Bursitis is one of those conditions that can creep up quietly and suddenly make everyday movement uncomfortable. Whether it’s kneeling, lifting your arm, walking upstairs, or even lying on one side, bursitis can make simple tasks feel like a struggle.
The good news? With the right approach, bursitis usually responds very well to physiotherapy. Understanding what to do and what not to do is key to settling symptoms quickly and preventing flare-ups.
What Is Bursitis?
A bursa is a small fluid-filled sac that reduces friction between bones, tendons, and soft tissues. When a bursa becomes irritated or inflamed from repetitive movement, pressure, or poor biomechanics, it leads to bursitis, a common cause of joint pain and swelling [4–6].
Common symptoms include:
● Sharp or aching pain around the joint
● Swelling or tenderness when pressing the area
● Pain with certain movements or positions
● Reduced range of motion
Most forms of bursitis are aseptic (non-infective) and respond well to conservative management such as load modification, strengthening and movement correction [4–6].
The Most Common Types of Bursitis (and How Physio Helps)
1. Shoulder Bursitis (Subacromial Bursitis / Subacromial Pain Syndrome)
The subacromial bursa sits between the rotator cuff tendons and the acromion. When irritated, it can cause a painful arc when lifting the arm, especially between 70–120° of elevation [1].
Why it happens:
- Repeated overhead activity
- Weak or poorly coordinated rotator cuff and scapular muscles
- Postural issues reducing subacromial space
- Sudden increases in load
How physio helps:
Strong evidence shows shoulder-specific exercise therapy is one of the most effective treatments for subacromial bursitis, often matching or outperforming injection therapy in the longer term [1–3].
Physio typically includes:
● Rotator cuff strengthening
● Scapular stabilisation
● Postural retraining
● Gradual overhead loading
● Short-term pain-relief strategies (manual therapy, taping, activity modification)
2. Hip Bursitis (Trochanteric Bursitis)
Hip bursitis commonly affects the trochanteric bursa on the outside of the hip. Patients often report pain when lying on the sore side, climbing stairs, walking uphill, or after long walks.
Why it happens:
● Weak gluteal muscles
● Gait mechanics causing excessive hip loading
● Compression from lying on the side or crossing legs
● Sudden increases in walking or running
While clinical presentation often overlaps with gluteal tendon irritation, the bursa itself can also be a primary source of pain, particularly with prolonged compression and overload [4–6].
How physio helps:
Physiotherapy focuses on:
● Hip abductor strengthening
● Reducing positions that compress the bursa
● Gait retraining
● Managing walking or running volume
● Restoring load tolerance gradually
NICE guidance supports conservative management as the first-line approach for lateral hip pain, including bursitis [6].
3. Knee Bursitis (Prepatellar and Pes Anserine Bursitis)
Prepatellar bursitis (“Housemaid’s Knee”)
Occurs in front of the kneecap, often due to repeated kneeling or direct pressure.
Symptoms: noticeable swelling over the kneecap, pain with kneeling, and tenderness on touch [9,10].
Pes anserine bursitis
Pain on the inner knee, often linked to tight hamstrings, poor alignment, or repetitive stress such as running.
How physio helps:
Evidence-based management includes:
● Avoiding direct pressure on the knee
● Quadriceps and hamstring strengthening
● Soft tissue work and stretching
● Adjusting running load, cadence or terrain
● Compression or padding as needed
Conservative care is strongly recommended as first-line in NICE guidance and clinical reviews [9,10].
4. Elbow Bursitis (Olecranon Bursitis)
The olecranon bursa sits at the tip of the elbow. When irritated, it produces a noticeable pocket of swelling and pain when leaning on the elbow.
Why it happens:
● Repeated leaning on the elbow
● Postural loading at work (desk leaning, trades)
● Trauma (falling onto the elbow)
Most cases are aseptic and resolve with conservative management such as rest, compression and activity modification [7,8].
