Bursitis refers to the inflammation of a bursa. A bursa is a fluid filled sac that prevents friction between bony surfaces and soft tissues in the body, especially in or around joints. When one of these bursae is inflamed, it becomes swollen and painful.
The inflammation of a bursa may occur as a result of excessive movement or pressure on the bursa, direct impact, infection or other diseases that may affect the joint and its environs (eg rheumatoid arthritis, gout or sepsis). Basically, anything with the word “itis” at the end means inflammation.
The most common cases involve the knee, a condition often referred to as "house-maid's knee".
However, it can affect almost any joint in the body, such as the elbow, ankle or shoulder. It is more likely that a person will contract bursitis if they are involved in a job or a hobby that involves repetitive movement or constant pressure on a particular joint or groups of joints, or constant pressure on a particular area (eg playing lots of tennis or golf, or poor posture whilst sitting for long periods of time).
Approximately 60% of cases of hip pain are caused by trochanteric bursitis, the painful inflammation of the bursa that covers the part of the thigh bone (femur) called the greater trochanter. Triggered by an injury or disease, this form of bursitis can affect anyone, but is more common in women and middle aged or older people than in men or younger people.
Inflammation or degeneration seen in the bursae when involving knees and elbows is usually the result of a repetitive movement injury.
When bursitis occurs with repetitive movement disorders, inflammation is often limited to a portion of the bursa.
Abnormal patterns of walking and standing cause 95% of the cases of hip bursitis. These gait problems can be the result of standing too long or incorrectly, or result from a difference in leg length. Either of these situations can put extra pressure on the hip, resulting in irritation and inflammation of the bursae.
Other problems that can cause trochanteric bursitis include a fall, injuries from overuse or minor accidents, previous hip surgery or hip replacement, minor traumatic injuries, scoliosis or other spinal diseases, and rheumatoid arthritis. It can also occur if you lie on one side of the body for too long (perhaps while recovering from an injury). Continually carrying heavy shopping, resting babies on the hip, and throwing out the pelvis through wearing exceedingly high shoes can also be contributory factors.
The first sign of bursitis is normally pain. This may get worse and may even be present when you are resting. This pain is often followed by a loss or restriction of movement about the joint. There is also tenderness and swelling as the area is inflamed.
Most cases of bursitis will disappear with appropriate treatment in a matter of weeks, while some may persist or recur. However, bursitis in the hip joint can be more challenging to treat. The conventional approach would be surgery to remove or repair the bursa. This only happens in a minority of cases.
In the absence of an infectious or systemic disease, physical examination is typically focussed on the painful region. Usually, this will involve a detailed rheumatologic and musculoskeletal evaluation of the affected region.
Diagnosis is based on:
- Pain on motion and at rest
- Occasional loss of active movement in the area
- Swelling (in foot, knee or elbow bursitis)
While these findings can also be consistent with tendonitis or muscle injury, loss of movement is more typical of synovitis, soft tissue contracture, or a structural abnormality of the joint.
Diagnosis is usually based on signs of swelling, pain, loss of movement, weakness and a history of trauma, infection or repetitive movement about a particular joint.
Usually, the only testing required may be a needle aspiration of fluid from the bursa to identify possible infections or systemic disease. Imaging through CT or ultrasound may be needed to guide aspiration of deep bursae.
How is bursitis treated medically?
- Education to limit the amount of movement about the joint or to reduce the potential for trauma
- Administration of anti-inflammatory drugs (NSAIDs) and/or steroid injections.
Occasionally, surgery may be needed to remove or repair the bursa. Surgery would be a radical method of treatment, most likely if the patient has allowed the problem to continue for too long without treatment. If this becomes necessary, the doctor will remove the sac through an incision made over the top of the hip. After all, you do need the bursa that cushions the joints otherwise the joints literally rub together and you would not be able to move without pain.
Natural therapies for bursitis
I have found Bowen therapy is excellent for treating bursitis.
I have had wonderful results with some people experiencing bursitis of the knee and elbow, with two cases resolving in six weeks. Obviously, this is an individual timeframe with regard to healing and each person’s ability to resolve from injury and recover differs. It’s important to comply with regular treatments, but unlike physio, where you are often required to attend twice a week, you would only attend weekly, and then, depending on how it is resolving, fortnightly.
