What is bursitis?
Bursitis is a medical condition characterised by inflammation of a bursa. A bursa is a small, thin, slippery membranous fluid-filled sac that acts as a cushion between bones, tendons, muscles, and skin. Its primary function is to reduce friction and facilitate smooth movement between these different anatomical components. Bursae are located near joints where friction and movement often occur, such as the shoulder, elbow, hip, knee, and heel.
How does a bursa become inflamed?
Bursitis is commonly diagnosed through a physical examination, subjective history, and sometimes imaging tests like ultrasound. It often occurs when there’s repetitive friction or pressure on a bursa, leading to inflammation.
Muscle weakness is a main contributor to the development of bursitis through a combination of altered biomechanics and increased stress on the affected joint. When certain muscles are weak, other muscles might compensate to maintain movement. This can lead to altered biomechanics, causing uneven pressure on joint surfaces and bursae. These imbalances can create friction and irritation, leading to bursitis. Muscles also help absorb shock and impact during movement. Weak muscles are less effective at absorbing these forces, causing excessive stress on the joint and the surrounding structures, including the bursa. Other causes of Bursitis include repetitive movements, trauma, or infection.
Autoimmune and inflammatory conditions such as rheumatoid arthritis or gout can also increase the risk of developing bursitis. When a bursa becomes inflamed, it can lead to pain, swelling and limited mobility in the affected area.
Where does bursitis occur?
The shoulder, hip, and knee are three common areas where bursitis occurs. In the shoulder weakness in the rotator cuff muscles can lead to poor stabilization of the shoulder joint, causing altered movement patterns that irritate the bursa in the subacromial space. Weak hip abductor muscles can cause improper pelvic and leg alignment during walking, leading to excessive friction on the trochanteric bursa on the outer hip. In the knee weak quadriceps muscles can result in poor knee joint stability, potentially increasing friction against the prepatellar bursa in front of the knee.
How do I know if it’s bursitis?
Some of the symptoms that present with bursitis include pain, swelling and limited range of motion. Pain is typically localized to the affected joint or area, the pain may worsen with movement or pressure. Pain can occur during movement, when staying sedentary or during the night. The inflamed bursa may become swollen and tender to the touch. In some cases, the bursa can appear red and feel warm to touch. The inflammation and pain can reduce the joint’s movement, leading to stiffness, weakness and difficulty moving the affected limb. It is important to remember these symptoms can overlap with other conditions, such as arthritis, tendinopathy, or joint injuries. If you’re experiencing persistent pain, swelling, or discomfort, it’s recommended to seek medical attention for an accurate diagnosis and appropriate treatment.
What does treatment look like?
Treatment of bursitis is often multifaceted and can involve a combination of load management, pain relief, and strengthening. Bursitis can be debilitating in the early stages; therefore, it is important to avoid/adjust movements that exacerbate the bursa. Changing the load on the Bursa will help reduce pain and inflammation, which in turn will improve range of motion and swelling.
If load management and rest isn’t enough to significantly reduce pain, taking pain relief or corticosteroid injections may be beneficial. It is important to talk to your health providers to determine the appropriate medications to use.
Once the symptoms have settled it is appropriate to start addressing the underlying cause of bursitis, this may involve correcting motor patterns and strengthening affected muscles. The muscles and movements to adjust will depend on the location of the bursitis, therefore there is no one exercise that will help everyone.
Seeing a physiotherapist will also be beneficial to give relief through hands on techniques. A physiotherapist can use hands on techniques such as joint mobilisations and soft tissue release, which can help release tight muscles and improve healing, however, it should be coupled with exercises for long term benefits.
Examples of exercises for the hip:
- Banded squats to a chair:
- Place a chair behind you, ensuring it is stable, tie a band just above your knees.
- Stand with your feet hip width apart, toes pointing outwards slightly.
- Gently pull belly button in to engage core and hold tension on the band.
- As you squat down to the chair keep tension on the band, touch chair and then return to starting position.
- Repeat multiple times.
- Isometric stability ball knee push
- Place a stability ball on the wall at the height of your knee.
- Place unaffected knee against ball and standing on affected leg.
- Stand up straight and push knee into the ball.