Bursitis is a painful condition resulting from the inflammation of a bursa, a small, fluid-filled sac located near joints throughout the body. These sacs function as cushions, minimizing friction between bones, tendons, and muscles during movement. When irritated, typically from repetitive motion or excessive pressure, the bursa swells, causing pain, stiffness, and restricted movement. Managing this condition involves a careful balance, as movement is necessary for long-term recovery but can be detrimental during a flare-up. The role of exercise shifts dramatically depending on the phase of inflammation, requiring specific modifications to prevent worsening the injury while promoting healing.
Managing Bursitis During Acute Inflammation
When bursitis first flares up, the immediate priority is to stop the inflammatory process, characterized by sharp pain, swelling, and warmth. Continuing to exercise during this acute phase will increase fluid within the bursa, significantly delaying recovery. The initial response should focus on minimizing stress to the affected area, often following the R.I.C.E. protocol: Rest, Ice, Compression, and Elevation.
Resting the joint is paramount, meaning all pain-inducing activities must be temporarily paused for 24 to 48 hours. Applying ice for 15 to 20 minutes several times a day helps reduce inflammation and numb pain. Compression, using a gentle wrap, helps limit swelling, while elevating the limb above the heart uses gravity to drain excess fluid. This initial rest period is only to calm acute symptoms; prolonged immobilization is discouraged as it can lead to joint stiffness and muscle atrophy. Once the sharp pain subsides, the focus shifts toward gradually reintroducing controlled movement to prevent long-term functional loss.
Therapeutic Exercise for Rehabilitation
Once the acute symptoms have lessened and the sharp pain has transitioned into a dull ache or stiffness, therapeutic exercise becomes an important component of recovery. The goal of this phase is to restore normal function by improving the joint’s range of motion and building strength in the muscles that support it. These movements must remain gentle and non-painful to avoid re-inflaming the bursa.
Range of motion (ROM) exercises are introduced first to combat stiffness developed from rest. These involve gentle, pain-free movements, such as passive stretches or pendulum exercises, which utilize gravity to move the joint without engaging the surrounding muscles forcefully. Maintaining flexibility in the muscle-tendon units around the bursa is important to reduce mechanical tension that can cause friction.
Strengthening exercises follow the restoration of motion and are designed to stabilize the joint and reduce mechanical stress on the bursa. Low-resistance, isometric exercises are frequently recommended because they contract the muscle without creating significant joint movement or compression. For example, a physical therapist may prescribe a gentle wall push for shoulder stability or a clamshell exercise to strengthen the gluteal muscles supporting the hip. Improving the strength of these supporting muscles ensures that the muscles, rather than the bursa, absorb the forces generated during daily activities, protecting the joint structures from future irritation.
Activities and Movements to Strictly Avoid
To prevent direct mechanical irritation, specific activities must be strictly avoided during both the acute and rehabilitation phases. Any movement that places direct and sustained pressure on the inflamed sac is likely to cause a painful flare-up. For instance, individuals with prepatellar bursitis in the knee should avoid prolonged kneeling, while those with olecranon bursitis in the elbow must refrain from leaning on hard surfaces. High-impact activities are also contraindicated because the jarring forces they generate are transmitted directly through the joint, compressing the bursa. This includes activities like running, jumping, and plyometrics, which can cause micro-trauma to the already sensitive tissue.
Repetitive motions that initially caused the bursitis must also be modified or stopped completely. For example, cycling may be problematic for hip bursitis due to repetitive hip flexion, and repetitive overhead lifting can aggravate shoulder bursitis. Heavy resistance training and deep range-of-motion movements, such as deep squats or lunges, place excessive compressive loads on the bursa and surrounding tendons. Modifying daily life to eliminate these high-risk movements is necessary to ensure the bursa has the opportunity to heal completely.