Understanding Bursitis – How can physical therapy help you?

Ryan LaCorte Lori Heuberger, Publications

Anatomy and Function of a Bursa

Bursae are fluid filled sacs that aid in joint motion. There are over 150 bursae in the human body. Bursae are filled with synovial fluid (a lubricant) and they secrete this fluid to counter joint friction with movement. It functions to provide a cushion between bones and muscles and their tendons, allowing pain free movement. Without a bursa, the tendons would grind over the bones with each movement. When bursitis occurs, it is the inflammation of the bursa sac causing irritation and making movements painful and difficult. Bursitis occurs most often later in life, majority of individuals being over 40 years of age. You can see signs of bursitis if the affected joint feels achy or stiff, if it hurts more when you press on it or move it or looks swollen or red.

How Bursitis is Diagnosed

Bursitis is often diagnosed through ruling out other pathologies and gathering a detailed medical history and physical exam. Imaging can be useful to diagnose bursitis; while X-RAY can rule out other pathologies, it cannot positively establish presence of bursitis. Ultrasound or MRI can be used to confirm the diagnosis.

Common Causes

Bursitis can occur for a number of different reasons. Repetitive motions, muscle weakness, poor coordination, improper posture, direct trauma, surgery, calcium deposits, infection or autoimmune disorders can all directly cause bursitis and result in pain and irritation with joint movement.

Types of Bursitis

Subacromial, prepatellar, trochanteric, olecranon and pes anserine are all common areas where bursitis can occur. Subacromial bursitis presents with pain around the shoulder usually caused by repetitive throwing or overhead reaching. This is the most common of all the types. Prepatellar and pes anserine bursitis affect the knee joint and can be irritated with kneeling or stairs. Trochanteric affects the hip joint and can be caused by sudden increased amount of walking or jogging. This type may cause pain with lying on the affected side. Olecranon bursitis affects the elbow, also known as student elbow and can often result in swelling.

Treatment Options

Conservative treatment is usually used first for the treatment of bursitis. This involves rest, ice and taking a pain reliever or anti-inflammatory medicines. If the bursitis is caused by injection, a prescribed antibiotic by a physician can be used. A corticosteroid injection can be used to decrease inflammation. Surgery may also be done to drain the bursa or remove it all together, which is a more rare option. Physical therapy is a highly affective and a less invasive option.

Physical Therapy and Bursitis

Physical therapist are educated and trained to help treat all types of bursitis. During the physical therapy evaluation, your therapist will take measurements to see what musculoskeletal deficits are present and design a personalized exercise program. The program will be targeted to your specific needs and will aim to improve several areas.

Increase Strength. Bursitis if often the result of weak musculature. Weak muscles can lead to injuries or coordination problems. By building up strength in the muscles, joints will move more efficiently and with improved mechanics, leading to decreased rubbing on the bursa and decreased irritation. Along with strength, power and endurance should be addressed since bursitis is often linked to overuse. Exercises may include free weights, therabands or weight bearing activities.

Improve Range of Motion. Physical therapy will help restore normal motion in the affected joint. Overtime from bursitis, joint motion may decrease due to pain or soft tissue changes. Your physical therapist may address this with passive range of motion exercises and then progress to active and stretching. Since any pressure on an inflamed bursa can increase pain, it is imperative to stretch any soft tissue structures that are tight or shortened to decrease pain.

Post-Surgical Care. Although surgery is not a common intervention used for bursitis, if it is performed then physical therapy can aid in your recovery. Your physical therapist will create a personalized program to help you regain strength and range of motion in the most pain free and time efficient manner possible.

Reduce Pain and Swelling. Modalities can be used to address the swelling in the joint. Therapeutic agents such as icing and electrical stimulation can be good way to modulate pain and decrease swelling. This in turn will allow for the underlying pathologies to be treated. Relative rest can also alleviate pain. Your therapist can instruct you in activity modification and altering movement patterns to decrease the stress placed on the joint.

Reoccurrence Prevention

Once your bursitis is treated, your physical therapist will have provided you with a home exercise program. Bursitis can be a re-occurring ailment and your home program will help prevent this. By keeping up with the exercises, you will maintain your strength and flexibility. By making simple modifications you can reduce your risk for bursitis and decrease severity of flare ups. Your physical therapist will instruct you in proper lifting techniques, maintaining proper posture and educate you in the importance of stretching and warming up prior to strenuous exercise.

At each one of All-Care Physical Therapy Center locations, our staff is knowledgeable and qualified to help you with bursitis. We will create an individualized exercise program to cater to your specific needs. Call for an appointment today!

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