Bursitis

Bursitis can make everyday movements surprisingly uncomfortable. Walking up the stairs, reaching overhead, kneeling, sleeping on your side, or simply getting up from a chair may start to hurt. A bursa is a small, fluid-filled sac located near many of the joints in your body. These sacs help reduce friction between bones, tendons, muscles, and other tissues as you move. When a bursa becomes irritated, the condition is called bursitis. Many people find relief through bursitis physical therapy, which targets the affected area to restore comfort and mobility.

Bursitis physical therapy can help address the movement, strength, and activity factors that may be contributing to irritation. At Reform Physical Therapy, treatment is based on where your symptoms are located, what movements bother you, and what you want to get back to doing.

What Is Bursitis?

Bursae are small cushions found throughout the body. They are located in areas where muscles, tendons, skin, and bones move against one another. Their job is to help these tissues move smoothly with less friction. When a bursa becomes irritated or inflamed, you may experience pain and tenderness around the nearby joint. Bursitis commonly develops around the hip, shoulder, knee, elbow, and heel.

What Does Bursitis Feel Like?

Bursitis symptoms depend on which bursa is irritated. Pain and tenderness near a joint are common. The area may feel sore when you press on it or place pressure directly over it. Certain movements may increase your symptoms. Some people experience stiffness or swelling. Others notice pain primarily during activity or afterward. Symptoms may gradually develop over time or appear after a sudden increase in activity.

What Causes Bursitis?

Bursitis can develop for several reasons. Repeated pressure on an area can irritate a bursa. This can happen from frequently kneeling, leaning on an elbow, or lying on one side. A sudden increase in physical activity can also contribute. Someone who recently started running more miles, returned to the gym, began a new sport, or spent an entire weekend doing yardwork may place more stress on an area than their body is prepared to tolerate. Movement patterns, muscle weakness, joint stiffness, and changes in training can also influence how much stress is placed around a joint. Sometimes bursitis develops after a direct blow or fall.

Can Bursitis Come on Suddenly?

Yes. Although bursitis often develops gradually, symptoms can sometimes appear relatively quickly. A fall onto the hip, knee, shoulder, or elbow may irritate a bursa. A sudden increase in activity can also cause symptoms to become noticeable within a short period. Understanding what happened before your pain began can help your physical therapist determine which factors may be contributing.

Hip Bursitis

Pain along the outside of the hip is commonly described as hip bursitis. One bursa in this area is located near a bony prominence on the outside of the upper thigh called the greater trochanter. When tissues around the outside of the hip become irritated, you may experience tenderness, pain while walking, discomfort climbing stairs, or difficulty lying on the affected side. However, not every case of outer hip pain comes exclusively from an inflamed bursa. Tendons around the hip can also contribute to symptoms. For this reason, your physical therapist will look beyond the location of the pain and evaluate the strength and movement of your entire hip and lower body.

Greater Trochanteric Bursitis

Greater trochanteric bursitis is a common term used to describe pain near the outside of the hip. Symptoms may become worse during prolonged walking, climbing stairs, standing on one leg, or lying on the painful side. You may also feel tenderness when pressing over the outside of the hip. Treatment often involves more than simply trying to reduce inflammation. Improving hip strength and gradually increasing the amount of activity the tissues can tolerate can be an important part of rehabilitation.

Why Does Hip Bursitis Hurt at Night?

Side sleeping places direct pressure on the outside of the hip. If the tissues in this area are already sensitive, that pressure can make symptoms more noticeable. Some people are uncomfortable sleeping directly on the painful side. Others notice discomfort in the top hip when lying on the opposite side. Changing your sleeping position or using pillows for support may temporarily make sleeping more comfortable while you work on the underlying problem.

Shoulder Bursitis

The shoulder contains bursae that help tissues move smoothly as you lift and rotate your arm. Shoulder bursitis may cause pain when reaching overhead, putting on clothing, reaching behind your back, or lifting objects. Some people also experience pain at night. Shoulder pain can involve several structures, including the rotator cuff tendons. A physical therapy evaluation can help determine which movements are limited and which muscles may need additional strength or control.

