plural form of bursa
Bursitis of the Knee is a painful condition in which one or more of the 11 bursa sacs in the knee become irritated and inflamed, affecting the bursa and the soft tissue around it. A bursa is a sac of synovial fluid, rich in protein and collagen that acts as a cushion to protect soft tissue from rubbing - usually against bone. Bursae exist to protect soft tissue (such as tendons, ligaments and muscle) from friction and excess pressure; without bursae, inflammation and/or tearing of soft tissue is probable.
If you experience bursitis, then the bursa sac has become swollen with synovial fluid, blood and or pus. If the bursa fills with blood, it is usually due to trauma - a specific injury such as a fall or perhaps even a car accident. If the bursa sac contains pus, this means it is infected (also known as septic) and you are advised to seek medical attention immediately as this can quickly become life threatening. In any case, once the bursa has swollen then the bursa can no longer serve its purpose as a friction reducer; you will most likely find that the swollen bursa sac(s) can cause a lot of pain and interrupt your lifestyle quite significantly.
We have approximately 160 bursae in our bodies with most of them located in our joints - usually sandwiched between tendons and bone. Bursae in the knee include the suprapatellar bursa, prepatellar bursa, infrapatellar bursa (deep & subcutaneous), anserinus bursa, pretibial bursa, fibular bursa, fibulopopliteal bursa, subpopliteal bursa, gastrocnemius bursa (lateral & medial) and the bursa semimembranosa. The most commonly inflamed Bursae in the knee are the prepatellar bursa followed by the infrapatellar bursa, pes anserinus bursa and suprapatellar bursa.
There are 2 different kinds of bursitis - "septic" and "aseptic" bursitis. If your bursa becomes infected, it's known as "septic bursitis". Septic bursitis is not something to take lightly, as an infected bursa can spread infection throughout the body and become life-threatening. Consult your physician if you think you have septic bursitis as only they can confirm the condition and prescribe proper treatment options.
"Aseptic bursitis" will happen when your bursa isn't infected but your bursitis has been caused by inflammation from another soft tissue injury. For knee bursitis this might mean that you've hurt some of the soft tissue in the knee from a trauma (like a fall) or from repetitive damage over time as can be imagined from certain professions such as carpet installation or roofing.
Bursae in the knee are most often injured from overuse or as a result from excessive strain (even a traumatic accident or fall). Bursitis is most common in males (80%) between the age of 40 and 60; however bursitis that occurs due to trauma is most common before the age of 35. (reference: link)
Poor posture, knee joint degeneration (arthritis, osteoarthritis), auto-immune disorders (gout, psoriasis, thyroid disease), previous surgical intervention, bone spurs / calcium deposits, prolonged kneeling and leg-length discrepancy (one leg is shorter than the other) are all risk factors for knee bursitis (reference: 1). Basically, degenerative conditions affecting the knee or any type of injury or condition that alters the way you walk, stand or sit can lead to a change in the position of the bones and tissue in the knee joint - and these changes in positioning can result in knee bursitis. Degenerative conditions like osteoarthritis or arthritis, can also be hereditary; you may experience more problems in your knee and/or hip if you have older family members that have suffered from similar conditions in the past.
Everyone can be affected by degeneration of their knee joints over time. As we age, our tissue ages too. Any repetitive or frequent movement can place stress on the bursae in your knee over the years. This includes restricted movement due to sitting at a desk job for years, careers that require constant knee bending or resting on the knees, or even physical activities on the weekend. Be aware that knee bursitis can happen to anyone - especially if due to trauma - and it is not just something that happens to someone else.
In most cases, mild to moderate knee bursitis can be treated through conservative treatments outlined by a physician.
Recovery from knee bursitis can take a long time but proper healing is essential to regain strength and get you back to the activities you enjoy. Complete recovery can be easily delayed by re-injury to the tendons, ligaments or other soft tissue in your knee.
It's almost impossible to keep from re-injuring soft tissue in your knee - especially if you incur knee bursitis due to an overuse injury. If you don't take care to remove the underlying cause of your knee bursitis you will always be at risk of re-injury. Sometimes though, it's just not possible to stop everything and rest the injury properly; if your job is the reason you are suffering from knee bursitis, you need to seriously evaluate whether you should change professions - at least temporarily. What ends up happening is we continually re-injure tissue in the knee through our work and daily activities and suffer through on-going flare-ups of knee bursitis - continually setting back our recovery time.
