What is bursitis?

What is bursitis?

Bursitis is a condition characterized by inflammation of the bursae, which are small, fluid-filled sacs or pockets located throughout the body. The bursae contain synovial fluid (joint fluid), providing a cushion between structures that would rub against each other, such as tendons rubbing on bones or other tendons.  It reduces friction and provides lubrication between these structures. When a bursa becomes inflamed, it can lead to pain, swelling, and limited range of motion in the affected joint. 

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The most common types of bursitis are:

1. Prepatellar bursitis: Inflammation of the prepatellar bursa located in front of the kneecap (patella). It is often referred to as "housemaid's knee" due to its association with activities that involve prolonged kneeling or recurrent minor trauma to the knee. 
2. Subacromial bursitis: Inflammation of the subacromial bursa located under the acromion (a part of the shoulder blade) that separates the rotator cuff tendons from the overlying bone. It is usually caused by overhead repetitive movements and even trauma.
3. Trochanteric bursitis: Inflammation of the trochanteric bursa located on the side of the hip, over the greater trochanter. It is the common cause of hip pain due to repetitive microtraumas such as running and exercise. Discomfort is also experienced after standing asymmetrically for long periods. Walking and climbing stairs aggravate the condition.
4. Olecranon bursitis: Inflammation of the olecranon bursa located at the back of the elbow, over the bony prominence called the olecranon. This inflammation can be caused by excessive rubbing of the elbow against a hard surface and is also referred to as “student’s elbow”. 
5. Retrocalcaneal bursitis: Inflammation of the bursa located at the back of the heel. Repetitive pressure on the area causes irritation that leads to pain and inflammation. Running uphill and standing on tiptoes aggravates the pain. 

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Common symptoms of bursitis

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Common symptoms of bursitis include:

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• Pain: The affected joint may be painful, often described as a localized dull aching pain. 
• Swelling: The area around the joint may become swollen or tender.
• Limited range of motion: Bursitis can lead to stiffness or difficulty moving the affected joint fully.
• Warmth and redness: These symptoms are more likely to be present on septic bursitis, a type of bursitis that is caused by infection. 
  

What causes bursitis?

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Bursitis can be caused by various factors, including:

• Repetitive motions: Repeated movements or activities that put stress on a joint can irritate the bursa over time, leading to inflammation. This is common in occupations or sports that involve repetitive motions or prolonged pressure on specific joints.
• Trauma or injury: Direct trauma to a joint, such as a fall or blow, can cause bursitis. In some cases, an infection may develop in the bursa following an injury.
• Prolonged Pressure:  This is one of the common causes of bursitis, wherein the bursa is stressed between the hard surface and the bony prominence (bony area that is close to the surface) such as; prolonged leaning and kneeling. 
• Infection: Bursitis can sometimes be caused by an infection in the bursa, which is known as septic bursitis. This happens due to trauma or direct puncture of the skin at the site of a bursa causing bacterial infection. This usually requires prompt medical attention and treatment.

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How can physical therapy help? 

Physical therapy can be beneficial in the treatment of bursitis by addressing the underlying causes, reducing pain and inflammation, improving joint mobility, and promoting healing. Here's how physical therapy can help with bursitis:

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1. Assessment and diagnosis: A physical therapist will assess the affected joint and conduct a thorough evaluation to determine the underlying cause and severity of the bursitis. This assessment helps guide the development of an appropriate treatment plan.
2. Pain and inflammation management: Physical therapists can utilize various modalities, such as ice therapy, electrical stimulation, or ultrasound, to help reduce pain, swelling, and inflammation in the affected area. These modalities can provide short-term relief and facilitate healing.
3. Range of motion exercises: Bursitis can lead to stiffness and limited joint mobility. Physical therapists will prescribe specific exercises to improve range of motion,  flexibility and fluid circulation in the affected joint. These exercises may include gentle stretches and joint mobilizations.
4. Strengthening exercises: Strengthening the muscles around the affected joint is crucial to provide support and stability, relieving stress on the bursa. Physical therapists will prescribe exercises targeting the surrounding muscles to improve strength and enhance joint function.
5. Posture and biomechanical correction: Poor posture or faulty movement patterns can contribute to bursitis. Physical therapists can assess and correct any biomechanical issues that may be placing excessive stress on the affected joint. They will provide guidance on proper alignment and movement techniques to reduce strain on the bursa.
6. Manual therapy techniques: Hands-on techniques, such as soft tissue mobilization, joint mobilization, or myofascial release, can be used by physical therapists to reduce muscle tension, improve tissue extensibility, and enhance blood circulation in the affected area. These techniques can help reduce pain and promote healing.
7. Activity modification and ergonomic education: Physical therapists can provide guidance on modifying activities or work-related tasks that may exacerbate bursitis symptoms. They will educate patients on proper ergonomics, body mechanics, and techniques to reduce stress on the affected joint during daily activities.
8. Functional training: Physical therapists can design exercise programs that simulate functional movements related to specific activities or sports. This helps individuals regain strength, flexibility, and coordination required for their specific functional goals while minimizing the risk of bursitis recurrence. In some cases, supportive or adaptive devices may be necessary depending on the affected area and expected functional activities.
9. Home exercise program: Physical therapists will develop and teach the patient a home exercise program that will help him or her adapt to work and recreational activities that are consistent with intervention strategies, so the patient becomes an active participant in the recovery process.  
10. Education and self-management strategies: Physical therapists play a vital role in educating patients about bursitis, its causes, what to expect, the time frame of healing, the signs and symptoms that he or she is pushing beyond the tolerance, and strategies for self-management. They provide guidance on pain management techniques, activity modification, and injury prevention strategies.

It's important to note that the specific treatment plan may vary depending on individual needs, the location of bursitis, and the underlying causes. Working closely with a physical therapist can provide personalized care and help optimize recovery from bursitis.

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