Subacromial Bursitis

The subacromial bursa is located near the top of the shoulder. Irritation in this area can contribute to pain when lifting the arm. Symptoms may be especially noticeable during overhead activities. Treatment may include improving shoulder and upper-back mobility, strengthening the rotator cuff and shoulder blade muscles, and gradually rebuilding tolerance for reaching and lifting.

Knee Bursitis

Several bursae are located around the knee. Different bursae may become irritated depending on the activities and stresses involved. Pain may develop at the front, inside, or other areas around the knee. Kneeling, climbing stairs, walking, or exercising may become uncomfortable depending on the location of the irritated tissue.

Prepatellar Bursitis

The prepatellar bursa is located at the front of the knee near the kneecap. Repeated kneeling can irritate this area. People who spend significant amounts of time kneeling for work, gardening, home projects, or other activities may be more likely to develop symptoms. Swelling can sometimes become quite noticeable at the front of the knee.

Pes Anserine Bursitis

Pain along the inner side of the knee may sometimes involve irritation around the pes anserine region. Symptoms may be noticeable while climbing stairs, exercising, or getting up from a chair. Hip and knee strength, activity levels, and movement patterns may all be considered during rehabilitation.

Elbow Bursitis

The olecranon bursa is located over the point of the elbow. Repeatedly leaning on the elbow can irritate this area. A direct blow or fall may also cause swelling. Elbow bursitis can sometimes produce a noticeable pocket of swelling around the back of the elbow. If the area becomes very red, hot, increasingly painful, or is accompanied by fever, medical evaluation is important because infection can occasionally affect a bursa.

Heel Bursitis

Bursae near the heel can become irritated by pressure, repetitive activity, footwear, or stress around the Achilles tendon. Pain may develop near the back of the heel. Because Achilles tendon problems can produce symptoms in a similar area, determining which tissues are involved is important. Your physical therapist can assess ankle mobility, calf strength, footwear demands, and activity levels as part of the evaluation.

Bursitis vs. Tendonitis

Bursitis and tendonitis can feel very similar and involves irritation of a bursa. Tendonitis involves irritation of a tendon, which connects muscle to bone. These tissues are often located close together. In some areas, both may contribute to symptoms at the same time. Rather than relying only on the name of the condition, physical therapy focuses on how the area moves, how strong it is, which activities trigger symptoms, and what your body currently tolerates.

Bursitis vs. Arthritis

Arthritis affects a joint itself, while bursitis involves a fluid-filled sac located near a joint. Both conditions can cause pain and stiffness. The location of symptoms and movements that trigger pain may provide clues, but symptoms can overlap. An evaluation can help determine what may be contributing to your discomfort.

Bursitis vs. Muscle Strain

A muscle strain occurs when muscle fibers are overstretched or torn. Bursitis involves irritation of a bursa. A strain is more likely to develop after the muscle is suddenly overloaded, although muscle strains can also develop gradually. Bursitis may be more closely associated with repeated pressure or irritation around a joint. Because symptoms can overlap, an evaluation can be helpful when the cause of pain is unclear.

How Is Bursitis Diagnosed?

Your healthcare provider will usually begin by asking where your pain is located and when it occurs. The area may be examined for tenderness, swelling, movement limitations, and other symptoms. Your strength and movement may also be evaluated. Imaging is not always necessary. In certain situations, X-rays, ultrasound, MRI, or other testing may be recommended to rule out another condition or better understand what is happening.

Should You Rest Bursitis?

Reducing or temporarily modifying activities that clearly aggravate symptoms may be helpful. However, complete rest is not always the best long-term solution. If you stop using an area for an extended period, the surrounding muscles may become weaker. The goal is usually to find an appropriate level of activity while gradually rebuilding the body’s ability to tolerate more.

Should You Ice Bursitis?

