Bursitis is the inflammation of a bursa, a small, fluid-filled sac that cushions bones, tendons, and muscles near a joint. When the bursa becomes irritated and swollen, movement is painful. Determining whether to use heat or cold therapy depends entirely on the specific phase of the bursitis.
Understanding Bursitis Pain
The body contains over 150 bursae, which reduce friction and allow for smooth movement within the musculoskeletal system. Bursitis develops when the bursa’s synovial lining thickens and produces excessive fluid, causing localized swelling and pain. This condition is divided into two main phases that dictate the best course of treatment: acute and chronic.
Acute bursitis is characterized by a sudden onset of severe pain, often accompanied by noticeable swelling, redness, and warmth around the joint. This phase is usually triggered by injury, trauma, or a sudden flare-up from overuse. Chronic bursitis refers to long-term inflammation, presenting as a persistent, dull ache, stiffness, and reduced flexibility.
The Role of Heat Therapy
Heat therapy is beneficial for managing chronic bursitis and general joint stiffness. Applying heat is not recommended during the acute phase, as it can worsen initial swelling and inflammation. Once the initial swelling has subsided, heat can be used to target persistent aches and limited range of motion.
The physiological mechanism behind heat’s effectiveness is vasodilation, the widening of local blood vessels. This increased blood flow delivers oxygen and nutrients to the affected area, promoting muscle relaxation and reducing stiffness. Heat also increases the elasticity of connective tissues, improving flexibility and joint mobility. Applications include warm compresses, heating pads, or warm baths for 15 to 30 minutes, two to three times per day.
The Role of Cold Therapy
Cold therapy, or cryotherapy, is the preferred initial treatment for acute bursitis or when a flare-up causes immediate pain and swelling. It is particularly effective within the first 48 to 72 hours of symptom onset, or whenever the area is visibly swollen, red, or warm to the touch.
Cold works by causing vasoconstriction, which is the narrowing of blood vessels. This process reduces blood flow to the site of injury, effectively minimizing swelling (edema) and inflammation. Furthermore, the cold temperature numbs the nerve endings in the skin, providing immediate and temporary pain relief. Apply an ice pack or cold compress, wrapped in a thin towel to protect the skin, for 10 to 15 minutes at a time, repeated several times a day.
Beyond Temperature: Other Home Relief Measures
While temperature treatments address the symptoms, other home strategies focus on reducing the underlying stress on the bursa to allow for healing. The most fundamental step is resting the affected joint by avoiding activities that caused or aggravate the pain. This offloading of stress prevents further irritation and gives the inflamed bursa time to recover.
For bursitis in an extremity, such as the ankle or knee, elevating the joint above the level of the heart can help drain excess fluid and reduce swelling, complementing the effect of cold therapy. Another common home measure is the use of over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen. These medications work to reduce the inflammation within the bursa sac itself, which directly contributes to lessening both the swelling and the pain.