Bursitis is caused by the inflammation of a bursa. A bursa is a small fluid-filled sac that acts as a cushion between bony surfaces and overlying soft tissue (tendons). They help to reduce friction and assist joint movement by facilitating movement of the tendon over the bony surface.
Bursa are located at many sites (every joint) around the body with the most troublesome including:
Subacromial (shoulder) bursa
Greater trochanteric (hip) bursa
Iliotibial band (lateral knee) bursa
Retrocalcaneal (Achilles) bursa
When a joint is injured or overused, the nearby bursa can become irritated and inflamed. As part of the natural inflammatory response the bursa fills with excess fluid and increases in size (swells).
Bursa have a high concentration of nociceptors and are incredibly sensitive so when they become inflamed and swollen, they generally cause significant pain, resulting in restricted movement of the joint.
Because bursa sit in spaces between bones or between tendons and bone, once they become inflamed and swollen, they occupy more of this space and are prone to becoming pinched (impinged) again, resulting in a cycle of irritation à swelling, which can be difficult to control.
The symptoms of bursitis can include:
Localised pain that may build up gradually or:
Sudden and severe pain that is aggravated by movement or pressure.
Swelling through the area (especially the elbow)
Sensation of heat in or around the affected area
Increased pain at night
Joint stiffness and diffuse pain on movement.
Reddening of the skin in the affected area.
Causes of bursitis can include:
Traumatic injury such as falling onto the area (knee or hip)
Repeated pressure and overuse of a joint (wrist, elbow, Achilles and shoulder)
Incorrect posture at work or home, especially seated posture (shoulder)
Poor warm-up and cool down routines (hip, knee and Achilles)
Overweight (hip and knee)
Medical conditions, such as rheumatoid arthritis, psoriatic arthritis, gout and diabetes.
An infection can also cause bursitis, it is called septic bursitis. This may occur if a joint is injured and bacteria get into the bursa. In this case there will be fever present as well.
Diagnosing bursitis can generally be achieved in the clinic based on medical history and physical examination. Further investigation may include ultrasound and MRI imaging to confirm the diagnosis.
Treatment of bursitis will ultimately depend on the cause and aims to relieve the symptoms to allow the healing process takes place. This revolves around reducing the inflammation and swelling in the bursa itself and optimising the space it occupies to minimise pressure or recurrent impingement.
1. Conservative treatment:
a. Rest from aggravating activity
b. Pain-relieving medications
c. Therapeutic ultrasound
d. Cold packs
e. Dry needling and soft tissue release
f. Gentle mobilising exercises
g. Restore biomechanical alignment to the joint
2. Steroid based anti-inflammatory medications may be used in cases of severe pain.
3. If infection is present, as well as pain and swelling of the affected area, one may develop other symptoms, such as a raised temperature. Treatment with an appropriate antibiotic is necessary.
4. Braces or splints can decrease the stress on the areas and support good alignment, if conservative treatment has been unsuccessful.
5. If conservative treatment has been unsuccessful, in persistent or extreme cases, surgical decompression or removal of the bursa may be indicated
Treatment plans, provided by physiotherapists, chiropractors and remedial massage therapists, will focus on reducing the inflammation through ultrasound therapy and soft tissue release to promote better alignment and then strengthening the surrounding muscles to provide better support to the joint and minimise the risk of recurrent impingement
Tips to minimise risk of bursitis:
Posture related bursitis:
Use ergonomically designed furniture and equipment.
Take regular breaks.
Do simple stretching exercises regularly throughout your day.
Keep benches at waist height so that your shoulders can relax.
Exercise related bursitis:
Engage in a dynamic warm-up prior to exercise
Make sure you use the correct technique and regularly perform strengthening and conditioning exercises that complement your particular sport.
Engage in a cool down routine inclusive of gentle, sustained stretches.
Make sure footwear and equipment are appropriate for you.
So that’s an overview of bursitis and how it occurs. If you have any questions or comments, please email us at firstname.lastname@example.org and we will be happy to answer them for you.
If you suffer from persistent joint pain, especially with movement, then bursitis could be the culprit, feel free to call us on (08) 9486 8653 and our therapists will be happy to chat with you about how to manage it.