What is Bursitis?
Bursitis is the inflammation of 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, the movement of your hands would be smooth and effortless. In other words, a bursa provides a low-friction, slippery and smooth interface between two moving objects, e.g. a tendon and a bone.
You have more than 150 bursae in your body. Bursae are found throughout your body, where muscles and tendons glide over bones. 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 bursa 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 sport, e.g. swimming, throwing, surfing, paddling, cricket bowling, water polo. It is more prevalent in poor posture (e.g. round shoulders, weak scapular muscles, tight 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 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 fall into the professional skill profile of physiotherapists. 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. 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 on your knee can acutely compress your prepatellar 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 bursitis,
- prevent a recurrence via the appropriate rehabilitation program.
Reduce Bursa Inflammation & Pain
Bursa treatment will usually commence with treatment modalities that aim to reduce bursa pain and inflammation. Treatment options may include:
- Anti-inflammatory Medications
- Anti-inflammatory Gels
- Corticosteroid/Anaesthetic injections.
- Deloading taping (e.g. 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 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, e.g. 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 identifying and then addressing any abnormal biomechanical 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 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 a 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
Acute Injury Signs
Acute Injury Management.
Here are some warning signs that you have an injury. While some injuries are immediately evident, others can creep up slowly and progressively get worse. If you don't pay attention to both types of injuries, chronic problems can develop.
For detailed information on specific injuries, check out the injury by body part section.
Don't Ignore these Injury Warning Signs
Joint pain, particularly in the knee, ankle, elbow, and wrist joints, should never be ignored. Because these joints are not covered by muscle, pain here is rarely of muscular origin. Joint pain that lasts more than 48 hours requires a professional diagnosis.
If you can elicit pain at a specific point in a bone, muscle, or joint, you may have a significant injury by pressing your finger into it. If the same spot on the other side of the body does not produce the same pain, you should probably see your health professional.
Nearly all sports or musculoskeletal injuries cause swelling. Swelling is usually quite obvious and can be seen, but occasionally you may feel as though something is swollen or "full" even though it looks normal. Swelling usually goes along with pain, redness and heat.
Reduced Range of Motion
If the swelling isn't obvious, you can usually find it by checking for a reduced range of motion in a joint. If there is significant swelling within a joint, you will lose range of motion. Compare one side of the body with the other to identify major differences. If there are any, you probably have an injury that needs attention.
Compare sides for weakness by performing the same task. One way to tell is to lift the same weight with the right and left sides and look at the result. Or try to place body weight on one leg and then the other. A difference in your ability to support your weight is another suggestion of an injury that requires attention.
Immediate Injury Treatment: Step-by-Step Guidelines
- Stop the activity immediately.
- Wrap the injured part in a compression bandage.
- Apply ice to the injured part (use a bag of crushed ice or a bag of frozen vegetables).
- Elevate the injured part to reduce swelling.
- Consult your health practitioner for a proper diagnosis of any serious injury.
- Rehabilitate your injury under professional guidance.
- Seek a second opinion if you are not improving.
Elite Sports Injury Management
You probably already know that a sports injury can affect not only your performance but also your lifestyle. The latest research continues to change sports injury management considerably. Our challenge is to keep up to date with the latest research and put them to work for you.
How we treated you last year could vary significantly from how we treat you this year. The good news is that you can benefit considerably from our professional knowledge.
What Should You Do When You Suffer a Sports Injury?
Rest from painful exercise or a movement is essential in the early injury stage. "No pain. No gain." does not apply in most cases. The rule of thumb is - don't do anything that reproduces your pain for the initial two or three days. After that, you need to get it moving, or other problems will develop.
Ice or Heat?
We usually recommend avoiding heat (and heat rubs) in the first 48 hours of injury. The heat encourages bleeding, which could be detrimental if used too early. In traumatic injuries, such as ligament sprains, muscle tears or bruising, ice should help reduce your pain and swelling.
Once the "heat" has come out of your injury, you can use heat packs. We recommend 20-minute applications a few times a day to increase the blood flow and hasten your healing rate. The heat will also help your muscles relax and ease your pain. If you're not sure what to do, please call us to discuss your situation specifically.
Should You Use a Compressive Bandage?
Yes. A compressive bandage will help to control swelling and bleeding in the first few days. In most cases, the compressive dressing will also help support the injury as you lay down the new scar tissue. This early healing should help to reduce your pain. Some injuries will benefit from more rigid support, such as a brace or strapping tape. Would you please ask us if you are uncertain about what to do next?
Gravity will encourage swelling to settle at the lowest point. Elevation of an injury in the first few days is beneficial, especially for ankle or hand injuries. Think where your damage is and where your heart is. Try to rest your injury above your heart.
What Medication Should You Use?
Your Doctor or Pharmacist may recommend pain killers or an anti-inflammatory drug. It is best to seek professional advice as certain medications can interfere with other health conditions, especially asthmatics.
When Should You Commence Physio?