Ice may temporarily help with discomfort for some people. If you choose to use ice, avoid placing it directly against your skin. Cold therapy may help manage symptoms, but it does not address all of the factors that may be contributing to bursitis. Strength, mobility, movement, and activity progression may also need to be addressed.

Is Heat Good for Bursitis?

Some people find heat comfortable, particularly when stiffness is present. Others prefer cold when the area feels irritated after activity. Neither heat nor ice should be considered the entire treatment plan. They are tools that may help manage symptoms while you work on restoring movement, strength, and function.

Should You Massage Bursitis?

Directly pressing or aggressively massaging an irritated bursa may make symptoms worse. Manual therapy may still be used in surrounding areas when appropriate. Your physical therapist can determine whether hands-on treatment is useful, and which tissues should be addressed.

Can Physical Therapy Help Bursitis?

Yes. Bursitis physical therapy can help address factors that may be placing additional stress around the painful area. Your therapist may work with you to improve strength, mobility, balance, movement control, and activity tolerance. Treatment should also consider why the problem developed. If symptoms began after increasing your running mileage, your plan may include adjusting training while progressively rebuilding lower-body strength. If shoulder pain developed from repetitive overhead work, treatment may focus on shoulder strength, mobility, and work-related movements. The goal is not simply to avoid everything that hurts. It is to help your body become better prepared for those activities.

Strengthening for Bursitis

Strengthening is often an important part of rehabilitation. Muscles help absorb and control forces around your joints. When those muscles are weak or unable to tolerate the demands being placed on them, surrounding tissues may experience more stress. Exercises are selected based on the location of your symptoms. Someone with outer hip pain may work on hip and lower-body strength. Someone with shoulder bursitis may strengthen the rotator cuff and muscles surrounding the shoulder blade. Your program should gradually become more challenging as your body adapts.

Mobility and Bursitis

Joint stiffness can change the way you move. If one area cannot move well, another part of the body may compensate. Your physical therapist may assess mobility around the painful joint as well as nearby areas. When appropriate, treatment can include exercises designed to restore comfortable movement.

Activity Modification

Activity modification does not necessarily mean giving up the activities you enjoy. Sometimes small temporary changes can reduce irritation while allowing you to stay active. A runner might temporarily decrease mileage. Someone with knee bursitis may reduce prolonged kneeling. A person with shoulder pain may temporarily adjust repeated overhead lifting. These changes can then be reversed as strength and activity tolerance improve.

Bursitis From Running

Running places repeated demands on the hips, knees, ankles, and feet. If mileage, speed, hills, or training frequency increase faster than your body can adapt, symptoms may develop. Physical therapy can assess strength, mobility, running-related movement, and training habits. The goal is often to keep you as active as possible while gradually rebuilding your ability to tolerate running.

Bursitis From Sports

Sports can involve running, jumping, throwing, cutting, reaching, and repeated impact. These movements place different demands on the body. Rehabilitation should eventually prepare you for the movements required by your sport. A tennis player with shoulder symptoms has different demands than a runner with outer hip pain. Your treatment should reflect those differences.

Bursitis From Work

Some jobs involve repeated kneeling, reaching, lifting, leaning, or standing. These activities may contribute to irritation around a bursa. Physical therapy can help identify which work activities are most challenging and build a program around those demands. As symptoms improve, exercises can become more similar to the movements you perform during the workday.

Bursitis From Yardwork and Home Projects

Gardening, raking, painting, cleaning, and home improvement projects can involve repetitive movements or prolonged positions that your body may not be accustomed to. A weekend of kneeling in the garden may irritate the front of the knee. Repeated overhead painting may aggravate the shoulder. A sudden increase in walking or lifting may contribute to hip symptoms. Gradually increasing activity and taking breaks can help your body adapt to these demands.

Can You Exercise With Bursitis?

In many cases, yes. The key is choosing an appropriate amount and type of exercise. Some discomfort does not automatically mean that exercise is causing damage. However, repeatedly pushing through significant pain may keep the area irritated. Your physical therapist can help determine which exercises are appropriate and how much activity your body currently tolerates.

