WHAT IS BURSITIS?
Bursitis is a painful inflammation condition that affects the bursa (small fluid-filled sacs). Bursa help to reduce friction between bones and soft tissue by acting like cushions during movement. There are over 150 bursa within the body. Bursitis is often a symptom of a tendinopathy in the same area.
Although bursitis can afflict any bursa in the body, the most common locations include:
Knee – Prepatellar (kneecap) bursitis
Often caused from constant kneeling, professions such as builders, carpenters, tilers, and gardeners would be at risk. Kneeling on hard floors could also aggravate the bursa (yoga on floorboards).
Hip – Trochanteric Bursitis
The most common bursitis of the hip is trochanteric bursitis which occurs on the lateral side of the hip, located over the bony point of the greater trochanter. It is a common condition in women, middle aged and elderly people. It typically occurs from repetitive actions, often to fatigue, such as walking, running, stair climbing and standing. It can also be the result of a hip injury, post-surgery, leg length discrepancy or arthritis. It can be very painful at night, especially if attempting the lie on the affected side.
Shoulder – Subacromial bursitis
There are many bursa around the shoulder joint but the subacromial bursa is the most commonly inflamed, most likely due to its position under the acromion process.
Shoulder bursitis usually affects people over the age of 30, with a higher incidence in females. Subacromial bursitis is often caused from repetitive overhead movements such as gardening, swimming, reaching up.
Elbow – Olecranon Bursitis
Often referred to as student’s elbow, it is commonly caused from excessively leaning on your elbow on a desk. It can also be caused from repetitive elbow use as in throwing sports (javelin, cricket, baseball).
The majority of cases of bursitis I see in the clinic are from overuse, where the individual partakes in repetitive actions over a period of time which in turn inflames and swells the bursa, often from the associated tendon continually rubbing over the bursa. It is rare that I see acute or trauma cases of bursitis but one such case that presented recently involved elbow bursitis, where the elbow had blown up enormously. It was hot and angry, causing exquisite pain for the individual. So what do you do in these situations?
Management
Acute Bursitis from trauma
In the case of the above elbow bursitis I provided the following advice:
Ice
Ice for 24-48hrs to ease the pain and cool down the area
Medication
As the area was highly inflamed the individual rubbed voltaren gel around the area for a few days. In this case gel vs oral NSAID medication was the preferred option as the bursa was located closer to the surface area and therefore he was able to keep the medication localised to the specific area.
Activity Modification
Avoid the aggravator and direct pressure – in this case, excessive leaning on a concrete surface
Infection
There is a risk of infection within the bursa if there is a scrape or puncture wound to the area. It is important to keep an eye on the area for infection.
Chronic Bursitis from repetitive use
Most cases of bursitis arise from overuse, initially the pain can be treated at home. If this does not settle the issue, make an appointment with your myotherapist for further treatment and management.
Ice and Heat
Once the condition has progressed beyond 72hours, you can interchange the use of ice and heat upon preference. Both are beneficial for pain relief. Heat is recommended if you want to increase blood flow to the area which will aid in increasing the range of movement.
Medication
As above, over the counter NSAID’s or anti-inflammatory gels may aid in reducing inflammation. It is not wise to use these over a prolonged period of time.
Activity Modification
Avoid the aggravating activity (walking, running, swimming etc) until the pain has settled. You should also avoid direct pressure on the area such as lying on a hip bursitis at night.
Myotherapy
If the above home remedies do not settle the issue it might be time to see your myotherapist. They can assess your biomechanics and discuss activities that may be contributing to the pain. A myotherapist can treat soft tissue around the area which may be causing tension, as well as providing you with some exercises to regain mobility as well as strengthen the associated muscles.
Other options
Hydrocortisone injections are often given to provide a quick pain relief solution but the long-term effects, including relapse, may make it not worth going down this path. For more information you can refer to my blog article https://www.myotherapyandmovementclinic.com.au/blog/2019/5/1/tendinopathy-treatments-what-works