Unless you seriously choose to rest your knee and let the injury heal, you will find that 100% recovery is nearly impossible without proper therapy. Eventually, if left untreated, you might have chronic inflammation of your bursa and/or surrounding soft tissue; treatment becomes even more problematic at this point (you might need surgery to remove your bursa).
Prepatellar Bursitis is also known as "housemaid's knee"
The prepatellar bursa is located in front of the kneecap and takes the form of a flat, round structure. Its main function is to separate the kneecap from the patellar tendon and skin on the front of the knee. Prepatellar bursitis has historically been known as Housemaid's Knee as this condition is often associated with people whose work required kneeling for extended periods of time.
To learn more about prepatellar bursitis, click here.
Infrapatellar Bursitis is sometimes known as "clergyman's knee, plumber's knee, parson's knee, vicar's knee, hoe's knee"
There are 2 infrapatellar bursa and both are located below the kneecap. The deep infrapatellar bursa lies beneath the patella tendon - the tendon connecting the kneecap to the tibia bone (lower leg). The superficial infrapatellar bursa lies in front of (or above) the patellar tendon. Despite the fact that they lie on opposite sides of the patellar tendon, it can be difficult to determine whether one or the other (or both) are causing discomfort.
To learn more about infrapatellar bursitis, click here.
Pes Anserine Bursitis
Pes Anserine Bursitis is also known as "goosefoot bursitis"
There is an area just below the knee joint on the inside (medial) part of the leg where the sartorius, gracilis and semitendinosus muscles (these are basically hamstring muscles) attach to the tibia (lower leg bone) just above the shin. These 3 muscles attach via tendons and these tendons effectively join together as they approach the bone. If you look at an image of the tendons, the form is similar to a goosefoot - ergo the term goosefoot tendon. There is a bursa between the goosefoot tendon and the tibia bone to prevent the tendon rubbing against bone, and this bursa is the pes anserine bursa, or more commonly termed the "goosefoot" bursa.
To learn more about pes anserine bursitis, click here.
General Information about Bursitis
Important: In some cases, an inflamed bursa may become infected with bacteria (referred to as septic bursitis) and this can quickly become life threatening! In all cases where you suspect you may have bursitis, see a physician for full diagnosis. If the bursa is septic (infected), getting to a doctor quickly may save your life.
There are two types of bursitis: chronic and acute. Chronic bursitis is caused by overuse or repetition of a certain area or joint. It will develop over time, and will likely get better and flare up over a long period of time. Acute bursitis is often the result of a trauma to the knee, such as a fall. It can also result from a simple movement such as lifting and twisting the wrong way or may come on quickly following irritation during knee surgery.
Some suffers cannot recall what triggered the knee pain, which is why some will not seek treatment, hoping it will resolve itself. However, it is always wise to address and deal with knee pain as soon as possible so that the problem does not worsen.
Knee Bursitis Symptoms
A healthy knee bursa is typically quite small, but it can swell very significantly when bursitis sets in. This is what creates the soft tissue damage in the area. Most symptoms of knee bursitis are specific to which type of knee bursitis you have, also common symptoms you may experience include:
- Pain around the bursa location that may extend up or down from the knee
- Swelling, tenderness in the area of the bursa
- Pain will probably increase when the knee is flexed
- Difficulty sleeping due to pain
- The area around the bursa is hot to the touch
- Stiffness and tightness in the knee joint due to tightened muscles and/or tendons
Knee Bursitis Causes
Bursitis of the knee has been found to be statistically more prevalent in cases where the sufferer is involved in, or experiences one or more of the following factors:
- Running, or participation in sports that involve a lot of load on the knee(s)
- Activities which require repeated kneeling (i.e. roofing, floor installer, floor cleaning, gardening)
- Bone spurs or calcium crystals that form inside can irritate the bursa
- An injury or blow to the knee
- Uneven leg length that causes excess pressure on the bursa in knee joints
- Being Overweight can increase your risk of contracting knee or hip bursitis.
