Most people will have never heard of a “bursa”, however it is a very common cause of significant pain and injury in the body (bursitis).
A bursa is a very thin, small fibrous sack that sits between bone and tendon. They are found in the shoulder, elbow, hip, knee and various other places throughout your body. The inside of the bursa is lined with synovial cells which secrete a very slippery fluid, which helps to reduce the friction between the tendon and the bone so that they can slide smoothly on one another.
How does injury occur?
Most commonly, injury occurs due to excessive mechanical irritation such as rubbing or compression on the bursa and may be due to tight muscles, overuse or external forces such as kneeling on the bursa within your knee. The excessive force causes an inflammatory reaction within the bursa that is not only painful but will also lessen the ability of the bura to reduce friction. If the mechanical irritation is present for a prolonged period of time, the fibrous sack may also become thickened which can cause problems in areas such as the shoulder, where taking up extra space will cause pain through impingement.
What can be done?
Treatment for bursitis should initially involve removing the mechanical irritation to the bursa. This could involve rest, stretching of tight muscles and correction of biomechanical abnormalities. Ice may be applied to superficial bursae to help reduce pain and inflammation. Physiotherapy including massage, ultrasound and exercises may be helpful. A doctor may prescribe non-steroidal anti inflammatory medications or a corticosteroid injection to reduce inflammation in the short term. In extreme cases surgical removal of the bursa may help to alleviate symptoms.
Common Sites of Bursitis and Treatment
Shoulder – Subacromial bursitis: Usually caused by impingement of the glenohumeral (shoulder) joint which may be the result of rotator cuff tears, poor scapulohumeral rythm, overuse or abnormal shoulder anatomy such as a hooked acromion.
Treatment: Rest followed by restoration of normal shoulder mechanics through scapula stabilisation exercises and rotator cuff strenghening.
Elbow – Olecranon bursitis: May be caused by direct trauma to the point of the elbow, or resting elbow’s on a desk
Treatment: Protecting the affected area, gentle stretching of the triceps, iceing the elbow
Hip – Trochanteric Bursitis: Often caused tight ITBs, direct pressure such as sleeping on one side
Treatment: Avoid sleeping on the affected side, stretching of the gluteal muscles and ITB, iceing the affected area, Core and glute strenghtning to minimise lateral pelvic movements while walking runinng etc.
Knee – Multiple Bursae (prepatellar, suprapatellar, infrapatellar, pesanserine)
Treatment: Rest from aggravating activities such as running, jumping, kneeling, breaststroke swimming. Iceing the affected area, stretching and strengthening as appropirate.
Written By Stuart Turner: Physiotherapist
Our Physiotherapists at Epping, Rozelle and Norwest are experienced in diagnosing and treating burisitis and it’s causes. Please contact us for more information.