Bursitis
By Brianna Delaney
Bursa are fluid filled sac like structures found near bony protuberances. They typically rest between the bone and other bones, muscles, tendons or ligaments and prevent friction between these structures that would otherwise move against each other. There are many bursa throughout the body of varying sizes. Bursitis is when these fluid sacs enlarge due to inflammation, this can be a result of injury of the bursa itself or as a response to a painful stimulus.
The most commonly affected bursa in the body include the following:
Pes anserine: sits between the hamstring tendons and the tibia
Trochanteric: is located in the lateral hip and sits between the gluteus maximus tendon and the insertion of the gluteus medius tendon on the femur
Olecranon: at the back of the elbow it protects the tricep tendon as it passes over the ulnar
Prepatellar: over the knee cap just under the skin
Bursa of the Patella
These help to prevent friction between the patella and the quadriceps tendon that runs over the top and attaches onto the Tibia.
Bursitis can be caused by overuse injuries, trauma or inflammatory disorders.The most common cause is prolonged pressure, where the surrounding structures place a continuous stress on the bursa (For example, leaning on your elbow or kneeling for too long on hard surfaces), or through repetitive motions. Alternatively a direct sudden pressure such as trauma can cause the bursa to become inflamed, this incident isn’t always immediately obvious.
Each bursa around the body has certain incidents or activities that are more likely to result in bursitis, for example, the olecranon bursitis (at the back of the elbow) is more likely in those that work in manual labor positions as necessary tasks will require repetitive movements and leaning or may be knocked. While the subcutaneous calcaneal bursa (found at the heel of the foot) can be inflamed from footwear that is too tight or poorly fitting.
When a bursa does get inflamed there is local pain and limited range of motion of the joint and pain on certain movements. However, in more chronic cases there may not be any pain as the structures have had time to accommodate the increase in fluid. In both cases there is often local swelling and musculoskeletal imbalances that may have contributed to the onset of bursitis.
There are a few ways to manage the onset of bursitis, initially, like many acute injuries the PRICE protocol can be used to manage symptoms. Osteopaths can help to educate on adjusting aggravating activities and how to manage symptoms. Treatment and rehab often aim to improve range of motion as well as building strength to support the area and reduce pressure over the bursa.