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Preventing Pain and Discomfort: What Causes Bursitis To Flare Up?

March 30, 2024

Bursitis is an inflammation of the bursa, a closed, fluid-filled sac that serves as a cushion and gliding surface to lessen tissue friction. The major bursae (the plural of bursa) are situated next to the tendons near the large joints, like in the elbows, shoulders, hips, and knees.

Bursitis is usually a temporary condition. It might limit motion but generally doesn't cause deformity. Nonetheless, it's still worth answering this question: What causes Bursitis to flare up?

Types of Bursitis

Bursitis can occur in any bursa in the body, but there are some common types of Bursitis, such as:

Retromalleolar Tendon Bursitis

This type is also called Albert disease. It is caused by disease, injury, or shoes with rigid back support. These cause extra strain on the lower part of the Achilles tendon, which attaches your calf muscle to the back of the heel. It can cause inflammation of the bursa, where the tendon connects to the heel.

Posterior Achilles Tendon Bursitis

This type, also known as Haglund deformity, is in the bursa situated between the skin of the heel and the Achilles tendon. This connects the calf muscles to your heel. It's aggravated by a walking type that presses the soft heel tissue into the shoe's hard back support.

Hip Bursitis

Hip bursitis, also called trochanteric Bursitis, is normally the result of overuse, injury, spinal abnormalities, arthritis, or surgery. This Bursitis is more common in women, middle-aged people, and older people.

Elbow Bursitis can be caused by injury or constant pressure

Elbow Bursitis

Elbow bursitis is caused by inflammation of the bursa between the elbow's skin and bones (the olecranon bursa). It can be caused by injury or constant pressure on your elbow (for instance, when leaning on a hard surface).

Knee Bursitis

Bursitis in the knee is also called Pes Anserine bursitis or goosefoot bursitis. The Pes Anserine bursa is found between the shin bone and the hamstring muscles' three tendons on the inside of the knees. This Bursitis may be caused by a lack of stretching before exercise, being overweight, tight hamstring muscles, arthritis, or out-turning of the knee or lower leg.

Kneecap Bursitis

Also called prepatellar Bursitis, this type is common in people on their knees, such as carpet layers and plumbers.

What Causes Bursitis to Flare Up?

Bursitis is induced by inflammation in a thin pocket of jelly-like fluid between bones and tendons. This fluid protects joints and bones from knocks, falls, bumps, and injuries when working properly.

If more than one is involved, this fluid cushion is known as a bursa or bursae involved.

When your bursae work normally, they act like lubricants for the bones and the soft tissue supporting them. This enables them to slide easily over one another.

Bursae also help to reduce friction. For example, your shoe rubbing against your foot creates friction, which the bursae absorb instead of your tendons or bones.

Your body can also produce a new bursa if it thinks a certain limb or joint needs added protection from friction. For instance, if your shoe keeps rubbing the same spot or you regularly lean on the same elbow, your body will make added cushioning there. It will either be done with an added bursa or by increasing the fluid in the already existing bursae.

Who Usually Develops Bursitis?

The following groups of individuals typically perform these motion types and commonly develop Bursitis:

Athletes. These can be anyone from weekend warriors to professional athletes. Many sports require repetitive motions, like throwing a ball, jumping, swinging a bat, or running. These repetitive motions can irritate your bursa and result in Bursitis.

Hard-labor/manual-labor workers. People who do highly repetitive, stressful movements, like heavy lifting, might also irritate the bursa and cause Bursitis.

Bursitis can also affect less active individuals who do their regular activities.

Less Active Individuals. People who aren't regularly active can irritate their joints quickly while doing everyday activities, like carrying groceries or exercising. This joint strain can lead to Bursitis. It is crucial to start any new workout routine gradually.

Other causes of Bursitis include injury or trauma to the affected joint, inflammatory arthritis (like rheumatoid arthritis), infection, and gout.

You're also more likely to get Bursitis at an older age or if your hobbies or occupation involve frequent repetitive motion.

What Are The Signs Of Bursitis?

The following are the most common signs of Bursitis. However, each person might experience symptoms differently.

  • Pain
  • Limited motion
  • Localized tenderness
  • Redness and swelling if the inflamed bursa is close to the surface of the skin

Chronic Bursitis might involve repeated attacks of swelling, pain, and tenderness. These might lead to a limited range of motion in the affected joint and muscle deterioration.

