Stop blaming the bursa!

It seems to be getting more and more common when people complain of joint pain, that bursitis is easily diagnosed. So why is this not necessarily an accurate diagnosis?

So what is a bursa and what does it do?

Most joints have a bursa of some sort. A good analogy is to imagine a fluid filled sac, like 2 sheets of cling film lined with washing up liquid. The 2 sheets of cling film are allowed to rub, friction free along each other, to allow the free movements of muscles and joints, kind of also alike a rope and pulley system.

Rope and pulley system

Image the bursa and the joint is the pulley and the muscles are the rope. When the rope is pulled, the rope glides seamlessly along the pulley and the load is move.

However, occasionally the rope can misalign on the pulley and not run correctly, the rope can therefore rub against the pulley when pulled incorrectly, causing friction, heat and ultimately smoke. If we revert this back to the bursa in a joint, this incorrect rub or friction causes inflammation and therefore the term: bursitis (itis: swelling).

So it is bursitis!?

Please don't think I am disputing that a bursitis occurs, because it does. What I am disputing is that a bursitis is a secondary response to something going wrong with your bio-mechanics (the rope not sitting correctly on the pulley). Therefore, does it stand to reason that if we merely treat something as a bursitis, we are not correcting what has gone wrong otherwise the bursa is at risk of returning?

Take 2 pathologies that we know this theory is correct for:

1. Trochanteric Bursitis

We used to believe that pain in our hip bone was due to a bursitis. However, numerous studies and research have identified that the pain suffered is due to a gluteal tendinopathy with a bursitis as an occasional secondary response.

When treating trochanteric bursitis, the treatment was to avoid what causes the swelling, we now know we need to strengthen the gluteals. Two very different treatment protocols, one significantly different result.

2. Subacromial Bursitis

Again, we perceived that pain and restriction in the shoulder was due to the bursitis, however recent studies by a colleague of mine has identified that pain occurred is owed to a rotator cuff tendinopathy. Additionally, with a bursitis as a secondary response.

Similarly, we used to suggest avoid what aggravates the shoulder, now we prescribe aggravating rotator cuff strengthening exercises. 2 very different approaches, one significantly better response. What does bursitis look like?

Simply:

Pre-patella bursitis!! I know this looks somewhat extreme but for a true bursitis to be present, there has to be an element of swelling. Your clinician when assessing you, can ascertain this through accurate assessment tests.

So, next time you have a joint pain and you are advised this is bursitis, remember this; ask your clinician what is causing the bursitis? What structure is not working correctly? Stop blaming the bursa!!!