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Bursitis Pain and Treatment

What is bursitis?

Bursitis pain treatment brisbane

Bursitis is a condition that can affect many areas of the body due to the presence of bursae near most joint structures. Hip and shoulder bursitis are common forms seen in an MSK Therapy Clinic setting. Bursae are small, slippery, fluid-filled pads that sit between soft tissues and bone and occur in high friction areas. The bursae act like a cushion or damper and differ in size and shape. Bursitis is simply the inflammation of a bursa, which may occur for many reasons. An inflamed bursa is likely to restrict mobility and result in myofascial pain, and if incorrectly managed, symptoms can quickly worsen. Once a bursa is inflamed, it is easy to create further irritation, immobility and pain. Not only are hips and shoulders more susceptible to bursitis, but for a variety of reasons, it is more common to see chronic cases in an MSK Clinic setting. Most daily activities rely heavily upon shoulder and hip joint structures for movement, making it relatively easy to irritate tissues further. Chronic or Persistent Pain can add a variety of complexities to treatment outcomes. Many sports and activities involve repetitive motions, easily highlighting existing or unresolved issues as symptoms occur. There are many seemingly unrelated Sports Injuries which can result in Bursitis symptoms.

The image below shows a number of bursae around the shoulder joint and the highlighted one is the Subacromial Bursa, which is a common form of shoulder bursitis.

Image of right shoulder and highlight subacromial bursa

Image of Right Shoulder and Subacromial Bursa (highlighted)

Images produced with kind permission of from Essential Anatomy 5

(Copyright © 2018 - 2024 3D4Medical. All rights reserved.)

Why might bursae become inflamed?

Bursae can become inflamed for many reasons:-

  • A specific trauma or injury
  • Changes in biomechanics
  • Previous unresolved injuries
  • Infection
  • Other medical conditions

Infection of a bursa and GP referral

Most of these causes fit within the remit of MSK therapy and other allied health. The author has seen and treated various bursitis issues during 16 years in the MSK field. During that time, he only saw one case, which he suspected was an infection. Such a situation meant a GP referral for further investigation and treatment, which resolved the issue. In such a situation, no amount of manual therapy is going to resolve the problem. However, manual therapy can prove helpful in addressing adaptive tissue changes and altered movement patterns caused by bursitis.

Specific trauma or Injury and inflammation

As with most injuries, trauma leads to an inflammatory response within the tissues injured, the surrounding structures and even further afield as with myofascial trigger points. A fall is a fairly common way of hurting one of the bursae in the hip, leading to Trochanteric Bursitis, hip pain, possible causes, treatment options and self-help. One might land on the hip, which leads to inflammation of the bursa and the surrounding soft tissue structures. It is not uncommon for people to hurt their shoulder in such a fall, which might lead to Subacromial Bursitis. As mentioned, there are many bursae within the body and more around complicated joint structures, like the shoulder complex. Usually, in the case of trauma, people are aware of the pain and restricted mobility from the start.

Image of Left Hip and highlight trochanteric bursa

Image of Left Hip and Trochanteric Bursa (highlighted)

Images produced with kind permission of from Essential Anatomy 5

(Copyright © 2018 - 2024 3D4Medical. All rights reserved.)

Changes in biomechanics and unresolved injuries

Man holding painful hip

Another cause of bursitis is often more subtle and due to changes in biomechanics. If everything moves normally, load transfer occurs without irritation to underlying tissues or structures. If the transfer of loads changes from normal, this can lead to increased loads in some areas, creating irritation and injury. The body's response is inflammation, leading to a cycle until the person notices a problem. The human body is very good at adapting (see the related article on tissue adaptation), and things become "normal" to us very quickly. Hence, most people do not notice the body's subtle changes to adapt to minor issues until a noticeable injury occurs. Runner's may experience Trochanteric Bursitis due to iliotibial band syndrome issues, caused by something else, a symptom of a symptom. Typically, biomechanics changes occur due to unresolved injuries or habitual behaviours. Far too often, people do not seek treatment for injuries or finish a treatment plan early. Being out of pain does not mean one has recovered from an injury. Equally, that does not mean that one needs constant treatment either, as the goal is self-management.

Although the body adapts to injuries, it also adapts to what we do with it, good or bad. How we move becomes learnt and second nature. If one were doing a repetitive activity and moving incorrectly, this is likely to irritate tissues and structures near the joints involved. Shoulders are quite susceptible to such injuries. One might see similarities between a sedentary lifestyle and prolonged sitting, quickly affecting the shoulders or hips. The tissues will adapt to how we use them and then adapt again when we use them differently. Hence, in the case of some long-term issues, successful treatment may highlight some other unknown problems that still need resolving.

Professional help and treatment

The author has found that a mix of MSK therapy techniques, soft-tissue therapy (STT), advice and prescriptive exercise can resolve most cases of bursitis quickly enough. However, the process is collaborative between the patient and the practitioner. Sadly, expecting a magic pill or having the practitioner fix things without any personal effort tends to result in poor outcomes. Taking control of the recovery process is a vital aspect of self-management. Bad actors within the MSK field rely on people not wishing to take control of their recovery, as the patient then needs regular treatment (see the article on finding a good practitioner).

The article was written by Terry Davis MChiro, BSc (Hons), Adv. Dip. Rem. Massag., Cert. WHS.

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About the Author

As of December 31st 2020, the author chose to leave the Chiropractic profession due to a planned move back to Australia, where his training and education are not recognised. Terry no longer works as a Chiropractor and works as a Myotherapist in Morningside, Brisbane. He developed an early interest in soft tissue therapy techniques and advanced myofascial release methods in 2006 for treating various conditions. Terry's interests in human performance and trauma have naturally led to him developing a specialism in treating work and sports-related musculoskeletal injuries and Chronic Pain symptoms.

The author possesses an unusual background for somebody who trained in the McTimoney Chiropractic technique. His education, training, and practical experience span over two decades and relate to health's physical and mental aspects. He also needed to push his body and mind to the limits of physical and psychological endurance as part of his time serving in Britain's elite military forces. His education includes a bachelor of science degree in Business Management, with a specialisation in psychology and mental health in the workplace, an Integrated Masters in Chiropractic, MChiro and a multitude of soft-tissue therapy qualifications (see the about section for more details). His soft tissue qualifications range from certificate level right through to a BTEC Level 5 Advanced Diploma in Clinical Sports and Remedial Massage Therapy. He has also taught as a senior course coach at the Advanced Diploma level (Myotherapy / Musculoskeletal Therapy) in Australia, both theoretical and practical aspects, including advanced Myofascial Release Techniques and has certification in training and assessment. Terry will have taught many of the first students to train as Myotherapists in Brisbane. Terry's combination of knowledge through education, training, elite military service, and personal injury history has paid dividends for the patients he sees and has treated over the last 16 years. Terry is still extremely active and enjoys distance running, kayaking, mountain biking and endurance-type activities.