How physio helps:
● Padding the elbow to reduce pressure
● Compression bandaging
● Gradual mobility and strengthening if needed
● Education on load modification
If redness, heat or fever occur, infection must be ruled out — this is a medical issue, not a physio one [7,8].
DOs and DON’Ts for Bursitis Management
DOs
DO modify aggravating movements early:
Avoiding positions that overload the bursa — such as kneeling, lying on a painful hip, or overhead lifting — allows inflammation to settle [4–6,9,10].
DO use ice for short-term pain relief:
Ice helps decrease inflammation and discomfort during the early phase [4,7–10].
DO strengthen the surrounding muscles:
Strengthening improves joint support and reduces excessive friction on the bursa. Exercise is strongly supported by evidence for shoulder bursitis [1–3] and recommended for hip, knee and elbow bursitis [4–10].
DO address movement mechanics:
Posture, gait and movement strategy can all influence irritation. Correcting these patterns reduces recurrence [1–6].
DO return to activity gradually:
Most bursitis responds best to progressive reloading rather than prolonged rest [1–6,9,10].
DON’Ts
DON’T push through sharp, catching or stabbing pain:
These symptoms usually indicate ongoing irritation and risk of worsening inflammation [4–6].
DON’T rely on rest alone:
Rest may calm symptoms, but without strengthening and movement correction, bursitis frequently returns once activity resumes. Long-term outcomes are superior when exercise-based rehab is used [1–3].
DON’T stretch aggressively over the irritated area:
Direct aggressive stretching can compress the bursa, worsening symptoms. Controlled mobility and strengthening are more effective [4–6].
DON’T ignore posture or faulty biomechanics:
Shoulder, hip, knee and elbow bursitis are all influenced by movement mechanics — addressing these gives the
best long-term results [1–6].
DON’T jump back into full load too quickly:
Sudden return to running, overhead lifting, kneeling or sport can easily trigger a flare-up [9,10].
Final Thoughts
Bursitis is painful, frustrating, and often stubborn when handled incorrectly, but with the right approach it responds extremely well to physiotherapy. The key pillars are:
● Calm the irritation
● Strengthen the right muscles
● Improve movement patterns
● Gradually rebuild load tolerance
If you’re experiencing persistent shoulder, hip, knee or elbow pain that feels like bursitis, a physiotherapy assessment can help identify what’s driving it and build a plan to get you moving comfortably again.
Our Barnet, Cockfosters & Enfield Physio’s have tons of experience and are specialists in treating all types of bursitis . Have confidence that our specialist Physiotherapists will closely assess, diagnose & treat you in the correct & evidence-based way for all injuries. You can book an appointment here.
Blog By: Emre Oz (Specialist MSK Physiotherapist/Head of Integrated MSK & Sports Medicine Operations at Crouch Physio).
References
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21(6), 789–802. - Steuri, R. et al. (2017). Conservative interventions for subacromial pain. Br J Sports Med, 51, 1340–1350.
- Roddy, E. et al. (2021). Optimising exercise and injection outcomes in subacromial pain. Br J Sports Med,
55(5), 262–271. - Ho, G. & Howard, T. (2012). Bursitis: diagnosis and management. Am Fam Physician, 85(11), 1107–1113.
- Bianchi, S. & Martinoli, C. (2007). Ultrasound of bursitis: pathophysiology and imaging. Semin Musculoskelet Radiol, 11(2), 95–108.
- Habusta, S.F. (2002). Bursitis: pathophysiology & treatment. Clin Sports Med, 21(3), 525–537.
- Nchinda, N. et al. (2021). Clinical management of olecranon bursitis. Curr Rev Musculoskelet Med, 14(3),
191–199. - Smith, D.L. (2006). Diagnosis and management of olecranon bursitis. Orthopedics, 29(8), 676–679.
- Pyne, D. & Golding, D. (1997). Prepatellar and infrapatellar knee bursitis. Postgrad Med J, 73, 39–41.
- Rishor-Olney, C.R. et al. (2024). Prepatellar Bursitis. StatPearls Publishing.
