Bursitis: Symptoms, Causes, Types, Diagnosis & Treatment

Bursitis is a painful condition involving a bursa — a small, fluid-filled sac that helps reduce friction between bones and surrounding tissues such as tendons, muscles and skin.

Bursitis can develop around many joints, but it is particularly common around the shoulder, hip, elbow, knee and heel. Symptoms may include localised pain, tenderness, swelling, warmth and reduced movement.

Although bursitis is often associated with repetitive loading or direct pressure, it is important to understand that not every episode of pain around a joint is caused by bursitis. Tendinopathy, osteoarthritis, muscle injury, referred pain and other conditions can produce similar symptoms.

At Vitality Chiropractic Australia, our approach begins with determining whether the presentation is consistent with bursitis and identifying the factors that may be contributing to your symptoms. Where appropriate, care focuses on symptom management, maintaining movement, progressive rehabilitation and modifying aggravating activities.

If your symptoms suggest infection, significant structural injury or another medical condition, we will recommend appropriate medical assessment or referral.

What Is Bursitis?

A bursa is a small sac containing fluid that helps tissues move smoothly against one another. Bursae are located throughout the body, particularly in areas where tendons, muscles or skin move over bony surfaces. Examples include bursae around the:

Shoulder
Hip
Elbow
Knee
Heel
Buttock

When a bursa becomes irritated, it can become swollen and painful. This may occur following repeated pressure, repetitive activity, trauma or other inflammatory or medical conditions. Importantly, the term “bursitis” describes a problem involving a bursa, but the underlying cause can vary considerably between individuals.

What Does Bursitis Feel Like?

The symptoms of bursitis depend on which bursa is affected. Common symptoms include:

Localised pain or aching
Tenderness directly over the affected area
Swelling
Warmth around the affected area
Redness in some cases
Pain when pressure is applied
Pain with particular movements
Reduced or uncomfortable joint movement
Difficulty performing normal activities
Pain that may be worse at night or when lying on the affected side

Some people develop a visibly swollen bursa, particularly with conditions such as olecranon or prepatellar bursitis. Symptoms may develop gradually following repeated loading, or more suddenly following direct trauma.

Common Types of Bursitis

Bursitis can occur in many locations. Some of the more commonly recognised types include:

Shoulder Bursitis

Shoulder bursitis commonly involves the subacromial-subdeltoid bursa. Pain may be felt around the outer or upper shoulder and can become more noticeable when lifting the arm, reaching overhead or lying on the affected side. Shoulder bursitis can occur alongside rotator cuff-related shoulder pain, which is why an accurate clinical assessment is important. See our related page on Rotator Cuff Syndrome.

Greater Trochanteric Pain Syndrome / Hip Bursitis

Pain over the outside of the hip was traditionally often labelled “trochanteric bursitis”. However, modern clinical understanding recognises that lateral hip pain frequently involves the gluteal tendons and surrounding tissues as well as the bursa. This is why the broader term greater trochanteric pain syndrome (GTPS) is often more appropriate than assuming that isolated bursitis is responsible for every case.

Symptoms may include:

Pain over the outside of the hip
Difficulty lying on the affected side
Pain walking or climbing stairs
Pain with prolonged standing
Discomfort after increased activity

Prepatellar Bursitis

Prepatellar bursitis affects the bursa located in front of the kneecap. It is sometimes associated with repeated kneeling and is sometimes referred to as “housemaid’s knee”.

Pes Anserine Bursitis

Pes anserine bursitis involves tissues on the inner side of the knee, below the joint line. Pain in this area can also arise from other structures, so clinical assessment is important before assuming bursitis is the sole cause.

Retrocalcaneal Bursitis

Retrocalcaneal bursitis affects the bursa between the Achilles tendon and the heel bone. It can cause pain at the back of the heel and may be associated with Achilles tendon problems. For this reason, assessment should distinguish bursitis from Achilles tendinopathy and other posterior heel conditions. See our Achilles Tendinopathy page for more information.

