BURSITIS AND TENDONITIS

MANY PEOPLE OVERDO. When you spend Saturday repainting the bedroom after sitting in a desk chair all week, how do you treat the sore shoulder that follows? Must be sore muscles, you shrug (or try to), deciding to work out the stiffness by relaxing on the golf course. The pain increases with each swing, but, hey, it's only nine more holes. A few days later, you can barely raise the phone to your ear. What's going on?

Any time you put excessive or unaccustomed demands on your body, you risk stirring up inflammation. Repetitive motions are particularly likely to inflame two joint structures: the tendons and the bursae. A tendon attaches muscle to bone. A bursa is a fluid-filled sac that cushions and reduces friction in joints.

Inflammation of these structures is called tendonitis and bursitis, respectively. Tendonitis is likely to affect the wrist, shoulder, elbow and knee; bursitis, the shoulder, elbow, hip and knee. Both can occur at once.

THE COMMONSENSE SORENESS CURE

If you suspect you've inflamed a tendon or bursa, protect it from further motion. Put your arm in a sling if your shoulder or elbow hurts. Get off your feet if it's your knee or hip. After a few days of babying the injury, begin to put the affected joint through its full range of motion - gently. Otherwise, you risk getting what's called a frozen joint. Frozen shoulder syndrome is particularly common and requires physical therapy to break up the adhesions that begin to bind the joint.

While lying on the sofa, apply a commercial cold pack, a bag of crushed ice, or a bag of frozen peas or sweetcorn over a damp cloth to protect your skin. Leave the ice in place for 15 to 20 minutes and repeat three or four times a day for the first few days.

THE HEALING POWER OF PROTEASES

Proteases are protein-digesting enzymes. They can help resolve inflammation by breaking down some of the inflammatory debris and improving circulation. Studies have shown benefits of proteases following blunt trauma and minor athletic injuries.

Two common proteases are found in fruits: papaya contains papain and pineapple contains bromelain. These can also be taken, between meals, in supplemental form.

Edmund R. Burke, Ph.D., director of the Exercise Science Program at the University of Colorado at Colorado Springs and author of Optimal Muscle Recovery, recommends selecting an enteric-coated protease product to help resist breakdown by stomach acid. Also, he prefers using proteases in a combination that includes bromelain, papain, trypsin, and chymotrypsin. Enzyme combinations vary product to product, so follow manufacturer's directions on dosage.

WHEN TO SEE YOUR DOCTOR

If you experience any of the following symptoms, check with your doctor or other health-care practitioner. You may have an injury that needs more than home care.

1. ignificant pain and swelling

2. Loss of significant range of motion in that joint

3. No improvement in the injury after two or three days of rest and ice

DRUG TREATMENT

Analgesics
Aspirin, paracetamol, ibuprofen, naproxen, ketoprofen. Function: ease tendonitis or bursitis pain.
Aspirin side effects: heartburn, indigestion, stomach irritation, and mild nausea or vomiting.
Ibuprofen, naproxen and ketoprofen side effects: continuous use may irritate stomach lining; long-term high-dose use may damage the liver or kidneys.
Paracetamol side effects: long-term use or higher dosages may damage the liver or kidneys.

HERBAL REMEDIES

Turmeric (Curcuma longa)
Long prized as an anti-inflammatory and antioxidant agent, turmeric is now the subject of studies examining the effect of its active ingredient, curcumin. In labouratory experiments, curcumin proved as effective in reducing inflammation as the potent anti-inflammatory drugs hydrocortisone and phenylbutazone, but without the side effects. In Ayurvedic medicine, turmeric is used both topically and internally for sprains and other muscle injuries.
Typical dosage: 400 to 600 milligrams in capsules three times per day. (Some products formulate curcumin with bromelain to improve absorption from the intestines, or with flaxseed oil to boost anti-inflammatory effects.)
Caution: high doses of curcumin may irritate the lining of the stomach and intestines. Do not take if you have ulcers, gallstones or bile duct obstruction. Not recommended if you are pregnant.

