Bursitis, the painful inflammation of small, fluid-filled sacs called bursae, is a common issue that can sideline active individuals. These sacs function as cushions, reducing friction between bones, tendons, and muscles near joints like the hips and knees. When a bursa becomes irritated and inflamed, it swells with fluid, making movements painful and difficult. For a runner, the answer, particularly in the acute phase, is usually a temporary halt to the activity.
Understanding Bursitis and Its Impact on Movement
Bursitis is an overuse injury for runners, caused by the repetitive stress and friction inherent in the sport. The bursa normally allows tendons and muscles to glide smoothly over bony prominences. When running, the constant, high-impact motion irritates this sac, causing it to fill with excess fluid, swell, and trigger localized pain.
Runners most often experience this condition in the hip (trochanteric bursitis) or the knee (pes anserine or prepatellar bursitis). In the case of trochanteric bursitis, the bursa over the prominent bone on the side of the hip becomes irritated, often due to altered movement patterns or muscle weakness that increases friction. Continuing to run when the bursa is inflamed forces the already irritated tissues to repeatedly rub against one another, which prevents healing and sustains the painful inflammation.
Immediate Management Strategies
The first step upon noticing bursitis symptoms is resting and ceasing any activity that aggravates the pain. Rest stops the mechanical irritation and friction that prevents the bursa from healing. Immediate management commonly involves the use of ice, compression, and elevation (R.I.C.E.) to mitigate inflammation.
Applying ice to the affected area for 10 to 20 minutes several times a day can help reduce swelling and pain, particularly in the first 24 to 48 hours. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can also be used to manage pain and reduce inflammation in the acute phase. However, if the pain is severe, if symptoms persist beyond a few weeks, or if there is a sharp increase in pain, a healthcare provider should be consulted.
Seek immediate medical attention if fever, spreading redness, or an inability to bear weight appear, as these symptoms can indicate a more serious condition like septic (infectious) bursitis. For cases that do not respond to conservative measures within four to six weeks, a physician may suggest a corticosteroid injection for localized anti-inflammatory relief. Physical therapy is another common recommendation for restoring function and addressing underlying causes.
Activity Modification and Safe Return
A return to running should only be considered when the affected area is pain-free during daily activities and has a full range of motion. Once the acute pain has subsided, activity modification is necessary to maintain cardiovascular fitness without re-aggravating the bursa. Low-impact cross-training alternatives, such as swimming, deep water running, or cycling, allow the bursa to continue healing while preventing muscle atrophy and deconditioning.
The goal is to reintroduce load gradually, starting with activities that do not involve the repetitive impact of running. When ready to resume running, a walk/run interval program is recommended to slowly condition the tissue and monitor the body’s response. For example, alternating one minute of running with two minutes of walking allows for a controlled increase in stress.
Footwear and running form are important components of a safe return. Analyzing running mechanics for abnormalities, such as overstriding or excessive cross-over motion, can identify factors that place extra strain on the bursa. Ensuring that running shoes are not worn out and provide adequate support can also help reduce the impact forces transmitted to the joints.
Prevention of Recurrence
Preventing bursitis from returning requires addressing the underlying biomechanical weaknesses and imbalances that contributed to the initial injury. A primary focus should be on strengthening the muscles surrounding the hip and core, which are responsible for stabilizing the pelvis during the single-leg stance phase of the running gait. Weak hip abductors, such as the gluteus medius, are a common culprit, as their inadequate function can lead to increased friction over the trochanteric bursa.
Implementing a consistent strength training routine that includes single-leg exercises, such as lunges and single-leg deadlifts, helps the muscles adapt to the load of running and manage increased training volume. Improving flexibility is equally important, particularly for tight muscles like the hamstrings, which can put excessive pressure on the pes anserine bursa at the knee. Regular stretching and a proper warm-up before activity can reduce this tension.
Consistency in these preventative measures, including gradual increases in mileage and intensity, is necessary. Runners should also pay attention to external factors, such as avoiding running on highly cambered or uneven surfaces, which can place asymmetrical stress on the hips and knees. By integrating strength, flexibility, and proper training load management, runners can significantly lower the risk of future flare-ups.