDS are especially beneficial when combined with an icing regimen, which helps draw the blood containing the active ingredients to the affected area.
  • Crutches and Braces—Depending on where the bursitis is located, and how bad it’s gotten, some doctors will prescribe the use of crutches, splints or braces to help rest and repair the joint. Compression bandages are often used for elbow bursitis. While crutches are used for hip, knee or heel issues. Splints are a common way of forcing rest for wrist bursitis as well.
  • Physical Therapy—Stretching and strengthening the muscles surrounding the affected joint is another common treatment option for Runner’s Bursitis. Exercises that loosen and strengthen the rotator cuff, adductor, and quadriceps, as well as the gluteus medius muscles can help alleviate the pain that comes with shoulder bursitis, hip bursitis and knee bursitis. Also ensuring the muscles of the calves are loose and conditioned, and that the ankles are properly rolled out before and after exercise can help with Achilles (or heel) bursitis.
  • Corticosteroid Injections—Especially for bursitis in the shoulder and wrist, corticosteroid injections in the joint may help with the pain. The steroids help to lubricate the joint and to reduce the swelling. These injections are most commonly used in cases of olecranon bursitis (or elbow bursitis) to bring down the enormous swelling that accompanies this type of bursitis. But they can also be used in other areas, either on a solitary or ongoing basis, to help provide temporary or permanent relief. It’s important to note that this is not always the best solution. Too many injections can cause damage to the bursa or the other tissue surrounding the joint and can bring on an entirely new injury.
  • Surgery—While surgery is often the last resort for treatment, and not needed in the majority of bursitis cases, it is occasionally used for more advanced or severe instances of runner’s bursitis. Only after trying all possible alternatives will physicians begin discussing surgery with their patients. There are several different methods of surgery for bursitis, but all involve the removal of the injured bursa sack. Sometimes a man-made alternative will be inserted, and sometimes there will be a complete omission of any medically assistive device (some joints—like the hip— don’t actually need a bursa sac to perform regularly).

Prevention

Trochanteric bursitis is the number one cause of pain around the hip joint. And while many treatment plans exist, the most useful—and easiest— plan is the prevention of bursitis in this and other joints. Not all types of bursitis are preventable (some, like those caused by certain types of arthritis, are literally written into you gene sequence), but most are.

The top methods for preventing runner’s bursitis are:

Let’s take a more detailed look at each of these methods.

  • Weight loss—Weight loss might seem like the hardest method of all (hey, no one said that shedding those extra pounds would be easy!), but if you are overweight, it can be the most effective and worthwhile. When our bodies carry too much weight, they begin to overwork our joints. The pull of gravity on those delicate junctures creates damage over time. Sometimes the bursa can be permanently warped, or bone and muscle irregularities can be created that cause friction and aggravate the bursa as it moves over them. Speak to your doctor, and ask if your weight is something that might cause more issues over time. If it is, consider developing a weight loss plan to help ease the symptoms of your bursitis.
  • Avoidance of repetitive activities—Another hard preventative method, but definitely one that’s worth it for runners. At the first onset of pain in any of the major joints, you should take a break from training. Rest and ice for a couple of days to a couple of weeks, and you might get away with a very mild case of bursitis. In some cases an alternative activity to running, that doesn’t intensify the friction on the joints, such as swimming or biking, might be acceptable during this period of rest. In other cases running on a softer terrain, like grass, trail or treadmill might count as a period of rest. And in some cases, a total physical stop to exercise might be what it takes to ease the bursitis pain. In any case, consult your physician. And after you’re cleared to begin running again be sure to start slowly and to gradually increase distance, speed and time, or else risk experiencing the second onset of pain and inflammation.
  • Increasing flexibility and strength—When the muscles surrounding the major joints (hip, shoulder, knee, elbow, wrist, and heel) are strong and flexible the joints are able to work more smoothly and with less friction. Making sure to incorporate exercises that strengthen rotator cuffs, adductors, glutes, quadriceps and calves, will help ensure that these muscles will pull less on the joints, create less friction, and in turn less inflammation of the bursa. The same goes for ensuring that the tendons and ligaments, like the Achilles tendon and those surrounding your ankle, are gently stretched before any physical activity. Tearing and pulling any tendons and ligaments surrounding a joint can lead to loose joints and decreased joint stability, a consequence of which could be bursitis.
  • Shoe inserts—For many people with legs of different lengths, the discrepancy is barely noticeable as the actual difference in length is less than a centimeter. These people can go about their normal lives and activities with no pain or discomfort. But for those with a bigger difference in length, pain comes more easily and frequently. Our bodies are able to find ways to compensate for this length discrepancy, either by altering our gait, hip tilt or use of certain muscle groups. These compensations allow us to engage in normal activities. While these alterations might sound minor, they actually end up throwing the entire body into an imbalance. This body imbalance is what brings the pain to the joints of the lower extremities. Doctors have found that high-intensity athletic activity makes this body imbalance worse and increases pain. Wearing a shoe insert, which raises the heel, will make the legs the same length, fixing the body imbalance and eliminating the pain. Shoe inserts are also helpful for those that experience bursitis in the ball of their foot. A cushioned insert placed in the shoe will help soften the blow every time a step is taken and will reduce the amount of friction the bursa will experience.