Ginger (Zingiber officinale)
With its anti-inflammatory, antioxidant and pain-relieving properties, ginger works, scientists have found, by inhibiting the production of inflammatory chemicals called prostaglandins and leukotrienes. A compound in ginger called 6-shogaol can mildly reduce pain, probably by blocking the nerves' transmission of pain signals.
Typical dosage: up to eight 500-milligram capsules per day; or 10 to 20 drops of tincture three times per day; or % to 1 teaspoon of the ground root per day; or 10 grams of fresh ginger (about a 6-millimetre slice) per day.
Caution: do not use if you have gallbladder disease.

Cayenne (Capsicum annuum)
Topical use of capsaicin, the compound that gives hot peppers their kick, has been the focus of a lot of pain research. When first applied to the skin, capsaicin initially activates pain nerves, then renders them unresponsive, thereby relieving pain. It will also increase blood flow and make the injured area feel warm. This effect may not do much, however, for the deeper pain of tendonitis and bursitis. You'll have to be the judge of whether these commercial creams work on your pain; apply them as the manufacturer directs. Cayenne has benefits as an antioxidant when taken internally, and contains high concentrations of salicylic acid, the chemical relative of acetylsalicylic acid (aspirin).
Typical dosage: up to three 400- to 500-milligram capsules per day; or 5 to 10 drops of tincture in water. Caution: he sure to wash your hands with soap after applying cayenne or capsaicin creams to avoid spreading the heat to eyes, nose or other sensitive tissues. Do not take with blood-thinning drugs, such as warfarin.

Willow (Salix alba and other Salix spp.)
This tree and other salicylate-containing plants - meadowsweet (Filipendula ulmaria), wintergreen (Gaultberia procumbens) and black birch hark (Retula lenta)-are very mild pain relievers. In fact, they're so mild that some experts think they can't possibly have a pain-relieving effect. Others swear by them.
Typical dosage: three 500-milligram capsules per day; or 5 to 10 drops of tincture in water three times per day.
Caution: Excessive doses may irritate the gastrointestinal tract. Do not take with blood thinners, such as warfarin. Do not use wintergreen or black birch oil internally.

Liquorice (Glycyrrhiza glabra)
This sweet-tasting root inhibits inflammation in two ways: it decreases generation of damaging molecules called free radicals at the site of inflammation, and it inhibits an enzyme that's involved in the inflammatory process.
Typical dosage: one 500-milligram capsule three times per day; or 20 to 30 drops of tincture three times per day; or 3 cups of tea per day (boil % teaspoon of herb in /, litre of water for 15 minutes). Because liquorice has an intensely sweet taste, you might want to blend it with other herbs when you make tea.
Caution: do not take liquorice for more than six weeks. Do not take it if you are on diuretics (water tablets), if you're pregnant, or if you have high blood pressure, diabetes, thyroid, kidney, liver or heart disease.

Boswellia (Boswellia serrata)
This gum resin extract has anti-inflammatory and analgesic properties. Whether it specifically relieves pain and inflammation has not been studied, but the way it acts on a biochemical level to inhibit inflammation suggests that it would. Typical dosage: follow the manufacturer's instructions.

Devil's Claw (Harpagophytum procumbens)
Scientific studies have confirmed that devil's claw reduces pain and inflammation. According to Francis Brinker, N.D., author of Formulas for Healthy Living, the root of this African plant has become popular in Europe for pain relief.
Typical dosage: up to six 500-milligram capsules per day; or 30 drops of the tincture three times per day. Caution: do not take if you have gastric or duodenal ulcers.

Peppermint (Mentha Y piperita)
Mint contains menthol, an aromatic oil. It acts as a counterirritant, a substance that causes an irritation that blocks another form of irritation.
In this case, the cooling sensation of mint oil interferes with the sensation of pain. Many commercial and herbal liniments contain menthol; use them as the manufacturer directs. Alternatively, combine 10 to 15 drops of peppermint essential oil with 2 tablespoons of vegetable oil and apply as needed to the sore area.
Caution: Some people develop an allergic skin rash when they contact peppermint essential oil or pure menthol. Try a test patch before slathering on a menthol-containing ointment.