At Jamie Bell physiotherapy we treat a number of people who suffer with bursitis and we have extremely good results from our treatment. Bursitis is the inflammation of bursa at different joints throughout the body. Bursae are small sacs filled with synovial fluid and their main function is to prevent irritation between different tissues in the body. They provide a cushioning and a smooth point for muscles and tendons to slide over bone, preventing irritation.
When the bursa become irritated they can become inflamed which can produce an intense deep pain. With continual irritation from tight muscles or abnormal movement, the bursa can become further inflamed and cause further pain. This pain is local to the joint, extremely painful and often described as a deep ache. Pain will be exacerbated with any movement to the particular joint and on a night time which often affects peoples sleep.
There are a number of bursae throughout the body, however there are a select few which are more commonly irritated. When irritated they can cause a deep pain to the specific joint where they are situated. Outlined below is each individual bursa, how it may become irritated and how this may manifest itself:
How can Physiotherapy Help Bursitis?
- Pre-Patellar Bursitis: The pre-patellar bursa is situated at the front of the patella (knee cap). This occurs either through direct trauma to the knee or repetitive trauma to the knee over a period of time. Often referred to as 'housemaids knee' or 'coal miners knee' because of the repetitive kneeling mechanisms that can predispose the individuals to the inflammation of this bursa. Bursitis to this area is also common with sports which include jumping, increasing pressure on to the front of the knee. Increased pressure to the bursa puts it under extra stress and predisposes it to irritation. This can also become apparent with tight quadriceps muscles (muscles over the thigh) which will cause extra pressure onto the pre-patellar bursa and also predispose the individual to patella tendonitis.
- Sub-acromial Bursitis: Due to the location of the bursa, bursitis to the sub-acromial bursa is commonly associated with impingement syndrome at the shoulder. The sub-acromial bursa separates the supraspinatus tendon (one of the rotator cuff muscles) from the ligaments, the coracoid and the acromion. The bursa therefore plays a big role in preventing damage and irritation to the supraspinatus tendon with overhead movements of the arms. However if the structures in this small area become irritated through poor posture, repetitive overhead movements (throwing, tennis, badminton squash, manual job) direct trauma, then the bursa can also become inflamed. This is presented as a deep ach pain with any shoulder movement to the front of the shoulder. There may also be redness and heat over the shoulder.
- Trochantetric Bursitis: Trochanteric bursitis is irritation to the bursa that sits over the hip bone (greater trochanter). It arises as a result of direct trauma, overuse, tightness to the overlying muscles and also muscular imbalance. It commonly coexists with obesity, low back pain and arthritis. As with sub-acromial and pre-patellar bursitis, trochanteric bursitis can become apparent through extra pressure over the bursa from the overlying muscle tissue. If the gluteal muscles are tight because of a muscle imbalance or over activity, extra pressure will be put on to the bursa, predisposing it to bursitis. Other causes can also include a leg length discrepancy, causing muscle balance. It will be apparent through an ache over the side of the hip, this pain will be increased with walking or palpation or contact to the area (lying on the affected side).
- Retrocalcaneal Bursitis: The retrocalcaneal bursa is situated behind the ankle by the heel. It acts as a cushion and lubricant to where the Achilles tendon attaches on to the heel bone. Bursitis to this area causes pain in the heel which is worse with walking, running, or when the area is palpated. The pain may also increase when wearing high heels as it increases compression to the bursa. Causes for irritation of this bursa involve excessive walking, running or jumping. If either of these activities is completed with poor biomechanics and aggressively (circuit training, intense aerobics) then it can put the bursa under extra strain and cause irritation. Retrocalcaneal bursistis can be often linked to Achilles tendonitis, occasionally misdiagnosed, however it is important to have a thorough assessment from one of our physiotherapists to ensure the correct diagnosis is made.
When treating bursitis it is important for the physiotherapist to consider all the contributing factors to the injury. As the causes are generally multifactorial, it is common for the physiotherapist to use a combination of treatment techniques to treat the bursitis.
At the first instance it is important to follow the PRICE protocol along side anti inflammatory and pain relieving medications (as directed by your doctor or a pharmacist) to allow the inflammation to slow and pain to reduce. After a thorough assessment the physiotherapist can determine which area of the body is contributing to the irritation and provide the most appropriate treatment.
The most common treatment method used is soft tissue massage alongside trigger point release treatment to reduce tightness in the muscle which will reduce tension and pressure on the bursa. As mentioned above in the trochanteric bursitis, tightness to the glute maximus and tensor fascia latae can increase compression on the trocanteric bursa. With massage and trigger point release treatment to these muscles it will reduced the tension in the muscles, and in turn reduce the compression on to the bursa, reducing irritation.
Biomechanical problems can also predispose a joint to developing bursitis. If the joint is not moving within a normal movement pattern then the bursa can become impinged or irritated causing inflammation. This is common in the sub-acromial bursa as mentioned above. By correcting the patient's posture and providing the individual with specific exercises to improve their movement patterns, the bursa can be offloaded and the inflammation will reduce.
Ultrasound has also shown to be beneficial in treating bursitis, it can help encourage tissue repair.
If conservative treatment is not sufficient, ultrasound guided corticosteroid injections can be administered to the bursa. This will need to be completed by your GP or an orthopaedic specialist, however it can provide brilliant relief to the area, reducing pain and improving function.
If you would like to discuss your problem before booking an appointment please give our physiotherapy team a call, we will do our best to help.