WHAT IS BURSITIS?
Bursitis is the inflammation of one or more bursae sacs around a joint. We have many bursae around the body (more than 150!), often between muscles/ tendons and bones, that act as a gliding surface for the tendons during movement. They are little sacs of synovial fluid that help to lubricate the joint and create a surface for other structures to slide across for painless movement.
When we have muscles or tendons that get injured, such as a muscle strain or a tendinitis, these structures become tight and put pressure on these bursa sacs. These bursae then become inflamed which perpetuates the problem and causes more pain. Some common bursae that get affected are at the shoulder (subacromial bursa), the knee (prepatellar bursa), the ankle (retrocalcaneal bursa, under the achilles tendon) and the hip (trochanteric bursa). Symptoms vary from pain, stiffness, localized swelling, pinching sensation, warmth around the area, grinding or snapping sensations.
The causes of bursitis are not always clear. Often bursitis is a result of another structure being injured (such as a tendonitis), so the cause of that injury must be dealt with to take the pressure off the bursa. Commonly a direct blow to the area from a fall can inflame the bursae. Such as a fall onto the elbow – think of that big, swollen elbow joint – that is an inflamed bursa at the back of the elbow. Or, a fall onto the front of the knee can cause that prepatellar bursa to swell up and become painful. Other causes may be infections, auto-immune disorders, gout, diabetes, and rheumatoid arthritis.
If there is no specific mechanism of injury that may have caused the bursitis, it is important to rule out an infection. In the case of an infection, there would likely be some other systemic symptoms such as a fever. Otherwise, bursitis is often treated initially with ice, rest and gentle mobility exercises to take the pressure off the area. It is important to identify what structures are at fault for the added pressure and rubbing along the bursa, and why those structures are aggravated. Again, the inflamed bursa is often a SYMPTOM caused by a different structure. The bursa is often not the original problem. When this issue becomes chronic, it is often due to being treated locally and not identifying the original issue. Steroid therapy (a cortisone injection) can be helpful in the short term to relieve pain, but will not address the root of the problem.
For example, a subacromial bursitis in the shoulder, often presents as a gradual onset of pain, stiffness and pinching during certain shoulder ranges of motion (especially 70-120 degrees of elevation).
Strength may be affected, inability to sleep on that side, and a dull, throbbing ache that may radiate down the upper arm. The supraspinatus and deltoid muscles slide across that bursa. If the supraspinatus is inflamed and becomes tight (overuse, neck issue), there will be impingement and excessive rubbing. The deltoid muscle tries to help out, but it works overtime and gets fatigued and tight. Then we start to compensate with our neck and upper shoulder muscles and hold our sore arm in a protective position. Do you see the cascade of events that can contribute to this poor bursa becoming inflamed? This change in mechanics, habitual movement patterns and repetitive issues are common at the shoulder, hip and knee. The therapists at Bragg Creek Physiotherapy would love to help you unwind these issues and get to the root of the problem. We want to help you get moving again and back to the activities you enjoy!
Jennifer Gordon (BSc.PT, GunnIMS, AFCI)
Physiotherapist – Bragg Creek Physiotherapy
www.braggcreekphysio.com