In most cases, "the early bird gets the worm". Researchers have found that the intervention of physiotherapy treatment within a few days has many benefits. These include:
- Relieving your pain quicker via joint mobility techniques, massage and electrotherapy
- Improving your scar tissue using techniques to guide the direction it forms
- Getting you back to sport or work quicker through faster healing rates
- Loosening or strengthening of your injured region with individually prescribed exercises
- Improving your performance when you return to sport - we'll detect and help you correct any biomechanical faults that may affect your technique or predispose you to injury.
What If You Do Nothing?
Research tells us that injuries left untreated take longer to heal and have lingering pain. They are also more likely to recur and leave you with either joint stiffness or muscle weakness. It's important to remember that symptoms lasting longer than three months become habitual and are much harder to solve. The sooner you get on top of your symptoms, the better your outcome.
What About Arthritis?
Previously injured joints can prematurely become arthritic through neglect. Generally, there are four main reasons why you develop arthritis:
- An inappropriately treated previous injury (e.g. old joint or ligament sprains)
- Poor joint positioning (biomechanical faults)
- Stiff joints (lack of movement diminishes joint nutrition)
- Loose joints (excessive sloppiness causes joint damage through poor control)
What About Your Return to Sport?
Your physiotherapist will guide you safely back to the level of sport at which you wish to participate. If you need guidance, ask us.
What If You Need Surgery or X-rays?
Not only will your physio diagnose your sports injury and give you the "peace of mind" associated, but they'll also refer you elsewhere if that's what's best for you. Think about it. You could be suffering needlessly from a sports injury. Would you please use our advice to guide you out of pain quicker? And for a lot longer.
If you have any questions regarding your sports injury (or any other condition), don't hesitate to get in touch with your physiotherapist to discuss. You'll find our friendly staff happy to point you in the right direction.
Arm Pain Causes
Arm pain and injuries are widespread. Arm pain can occur as a result of either sudden, traumatic or repetitive overuse. The causes can be related to sports injuries, work injuries or simply everyday arm use.
Causes of Arm Pain by Region
Causes of Arm Pain by Structure
Neck-Related Arm Pain
Shoulder-Related Arm Pain
- AC Joint Injury
- Biceps Tendinopathy
- Broken Shoulder - Fractured Humerus
- Bursitis Shoulder
- Dislocated Shoulder
- Frozen Shoulder
- Rotator Cuff Calcific Tendinopathy
- Rotator Cuff Syndrome
- Rotator Cuff Tear
- Shoulder Arthritis
- Shoulder Impingement
- Shoulder Tendonitis
- Swimmer's Shoulder
Elbow-Related Arm Pain
Wrist-Related Arm Pain
Hand-Related Arm Pain
Muscle-Related Arm Pain
- DOMS - Delayed Onset Muscle Soreness
- Muscle Strain (Muscle Pain)
- RSI - Repetitive Strain Injury
- Overuse Injuries
Other Sources of Arm Pain
Common Causes of Arm Pain
- Your rotator cuff or frozen shoulder most commonly causes shoulder pain.
- Elbow pain is most commonly caused by tennis elbow or golfers elbow.
- Wrist & hand pain can be related to carpal tunnel, wrist arthritis or even a thumb tendon condition known as de Quervain's tenosynovitis.
Referred Arm Pain
As mentioned earlier, arm pain can be referred to from another source. Cervical radiculopathy is a common source of referred arm pain. Cervical radiculopathy will not respond to treatment where you feel the arm pain. However, it will respond positively to treatment at the source of the injury (e.g. your neck joints).
Professional assessment from a health practitioner skilled in diagnosing both spinal-origin and local-origin (muscle and joint) injuries (e.g. your physiotherapist) is recommended to ensure an accurate diagnosis and prompt treatment directed at the arm pain source.
Arm Pain has Diverse Causes.
The causes of your arm pain can be extensive and varied. Due to this diversity, your arm pain should be assessed by a suitably qualified health practitioner to attain an accurate diagnosis, treatment plan and implementation specific to your arm pain.
What Arm Pain is Associated with a Heart Attack?
Left-arm pain can be an early sign of a life-threatening cardiac issue. Based on this, a professional medical assessment that involves an accurate history, symptom analysis, physical examination and diagnostic tests to exclude a potential heart attack is important to exclude this potentially life-threatening source of arm pain.
For more information, please consult with your health practitioner, call an ambulance on 000, or visit a hospital emergency department to put your mind at ease.
Good News. Most Arm Pain is NOT Life-Threatening.
Luckily, life-threatening arm pain is far less likely than a local musculoskeletal injury. Arm pain caused by a localised arm muscle, tendon or joint injury should be assessed and confirmed by your health practitioner before commencing treatment.
Arm Pain Prognosis
The good news is that arm pain, and injury will normally respond very favourably to medical or physiotherapy intervention when early professional assessment and treatment is sought. Please do not delay in consulting your healthcare practitioner if you experience arm pain.
Common Arm Pain Treatments
With accurate assessment and early treatment, most arm injuries respond extremely quickly to physiotherapy or medical care, allowing you to resume pain-free and normal activities of daily living quickly.
Please ask your physiotherapist for their professional treatment advice.