Bursitis: What It Is, Why It Happens, and How Physiotherapy Can Help

Bursitis is one of those conditions that sounds more complicated than it is. In simple terms, it means that a small fluid-filled cushion near a joint has become irritated or inflamed. These cushions are called bursae, and their job is to reduce friction between bones, tendons, muscles and skin. When a bursa becomes overloaded or compressed, it can become painful, swollen and sensitive to movement.

Bursitis can occur in many areas of the body, but it is especially common around the shoulder, hip, knee and elbow. In a physiotherapy setting, we often see bursitis linked with changes in load, repeated pressure, poor movement patterns, weakness around the joint, or a sudden increase in activity.

What is bursitis?

A bursa is a small sac filled with fluid. Think of it like a soft cushion that helps tissues glide smoothly over one another. When the bursa becomes irritated, it can swell and become painful. This is called bursitis.

Technically, bursitis refers to inflammation of the bursal sac, often due to repetitive mechanical compression, friction, trauma, systemic inflammatory conditions, crystal deposition, or, less commonly, infection. In everyday terms, the area has become “angry” because it is being overloaded, compressed, or irritated more than it can currently tolerate.

Common types of bursitis include:

• Shoulder bursitis, often involving the subacromial bursa

• Hip bursitis, commonly referred to as trochanteric bursitis or greater trochanteric pain syndrome

• Knee bursitis, such as prepatellar bursitis

• Elbow bursitis, also known as olecranon bursitis

• Heel bursitis, which can occur around the Achilles tendon region

  
  

How do people get bursitis?

Bursitis usually develops when a bursa is exposed to too much pressure, friction, or repetitive load. Sometimes it comes on quickly after a fall or direct knock. Other times, it builds gradually over weeks or months.

Common causes include:

Repetitive movement or overuse: This may happen with repeated lifting, reaching, kneeling, running, walking hills, or returning to exercise too quickly.

Sustained pressure: For example, kneeling for long periods can irritate the knee bursa, leaning on the elbow can irritate the elbow bursa, and sleeping on one side may aggravate lateral hip pain.

Muscle weakness or poor load control: If the muscles around a joint are not absorbing load well, the bursa and surrounding tendons can become more sensitive. This is particularly common in hip and shoulder presentations.

Poor biomechanics or technique: Running mechanics, shoulder blade control, hip stability, work posture, lifting technique and exercise technique can all play a role.

Sudden changes in activity: A big increase in gym training, running distance, Pilates load, overhead work, gardening, sport, or manual work can be enough to flare symptoms.

Inflammatory or medical causes: Some cases may be associated with inflammatory arthritis, gout, infection, or other systemic conditions. If bursitis is hot, red, very swollen, associated with fever, or worsening quickly, it should be medically assessed. Diagnosis of infection or crystal-related bursitis may require fluid analysis.

Common signs and symptoms of bursitis

Bursitis symptoms vary depending on the area involved, but common signs include:

• Localised pain near a joint

• Tenderness when pressing over the area

• Pain with movement or loading

• Swelling, particularly around the elbow or knee

• Reduced range of motion

• Pain when lying on the affected side, especially with hip or shoulder bursitis

• Pain with overhead activity in shoulder bursitis

• Pain walking, climbing stairs, or getting up from a chair in hip-related bursitis

• Warmth or redness in some cases

  
  

From a clinical perspective, bursitis often presents as localised pain and tenderness with provocation during compressive or loaded movements. However, pain around a bursa does not always mean the bursa is the only structure involved. Tendons, joints, nerves and referred pain can all mimic bursitis.

Physio treatment for bursitis

Physiotherapy treatment for bursitis is not just about “settling inflammation.” The bigger goal is to work out why the bursa became irritated in the first place, reduce the aggravating load, and then build the area back up so symptoms are less likely to return.

1. Accurate assessment

Your physiotherapist will assess:

• Where the pain is coming from

• Joint range of motion

• Muscle strength

• Tendon involvement

• Movement patterns

• Work, sport or training loads

• Sleeping positions or daily aggravating habits

• Whether imaging or medical review is needed

Bursitis is often diagnosed clinically, although imaging such as ultrasound or MRI may be useful in some cases, particularly for deeper bursae or unclear presentations.

2. Load modification

This is usually the first key step. Load modification does not mean complete rest forever. It means temporarily reducing the things that are compressing or irritating the bursa.

