Bursitis

Bursitis (bur-sigh-tus) is a condition that makes the area around a joint or bone painful, red and swollen. It can affect both adults and children.

It commonly affects the feet, shoulders, elbows, knees and hips. However, you can get it in or around any joint, and it can stop you being able to move that part of your body properly.

You may have bursitis if a part of your body, particularly areas close to a joint or directly over a bone, is:

• red or swollen
• hot and sore
• painful - usually with a dull, aching pain
• sensitive and painful if you try to press on or move it.

If the bursa is just under your skin, you may also be able to see its outline, because of the swelling inside it.

Bursitis is caused by inflammation in a thin pocket of jelly-like fluid that sits between your bones and tendons. When it’s working properly, this fluid protects your joints and bones from knocks, falls, bumps and injuries.

This fluid cushion is called a bursa (bur-sa), or bursae (bur-sigh) if more than one is involved.

When your bursae are working normally, they act like lubricants for your bones and the soft tissue that supports them. This allows them to slide easily over one another.

Bursae also help to reduce friction. An example of this would be your shoe rubbing your foot. This creates friction, which is absorbed by the bursae instead of your bones or tendons.

Your body can also create a new bursa if it thinks a certain joint or limb needs added protection from friction. For example, if your shoe keeps rubbing the same area, or you regularly lean on the same elbow, your body will create added cushioning there. This will either be with an extra bursa, or by increasing the fluid in the bursae that are already there.

You get bursitis when you have inflammation inside a bursa. This increases the amount of fluid in the bursa and makes it expand. The area around the bursa then becomes painful, swollen and hot, which can stop you being able to use that joint or limb properly.

The bursae in your feet can become inflamed if you wear high heels or tight shoes, or if you do too much weight-bearing exercise, such as running, jumping, or lifting weights while standing.

A sign of bursitis is often a dull, aching pain and swelling in the balls of your feet. This is usually caused by inflamed bursae.

Jobs and hobbies where you use repetitive movements or activities can make you more likely to get bursitis. This includes:

• carpet fitters who kneel a lot
• people who lean on their elbows to work or study
• people who spend a long time on their feet, standing or walking around.

You can get inflamed bursae next to large bunions or other joints, such as at the backs of your elbows or the side of your hips.

You can also develop bursitis if you have:

• gout or another condition that causes hard crystals to gather in or around your joints
• an injury that keeps coming back
• an infection in or near a joint
• an inflammatory condition – such as rheumatoid arthritis (roo-ma-toy-d arth-ri-tus) increases your risk of getting it.

Bursitis in the shoulder, hip, knee or ankle commonly occurs due to a problem in a tendon. If this is the case, your treatment will probably be focussed on treating your tendon problem, which can often make your recovery slower.

You can find more information about pain in specific areas of the body by visiting our information on:

• shoulder pain
• elbow pain
• hip pain
• foot and ankle pain.

In most cases, you can reduce the pain and inflammation caused by bursitis by reducing the pressure on the affected area. You can also try the following:

Ice packs

Apply an ice pack, or bag of frozen vegetables, wrapped in a damp tea towel to the swollen area for 10 minutes at a time, every 2-3 hours.

Padding

If you have bursitis around your knees, using a thick foam cushion or knee pads can help reduce the pressure and make kneeling less painful.

If lying down is uncomfortable, try to avoid sleeping on the side that hurts. A pillow placed behind your back can stop you rolling onto the painful side and should help you sleep better.

If you’ve got bursitis in your shoulder, you can place that arm on a pillow in front of you. This will support your arm and stop it falling across your body.

Footwear

Comfortable, properly fitted shoes or trainers and protective insoles can help relieve the pressure on swollen bursae in your feet. They should also reduce any rubbing that is making your bursitis worse.

Physical therapy

A physiotherapist is a trained specialist, who can:

• show you exercises to improve your movement
• advise you on how to reduce any friction that could be making your bursitis worse.

A walking sick can also help relieve the pressure on the affected area. Your doctor or a specialist in aids and adaptations, known as an occupational therapist, can advise you on how to pick the right walking stick.

Your GP can refer you for physiotherapy and occupational therapy, or you may be able to refer yourself.

It can take a while to get referred to an NHS physiotherapist or occupational therapist. You could see one quicker if you go private, but you’ll have to pay for this.

Find a private physiotherapist on the Chartered Society of Physiotherapy website. 

You can also find an occupational therapist who works privately on the Royal College of Occupational Therapists’ website. 

Medication

Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen could help your pain. A painkiller, such as paracetamol, could also help. These can be bought from supermarkets and pharmacies.

It’s important to read the patient information leaflet that comes with your medication, to check how much you should take.

If these work for you, your pain should improve within a couple of weeks, though you may still have swelling for a while afterwards.

Sometimes treating the bursitis yourself, using methods such as NSAIDs, rest and support, doesn’t work.

You should see your GP if:

• you have a high temperature, or feel hot and shivery
• the skin over the swollen area is broken
• you can’t move the affected joint
• you have a sharp, shooting pain in the joint
• you’ve tried to treat bursitis yourself, but it still hasn’t improved after a week or two.

Your GP should be able to diagnose bursitis by examining the affected area. They may ask about any:

• any recent injuries
• any history of joint problems
• your job or work practices.

In some cases, your doctor may send you for an ultrasound scan to confirm the diagnosis. You may also be referred to a physiotherapist for an assessment.

If your doctor thinks your bursitis is due to an infection, they may recommend aspiration. This is where a needle and syringe are used to get fluid from the bursa. This may be done by your GP, or you may be referred to hospital.

The drained fluid can then be sent for testing in a lab, to find out what infection you have and the best way to treat it.

Your doctor may advise you to try a course of stronger NSAIDs or painkillers to treat your pain and inflammation. Alternatively, they may refer you to a physiotherapist, who can assess your condition and design a series of stretching and strengthening exercises to treat your specific problem.

Sometimes, in joints like your shoulders or hips, you may be told you have other problems as well as bursitis. The need to treat all your symptoms can often mean it takes longer to get better.

Aspiration can relieve some of the pressure in the bursa and help reduce the pain you’re feeling. Sometimes, if the bursa is large, a steroid will be injected into the bursa after aspiration to reduce the swelling.

If your doctor thinks your bursitis has been caused by an infection, they will probably prescribe you antibiotics. If you continue to get bursitis in the same place, even after treatment, you may be referred to hospital for intravenous (in-tra-vee-nus) antibiotics or surgery.

Your doctor may also refer you for further tests. These include:

• blood tests to look for other conditions, like rheumatoid arthritis or gout
• scans to look for other causes, such as damage to the muscles.

Bursitis can be treated, but it can come back. To stop this from happening, try:

• keeping your weight down. If you’re overweight, you’re putting more pressure on the bursa
• preventing infection by cleaning any cuts properly
• using padded foam cushions or extra padding to reduce pressure on your joints – for example, when sitting or kneeling down
• wear properly fitting shoes and protect your feet with insoles
• protecting your joints from any knocks or bangs
• taking regular breaks from your work or the activity that’s putting the bursa under pressure.

If you have more questions about your condition, you can speak to one of our trained Helpline Advisors for free on 0800 5200 520.

You could also chat to our virtual assistant or take a look around our website for more advice about things that could help your bursitis improve. This includes footwear, occupational therapy, physiotherapy and exercise.