Stretches and exercises for Runner’s Bursitis

 There are several stretches and exercises that help ease and eliminate the pain associated with Runner’s Bursitis. Below are several of our favorites.

Hip

Gluteal Stretch

  1. Lie on your back with both knees bent.
  2. Rest the ankle of your injured side on top of your opposite knee.
  3. Grab the bottom of the uninjured thigh and pull your leg towards your chest.
  4. Continue until you feel a stretch along the side of the glute and thigh.
  5. Hold 15-30 seconds, repeat 3 times.

Iliotibial Band Stretch

  1. Cross your uninjured leg in front of your other leg.
  2. Without bending your knees, reach towards your toes.
  3. Hold 15-30 seconds, repeat 3 times.

Clam Exercise

  1. Lie on your uninjured side, with hips and knees bent and feet together.
  2. Raise the top leg to the ceiling without taking the feet apart; hold for 2 seconds.
  3. Do 2 sets of 15 repetitions each.

Prone Hip Extensions/Straight Leg Raise

  1. Lie on your stomach, with legs straight behind you and head resting on arms.
  2. Tighten abdominals, as well as glute and thigh of the injured leg.
  3. Lift the injured leg about 8 inches off the floor (keep the leg straight).
  4. Hold for 5 seconds.
  5. Do 2 sets of 15 repetitions each.
  6. Flip to your back and repeat the exercise.

Knee

Hamstring Stretch

  1. Lie on your back close to a doorway.
  2. Stick your uninjured leg through the doorway, and, with a straight knee, raise your injured knee to the wall.
  3. Keeping your leg as straight as possible let it rest on the wall for 15-30 seconds. You should feel a stretch along the back of your thigh.
  4. Repeat 3 times.

Standing Calf Stretch 

  1. Stand to face a wall, with your hands bracing at eye level.
  2. Place your injured leg behind your body, and move the uninjured leg towards the wall, bending the knee slightly.
  3. Turn your back foot inward slightly.
  4.  Slowly lean into the wall until you begin to feel a stretch in the back of your calf.
  5. Hold for 15-30 seconds.
  6. Repeat 3 times.

Heel

 Soleus Stretch

  1. Stand to face a wall, placing feet in a toe-to-heel line (injured heel behind, healthy heel in front).
  2. Bracing yourself against a wall, keep both heels firmly planted.
  3.  Bend the knees and lean into the wall until you feel a stretch.
  4. Hold for 15-30 seconds.
  5. Repeat 3 times.

Heel Drop Exercise

  1. Place both feet side by side on a step.
  2. Scoot back so that the back of both feet hangs off the step (from about mid-arch to heel).
  3. With the front half of the foot secured, push both feet to relieve.
  4. Slowly, with a controlled movement, lower the heels below horizontal, until you feel a stretch in the Achilles.
  5. Repeat 10-15 times.

