Bursitis: what it is, why it hurts and how to settle it

Maybe it’s the outside of your hip that aches when you lie on that side at night. Maybe it’s a shoulder that catches when you reach for the top shelf, or a puffy, tender spot on the front of your knee after a weekend of tiling. These can all be signs of bursitis, or of the tendon problems that often travel with it.

Bursitis can be painful and annoying, but it usually responds well to the right mix of load management, exercise and practical changes. Here’s what’s going on and how our Byron Bay team can help.

What is a bursa?

A bursa is a small, fluid-filled sac that sits between bones and soft tissues such as tendons, muscles and skin. Bursae reduce friction and help structures glide smoothly. You have them throughout your body, with common trouble spots including [4]:

• Shoulder: the subacromial bursa, under the bony point of the shoulder
• Hip: the trochanteric bursa, on the outside of the hip
• Knee: the prepatellar bursa, at the front of the kneecap
• Elbow: the olecranon bursa, at the point of the elbow

What is bursitis?

Bursitis is irritation and swelling of a bursa. It is usually caused by [4]:

• Repeated pressure or friction, such as kneeling, leaning on elbows, or repetitive overhead work
• A direct knock or fall onto the area
• Overload of nearby tendons, particularly at the hip and shoulder
• Less commonly, infection or an underlying condition such as gout or rheumatoid arthritis

Hip pain is often more than "just bursitis"

Pain on the outside of the hip used to be called trochanteric bursitis. We now know it’s usually a problem with the gluteal tendons, which may or may not involve the bursa as well. It’s now often called greater trochanteric pain syndrome or gluteal tendinopathy [2]. That matters, because treatment focuses on calming and then strengthening the tendons rather than just the bursa. Similarly, at the shoulder, bursitis often travels with rotator cuff irritation.

Common signs

• localised pain and tenderness over the bursa
• swelling, sometimes visible at the knee or elbow
• pain with pressure, such as lying on the hip or kneeling
• pain with certain movements, such as reaching overhead (shoulder), climbing stairs or standing on one leg (hip)
• stiffness or reduced movement

When to see a doctor promptly

See your GP the same day if the area is hot, red and very swollen, if you feel unwell or feverish, or if there’s a cut or graze over the bursa. These can be signs of an infected bursa, which needs medical treatment [4].

How long does it last?

Mild bursitis may settle within a few weeks once the aggravating pressure or load is reduced. Longer-standing hip and shoulder problems, particularly where tendons are involved, often take a few months of consistent rehab, but most people improve well.

What helps?

Reduce pressure and irritating positions

• Hip: avoid lying on the sore side, or put a pillow between your knees when lying on the other side. Avoid crossing your legs and "hanging" on one hip while standing.
• Knee: use a kneeling pad or change tasks.
• Shoulder: reduce prolonged or repetitive overhead work for a while.

Exercise that loads tendons gradually

For hip pain, the LEAP trial (run in Australia) compared education plus a targeted exercise program, a corticosteroid injection, and a wait-and-see approach. The education and exercise group had the greatest improvement at eight weeks and better outcomes at one year than wait-and-see. The injection helped in the short term but not over the longer term [1]. Similar principles apply at the shoulder.

Pain relief and injections

Talk to your GP or pharmacist about pain relief options. A corticosteroid injection may provide short-term relief for some people [1][3]; our article on corticosteroid injections covers the pros and cons.

Ice or heat

Use whichever you find more comfortable for short-term relief.

How we can help at Retrain Health

Our osteopaths regularly help people with hip, shoulder and knee pain, from runners and surfers to tradies and desk workers. Care may include:

• A careful assessment to work out whether the bursa, nearby tendons or something else is the main driver, and to screen for anything that needs a GP.
• Hands-on treatment for comfort and movement, plus remedial massage for surrounding muscle tension if helpful.
• A progressive strength program for the hip or shoulder, building through exercise rehabilitation if you want hands-on coaching.
• Practical advice on sleep positions, work set-up, training load and footwear.

More information is on our sports injuries and other musculoskeletal issues pages.

Sleep on your side again

You don’t have to put up with hip or shoulder pain that wakes you at night. Book with our Byron Bay osteopaths and get a clear plan to settle things down and build strength.

This article is general information only and isn’t a substitute for individual advice. Recovery times vary from person to person.