Itis means inflammation, usually as a result of trauma (such as a tendon strain) or infection. However, inflammation can also occur from nutritional problems as well as local muscle and joint dysfunctions, and I’d say this is much more common than actual trauma and infection. Think about how often a runner develops an injury to their foot or knee—it suddenly creeps up on them, and their physician diagnoses it as tendonitis. Or a tennis player or swimmer notices some shoulder pain that gets worse and worse, and they are eventually told they have bursitis.
Although the suffix itis typically denotes a more acute problem, rather than one that has been occurring for a long time (chronic), many people are told they have some injury with inflammation months or years after it first appeared. A lot of people have chronic inflammation throughout their bodies that affects their lives each and every day, resulting in symptoms such as fatigue, body aches, and accelerated ageing. Different types of inflammation sometimes require different treatments even though they often accompany one another when an injury strikes.
Understanding Tendonitis in Athletes
Tendonitis is inflammation of a tendon, which is where a muscle connects to a bone. This is probably the biggest complaint athletes have regarding injuries. It is also one of the most used diagnoses, and perhaps sometimes incorrectly applied. For example, many physicians now think of Achilles tendonitis as Achilles tendonosis (also spelled tendinosis), which is a chronic degenerative condition with some micro-tearing of the tissues without inflammation. Resolving tendonitis (as well as a tendonosis) involves both local and global “systemic” treatment.
Trigger point therapies, as I explain and demonstrate in the Sock Doc videos, and meridian (acupressure/acupuncture) therapies can help tremendously with pain and inflammation reduction, as well as healing the involved tissues.
Gait disturbances can cause tendonitis. Walking or running incorrectly due to muscle imbalances or joint dysfunctions caused by another injury or from wearing improper footwear can result in tendon problems. What you put on your feet will have a dramatic effect on your entire body, not just your feet. I have treated many people with shoulder tendonitis because of an improper gait—some because of poor shoes and some because of old injuries that were still unknowingly affecting them. Every arm swing forward when you walk or run must also be in sync with the muscles of your opposite-side leg. An old injury or surgery to your knee, for example, could still be affecting your gait, causing an imbalance that results in the improper motion of your shoulder on the opposite side. Next thing you know, you have tendonitis in that shoulder.
Your adrenal glands, pancreas, and liver are the three major organs involved in tendonitis problems. The adrenal glands are your hormonal glands that deal with stress. They will secrete excess cortisol when there is too much dietary, physical, or emotional stress. Over time, the beneficial hormone DHEA, also made in the adrenal glands, will become depleted with persistent chronic stress, resulting in low sex hormone levels such as testosterone and estrogen, as those are made from DHEA. This constant cortisol burden will tax the liver, which must detoxify the hormone, and much of this is done via a process known as sulfation. When your body uses up sulfur, it has less available to heal injured tendons, as well as the cartilage (joints) they attach to. So chronic stress leads to chronic cortisol, which leads to chronic inflammation and the inability to heal. The increased cortisol also plays off the pancreas, creating a constant tug-of-war between the two organs (the pancreas and the adrenals) as they try to keep blood sugar levels from swinging out of control as you work, exercise, and sleep. This, as discussed here, will create insulin and carbohydrate sensitivities and, in turn, create even more inflammation.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are often prescribed for many “itis” problems. Guess what? These will also deplete sulfur from your body because that’s how your liver detoxifies them, so overall healing is even further delayed. If you ever feel better from taking an NSAID, it’s a sure sign that you have a fatty acid metabolism problem occurring in your body. If there were no fatty acid metabolism problem or imbalance, you’d see no benefit from taking the drug. If there isn’t actually inflammation to be treated and you’re dealing with an “osis” rather than an “itis,” you may not see an NSAID benefit. However, it’s very rare for a person to have a chronic injury that their body can’t heal and not have some degree of inflammation. More on fats, NSAIDs, and inflammation here.
Using ice can sometimes help with the pain and inflammation during the acute phase of the injury, but it should not be used for weeks or months. This may just numb your pain temporarily during use, but delay the healing by constricting blood flow to the area and artificially reducing inflammation too much for the tendon to heal. You do need some inflammation to heal in the acute phase—not too much for too long, and not too little!
Understanding Bursitis in Athletes
You have hundreds of bursa all over your body, which can be thought of as little bags of oil that help reduce friction between two joints moving in opposite directions, as well as where muscles and tendons slide over bone. Bursitis, or inflammation of a bursa, is often described as hot and stabbing pain and has some degree of swelling. Bursitis can be caused by a local injury to a joint, such as the elbow or knee, and by improper repetitive motion between muscles. For example, if your biceps muscle is not functioning properly (there is some muscle “weakness”—inhibition), then your triceps will work harder due to the opposing muscle inhibition of the biceps. This muscle imbalance will cause stress on the elbow and shoulder joints. If the bursa in the elbow were to become inflamed because of the chronic joint and muscular imbalances, you would have a diagnosis of olecranon bursitis. Trochanteric bursitis in the hip is also a very common spot for bursa problems. Swelling of the bursa behind the knee, where the calf and hamstring muscles cross, is also very common—this is called a Baker’s cyst.
Similar local therapies that help treat tendonitis also help with bursitis, but the nutritional aspect of bursitis is a bit different. Nutritionally, bursitis has to do with calcium, fats, and the acidity of your tissues. Here’s the common bursitis “nutritional” scenario: When you’re under too much stress of any kind, especially when there is trauma to the area, your body requires additional protein. This protein can come from your diet, as well as muscle breakdown, and even from the area around your actual bursa. The robbing of protein from the tissue and bursa creates a more alkaline medium in that area. Calcium is then deposited in the bursa as a result of the alkaline environment to help protect the bursa. Unfortunately, this creates pain and inflammation—bursitis.
Treating the bursitis involves not only dealing with the inflammation but also mobilizing the calcium out of the area by creating an acidic environment in the tissues. One of the best ways to acidify the tissues is to add 1–2 tablespoons of vinegar to your diet every day (many use apple cider vinegar), although sometimes more may be needed. Some people actually have bursitis because they are too alkaline in many areas of their body due to low levels of stomach hydrochloric acid. Low stomach HCL also creates poor protein metabolism, allowing more calcium to precipitate into the alkaline environment, resulting in bursitis symptoms. In addition to acidifying the tissues to mobilize the calcium, sometimes essential fatty acids are needed to help fight the inflammation. Omega-3 fats such as flax oil and fish oil, and omega-6 fats such as black currant seed, borage, and especially unrefined sesame seed oil, can be of use here. Other anti-inflammatories like quercetin and turmeric can help too.
Don’t forget to deal with the root cause, whether you have bursitis or tendonitis. Evaluate your stress levels, your training, your diet, and your overall lifestyle. Tendonitis and bursitis, unless the result of some traumatic accident (you fell off your bike, for example), are warning signs that your health is suboptimal.