Examples may include:

• Avoiding direct pressure on the area

• Reducing painful overhead work

• Modifying running volume or hills

• Avoiding sleeping directly on the painful hip or shoulder

• Adjusting gym exercises

• Changing kneeling or sitting positions

• Reducing repetitive aggravating movements for a short period

The aim is to calm the area down without deconditioning the whole body.

3. Pain relief and symptom management

Depending on the presentation, your physio may recommend:

• Ice or heat depending on symptom behaviour

• Gentle mobility exercises

• Taping or offloading strategies

• Soft tissue techniques

• Short-term activity modification

• Advice around anti-inflammatory medication where appropriate, in consultation with a GP or pharmacist

  
  

In more severe cases, corticosteroid injection or aspiration may be considered by a medical practitioner, but this depends on the type of bursitis, cause, infection risk, and whether symptoms are improving with conservative care.

4. Strengthening and rehabilitation

This is where physiotherapy becomes especially important. Once the irritated bursa settles, the area often needs progressive strengthening to improve load tolerance.

For shoulder bursitis, this may include:

• Rotator cuff strengthening

• Scapular control exercises

• Thoracic mobility

• Gradual return to overhead loading

For hip bursitis or lateral hip pain, this may include:

• Gluteal strengthening

• Hip control exercises

• Pelvic stability work

• Walking and stair tolerance

• Gradual return to running or lower body training

For knee or elbow bursitis, this may include:

• Strengthening around the joint

• Technique changes

• Pressure reduction strategies

• Gradual return to kneeling, lifting, sport or work tasks

  
  

The key is progressive loading. Too little loading can leave the area weak and sensitive. Too much loading too soon can keep it irritated.

5. Preventing recurrence

Bursitis can come back if the underlying driver is not addressed. Prevention usually involves:

• Improving strength around the joint

• Managing sudden spikes in activity

• Adjusting technique or posture

• Using padding for kneeling or elbow pressure

• Improving movement control

• Returning to sport or gym gradually

• Addressing workplace or ergonomic contributors

  
  

At Urban Physiotherapy, we look beyond the sore spot. We assess how the joint is moving, what loads are going through the area, and what needs to change so the problem does not keep returning.

Differential diagnosis: what else could it be?

Not all pain around a bursa is bursitis. This is why a proper physiotherapy assessment matters.

Depending on the body region, conditions that may mimic bursitis include:

Shoulder pain differential diagnoses

• Rotator cuff tendinopathy

• Rotator cuff tear

• Shoulder impingement-related pain

• Frozen shoulder

• AC joint irritation

• Cervical spine referred pain

• Labral injury

• Osteoarthritis

  
  

Hip pain differential diagnoses

• Gluteal tendinopathy

• Greater trochanteric pain syndrome

• Hip osteoarthritis

• Lumbar spine referred pain

• Femoroacetabular impingement

• Stress fracture

• Iliotibial band-related compression

• Sciatic nerve irritation

  
  

Knee pain differential diagnoses

• Patellofemoral pain

• Meniscal injury

• Knee osteoarthritis

• Patellar tendinopathy

• Fat pad irritation

• Ligament injury

• Gout or inflammatory arthritis

• Infection in cases of redness, heat and significant swelling

  
  

Elbow pain differential diagnoses

• Olecranon bursitis

• Tennis elbow

• Golfer’s elbow

• Triceps tendinopathy

• Elbow joint arthritis

• Ulnar nerve irritation

• Gout or infection

A good assessment will help determine whether the bursa is the main issue, part of a broader tendon/joint problem, or not the source of pain at all.

When should you see a physio?

You should consider seeing a physiotherapist if:

• Pain has lasted more than a few days or keeps returning

• You are struggling with walking, lifting, sleeping or exercising

• Pain is limiting work or sport

• You are unsure whether to rest or keep training

• You have had bursitis before and it keeps flaring

• You want a structured plan to return to activity safely

You should seek urgent medical review if the area is very red, hot, rapidly swelling, associated with fever, or extremely painful at rest, as this may suggest infection or another medical cause.

Need help with bursitis?

If you are dealing with shoulder bursitis, hip bursitis, knee bursitis, elbow bursitis or ongoing joint pain, physiotherapy can help identify the cause, reduce symptoms, and guide a safe return to movement.

At Urban Physiotherapy, our physiotherapists assess the mechanics behind your pain and create a tailored plan to improve strength, mobility and load tolerance.

Book an appointment with Urban Physiotherapy today to start addressin

g your bursitis symptoms properly.