Bursitis: The Simple Facts
What Is Bursitis?
Bursitis is a condition characterised by the inflammation or swelling of a bursa. A bursa is a synovium-lined, sac-like structure found throughout the body, particularly near bony prominences and between bones, muscles, tendons, and ligaments. There are over 150 bursae in the human body, which facilitate movement within the musculoskeletal system by providing a cushion between tissues that move against one another. When bursitis occurs, the bursa becomes enlarged with fluid, resulting in pain whenever there is movement against or direct pressure on the affected area. This condition can arise from various causes, including overuse injuries, infectious diseases, trauma, and inflammatory disorders. It’s important to note that not all forms of bursitis are primarily due to inflammation; often, the swelling of the bursa is a response to a noxious stimulus.
What Causes Bursitis?
Bursitis can be caused by a variety of factors, with the most common being prolonged pressure on a bursa. This typically occurs when the bursa is compressed between a hard surface and a bony prominence, such as in students resting their elbows on desks or workers kneeling without adequate padding. Repetitive motions can also irritate the bursa, leading to inflammation. Trauma is another frequent cause, where direct pressure on the bursa can induce bursitis. In such cases, the patient might not recall the specific incident since it may have seemed minor at the time. Traumatic bursitis increases the risk of septic bursitis, often due to the direct penetration of the bursa through the skin, typically caused by Staphylococcus aureus. Though rare, septic bursitis can also occur through hematogenous spread. Autoimmune and systemic inflammatory conditions, such as rheumatoid arthritis, osteoarthritis, lupus, scleroderma, spondyloarthropathy, and gout, are also significant causes of bursitis. In some instances, bursitis can be idiopathic, meaning it arises without a known cause. Additionally, invasive procedures can induce septic bursitis.
Who Is Prone To Bursitis?
Bursitis is a reasonably common condition, affecting at least 1 in 10,000 people annually, particularly in the knees and elbows. About one-third of these cases are due to bacterial infections. If the inflamed area is rested, the symptoms typically subside within 2-3 weeks. However, chronic diseases like diabetes and rheumatoid arthritis can delay recovery. Bursitis affects both genders equally overall, but certain types like pes anserine and trochanteric bursitis are more common in women, particularly those who are obese. Men, on the other hand, are more prone to olecranon bursitis due to their higher likelihood of engaging in manual labour jobs. Various types of bursitis have been colloquially named based on their common causes, such as “housemaid’s knee” for prepatellar bursitis and “student’s elbow” for olecranon bursitis. Infrapatellar bursitis is often called “clergyman’s knee,” and ischial bursitis is known as “weaver’s bottom.” Tight or ill-fitting footwear can provoke bursitis of the subcutaneous calcaneal bursa, commonly seen in dancers and figure skaters. While bursitis can affect people of all ages, the elderly are at higher risk due to chronic conditions like osteoarthritis. Immunocompromised individuals, such as those with diabetes, certain rheumatologic disorders, alcoholism, or HIV, are at increased risk for septic bursitis.
How Is Bursitis Diagnosed?
Diagnosing bursitis, particularly for bursae located just under the skin, can often be straightforward. Inflamed bursae present with swelling, pain, and sensitivity to pressure. Additionally, reddened and warm skin indicates inflammation. Determining whether the inflammation is bacterial in origin is crucial. Symptoms like fever or a nearby wound often suggest a bacterial infection. To confirm, a doctor might extract fluid from the bursa using a hollow needle for lab testing. Blood tests can further identify infections or conditions like gout that might cause inflammation. Imaging techniques like ultrasound or X-rays can be valuable tools for ruling out other potential causes, such as bone or joint injuries. These methods also help assess if the bursitis has affected surrounding tissues. There is a particular focus on separating bursitis from septic bursitis. Ultrasonography is an effective tool to differentiate bursitis from cellulitis. Blood tests, including white blood cell counts and inflammatory markers, alongside magnetic resonance imaging (MRI), are instrumental in distinguishing infectious causes from non-infectious ones. A thorough clinical assessment focuses on visible symptoms like swelling, redness, and warmth. It considers patient history to identify potential repetitive motion or trauma. Lab tests, imaging, and fluid aspiration collectively guide an accurate diagnosis and appropriate treatment plan.
