Issue 146

Injury rehab specialist Nick Doughty takes a look at bursitis, one of MMA's most common injury problems, and one that can submit your chances of reaching peak performance levels.

NICK DOUGHTY

The founder of the Unique Performance Clinic that offers structured and advanced techniques to the rehabilitation and training needs of its athlete clientele, Nick has 10 years experience as a trainer and clinical corrective exercise specialist. UP Clinic also has an interdisciplinary center that has helped sports-related musculoskeletal injuries and general recovery for injuries.

Whether you spend your time at the gym learning how to escape from armbars, guillotine chokes and neck cranks, or if you're just hitting the weights and pounding the treadmill, at some point, you're probably going to feel as though someone's stuck a red- hot poker into one of your joints.

One of the most common causes of this debilitating pain is bursitis; yet few people have even heard of it let alone know what its symptoms are and how to prevent or cure it.

WHAT IS IT?

Bursitis is the painful inflammation of the bursa sac, which is filled with a synovial fluid that has the consistency of a raw egg white. The bursa sac protects and lubricates all your major joints, allowing for a smooth, functional glide surface and effective pain-free movement.

When bursitis occurs, moves that rely on the inflamed bursa will become difficult and painful as tendons and muscles move over the inflamed bursa and aggravate the inflammation.

CAUSES

Bursitis is commonly caused by the overuse of repetitive movement and excessive pressure. Bruising and bumping can also cause it, with elbows and knees the most commonly affected in combat sports.

The inflammation irritates because the bursa no longer fits in the original small area between the bone and the functionary muscle or tendon. When the bone increases pressure upon the bursa, bursitis results. Inflammation of the bursa might also cause other inflammatory conditions such as rheumatoid arthritis. Bursitis that is infected requires further investigation such as MRI scans and antibiotic therapy.

SYMPTOMS

They vary from local joint pain and stiffness, to burning pain that surrounds the joint. In this condition, the pain is worse during and after activity, and then the bursa and the surrounding joint become stiff the next day, predominately in the morning.

STAT ATTACK

There are four types of bursa sac: synovial, subcutaneous, sub-muscular and adventitious.

The most common examples of this condition in MMA are:

Housemaid's Knee

Your doctor will know it as prepatellar bursitis, but for us laymen it just means that prolonged and/or repetitive kneeling causes friction and puts pressure on the bursa and kneecap, or a direct blow. Symptoms: Swelling at the front of the knee may cause pain and redness over the front of the knee cap and make it difficult to bend the leg, kneel down or walk.

Student's Elbow

Olecranon bursitis. It's characterised by pain and swelling in the elbow and normally develops as a result either of a single injury, or repeated minor injuries, such as repeated leaning on a hard surface. The chance of developing bursitis is higher in combat sports due to the nature of repetitive movement. Symptoms: Swelling at the tip of the elbow may cause pain and redness and make it difficult to bend or lean on the joint.

Spidey's Shoulder

No one has given subacromial bursitis a catchy name yet, so we've decided to call it ‘Spidey's Shoulder,’ just because we can. It's caused by overuse of the shoulder joint and muscles or from a more significant trauma such as a fall. But don't be too quick to label all shoulder pain as bursitis. Symptoms: It's identified as pain when lifting up your arm sideways within an initial 60-degree arc and localized pain that radiates as far as the deltoid muscle.

TREATMENT

Bursitis that is not infected can be treated with rest, ice compresses, anti-inflammatory drugs and pain medication. Activity needs to be reduced around the affected area and symptoms will begin to disappear. If you know the exact movement, or more specifically any actions (such as grappling, defense, groundwork etc.) that have caused the pain, it's time to back off that activity, at least temporarily. The pain of bursitis may disappear after a few days' rest. But do not cease all movement as joints that seize up become riddled with adhesions (fibrous tissue) and scar tissue.

The good news is: bursitis usually goes away within a couple of weeks, but it can be a recurring condition. Strengthening tendons and muscles around the joint can prevent it returning. A more aggressive treatment involves injecting corticosteroid drugs into the swollen area for immediate relief.

Draining fluid from the bursa to reduce pain and allow a fuller range of motion is common practice, but in rarer cases removal of the bursa sac

has been prescribed. When it becomes regularly inflamed and causes significant pain, removal is the best course of action.

Five Of The Bursitis Busters

1: ICE, ICE BABY

Ice brings down swelling by slowing the blood flow into the area. Leave an ice pack on the joint for about 20 minutes, or twice as long if your bursitis is deep in the joint. Don't forget to protect your skin by putting a towel or cloth between the ice pack and bare flesh. Ice treatment works really well for reducing discomfort and swelling straight after injury and up to 72hrs.

2: TURN UP THE HEAT

After the initial swelling has been brought down, heat from a heating pad or heat pack will not only feel good but will get rid of excess fluid in the bursa by increasing circulation. A little gentle massage can also achieve the same effect, but avoid massage if an infection is connected with your bursitis.

3: PROTECT & SERVE

Sparring and being struck or bumped on the elbow can result in bursitis so by using something as simple as elbow pads is all that could be needed to continue to train injury-free. The body does an amazing job of protecting itself, but when you are regularly asking it to adapt, you may need to make some adaptations you.

4: Beware of Infections

If soldering with bursits, make sure you're not ignoring a more severe problem. It's common to feel warmth around the swollen area, but if you're running a temperature, you may have an infection, which needs diagnosis by a physician. If symptoms like swelling and soreness persist for a period of two weeks or more, your body is trying to tell you something. Do not ignore it, as it may lead to something more serious.

5: BENCH YOURSELF

If you have bursitis on your elbow or your knee, change the activity that caused it such as avoiding elbow strikes or groundwork on your knees.