Can You Go to the Gym With Bursitis?

You may not need to completely stop going to the gym. Instead, certain exercises may need to be temporarily modified. Your therapist can help identify movements that aggravate symptoms and provide alternatives. As strength and tolerance improve, those exercises can gradually be reintroduced.

Returning to Running

If bursitis has interrupted your running routine, returning gradually is important. Before increasing mileage, your therapist may assess lower-body strength, single-leg control, walking tolerance, and other factors related to your symptoms. A return-to-running program may begin with shorter distances or intervals. Mileage, speed, and hills can then be progressively added.

Returning to Sports

Returning to sports requires more than simply having less pain. Your body needs to tolerate the specific demands of your activity. Depending on your sport, rehabilitation may include jumping, landing, running, throwing, reaching, changing direction, or other movements. These activities can be gradually introduced as strength and confidence improve.

How Long Does Bursitis Take to Improve?

Recovery varies. The location of the bursitis, how long symptoms have been present, your activity level, and other contributing factors all influence how quickly you improve. Some people notice meaningful changes within several weeks. Long-standing symptoms may require a longer period of progressive rehabilitation. Instead of relying only on a timeline, we look at how your strength, movement, function, and activity tolerance are changing.

Why Does My Bursitis Keep Coming Back?

Recurring symptoms may happen when the activities causing irritation return faster than the body is prepared to tolerate them. For example, symptoms may settle after several weeks of rest. If you immediately return to your previous running mileage or lifting routine without rebuilding strength and tolerance, pain may return. Rehabilitation can help bridge the gap between feeling better and being physically prepared for your normal activities.

Do You Need an Injection for Bursitis?

Some people with bursitis receive injections to help manage symptoms. Whether an injection is appropriate depends on the location of the problem, your symptoms, medical history, and other factors. This is a decision to discuss with your healthcare provider. Even when an injection decreases pain, rehabilitation may still be useful for addressing strength, mobility, and activity tolerance.

Does Bursitis Require Surgery?

Most cases of bursitis do not require surgery. Conservative treatment is commonly used first. Surgery may occasionally be considered when symptoms remain significant despite appropriate treatment or when another medical issue is involved. Your healthcare provider can determine whether additional treatment is necessary.

When Bursitis May Need Medical Attention

Most cases of bursitis are not emergencies. However, a bursa can occasionally become infected. This is known as septic bursitis. Seek medical care if swelling is accompanied by significant redness, warmth, fever, chills, drainage, or rapidly worsening pain. You should also seek evaluation after a significant injury or when you are unable to use the affected joint normally.

What Happens During a Bursitis Physical Therapy Evaluation?

Your physical therapist will begin by asking about your symptoms. We will want to know where the pain is located, when it began, which movements bother you, and what activities you want to return to. Your examination may include joint mobility, muscle strength, balance, walking, and functional movements. We may ask you to perform movements that are similar to the activities causing your symptoms. Someone with hip pain may perform a squat, step-down, or single-leg movement. Someone with shoulder pain may reach overhead or perform resisted shoulder movements. This helps us understand how your body responds to the demands that matter to you.

Bursitis Physical Therapy at Reform

At Reform Physical Therapy, we treat the person rather than simply focusing on the name of the diagnosis. Two people with bursitis may have completely different needs. One person may want to walk up the stairs without hip pain. Another may want to return to running. Someone else may need to kneel comfortably for work or reach overhead without shoulder pain. Your physical therapist will build your treatment around your symptoms, movement, strength, and goals. As you improve, your program progresses with you. The goal is to help you return to the activities that matter to you with greater strength, movement, and confidence.

Schedule a Physical Therapy Evaluation

If bursitis is making it difficult to walk, sleep comfortably, exercise, work, or participate in activities you enjoy, physical therapy may be able to help. A physical therapy evaluation can identify limitations in strength, movement, and function that may be contributing to your symptoms. From there, your therapist can develop an individualized plan to help you move forward.

Contact Reform Physical Therapy to schedule an evaluation at one of our Maine clinic locations.