Understanding Bursitis: What It Is, Why It Happens, and How to Fix It
Subacromial bursa in green - Image: Essential anatomy
If you’ve ever had a joint that felt sore, stiff, or swollen, bursitis could be the culprit. But don’t worry - bursitis is common, and understanding it is the first step toward feeling better. Let’s break it down in simple terms.
What Is Bursitis?
Inside your joints, there are tiny, fluid-filled sacs called bursae (singular: bursa). Think of them like little cushions or shock absorbers that help your muscles and tendons glide smoothly over your bones. The image highlights just one of the many bursae in the shoulder, all the round blobs are bursae.
When a bursa gets inflamed, it’s called bursitis. This can make your joint painful, swollen or stiff, and moving it might feel uncomfortable.
Where Does Bursitis Happen?
Bursitis usually occurs in joints that do a lot of repetitive movement or carry weight. Common areas include:
Shoulder – can make lifting your arm painful
Elbow – often called “student’s elbow”
Hip – outer hip pain is a common sign
Knee – especially in people who kneel a lot
Heel/foot – called retrocalcaneal bursitis, can make walking painful
What Causes Bursitis?
Bursitis usually happens because of repetitive movements, pressure, injury, poor movement or alignment issues. Arthritis can also be a cause.
I was diagnosed with bursitis in my shoulder several years ago. I believe it was the subacromial bursa as indicated in the image. It was caused by overuse which led to poor alignment and poor movement. The muscles around my shoulder had become so imbalanced my arm was no longer stable in the shoulder joint and thus, caused pressure every time I moved it, creating bursitis.
As you can see, the bursa lies directly under the AC joint. As my chest and bicep muscles were really tight, they pulled the humerus (arm bone) forward, so the bursa would be squashed every time I moved my arm forward. It was too painful to move it upwards, let alone to the side. I was in a bit of a pickle.
Thankfully, I was able to resolve it without much issue. That isn’t to say it didn’t take a long time though. It is so important to create balance in your muscles as prevention, because injuries are not only a blight on your life, losing you sleep, stopping you doing what you want, but they take far longer than you expect to resolve.
How Do You Resolve Bursitis?
Rest and reduce pressure – avoid movements that aggravate the joint for a short period. This is easier said than done, but if for example you know that lifting your arm overhead causes pain, you’d avoid that movement. If doing breast stroke irritates your hip, you’d avoid that too.
Ice and gentle compression – helps reduce swelling and discomfort.
Posture and technique – once the pain settles, it is worth checking your alignment during activities to reduce stress on the joint. Someone with shoulder bursitis may have poor posture - rounded shoulders and slouched posture. Someone with hip bursitis often compensates in other areas to avoid pain, this in turn affects posture:
You might:
Leaning to the opposite side while standing or walking
Shorten steps or limp
Tilt the pelvis
Avoid lying on the painful side
These shifts can keep the bursa irritated and slow recovery. So what can you do?
Movement and strengthening – gentle exercises and stretches can improve joint movement. You need to
strengthen and rebalance the muscles surrounding the joint.
Be mindful of your movement to keep your weight even
Recovering from shoulder bursitis required rebalancing all the muscles around my shoulder complex, and rebuilding the strength. As the shoulder is a ball and socket joint, it is capable of a vast range of movements, which means there were a lot of movement to cover.
The hip would be similar, as it is also a ball and socket joint, therefore able to make a large range of movements.
How do you know what exercises to do?
There are different severities of injury and this dictates the healing and rehab process. For some, being able to hold the joint in the correct static position (isometric exercise) would be the starting point. For others, it might be making small controlled movements. If you are unsure, you should seek help from a professional. If it’s a severe injury, your best point of call would be a physiotherapist. If it’s overuse and something you’ve had for a while, I can assist.
Recovering from injury is complex and takes time. Exercises need to be regularly progressed - made harder, so the muscles will be prepared to cope in normal use. Many people stop their exercises too early, namely after they start to feel better, however this isn’t a good idea. The pain may have stopped, but the muscles still aren’t strong enough for them to support you in what you want them to do, resulting in recurring injury. Think of it like antibiotics - you wouldn’t stop taking them partway through a course, would you?
Take my shoulder as an example - imagine I started to feel better after a few weeks of doing the exercises. Rather than progressing them, I decided I’d go straight back to throwing javelins. What do you think would happen? The weight and power needed to throw the javelin irritates the muscles around the shoulder because they are not yet strong enough to hold the humerus centrally in the socket - this results in immediate pain and further injury.
Trust the process
Rehabilitation is boring and slow, but it’s a process and you can only work with the speed at which your body adapts. The moral of the story is, create balance now to avoid future pain.
Want help with painful movement?
Sabrina is a movement specialist based in Worcester Park, London, helping people overcome pain, move better, and enjoy active, fulfilling lives. With expertise in sports and remedial massage, personal training, and the Emmett Technique, she works with clients to relieve pain, improve mobility, and build strength. Treatments and training sessions take place in her private home treatment and training room. If you would like to discuss your needs, book a Discovery Call.