The treatment consists of light moves around the inflamed area and specific moves to the actual limb and other parts of the body to encourage blood flow and energy to the nerves and tissues. Homeopathic remedies are administered to assist in counteracting the inflammation during the treatment along with specific liniments if required.
The client is shown exercises to practise daily and any underlying deficiencies in protein or minerals would be addressed and treated with relevant remedies to speed up the healing process. If the body is out of alignment then the treatment will correct that also, since the idea is to treat the whole person not just the site of injury.
One man was injured while working on a construction site. A brick fell onto the back of his knee and created the bursitis through impact. He received numerous treatments elsewhere and arrived on crutches after suffering for two months. Being young and usually very active he was becoming extremely frustrated and angry since he was seeing no improvement.
I treated him with Bowen therapy, which also supports the emotions for more efficient healing, along with relevant minerals. He was encouraged to perform some gentle exercises each day with a knee pack to drain off the excess fluid overnight. He was so eager to recover he followed the regime diligently and received weekly for five weeks, then came back two weeks later for his sixth and final treatment. By then he was surfing and riding his bike as normal, absolutely ecstatic at being able to do what he loved so much!
A second client suffered his injury while working. Lifting heavy boxes was a daily task for him. He had exceeded his limit due to deadlines and demands to complete work urgently and suffered an injury to the elbow. The bursitis was just as inflamed as the previous man with the injured knee. Again I applied Bowen therapy and supported the healing with homeopathic anti inflammatory and specific liniments to encourage blood flow to nerves and tissues. I worked gently around the bursa, which was extremely tender and by the third treatment we were seeing a great deal of improvement. He also complied by not lifting and had been given light duties at work. By the sixth treatment his bursitis was also fully resolved with 100% strength and movement back in his arm.
Some people receive acupuncture for bursitis; this is also an excellent therapy to consider.
Acupuncture is very useful in relieving pain generated through inflammation, but is not always appropriate for alignment of the body. For those who don’t like the idea of needles Bowen therapy is an excellent choice. Combining acupuncture and Bowen would be excellent in the early stages of pain and inflammation, perhaps followed by sports massage with trigger point and acupressure once the inflammation has receded to help correct alignment and improve gait. It is important to relieve pain before beginning the massage step.
All these therapies assist in releasing stress to tissues and ligaments and encourage blood flow and flexibility, especially if you are taking up the usual working tasks again.
When the gait is abnormal due to one leg being shorter than the other, the ideal solution is to receive regular treatments to realign the body, balance the pelvis/hips and ensure that the shorter leg side is kept more in line so that the gait is less obvious.
A “short” leg can occur simply due to poor posture that throws out the entire lumbar/sacral region, creating what is known as a tilting pelvis. The way we place our feet on the ground when walking and running is very important. Those who pronate (roll slightly inward on the big toe) will roll the hips forward and this repetitive movement will throw out the alignment of the pelvis and hips. This calls for specific treatments including orthotics and investing in correct walking/running footwear that absorbs shock and impact, giving firm and cushioned support.
Whatever type of treatment you choose, it’s crucial to follow through in order to recover, complying with all instructions and ceasing the tasks that initiated the problem in the first place until full strength and recovery is present. It is best to take action and receive treatment at the first sign of bursitis to prevent it worsening.
I highly recommend anyone who has had poor posture and habitually used their body incorrectly over time to take up Pilates in conjunction with any of the above mentioned therapies, but please wait until the inflammation has receded before you do this. Pilates can be very challenging, but is an excellent exercise to correct posture and strengthen and stretch out constricted muscles allowing you to become more flexible and teaching your body to sit, stand, bend, lift and move correctly.
All cells in the body retain the memory of experiences and how we have habitually moved incorrectly, but you can retrain this “memory” and become stronger, flexible and pain free.
Lyn Craven is a practitioner of Naturopathy, Bowen Therapy, Energy/Reiki therapist, meditation teacher and Corporate Health Consultant. She is also a health researcher/writer and has produced a meditation CD assisting people to manage anxiety and stress. She runs a private practice in Sydney and can be contacted on +61403 231 804