- Following surgery in the knee in which the bursa may have been irritated
- Suffering from certain disorders such as arthritis, gout or diabetes has been known to increase your risk of contracting bursitis.
The Painful Symptoms of Acute & Chronic Knee Bursitis
The pain you'll feel for acute (short-term) vs. chronic (long-term) knee bursitis will be different. In the beginning you might feel a sharp, intense pain at your knee - however, the longer you have this injury the more this pain is likely to spread out into more of an achy feeling. One clear sign that you've re-injured your knee while recovering from knee bursitis is feeling that sharp, intense pain again if you've overworked it.
You may even notice an intense pain while getting up from a seated position - especially if you have a desk job, spend a lot of time seated on the couch or a kitchen chair during your "down time" or drive in your car for long distances.
Over time, if left untreated, you will start noticing more and more constant pain and have trouble sleeping at night. As I mentioned before, if this injury is left untreated you might need to get your bursa removed through surgery (a bursectomy). You might even suffer from "septic" bursitis - where your bursa gets infected by a bacteria. On-going pain, chronic swelling, or symptoms of an infection (fever or a general sick feeling) should be treated immediately by a doctor.
What Should I Do?
If you think that you're suffering from knee bursitis and your mobility is steadily declining, the first thing you need to do is see your doctor. Only your doctor can give you a proper diagnosis and from this, determine a course of proper treatment.
If you've been diagnosed with knee bursitis,
- After seeking medical advice, your doctor may decide to aspirate (drain fluid from) the bursa, surgically remove the bursa (known as a bursectomy) or recommend conservative treatment options. Usually conservative treatment methods are all that's needed to treat bursitis - surgery is only ever used if long-term conservative treatment methods don't work. Conservative treatment options for bursitis typically include rest, icing of the injury, elevation and anti-inflammatory medication (reference: 1, 2, 3).
- Second, if your doctor has decided that your injury can be treated with conservative treatment options, then you'll find that many of our customers have had great success treating themselves with our powerful conservative treatment products - the Knee T•Shellz Wrap® and Arnica Pain Relief Cream.
- Or, if surgical intervention is required, talk with your doctor about using these same products for post-surgery recovery as you will find them to be effective for reducing post-surgery inflammation, enhancing range of motion and reducing scar tissue growth.
... and Re-injury to your knee must be avoided at all costs!
Time is hard on an immobilized joint - you lose strength in your knee but worse than that, you lose the range of motion from atrophy (your flexible tendons, muscles and ligaments slowly shrink / waste away, decreasing joint elasticity). The more time that goes by with your knee immobilized, the more likely you'll wind up with a chronic problem (long term injury such as tendonitis or chronic inflammation / bursitis pain). Basically it means that your knee won't perform as well as it once did and it becomes more prone to injury again later on.
If you have an inflamed bursa in your knee, it's very important to heal it quickly and completely. Minimizing the healing time of your knee bursitis should be an obvious goal, as knee bursitis will limit your ability to go about your daily routine. As stated here (MedicineNet.com), if your long-term (chronic) knee bursitis is left untreated, calcium deposits can form within the bursae. These calcium deposits can lead to permanent stiffness in your injured knee.
Dealing with continuous re-injury, chronic inflammation / swelling and the possibility of getting calcium deposits means you'll have a greater chance of winding up with a chronic knee condition or a serious case that needs to be resolved with surgery.
You need to avoid chronic inflammation and the potential for developing calcium deposits. If you don't, your knee bursitis injury may plague you forever. This is why it's so important to continuously use conservative treatment tools to heal any recurring soft tissue damage and swelling from your bursa before it can build into something big. For any knee bursitis sufferer, having the right tools makes all the difference.
Treatments for Knee Bursitis
Relieving the symptoms of bursitis initially focuses on keeping the pressure off the bursa. Surgery may be required if your bursa irritation is a result of a bone formation problem, such as a bone spur. If your bursitis is caused by an infection (septic bursitis), the doctor will probably drain the bursa sac with a needle and prescribe antibiotics to treat the infection. For non-infectious bursitis, the preliminary treatment starts with non-operative options such as cold compression therapy via use of a Cold Compress or Ice Pack.