How Is Bursitis Treated?
Treating bursitis usually begins with conservative measures to alleviate pain and restore function. Most cases resolve independently, but several approaches can expedite recovery and provide symptomatic relief. Key strategies include rest, ice, compression, and elevation (RICE). These methods help reduce inflammation and discomfort. Patients should be educated on proper ergonomics to avoid aggravating movements. Protective padding is recommended for those whose occupations involve prolonged pressure on joints, such as elbows or knees. A foam doughnut can relieve ischial bursitis while stretching and core strengthening exercises can help improve symptoms. However, in circumstances where bursitis doesn’t resolve on its own, multiple first-line treatments have been shown to improve bursitis symptoms:
Extracorporeal Radial Shockwave Therapy (ESWT) has emerged as a valuable treatment for bursitis. This non-invasive technique delivers shockwaves to the afflicted area, penetrating 3-5 centimetres below the skin’s surface. These shockwaves induce microtrauma in the tissue, catalysing the body’s natural healing mechanisms and fostering tissue regeneration by promoting growth factors and stem cells, primarily Vascular Endothelial Growth Factor (VEGF) and Transforming Growth Factor-beta (TGF-β). ESWT’s efficacy extends beyond pain relief; it also disrupts bursitis calcifications and stimulates neovascularisation, effectively enhancing blood flow to the area by encouraging the formation of new blood vessels. This dual-action approach of disrupting calcifications and boosting blood circulation significantly aids healing.
Clinical studies have consistently highlighted ESWT’s effectiveness in alleviating pain and improving functionality in bursitis patients. This makes it a preferred treatment option in reputable pain management clinics. The non-surgical nature of ESWT, coupled with its ability to target specific areas with precision, positions it as an appealing choice for those seeking relief from bursitis without the invasiveness of traditional surgical methods.
High-Intensity Laser Therapy (HLT) presents an innovative and non-invasive approach to managing bursitis, effectively targeting pain and inflammation associated with the condition. Utilising high-intensity lasers, HILT focuses on the affected bursa, promoting tissue repair and diminishing inflammation in the bursitis-impacted regions. HILT operates by penetrating the skin and activating chromophores within the mitochondrial cells, leading to enhanced adenosine triphosphate (ATP) production and improved cellular metabolism. This biochemical process fosters tissue healing while modulating inflammatory mediators such as cytokines and prostaglandins, crucial in reducing pain and enhancing function for bursitis patients. Clinical research underscores the efficacy of HILT, with numerous studies documenting significant improvements in pain levels and functional outcomes for those afflicted by bursitis.
Physical therapy and range-of-motion exercises are critical in treating bursitis, particularly for subacromial bursitis, where preventing immobilisation-related issues like atrophy, retraction, and frozen shoulder is paramount. Physiotherapy is central to a comprehensive bursitis management plan, offering various interventions for pain reduction, mobility enhancement, and functional improvement. A fundamental component of this approach is exercise therapy, which involves targeted exercises designed to strengthen muscles, improve joint stability, and restore range of motion. Addressing muscle imbalances and promoting proper biomechanics through these exercises can significantly alleviate stress on the affected bursa, reducing the risk of further injury. For instance, strengthening exercises targeting the rotator cuff and scapular stabilisers benefit shoulder bursitis. At the same time, hip abductors and gluteal muscles are often the focus of hip bursitis.
Education and self-management strategies are integral components of physiotherapy for bursitis. These strategies empower patients with the knowledge and skills needed to manage their condition effectively and prevent the recurrence of symptoms. Patients are educated on ergonomics, posture correction, and activity modification to avoid movements and positions that exacerbate bursitis. The holistic approach of physiotherapy addresses both immediate symptom relief and long-term functional improvement, optimising outcomes for individuals with bursitis. Combining targeted exercises, manual therapy, and patient education, physiotherapy provides a robust framework for managing bursitis, ultimately enhancing the patient’s quality of life and functional independence.
Addressing the underlying disease is crucial for bursitis resulting from systemic inflammatory conditions. Septic bursitis requires systemic antibiotics targeting gram-positive organisms, with most cases managed outpatiently using oral antibiotics. Hospital admission is necessary if systemic or joint involvement is suspected or if the patient appears unstable. In stubborn cases, surgical excision of the bursa may be required to resolve the issue, typically via endoscopic or arthroscopic procedures.
