What is bursitis?
To understand bursitis we must first understand the bursa. A bursa is a small sac of fluid designed to help reduce friction at various points in the body. It is made of a thin synovial membrane and filled with synovial fluid. It can be helpful to think of a bursa like a blister. A blister can develop under the skin at points where there has been too much rubbing or pressure on an area; and the body does this to reduce rubbing over that area. A bursa is similar in that it helps to facilitate a gliding movement where tissues rub against each other by acting like a thin cushion. We all have a set number of bursas throughout the body, exceeding 150! Most of these are present from birth, some develop as we grow up. This is important to know as many people present to physiotherapy reporting ‘I have a bursa’. To which we sometimes jokingly reply, ‘that’s good, you’re meant to!’. What they may have misunderstood is that having a bursa is good and normal, what is likely to be causing them difficulty is irritation of this bursa; also known as… bursitis.
When a bursa becomes inflamed the membrane (outer layer) will thicken and more synovial fluid will be produced, making the bursa fatter as it swells. It is this inflammation of a bursa that is known as bursitis. When the name is broken down burs- (coming from bursa) and -itis (meaning inflammation) it really explains itself!
Symptoms
Bursitis is usually characterised most notably by tenderness over the area. If it is a superficial bursa there may be visible swelling over the area. As it is an inflammatory presentation it is common the pain may be worse when you first wake up, and stiff/slow to get going in the morning. Often direct pressure over the area can be uncomfortable such as lying on your side with hip bursitis.
Causes
Bursas start to become inflamed due to increased load. Usually, this is a gradual repetitive increase over time through overuse and repeated rubbing over the site, causing a gradual build in inflammation. Less commonly bursitis can occur acutely if there is a high pressure, sudden impact causing acute trauma to the bursa. It is far more common to develop bursitis over joints used in a repetitive way or that are under a lot of load. These joints commonly include hip, shoulder, knee and elbow.
Risk Factors
Due to its main causing factor of excess load through a bursa a common risk factor is a sudden increase in physical activity or change in repetitive work.
Usually, there is an association with how the muscles around the joint work and what is called biomechanics. Biomechanics relative to the human body is the association between forces and positions of joints and muscles. For example, someone with a pronated foot posture (where the foot has a lower arch and is rolled inwards) can change the way force travels up the leg, putting greater pressure on the outside of the hip and contributing to bursitis on the outside of the hip.
Do I need a scan?
In most cases, a scan is not required and bursitis can be diagnosed through a subjective and physical assessment by your physiotherapist.
Treatment
The first focus is to reduce load on the affected area. This is generally through reducing activity and increasing rest. Using an ice pack can be beneficial to reduce the inflammation of the bursa. Medication is often not needed, especially if identified early but some individuals find that taking anti-inflammatory medication can be beneficial in easing the symptoms.
Depending on the body area there are braces and taping options that can help to reduce load through the bursa. This is obviously not a long-term strategy but can assist in relieving the load to allow ongoing mobility and use of the area.
Addressing contributing factors through exercises. The important consideration with any injury is considering why this has developed in the first place. Bursitis is often associated with tightness or weakness of the muscles around the area so a comprehensive rehabilitation program to address this is important in reducing the likelihood of reoccurrence.
Steroid injections (often known as cortisone injections) can be considered, however, this should not be the first option considered. There is mixed evidence on the benefit of cortisone injections and most importantly they don’t address the contributing factors. Meaning that if a cortisone injection is the only treatment done the bursitis may return in the future as the reason for load around the area hasn’t been addressed. A steroid injection should only be considered as part of a larger management plan involving exercises and activity modification.
Written by Maddie Kavanagh
Physiotherapist at Back In Motion Brighton