Bursitis

Bursae are small, fluid-filled sacs positioned around joints throughout the body, cushioning and reducing friction where tendons, muscles and bones would otherwise rub against one another. Bursitis occurs when a bursa becomes irritated and inflamed, causing localised pain and swelling. It’s most commonly seen at the hip (trochanteric bursitis) and shoulder (subacromial bursitis), though it can affect other joints too, including the knee and elbow.

Bursitis is often secondary to another underlying issue rather than a standalone problem — a tendon that’s overworking, a muscle imbalance, or a movement pattern that repeatedly compresses the bursa can all trigger inflammation. This is an important part of why treating bursitis effectively usually means looking beyond the bursa itself to whatever is driving the irritation in the first place.

What causes bursitis

Bursitis typically develops from one of a few sources: repetitive movement that repeatedly loads or compresses the bursa; prolonged direct pressure, such as lying on the affected hip at night or leaning on the elbow for extended periods; or a secondary reaction to another problem nearby, such as a rotator cuff tendon issue at the shoulder or gluteal tendon dysfunction at the hip. Muscle weakness and altered movement patterns around the joint often mean the bursa ends up absorbing load it isn’t designed for, which is why bursitis can become a recurring issue if the underlying cause isn’t addressed.

Hip bursitis (more accurately described these days as part of a broader condition called greater trochanteric pain syndrome) is often linked to weakness in the gluteal muscles, which normally help control the hip during walking and standing on one leg. Shoulder bursitis frequently develops alongside rotator cuff tendon irritation, since the subacromial bursa sits directly above the rotator cuff tendons and becomes compressed when the shoulder’s normal mechanics are disrupted. In both cases, the bursa itself is often more a symptom of a deeper mechanical problem than the root cause.

Bursitis can also develop at the knee (prepatellar bursitis, sometimes called “housemaid’s knee,” from repeated kneeling) or the elbow (olecranon bursitis, from repeated leaning or a direct knock), though these tend to relate more directly to local pressure or friction than to a deeper biomechanical cause.

When to see a physiotherapist

Most bursitis responds well to conservative physiotherapy once the irritation is identified and managed appropriately. However, if the affected area becomes significantly red, hot and swollen, especially with fever or feeling unwell, this can indicate an infected bursa (septic bursitis), which needs prompt medical assessment rather than routine physiotherapy — this is uncommon but important to rule out, particularly where there’s been a break in the skin nearby. Bursitis that hasn’t improved despite activity modification, or that keeps recurring, is also worth a proper assessment, since there’s usually an underlying biomechanical driver that hasn’t yet been addressed.

Physiotherapy treatment for bursitis

Treatment focuses on two things at once: calming the current inflammation, and identifying and addressing whatever is driving it, so the bursitis doesn’t simply return once the current flare settles. Andrew’s approach typically includes:

• Manual therapy and soft tissue techniques to offload the irritated bursa, ease surrounding muscle tension, and improve movement patterns that may be contributing to the compression.
• Electrotherapy, such as ultrasound or TENS, to help settle pain and inflammation, particularly during a more acute flare-up.
• Activity modification advice — practical adjustments to positions, movements or habits (like which side you sleep on, or how you’re loading the joint during exercise) that are aggravating the bursa in the meantime.

Because bursitis is so often secondary to another issue, Andrew’s assessment also looks specifically for — and addresses — the underlying cause, whether that’s a tendon problem, muscle weakness, or a movement pattern placing repeated load on the bursa.

What to expect from treatment

Andrew will assess which bursa is affected, how irritable it currently is, and what’s likely triggering it, before explaining the treatment plan and roughly how quickly you should expect it to respond. Many people notice a meaningful reduction in pain within the first few sessions as inflammation settles, though the longer-term work — addressing the underlying tendon, strength or movement issue — is what determines whether the improvement lasts.

Preventing recurrence

Because bursitis so often relates to an underlying tendon or muscle issue, ongoing prevention usually means continuing the strengthening and movement work Andrew builds into your programme, alongside sensible adjustments to habits or positions that place sustained pressure on the joint — even after the current flare-up has fully settled.

For hip bursitis, this often means an ongoing gluteal strengthening programme and attention to habits like consistently sleeping on the affected side or standing with weight shifted onto one hip, both of which keep compressing the bursa. For shoulder bursitis, addressing rotator cuff strength and shoulder blade control tends to matter more, in the long run, than any single treatment aimed at the bursa itself. Andrew will tailor this ongoing plan to whichever joint and underlying cause apply to you.