For deeper bursae, corticosteroid injections may provide short-term relief when combined with a local anaesthetic. However, local injections are not recommended for superficial bursae due to risks like septic bursitis, tendon injury, skin atrophy, or sinus tract formation. Furthermore, Corticosteroid injections may also mask other conditions, such as a rotator cuff tear, delaying necessary diagnosis and treatment. The evidence supporting corticosteroid injections for chronic bursitis is limited, with some studies suggesting no significant benefit.
Custom insoles or orthotics can be a vital part of the treatment plan for bursitis, particularly for those suffering from foot-related bursitis. Orthotics can help for several key reasons:
We know instinctively that inside the body everything is connected on some level. Fascia is the missing piece of that puzzle. It truly runs through the whole body, connecting every part with every other part. It has different layers, with a superficial and deeper layer, but even those are not entirely separate.
With more than six times as many nociceptors than muscles, fascia has an important role in pain complaints, and the full extent is still as yet unknown. In clinical practise, it is well known that pressing certain tender points can elicit a referred pain in a distant body part. You cannot treat pain seriously without at least considering the role of the fascia.
We know instinctively that inside the body everything is connected on some level. Fascia is the missing piece of that puzzle. It truly runs through the whole body, connecting every part with every other part. It has different layers, with a superficial and deeper layer, but even those are not entirely separate.
With more than six times as many nociceptors than muscles, fascia has an important role in pain complaints, and the full extent is still as yet unknown. In clinical practise, it is well known that pressing certain tender points can elicit a referred pain in a distant body part. You cannot treat pain seriously without at least considering the role of the fascia.
The concept of tensegrity describes how seemingly free-floating parts are suspended and held in place through tension and connection to other parts balancing the whole. By altering the suspension in one area, or picking up one solid part and taking the balance off that part, every other part is affected. Fascia enables a sophisticated blend of mobility and rigidity to exist within a physical system made of many individual anatomical parts.
The concept of tensegrity describes how seemingly free-floating parts are suspended and held in place through tension and connection to other parts balancing the whole. By altering the suspension in one area, or picking up one solid part and taking the balance off that part, every other part is affected. Fascia enables a sophisticated blend of mobility and rigidity to exist within a physical system made of many individual anatomical parts.
Fascia connects our skin with underlying muscles, bones, and nerves, penetrates organs, and runs all throughout the whole body… It creates space between different sets of tissues, within tissues, and between single cells. It makes it possible to absorb shock and impact forces, allows muscles and tendons to slide to do their job properly, allows nutrients and waste products to travel, and communicates with other parts of the body. It is a fabulously c complex blend of deliberate separation and connection.
Your fascia is an ever changing system, adapting to the demands of daily living that you apply to it. This adaptability is referred to as plasticity. If you are tied to the desk for your job, chances are your fascia has adapted and holds you in what you call “bad posture”. Changing it requires a lot of patience and a fair amount of (regular!) work. When you have an injury, the fascia plays the role of redirecting forces away from it and directing your body in compensatory movements that may remain long after the injury has healed. Facia is full of nerve receptors and has a huge impact on your coordination or lack thereof.
Due to its plasticity fascia requires care in order to remain healthy. Putting your body through repetitive, unchanging movement patterns makes your fascia stiff and less willing to allow other movements. Ingrained postures or patterns are hard to break and need time and ongoing effort. By giving your fascia different input on a regular basis, it allows for better, smoother range of movement, improving balance, and preventing you from injuries.
If you are wondering if your fascia is playing a role in perpetuating your pain; it’s well worth getting checked out by some professionals who have put the necessary time and effort into diagnosing fascial issues… with your tissues! Thats where we come in :)
The Relationship Between Low Testosterone and Erectile Dysfunction Testosterone is the principal androgen hormone in males, playing a critical role
Erectile Dysfunction and The Male Pelvic Floor – What’s The Connection? Introduction to The Male Pelvic Floor The male pelvic
Prepatellar Bursitis: What You Need To Know Overview of Prepatellar Bursitis Prepatellar bursitis, colloquially referred to as “housemaid’s knee” or
Leave a Reply
Want to join the discussion?Feel free to contribute!