Ischial Bursitis

Ischial bursitis affects the bursa around the sitting bones and can cause pain around the buttock, particularly with prolonged sitting.

Olecranon Bursitis

Olecranon bursitis affects the bursa at the back of the elbow. It can produce a noticeable lump or swelling over the point of the elbow. Repeated pressure, such as leaning on the elbows, direct trauma and infection can all contribute.

What Causes Bursitis?

Bursitis does not have one single cause. Common contributing factors include:

Repetitive Loading

Repeated movements or activities can irritate a bursa over time. Examples may include:

Repetitive overhead work
Gardening
Painting
Manual work
Repeated kneeling
Running or sporting activities
Repetitive lifting

Direct Pressure

Repeated pressure over a bursa can contribute to irritation. Examples include:

Frequently kneeling
Leaning on the elbows
Prolonged sitting on hard surfaces
Sleeping repeatedly on one side

Trauma

A direct blow or fall can irritate a bursa and cause local swelling and pain.

Sudden Changes in Activity

Bursitis symptoms can sometimes appear after a substantial increase in training volume, work demands or physical activity. The issue may not be the activity itself but rather a rapid increase in the amount or intensity of loading.

Other Health Conditions

Certain systemic conditions can increase the risk of bursitis or contribute to inflammation around bursae. These include conditions such as:

Gout
Rheumatoid arthritis
Other inflammatory arthritic conditions
Diabetes
Certain metabolic or systemic disorders

Infection

A bursa can become infected, resulting in septic bursitis. This requires medical assessment and potentially antibiotic treatment. Infection should be considered particularly when significant redness, warmth, swelling, fever or feeling unwell accompany the local symptoms.

Is Bursitis Caused by Poor Posture?

Posture can influence how forces are distributed through the musculoskeletal system, but poor posture should not automatically be described as the cause of bursitis. Bursitis is better understood in terms of the interaction between:

Tissue loading
Repetitive activity
Direct pressure
Recent changes in activity
Injury
Individual capacity
Recovery
Other medical conditions

Rather than trying to “correct” one posture or alignment, rehabilitation generally aims to help the affected region tolerate appropriate movement and loading again.

Bursitis or Something Else?

One of the most important parts of assessing bursitis is determining whether the symptoms are actually coming from a bursa. Several conditions can produce similar pain. Depending on the location, differential considerations may include:

Tendinopathy
Muscle strain
Ligament injury
Osteoarthritis
Rotator cuff-related shoulder pain
Greater trochanteric pain syndrome
Joint inflammation
Referred pain from the spine
Nerve-related pain
Fracture
Gout
Inflammatory arthritis
Infection

For example, pain around the outer hip may involve the gluteal tendons rather than isolated trochanteric bursitis. Similarly, pain around the shoulder may involve the rotator cuff rather than the bursa alone. This is why a clinical assessment is more useful than assuming that every episode of localised joint pain represents bursitis.

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How Is Bursitis Diagnosed?

Bursitis is usually diagnosed using a combination of:

Your history
The location and behaviour of your symptoms
Physical examination
Assessment of movement and function
Consideration of alternative diagnoses

Your clinician may assess:

Pain location
Swelling
Local tenderness
Active range of motion
Passive range of motion
Muscle strength
Joint function
Relevant neurological findings
Activities that aggravate or relieve symptoms

Do You Need an X-Ray or MRI?

Not necessarily. Imaging is not required for every uncomplicated case of bursitis.

However, imaging may be appropriate when the diagnosis is uncertain, symptoms are persistent, significant trauma has occurred or another condition needs to be investigated. Depending on the clinical situation, this may include:

X-ray
Ultrasound
MRI

Ultrasound can be particularly useful for assessing superficial bursae and surrounding soft tissues. In some cases, a healthcare professional may recommend aspiration of bursal fluid to investigate possible infection or other causes. Healthdirect notes that assessment may include X-ray, ultrasound, blood tests or fluid analysis depending on the clinical presentation.

