Bursitis: Physiotherapy & Chiropractic Treatment Advice
Bursitis is the inflammation or irritation of a fluid-filled sac called a ‘Bursa.’ There are various bursa located around between bone, muscle and tendons and are designed to reduce friction or irritation. In fact, there are over one hundred and fifty bursa throughout the human body. Bursitis is most often caused by repetitive movement or less commonly due to a traumatic or direct contact injury. While this is the case, the incidence of Bursitis increases as we age due to a loss in the elastic properties of tendons. It is generally considered that activities such as gardening, raking, carpentry, shovelling, painting, scrubbing, tennis, golf, skiing, throwing, and pitching significantly increase the risk of developing Bursitis. Perhaps the most common reasons we encounter Bursitis in clinical practice is due to incorrect or poor posture. Stress or inflammation from other conditions, such as rheumatoid arthritis, gout, psoriatic arthritis, thyroid disorders, or unusual medication reactions may also increase a person’s risk.
SYMPTOMS OF BURSITIS
Without doubt the most common clinical symptom of Bursitis is a deep aching or burning pain. The pain may progressively worsen over time or be sudden and severe in onset. Sufferers typically report a significant difficulty in using the affected limb or area.
AREAS OF THE BODY EFFECTED BY BURSITIS
- Achilles tendon
REACHING A DIAGNOSIS OF BURSITIS
Bursitis is generally detected as a tender, warm swelling at the site of a bursa. It is important for you practitioner or health care professional to rule out other possible differential diagnoses before commencing treatment. A consultation with a primary health care practitioner such as a Chiropractor or Physiotherapist may include the following analysis:
- Review of medical history as well as various injury specifics such as mechanism of injury, location of pain, quality of pain, aggravating and relieving factors to assist your therapist in determining your problem
- Physical examination including palpation, muscle testing, range of motion assessment as well as various injury specific orthopaedic and neurological tests if required
- Referral for imaging may be clinically indicated to assist your practitioner in formulating an appropriate diagnosis and therefore management plan. Such images may include X-ray, Ultrasound, MRI or CT.
Bursitis can be quite a difficult and persistent problem to treat. While this is the case there are various methods which are recommended:
- Avoiding activities that aggravate the problem
- Resting the injured area to assist with reducing inflammation, pain and improving general function
- Other anti-inflammatory measures such as ice application to the injured area, anti-inflammatory medication as well as dietary or nutritional changes
If after completing the above steps you see no improvement in your condition it is recommended that you seek appropriate attention from your family physician or musculoskeletal therapist.
Chiropractic & Physiotherapy
Treatment will vary depending upon the exact location of your Bursitis. However, traditional management is aimed at reducing inflammation, eliminating pain and enhancing general function and ability to complete activities of daily living. Treatment may include techniques such as joint mobilisation, stretching, massage, physiological therapeutics (ice/heat/ultrasound/laser/shockwave therapy) and specific exercise advice.
Your doctor may prescribe medication to reduce inflammation in the Bursa. Corticosteroids, also known simply as “steroids,” are often used because they work quickly to decrease the inflammation and pain. Steroids may be injected directly into the injured Bursa.
While rare, surgical intervention may be warranted if all other treatment methods have been exhausted and deemed unhelpful. It is recommended that you discuss various surgical intervention options with your general practitioner.
WHAT DOES THE RESEARCH TELL US?
- Trochanteric bursitis is quite a common cause of general hip pain & discomfort. Conservative management such as Chiropractic treatment is warranted before more invasive therapies are considered. Gerber, J.M (1994). Conservative treatment of calcific trochanteric bursitis. Journal of Manipulative & Physiological Therapeutics, 17(4); 250 – 252.
- Cases of calcific trochanteric bursitis respond favourably to non-invasive modalities such as Physiotherapy & Chiropractic management that incorporates high dosed pulsed ultrasound therapy. Wiener, K (2002). Calcific trochanteric bursitis: resolution of calcifications and clinical remission with non-invasive treatment. A case report. Journal Article, 114(8-9); 345 – 348.