The most important factor in healing bursitis is resting your knee. This can be difficult when you have to carry on with daily activities, but resting whenever you can is recommended. During your recovery you will probably have to modify or avoid the activities that stress your bursa until your pain and inflammation settle.
Treatments should involve decreasing swelling, relieving stress on the knee joint, correcting any bio-mechanical dysfunction (uneven leg length, bone spur, etc.), treating scar tissue, and then finally restoring strength and movement in your leg and knee. Deep Tissue Therapy is recommended once inflammation has been calmed to heal the bursa and surrounding tissue faster and reduce the risk of bursitis returning.
Cold Compress or Ice Pack Cold Therapy
To decrease inflammation and relieve the pain of trochanteric bursitis doctor's recommend cold therapy. Applying cold to your inflamed bursa is the first step in treating bursitis - basically it gets the swelling down.
T•Shellz Wrap® Deep Tissue Regeneration Therapy
Once the inflammation of your bursitis has been reduced with cold therapy it is time to take the next step in bursitis treatment. Use a Knee T•Shellz Wrap® to improve blood flow while simultaneously helping surrounding soft tissue to become elongated and more elastic. What this means is that not only is increased blood flow helping the bursa and surrounding soft tissue to heal, the tendons/muscles/ligaments that were rubbing on your bursa are now longer and more elastic. The T•Shellz Wraps are basically the perfect bursitis treatment - helping reduce friction and rubbing on the bursa while healing at the same time!
How Do You Use a T•Shellz Wrap® (Heat) to Heal a Soft Tissue Injury in Your Knee?
HEAT (warmth) is used after you've reduced your swelling / inflammation and the sharp pain is less intense (you have more of a dull / nagging ache and soft tissue tightness in your knee). Warming up deep tissue using Electromagnetic Energy is a natural way to encourage healing of bursitis and heal surrounding soft tissue. Increasing the temperature of deep tissue results in increased blood flow circulation as the body sends more blood to attempt to remove this same heat. It's the blood in your body that will bring oxygen, nutrients, antibodies and energy to your injured knee to help with healing.
When heat is applied to deep tissue in the knee, veins will start to get bigger (expand) to allow more blood flow through to your damaged or torn soft tissue. This in turn relaxes your knee, making the tissue more flexible and elastic. This is why heat is used on older (chronic) injuries, to loosen tissue and bring in the blood flow needed for healing. Your body will begin to heal itself after it is injured - increasing your blood flow with heat will speed up this natural process - often surprisingly well.
Doctors usually call this process 'Vasodilation'.
Heat can Make Inflammation, Swelling and Newer Injuries Worse - How?
When we injure ourselves, we start healing right away. The body will naturally raise the temperature at the site of the injury resulting in the inflammatory response (redness, heat sensation, inflammation and swelling). This 'fake fever' leaks blood flow to the area to cool it down and start the healing process.
Adding 'heat' to your knee when it's already inflamed and tender may make your body think there's a new threat to your tissue and increase the pain in order to get you to stop. For some people applying heat on inflamed / swollen tissue will cause the injury to swell-up even more (as much as 3 times larger than normal). You'll feel even more pain as the pressure builds in your knee.
Heat is NOT a good treatment method for inflamed soft tissue, new injuries (within the first 24 to 72 hours), right after surgery or right after a re-injury (over-use and/or sharp, throbbing pain). In these cases, heat should be applied later on in the healing cycle. In the meantime, use a Cold Compress or Ice Pack to decrease any inflammation induced pain.
When To Use Heat to Treat Your Injured Knee
A T•Shellz Wrap® temperature treatment works best to increase blood flow circulation and stimulate healing for older (chronic) injuries, re-injury (after swelling has been reduced) and during long-term post surgery recovery. Warmer temperatures should be used approximately 3 to 5 days after you first have the injury. Heat should not be started for a least 2 weeks after surgery because inflammation levels will be very high as the healing process starts over again. Any use of heat should also be combined with gradual movement to stretch out your hip and increase range of motion.
If you have a chronic knee injury that keeps getting re-injured you should use heat before activity to loosen up your tissue (making it more flexible). When used at this time the warm temperatures naturally extend the elasticity (elastic-nature) of the joint, making it more movable / pliable for activity.