Bursitis Treatment

Treatment depends on the location, severity and underlying cause of the problem. For many uncomplicated cases, conservative management is appropriate. The initial goals are generally to:

Reduce aggravating load
Manage pain
Maintain appropriate movement
Gradually restore strength and capacity
Address contributing activity or training factors
Reduce the risk of recurrence

Activity Modification

Complete rest is not always necessary. Instead, it is often more useful to temporarily modify the activities that significantly aggravate symptoms while maintaining comfortable movement. For example, this may involve:

Reducing repetitive overhead activity
Temporarily limiting kneeling
Modifying sporting loads
Avoiding prolonged direct pressure
Adjusting work tasks
Gradually rebuilding activity tolerance

Ice and Other Symptom-Management Strategies

Cold therapy may provide short-term symptom relief for some people, particularly during an irritable episode. Other strategies may be appropriate depending on the location and presentation. Medication such as anti-inflammatory drugs may be considered in some cases, but these should be discussed with your doctor or pharmacist because they are not appropriate for everyone.

Exercise and Rehabilitation

As symptoms settle, progressive exercise can help restore:

Strength
Mobility
Load tolerance
Coordination
Functional capacity

The appropriate exercises depend on the affected region. For example, rehabilitation for shoulder bursitis will be different from rehabilitation for hip, knee or heel symptoms. The goal is not simply to avoid pain forever. The longer-term objective is to gradually rebuild the capacity needed for your work, sport and everyday activities.

How Chiropractic Care May Help With Bursitis

Chiropractic care does not directly “cure” every case of bursitis, and not every person with suspected bursitis requires chiropractic treatment. Where appropriate, chiropractic care can form part of a conservative, rehabilitation-focused management plan.

At Vitality Chiropractic Australia, assessment may consider:

The affected joint and surrounding tissues
Movement limitations
Strength and functional capacity
Musculoskeletal contributors
Activity and training loads
Work-related demands
Relevant spinal or regional joint function
Alternative explanations for your symptoms

Depending on the presentation, management may include:

Education

Understanding what is likely contributing to your symptoms can help you make appropriate decisions about activity, recovery and rehabilitation.

Manual Therapy

Appropriate manual therapy or joint mobilisation may be used to help manage pain or movement restrictions around the affected region. The aim is not to “realign” a bursa but to address relevant musculoskeletal impairments where this is clinically appropriate.

Soft-Tissue Techniques

Soft-tissue techniques may be used around surrounding muscles and tissues when they are contributing to restricted movement or discomfort.

Exercise Rehabilitation

Progressive exercises may be prescribed to restore strength, mobility and load tolerance.

Activity Modification

We can help identify movements, work tasks or training patterns that may be unnecessarily aggravating the area and develop a gradual return-to-activity strategy.

Referral When Appropriate

If symptoms suggest infection, significant structural injury, inflammatory disease or another condition requiring medical management, referral to your GP or another appropriate healthcare professional is recommended.

When Should You See a Doctor?

Medical assessment is particularly important if bursitis symptoms are accompanied by:

Significant redness
Increasing warmth
Rapidly increasing swelling
Fever
Chills
Feeling generally unwell
Severe or unexplained pain
Significant loss of function
A major traumatic injury
A wound near the affected bursa
Symptoms that are progressively worsening
Symptoms that fail to improve with appropriate conservative management

These features can indicate infection or another condition requiring medical investigation. Septic bursitis can require antibiotics and, in some circumstances, drainage or other medical treatment.

Bursitis and Corticosteroid Injections

Corticosteroid injections may sometimes be considered for persistent or severe bursitis. The decision should be made by an appropriately qualified medical practitioner after considering the diagnosis, severity and potential risks. An injection is not appropriate for every type of bursitis, particularly when infection is suspected. Healthdirect notes that corticosteroid injections may be considered in severe cases, while infection requires different management.

Can Bursitis Come Back?

