Bursitis Isn’t Real (JK…Kinda)

People typically receive a diagnosis of bursitis from a primary care physician with non-specific joint pain without a specific mechanism of injury. If you’ve ever been to the doctor and complained of joint pain, it’s likely they’ve blamed bursitis as the culprit. And if you’ve never been diagnosed with it, I bet you know someone who has.

Bursitis is often a “blanket diagnosis” that is given to joint pain without thorough assessment and consideration of signs, symptoms, and clinical presentation.

What are bursae? 

A bursa is a fluid-filled sac in the body within each of our joints. Bursae are located between skin and bones, between bone and tendons, and between bones and muscles. We have over 150 bursae in our bodies. They help reduce friction and act as shock absorbers in the joints, so our bones can move easily over one another without pain.

What is bursitis? 

Bursitis is a condition in which a bursa becomes inflamed, most commonly due to excess friction or overuse. Bursae can also become inflamed in the presence of injection or direct trauma to a joint. Common symptoms associated with bursitis include joint stiffness or achiness, pain with direct pressure on the area, and localized swelling and/or redness. Bursitis most commonly occurs in the shoulder, elbow, or hip, but can occur in other joints as well.

What do you mean bursitis isn’t real?!?

While bursitis is a real condition, joint pain is widely and often misdiagnosed as bursitis. There are a number of biomechanical and musculoskeletal factors that can lead to joint pain, and inflammation of a single bursa is less commonly the primary cause than we once thought. 

Research has shown that many patients with lateral hip pain diagnosed as bursitis have shown no signs of inflammation of the hip joint bursae on imaging. Instead, it has been suggested and seems more likely that lateral hip pain more commonly occurs as a result of degeneration of the glute tendons. 

Research has also shown that bursitis in the shoulder is often not the main contributor to shoulder pain, and is more likely to be associated with dysfunction of the rotator cuff and postural muscles that are causing aggravation of the joint and surrounding structures. 

I got an MRI and it shows my bursa is inflamed. Now what?

In acute stages, pain management strategies including elevation and analgesics can be helpful to reduce inflammation. In cases of chronic pain or severe inflammation, corticosteroid injections can be helpful. 

However, treating the symptoms alone will likely not tackle the source of the problem, which is faulty mechanics that caused excess friction and stress within the joint. This is where exercise and strength training is important, as it will help reduce the stress that caused the inflammation in the first place. Bursitis is often a recurring issue, because oftentimes once the pain has been managed, people forget about it and expect it to be gone forever. However, if you don’t address the movement patterns that are causing the pain and inflammation, you’re likely to be paid multiple visits from your friend Mr. Bursitis.

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