Sometimes we feel pain while doing a certain activity - should you still use heat? Using heat in the morning before you start your day or before activity can help to boost the healing process and reduce your risk of re-injury. Too much heat (especially when you suffer a set-back with swelling / inflammation) can make your inflammation worse. Cold treatments with a Cold Compress or Ice Pack should be used part-way through your day when you suffer from on-going pain and inflammation as a natural pain-reliever.
Keep using Deep Tissue Regeneration Therapy before activity and when you notice any stiffness in your knee to 'warm up' your muscles, tendons & ligaments - and stimulate healing.
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Anti-Inflammatory Medications for Bursitis
NSAIDs, non-steroidal anti-inflammatory drugs, can be used if required to help manage your pain. However, these aren't recommended for long term use, as they can cause gastrointestinal difficulties and increase the risk of cardiovascular disease. The T•Shellz Wrap®, when used in conjunction with NSAIDs can greatly improve the effect of the medication; this can not only help you heal quickly but also reduce the amount of NSAIDs that you ultimately may require.
Surgical Procedures for Bursitis
Your doctor may aspirate your inflamed bursa. This involves removing the extra fluid that has built up with a needle. Sometimes, the fluid will be tested at a laboratory to rule out infection.
If your bursitis does not get better with conservative treatments, the bursa may be surgically removed. Usually this is done by arthroscopic surgery - a procedure where tiny incisions are made and a pencil-sized camera is inserted through one of the incisions. A small shaver is inserted into another incision, and is used to remove the swollen bursa all together. The surgeon will then look for any damage in the area and make repairs if necessary. This is also done to remove any bone spurs.
Recovery time for the surgery will depend on a number of different factors including your healing ability, diet, rest and how many procedures were done in your surgery.
Post-op recovery time can be reduced with the use of conservative treatments recommended by your physician. Cold compression is recommend by doctors following surgery to treat your pain in a natural, non-addictive way and to reduce swelling. Once the incision has healed, speak with your doctor about the use of a T•Shellz Wrap®. Deep heat from the T•Shellz Wrap® encourages the body to increase blood flow in the treatment area. This increased blood flow brings mroe oxygen and nutrients into the area, helping speed up the body's healing process. Once your physician approves usage of the Knee T•Shellz Wrap® following your surgery, the deep heat will help your soft tissue flexible and elongated, helping prevent and/or minimize scar tissue growth that will form as your soft tissue heals. Treating scar tissue is the most important step following surgery, especially in a joint, to improve range of motion; leaving the scar tissue untreated can lead to stiffness, chronic hip pain, osteoarthritis or other chronic conditions - this is why physical therapy is such an important component of surgery recovery.
Rehabilitation Exercise for Bursitis
Physical therapy is a beneficial way to restore atrophied muscles and improve strength and mobility after treating bursitis. The type of physical therapy and the duration will be dependent on the tissue damage and your symptoms. When you are treating or recovering from bursitis, it is important to ensure you do not perform any exercises that will further irritate the bursa.
Once your pain starts to diminish, a physiotherapist will set up an individualized strengthening and stretching exercise program for you to perform at home or in the gym. This will be based on your needs and abilities, and will help you return
to performing your normal routines.
Individuals will often lift weights on their own, to try and build up their strength. However, in doing so, they can do more damage to their joint. It is extremely important to strengthen your muscles properly, as they may have weakened during the period of non-use. A trained therapist will help to ensure your rehabilitation process is appropriate and effective. For best, long term results use T•Shellz Wraps at home, in conjunction with physical therapy and an exercise program.
We've helped thousands of people treat their painful injuries and conditions to get them back on the road to a pain-free life!
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Our customer service lines are open 5 days a week helping people understand their injuries and how to treat them. Simply call toll free 1-866-237-9608 to talk or place an order with one of our knowledgeable Product Advisers. They have the ability to answer questions and even put together a treatment plan for you.
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During your recovery, you will probably have to modify and/or eliminate any activities that cause pain or discomfort at the location of your soft tissue injury until the pain and inflammation settle. Always consult your doctor and/or Physical Therapist before using any of our outstanding products, to make sure they are right for you and your condition. The more diligent you are with your treatment and rehabilitation, the faster you will see successful results!