Yes. Recurrence can occur if the factors contributing to the original episode remain unchanged. Reducing recurrence risk may involve:

Gradually increasing activity
Avoiding sudden spikes in training load
Modifying repetitive tasks
Reducing prolonged pressure on the affected area
Maintaining appropriate strength
Improving work ergonomics where relevant
Allowing adequate recovery
Gradually returning to sport

The objective is not necessarily to avoid the activity that caused the problem forever. Instead, rehabilitation should help build the capacity required to perform that activity again.

Bursitis Recovery: How Long Does It Take?

Recovery time varies considerably. Factors that influence recovery include:

The location of the bursitis
Severity of symptoms
Whether the bursa has been traumatised
Ongoing exposure to aggravating activities
General health
Activity demands
Whether another condition is contributing to symptoms

Some uncomplicated episodes settle relatively quickly after aggravating activity is modified, while persistent or recurrent presentations may take considerably longer. If symptoms are not progressing as expected, reassessment is important.

What to Expect at Vitality Chiropractic Australia

If you book an assessment for pain that you believe may be bursitis, your appointment will begin with a detailed discussion about your symptoms and how they developed.

We may discuss:

When your symptoms began
Whether there was an injury
Recent changes in activity
Work and sporting demands
Pain triggers
Relieving factors
Previous episodes
Relevant medical history

Your physical assessment may include examination of:

Range of motion
Strength
Joint function
Local tenderness
Movement patterns
Relevant neurological function
Surrounding muscles and soft tissues

The purpose is not simply to label the problem as “bursitis”, but to determine whether the symptoms are consistent with bursitis and whether there are other conditions that should be considered. Where further investigation is warranted, we can recommend appropriate referral or medical assessment.

Bursitis Treatment in Mill Park, Melbourne

Vitality Chiropractic Australia provides conservative musculoskeletal care in Mill Park, serving patients from surrounding Melbourne northern suburbs including South Morang, Epping, Bundoora, Thomastown, Doreen, Lalor, Mernda and Wollert. If you have persistent pain around the shoulder, hip, elbow, knee or heel and are unsure whether bursitis is responsible, a clinical assessment can help clarify the likely source of your symptoms and the most appropriate next step.

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Related Conditions

Bursitis can overlap with a number of other musculoskeletal conditions.

You may also find these pages useful:

Rotator Cuff Syndrome — shoulder pain involving the rotator cuff and surrounding tissues
Adhesive Capsulitis / Frozen Shoulder — persistent shoulder pain and marked restriction of movement
Tennis Elbow — a common cause of lateral elbow pain
Golfer’s Elbow — medial elbow pain involving the flexor-pronator tendon complex
Plantar Fasciitis — common cause of heel and foot pain
Shoulder Pain — broader information about causes of shoulder pain

What is bursitis?

Bursitis occurs when a bursa becomes irritated or inflamed. Bursae are small fluid-filled sacs that reduce friction between bones and surrounding soft tissues.

What are the most common types of bursitis?

Common examples include shoulder bursitis, greater trochanteric pain syndrome, olecranon bursitis, prepatellar bursitis, pes anserine bursitis, retrocalcaneal bursitis and ischial bursitis.

Is bursitis the same as tendonitis?

No. Bursitis involves a bursa, while tendinopathy involves a tendon. However, they can occur in the same region and produce similar symptoms, so clinical assessment may be needed to distinguish them.

Can bursitis heal on its own?

Many uncomplicated cases improve with appropriate activity modification, symptom management and gradual return to normal movement. Persistent or recurrent symptoms should be reassessed.

Can bursitis be caused by poor posture?

Posture may influence how forces are distributed through the body, but it is rarely appropriate to describe poor posture as the single cause of bursitis. Activity, load, pressure, injury and individual capacity are usually more clinically relevant.

Take the Next Step

Persistent pain around a joint can have several possible causes. If you suspect bursitis, the first step is to determine what is actually causing your symptoms. At Vitality Chiropractic Australia, we can assess the musculoskeletal aspects of your presentation, provide appropriate conservative management where suitable, and recommend further medical assessment or referral when required.