Shoulder

Posterior Stretching Exercise

  1. Angling your injured arm diagonally across your body, use your uninjured arm to grab the elbow of the injured arm.
  2. Gently pull your injured arm up and across your body.  Continue until your hand extends above the top of your shoulder.
  3. Hold for 15-30 seconds.
  4. Repeat 3 times.

Overhead Stretch

  1. Stand at arm’s length away from a steady surface (counter, table, chair, etc.), and grasp it tightly with both hands.
  2. Slightly bend your knees, but keep the arms straight.
  3. Bend at the waist, lowering your upper body below horizontal, until you feel a stretch in your shoulders.
  4. Hold for 15-30 seconds.
  5. Repeat 3 times.

Elbow

Elbow Extension Stretch

  1. Extend your injured arm in front of you, with your elbow straight and your palm facing away.
  2. Bend your wrist 90 degrees, so that your fingertips point at the ceiling.
  3. With your uninjured arm, gently push your hand and wrist farther back until you feel a stretch in the elbow.
  4. Hold for 15-30 seconds.
  5. Repeat the stretch with the fingers facing down to the floor (as opposed to up at the ceiling).

Pronation and Supination Flips

  1. Bend your injured arm 90 degrees, and, keeping your elbow at your side, make a fist.
  2. Without moving your elbow or shoulder, slowly turn your forearm as far as you can in both directions.
  3. Hold each extreme for 6 seconds.
  4. Repeat the stretch 10-12 times.

To Sum It Up

 Runner’s Bursitis is an umbrella term for a condition that affects the small, fluid-filled, bursa sacs that provide a cushion between bone and muscle in a runner’s body. Bursitis in runners is most commonly found in the legs and feet at the major joints—the hip, knee, Achilles heel, and ball of the foot. However, it can also be found in the shoulder and elbow. Bursitis is brought on by repetitive movement (i.e. the pounding of the sidewalk as you log your daily miles). It is often characterized by swelling, redness and continuous pain. Not to be confused with Arthritis or Tendonitis, Bursitis can be treated easily with NASIDS, ice and rest. Only in some extreme cases will it require corticosteroid shots or surgery. Runner’s Bursitis can be prevented by ensuring that the muscles surrounding the major joints are properly stretched and conditioned.

Ensuring that your training plan ramps up appropriately, and consulting a doctor after the first signs of pain are important steps in bursitis treatment and prevention. Understanding and caring for your body are key components of a long and healthy running career!

Disclaimer

 The information found in this article was pulled from scientific studies and the online resources of several credible medical professionals and organizations. We do our best to make sure that everything discussed is accurate and informed, but this article is not meant to take the place of professional medical advice. You should always consult a doctor when experiencing any sort of unfamiliar pain in order to get a comprehensive and personalized diagnosis. Happy running!

 

Sources

  1. American Academy of Family Physicians, Bursitis of the Hip, Family Doctor, May 15, 2017
  2. American Academy of Orthopaedic Surgeons, Hip Bursitis, American Academy of Orthopaedic Surgeons, May 15, 2017
  3. Government of Alberta, Elbow Bursitis: Exercises, My Health, May 15, 2017
  4. Government of Alberta, Shoulder Bursitis: Exercises, My Health, May 15, 2017
  5. Judith Manzon, Soft-Tissue Rheumatic Conditions, May 15, 2017
  6. Mayo Clinic, Bursitis, Mayo Clinic, May 15, 2017
  7. National Institute of Health, What are Bursitis and Tendonitis, US National Library of Medicine National Institutes of Health , May 15, 2017
  8. Philip S. Weinstein, Juan K. Canoso, Jeffrey R. Wohlgethan, Long-term Follow-up of Corticosteroid Injection for Traumatic Olecranon Bursitis, British Journal of Sports Medicine , May 15, 2017
  9. Sports Injury Clinic, Achilles Tendonitis Exercises, Sports Injury Clinic, May 15, 2017
  10. Summit Medical Group, Hip Trochanteric Bursitis Exercises, Summit Medical Group, May 15, 2017
  11. Summit Medical Group, Kneecap Prepatellar Bursitis Rehabilitation Exercises, Summit Medical Group, May 15, 2017