Is Your Bursitis Trying To Tell You About Wear And Tear?


The most common symptoms of bursitis are pain and limitation of comfortable movement range. In many ways bursitis is very difficult to differentiate from tendonitis, muscle pain, fascial pain and joint pain. People with bursitis pain often complain of pain that is triggered by certain movements and certain positions that they assume in day to day life. Occasionally people with bursitis also have aching type pain during periods of inactivity.

The only way to know for sure if you have bursitis is by working with a professional who knows how to diagnose complex pain conditions. One of the most important things to understand about bursitis is that having an enlarged bursa on a scan is not confirmation of bursitis. You can have an enlarged bursa that is NOT inflamed. You can also have inflamed tendons causing your pain that do NOT show up on a scan. These facts often make for a complex situation.


Who Gets Bursitis

There are many bursae in the human body, any of which can in theory become inflamed if they are exposed to enough strain. The most common locations for bursitis to show up in the body are the knee, hip, shoulder and elbow. These joints are the locations for the major muscle attachments that attach the limbs to the trunk, note the wrist and ankle are not known for bursitis and neither is the spine. 

Virtually anyone can suffer from bursitis, depending on what they do, how much they do and how they do it. Of these 3 factors ‘how they do it’ is by far the most common cause of bursitis. Most cases of bursitis are caused by chronic long standing strain on the bursa and its surrounding tissues, in a few cases it can also be caused by an injury to the bursa. Athletes can develop bursitis related to their training and performance.. but then so can office workers. 

Image of the shoulder joint which is prone to bursitis pain.

The shoulder is an extremely active joint and is prone to developing bursitis related pain.

What Is Bursitis – The Traditional Medical View

If you have been diagnosed with hip bursitis, shoulder bursitis, elbow bursitis or knee bursitis it is highly likely that you have been put through the traditional medical process that is applied to bursitis.

Typically, the process starts with an undiagnosed pain somewhere in the region of a bursa. Your doctor performs a few movements tests and asks you some relevant questions. The next step is a scan (usually ultrasound) which reveals an enlarged bursa. The scan report is conveyed to the patient and they are informed that the diagnosis for their pain is bursitis. From this point on the most common recommendations are painkillers or anti-inflammatories to reduce the pain, cortisone injections to reduce the inflammation. All of these methods can be effective in a percentage of cases. In any case a diagnosis of bursitis has been rendered and treatment given, there are no surgical options, so win lose or draw that’s the end of the story.


What Is Bursitis Really – The Whole Story 

The other way in which bursitis is often (perhaps not often enough) managed is the following. An extensive history of symptoms and other related issues is taken which takes 30 or more minutes, this is backed up with extensive orthopedic tests. In the case that of all the above point to a likely diagnosis of bursitis scans will be ordered the same way they were at the doctors office.

If the scan comes back showing an enlarged bursa a tentative diagnosis of bursitis is issued and physical therapies are used to try and take pressure off the bursa and also increase blood flow in the area. If this is successful the next step is to perform an extensive biomechanical assessment to figure out what caused the bursa to become inflamed in the first place. Using the shoulder as an example, it is often found that the person has significant postural alterations that had placed pressure on the bursa, which is nearly always the case.

At this point in proceedings the ACTUAL DIAGNOSIS is a ‘postural weakness’  .. the bursitis was a just a SYMPTOM. Sneezing is a symptom of a virus or an allergy , bursitis is a symptom of an injury or a misalignment or weakness… bursitis is a symptom not a diagnosis !!!!

In this style of treatment for bursitis exercises are prescribed for the underlying postural, alignment or movement issue that was uncovered in the biomechanical analysis.


Bursitis – Alignment/Wear & Tear

As we have seen in the previous description and example bursitis is most commonly a symptom of some underlying movement issue. There are a few exceptions but the vast majority of bursitis sufferers have alignment, postural and weakness issues the same way the vast majority of tooth decay is caused by dietary sugars.

The other truth about bursitis is that while it can be very painful indeed it is not a particularly serious side affect of chronic mis-alignment and weakness in the body. Far more debilitating issues like osteoarthritis and spinal disc tears are just 2 examples of far more serious issues that can arise from chronic alignment, postural and weakness issues in the body. 

It has been my observation after taking thousands of case histories over the years, that many of the stubborn aches and pains we get earlier in life are warning signs from our bodies; about the more serious and degenerative pains we get later in life. This may not be an entirely earth shattering observation given that most hips needing replacement don’t just start hurting overnight. The majority of severe issues later in life happen in body parts that have been ‘talking’ to us for decades.

I believe based on what I have observed over 2 decades that in many cases bursitis is one of the bodies early warning signs. Warning shots  about persistent wear and tear occurring in our bodies. When a bursa becomes sufficiently irritated that it enlarges and stays that way there is for sure some serious strain occurring in your body that is not occurring in the bodies of your bursitis free fiends and family! If you had a serious injury fair enough, but if not something is going on to irritate that bursa.


Bursitis & Misdiagnosis

I would estimate that over 80% or the people who have come to my office over the years with a pre-existing diagnosis of bursitis were actually suffering from tendon pain. This fact is traceable back to a major ‘diagnostic blind spot’ that currently exists in our medical system.

The piece of background info that will help bring this together for you is that you can very easily have an enlarged bursa without it being painful. This kind of fact is frequently overlooked by medical professionals and patients alike, did you know for example that if you can even have a disc injury in your lower back and never feel any pain from it.. in fact that isn’t even a rare occurrence.

So bearing in mind that you can have an enlarged bursa and no pain whatsoever.. if you have an enlarged bursa on your scan it may or may not be the cause of your pain. There are many other tissues in your shoulder or knee that could be sore after all.. and many of them can be sore in a way that doesn’t show up on scans. The biceps tendon, the supraspinatus tendon and the subscapularis tendons are all prone to tendonosis, tears and tendinitis. The other joints of the body like the hip, knee and elbow also have their own tendons and soft tissues that are susceptible to pain.

Knee joint pain caused be prescription-pateall bursitis image.

The knee joint is extremely prone to bursitis pain, it is also predisposed to many other kinds of soft tissue pain however.

Truth be told tendon pain in the human body is many times more common than bursitis. The fact that virtually all this tendon pain is invisible on scans, while enlarged bursae are highly visible on scans is the reason why the the tendon pain often gets a fraction of the coverage it deserves. It is also the reason why armies of people walk through my door each year mistakenly believing they have bursitis when they have no such thing. 

Conclusion – Freedom And Comfort

Whether it is bursitis, tendinitis, tears, osteoarthritis, knee ligament issues or just a good old fashioned weak core, when we talk about pain we are always talking about freedom. Being able to stand, walk, run and exercise comfortably without pain or fear of pain are all forms of freedom. Being able to perform life’s tasks, from work duties through  to caring for children and housework without pain are forms of freedom. Even being able to sit and lie down comfortably so that you can be comfortable around the clock and get healthy deep sleep are basic forms of freedom. If you don’t believe me ask anyone who has had chronic pain, they’ll put your straight because every single one of them feel constrained by their pain. Pain represents a loss of freedom to thrive and to enjoy life. 

Freedom to be able to operate without pain is one of the major cornerstones of your quality of life. Anything that threatens that is worth your attention. If you have been diagnosed with bursitis and you are not getting better rapidly I strongly urge you to keep seeking answers, not only because your body is worth the trouble but because the overwhelming majority of people who have been diagnosed with bursitis are very treatable. 


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