Article by John Miller
What is Bursitis?
Bursitis is the inflammation of a bursa.
What is a Bursa?
A bursa is essentially a self-contained bag of lubricant that keeps reduces friction between two moving structures in your body. If you imagine rubbing this bag between your hands; movement of your hands would be smooth and effortless. In other words, a bursa provides a a low-friction, slippery and smooth interfaces between two moving objects eg a tendon and a bone.
Bursae are found throughout your body, where muscles and tendons glide over bones. You have more than 150 bursae in your body. Without your bursa between these surfaces, your movements would be painful due to friction. Much like the pain associated with bursitis.
What Causes Bursitis?
Your can be injured via direct trauma, or more commonly via repeated irritation. Certain systemic conditions can also predispose you to bursitis.
During active bursitis, your bursa loses its painless and low-friction gliding capabilities. The added bulk of the swollen bursa causes more friction within an already confined space.
There are several common causes of bursitis. They include the following:
- repetitive bursa irritation
- traumatic injury
- systemic disease
Repetitive Bursa Irritation
Bursitis usually results from a repetitive movement or due to prolonged and excessive pressure.
Shoulder bursitis (or most commonly, subacromial bursitis) is common in overhead activities at work or in sport eg swimming, throwing, surfing, paddling, cricket bowling, waterpolo. It is more prevalent in people with poor posture eg round shoulders, weak scapular muscles, thigh pectorals or poor technique. All of these deficits can be assessed and successfully treated by a skilled shoulder physiotherapist.
Trochanteric bursitis (or hip bursitis) sufferers usually have weak hip/gluteal muscles and tend to sway sideways (or collapse) as they walk, which irritates your trochanteric bursa. The long-term solution is to address the weak gluteal muscles rather than solely focus on the bursitis itself.
Any bursa in your body, and remember there are 150+ can be susceptible to repetitive trauma due to poor muscle control of movement patterns. Identification and correction of these poor movement patterns falls into the professional skill profile of physiotherapist. Please seek their professional opinion especially in longstanding or repeat episodes of bursitis.
Another cause of bursitis is a traumatic injury. Following trauma, such as a car accident or fall, a patient may develop bursitis. Usually the acute compression of your bursa causes an inflammatory healing reaction that results in swelling within the bursa, or bursitis. Once the bursa is inflamed, normal movements and activities can become painful from either the pain-sensitive chemical reaction within the bursa or the swollen bursa can provide additional frictional forces in the subsequent movements.
A fall and land onto your knee can acutely compress your prepatella bursa resulting in knee bursitis.
Systemic inflammatory conditions, such as rheumatoid arthritis, may also lead to bursitis. These types of conditions can make patients susceptible to developing bursitis.
Common Types of Bursitis
- Bursitis Shoulder ( Subacromial Bursitis )
- Bursitis Hip ( Trochanteric Bursitis )
- Bursitis Knee ( Patella Bursitis )
- Bursitis Elbow (Olecranon Bursitis)
- Bursitis Heel (Retrocalcaneal Bursitis)
Bursitis treatment has several phases:
- reduce the acute bursitis pain,
- reduce the bursa inflammation,
- assess the cause and rectify any reason that would predispose to a bursitis,
- prevent a recurrence via the appropriate rehabilitation program.
Reduce Bursa Inflammation & Pain
Bursa treatment will usually commence with treatment modalities that aim to to reduce bursa pain and inflammation. Treatment options may include:
- Anti-inflammatory Medications
- Anti-inflammatory Gels
- Corticosteroid/Anaesthetic injections.
- Deloading taping eg kinesio taping
- Avoid activities that reproduce your pain.
Assess Non-Traumatic Causes
Bursitis pain usually settles within a few weeks with the appropriate bursa treatment. All non-traumatic origin bursitis should be investigated to discover what is causing your bursitis.
Recurrent flare-ups or recalcitrant bursitis can be common and frustrating for the sufferer. The important thing when managing persistent bursitis is to delve deeply into WHY your bursa is inflammed. Once the reason is identified, controlling your bursitis becomes a much easier project.
Remember the source of a recalcitrant bursitis may be your poor biomechanics, muscle weakness, tightness, movement patterns or postural habits that your physiotherapist can identify and help you to correct.
Secondly, the cause may be disease related. If this is the case, please consult your doctor. If they deem it appropriate, they may advise some tests, eg blood tests, to eliminate or confirm a potential systemic cause of your bursitis.
Prevent a Recurrence
Bursitis is often a secondary symptom caused by many other factors. The best form of bursitis treatment is to identify, and then address, any abnormal biomechanical of muscle control findings, to reduce your likelihood of a bursitis recurrence. Your physiotherapist is highly skilled in identifying these deficits to help you recover quickly from bursitis and then prevent a bursitis recurrence. After thoroughly assessing you, your physiotherapist may prescribe a stretching, strengthening, movement correction/control program.
For professional advice specific to your bursitis, please consult a physiotherapist who has special interest in the assessment, treatment and management of bursitis.
Persistent or Chronic Bursitis
Persistent or chronic bursitis may find a corticosteroid injection beneficial. There are some potential side effects related to corticosteroid injection esp diabetics. Please consult your doctor for an opinion regarding your suitability to bursitis injections.
Bursitis occasionally persists despite all of the best efforts of your medical team. In these cases, a bursectomy (surgical removal of your bursa) may be considered.
Bursitis Related Injuries
Helpful Bursitis Treatment Products
Bursitis Treatment Options
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