Dr. James Nace

Dr. James Nace is an orthopedic surgeon with LifeBridge Health Rubin Institute for Advanced Orthopedics. (Courtesy of LifeBridge Health, Baltimore Sun / February 5, 2014)

Putting too much stress on your joints? Or maybe arthritis has become an issue?

Athletes, seniors or anyone in these categories could develop a bone spur, or extra bone produced by the body. There are some things to do at home if it causes short-term pain, and a doctor can offer suggestions if the pain doesn't stop, according to Dr. James Nace, an orthopedic surgeon with the LifeBridge Health Rubin Institute for Advanced Orthopedics and a physical therapist.

What is a bone spur, and why does it form?

A bone spur is extra bone that the body produces in response to an area that is under an unusual amount of pressure or tension. Unfortunately, instead of helping, the process can end up triggering a lot of difficulties. Problematic stress can develop for several reasons, but two of the most common are as follows. First, it can occur if people have a degenerative joint disease, such as arthritis. This causes cartilage, the firm rubbery protein material that acts as a cushion or shock absorber between the ends of bones, to deteriorate. This means that bone can grind against bone, and this undue pressure causes the body to attempt to help by making even more bone, which can turn into an osteophyte, also called a spur. The second most common reason that a bone spur can develop is if a tendon, the tissue that connects muscle to bone, isn't flexible enough for activities of daily living. The tendon has increased tension or pressure exerted on itself from being stretched. Again, the body tries to reinforce the area with more bone where it shouldn't be. However, no matter why a bone spur develops, if there is not enough space for the extra bone, it can poke into the soft tissue surrounding it, or it can pull a tendon too tightly to accommodate it, and the results can be very painful.

How common are bone spurs. and where in the body do they most often appear?

Bone spurs are commonplace and most often affect weight-bearing joints, such as the heels and the knees as well as the shoulders. They can form anywhere there are joints, including the spine, hips, hands and ankles. The heels and knees are particularly vulnerable because they help to carry a person's entire weight. As activity level and age increase, additional wear and tear on tendons and joints can occur. If a person is overweight, that puts additional stress on the knees, the feet and heels. Sports that include a lot of running can also speed up the formation of bone spurs because the legs and feet hit the ground with a lot of force. It should also be no surprise that shoulders are common sites for bone spurs because of the lifting and moving that's done. In fact, that's why from time to time, you'll hear about a baseball pitcher with a rotator cuff issue from overuse or injury.

Are there any symptoms, and are there any home treatments for bone spurs?

If a bone spur juts into the surrounding soft tissues, it can cause irritation and inflammation. This can produce a dull ache, a sharp shooting pain and/or swelling. The mainstay of treatment is stretch, stretch and stretch some more. Initiating a light stretching and strengthening program can restore the appropriate tension to the affected area. There are no rules as far as which modalities are best for bone spurs. All individuals are different, so they should do what works for them. Some people say that applying moist heat to an affected area works well; others claim that using cold packs or ice massage is the treatment that takes their pain away. Over-the-counter pain relievers and anti-inflammatories are also helpful for some sufferers. However, checking with one's doctor is recommended before they are taken over a long period of time.

When is it time to see a doctor, and what are the treatments available?

It is time to see a doctor if the symptoms persist for more than a week or two, if the pain worsens and/or if a person has not responded to the above treatments. An orthopedist will diagnose the bone spur with an X-ray, and he or she may recommend drug therapies, modalities, stretches or injections to try to alleviate the discomfort. If symptoms persist, occasionally a surgical procedure may be necessary. Options can include removal of part of the bone or osteotomy, lengthening of the affected tendon, or arthroplasty (a joint replacement). The bone spur itself is not the focus of the treatment. Instead, the underlying conditions, such as the degenerative disease or tendon contracture/ inflexibility, must be addressed. Otherwise, the bone spur can develop again, even if it is removed.

Is there anything that can be done to prevent bone spurs from forming?

There are some things people can do to reduce the risk of developing a bone spur like a program of stretching and weight reduction, as well as a low-impact maintenance exercise program that strengthens the core and stretches those tendons most affected, such as the hamstrings, calves, and quads. Walking on a soft surface with cushioned supportive shoes, swimming, using an elliptical machine or bicycling are also good ways to stay fit without adding extra pressure to the joints and tendons. Your body must remain "tuned-up" analogously to your car in order to perform efficiently and without problems.