You have been having pain for a little while now and have been to the doctor to be diagnosed with bursitis.
But what actually is bursitis? What can cause it? And most importantly, you are wondering what can I do to fix it?!
We are so glad you asked!
What is bursitis?
Bursitis, is essentially the inflammation of a bursa. Simple right?!
But, what on earth is a Bursa?
A bursa is a fluid filled sac, that generally sits between two surfaces (commonly a tendon and bone).
Its main job is to prevent friction between the tendon and the bone, and act as a lubricator to allow a muscle or tendon to glide more freely during the movement of a joint.
Imagine your bursa as a balloon filled with fluid.
If you place the balloon between your hands and rub your hands together, this movement becomes effortless with the balloon reducing friction between your palms.
Now let’s take that same scenario and apply it to your shoulder.
The bursa should allow effortless gliding when you take your arm over your head, out to the side, behind your back or whatever the movement may be.
How did I get bursitis?
You remember the pain starting, but you cannot think of what may have caused it.
Here are a few of the common causes of bursitis listed below;
- Direct Impact or Trauma. This causes the bursa to swell, resulting in pain and irritation at the joint that was previously healthy.
- eg. knocking the side of your hip on the corner of a sharp table.
- Repetitive Irritation. This is caused by repetitive use of the joint (and is the most common cause of bursitis that we see in the clinic)
- eg. washing all the windows in your house in one day can cause bursitis in the shoulder due to a sudden repetitious movement that is out of the ordinary.
- Prolonged Pressure. Prolonged and/or excessive pressure can again cause irritation and swelling of the bursa.
- eg. Now that you are pregnant and unable to sleep on your back, sleeping on your side can irritate the bursa in your hip that is not used the constant pressure.
A lot of the time, bursitis does not occur as a stand-alone.
Often, there will be an irritated and overloaded tendon that accompanies it, which will also require attention (for example in the shoulder, tendons that form the rotator cuff can also inflame with sub-acromial bursitis).
Where can bursitis occur?
There are over 150 bursae around the body, which means that yes, it can occur at any one of these.
However, the two most common forms of bursitis are:
Shoulder Bursitis (sub-acromial bursitis)
Bursitis at the Olecranon (in the elbow)
Pre-Patellar (at the front of the knee)
What are the symptoms of bursitis?
It is important to understand that symptoms will vary between individuals and between joints. However, some of the common symptoms include;
- Pain with movement, often getting worse with repetition.
- Pain with prolonged pressure to an already inflamed bursa (e.g. laying on the affected shoulder or hip)
- Pain in the affected area and/or radiating down the affected limb (e.g. shoulder bursitis can cause an ache into the forearm)
- Weakness in the affected muscles and joint
- Restricted range of movement at the affected joint
What are the treatment options for bursitis?
In some cases, bursitis will resolve on its own with rest and anti-inflammatory medication.
However, it often requires professional attention and it left unattended to, (as we all like to put things off for as long as we can!) can take a longer time to resolve.
There are some essential steps of treating any bursitis. These include;
- Reducing the pain and inflammation
- Correcting biomechanics
- Assessing and correcting muscle strength and flexibility imbalances
- Preventing re-occurrence and flare ups
How do we do this as physiotherapists?
Our physiotherapists in Adelaide use conservative treatment methods to help reduce your pain, improve our function and prevent re-occurrences. These include;
- Specialised tests to determine if it is just the bursa at fault or if there are other contributing factors that are causing an increased pressure on the bursa (e.g. inflammation in a tendon/s).
- We work with you to educate you on movements/activities that may be aggravating, which in the short term may lead you to avoiding or altering such aggravating factors.
- Hands on techniques such as massage, acupuncture and dry needling to reduce tightness in the muscles that may be contributing to poor movement and biomechanics of the joint
- Ultrasound therapy to reduce inflammation
- Taping the joint to unload the bursa and provide extra support to the joint
- Using a combination of isometric, isotonic and isokinetic exercises to help rebuild strength to the surrounding muscles and correct joint biomechanics.
Less conservative treatments are also available to treat particularly difficult cases or ones that haven’t settled down with conservative methods. This includes corticosteroid injections and occasionally surgery.
It is important to understand that just because you have had it once, does not mean that you will have it forever or it will be an area of weakness for you, especially if it is treated correctly initially.
Bursitis can often rear its ugly head months and sometimes even years down the track ONLY IF there is an underlying issue that hasn’t been addressed.
In many cases, a muscle imbalance at a joint resulting in poor biomechanics can be the cause and/or reason for a longstanding or reoccurring bursitis.
Your physiotherapist is highly trained in assessing the cause of your bursitis and any biomechanical issues.
They will provide you with a strengthening and stretching program, which will assist in correcting altered movement patterns and incorrect biomechanics.
This will help with reduced pain at the time, as well as preventing future occurrences.
We recommend you consult your physiotherapist if you suspect you have bursitis or had had a scan confirming bursitis.