Bursitis symptoms may resemble those of other medical conditions or issues. Always consult a healthcare provider to get a diagnosis.

How Is Bursitis Diagnosed?

It is important to consult with a doctor to receive a diagnosis

A medical history and physical examination can diagnose Bursitis. Some cases will be free of additional tests or imaging. Still, they can be helpful in other situations, particularly if the doctor wishes to rule out other conditions with similar symptoms, like arthritis, gout, or sciatica.

Septic Bursitis may also include symptoms such as fever, redness, and warmth in the area around the swollen bursa. On the first visit, a primary care physician will try to determine the nature of the problem and differentiate it from other conditions. In the medical history, be prepared to answer questions such as:

  • When did the pain begin?
  • Did the pain come on suddenly, or has it been growing over time?
  • What activities were you doing (i.e., kneeling, playing tennis, etc.)?
  • Did the pain result from a specific incident?
  • Has that area been injured or painful before?

In a physical exam, the healthcare provider will check for pain, look for swelling, and measure range of motion.

An X-ray or MRI may be ordered if the doctor suspects the cause is due to an injury or to rule out other conditions, like fractures. An ultrasound might also rule out other conditions or if the doctor suspects septic Bursitis.

If the physician suspects the swelling is due to infection or crystalline joint disease, fluid from the bursa will be drawn out using a syringe—a procedure called aspiration—and then tested for bacteria or crystals. Blood tests are rarely necessary, but they may provide evidence of infection.

Treatments for Bursitis Flare-up

Most cases of Bursitis will resolve on their own. Activity modification, rest, and pain medications are the only treatments required. More severe or chronic cases may require additional treatment, such as prescription medication, physical therapy, assistive devices, or surgery.

Treatment, however, will depend on the type of Bursitis. Septic Bursitis can only be treated with antibiotics. Treatment will primarily focus on managing the underlying condition of Bursitis caused by inflammatory diseases or joint diseases.

Rest

The near-universal treatment for Bursitis is to rest the joint. This may require immobilizing the joint for one or two days, followed by using the joint minimally for several days to a few weeks. Applying ice, using compression devices, elevating the joint, and taking over-the-counter NSAIDs can help manage the pain and swelling.

Lifestyle Changes

Treating and preventing Bursitis may require lifestyle changes such as modifying or eliminating activities that cause Bursitis to flare up, such as using knee pads or cushions, reducing weight, and wearing properly fitted footwear.

Physical Therapy

Physical therapy concentrates on stretching and strengthening muscles, improving range of motion, and training patients to manage their conditions. It might include stretching, yoga, passive movement, strength exercises, and flexibility training.

Assistive Devices

Assistive devices, including walkers or canes, can help rest the joint for hip, knee, or ankle bursitis. Immobilization devices for the shoulder, elbow, knee, or hip can keep the joint stable for a few days while swelling decreases.

Medications

Most bursitis cases will resolve without medications. Over-the-counter pain relievers and NSAIDs are sufficient to manage pain and swelling, but deep Bursitis, such as hip bursitis, may require a corticosteroid injection. Septic Bursitis, however, can only be managed with antibiotics.

There are different ways to relieve the discomfort caused by Bursitis flare ups

Surgery

Surgery is the treatment of last resort for chronic Bursitis. An orthopedic surgeon may entirely remove the inflamed bursa through a bursectomy, shave down bone, or repair tendons in the joint. A bursectomy is a minimally invasive procedure carried out with an endoscope, a long, thin tube inserted into the affected area. The surgeon can use the endoscope to examine the affected joint and even insert special tools to perform the procedure. Removing the swollen bursa does not damage or debilitate the joint. Most patients will recover their previous range of motion.

Prevention of Bursitis

Some types of Bursitis can't be prevented. You can do some things to help lessen your risk of Bursitis due to overuse or overstrain of a joint. These prevention methods include the ones below:

  • Exercise, warming up, and stretching. Stretching and exercise help keep the muscles conditioned, making Bursitis less likely.
  • Using kneeling pads. If you know you'll be kneeling for a long time, use padding to reduce the pressure on your knees.
  • Taking breaks. Ensure that repetitive tasks are alternated with rest so the joints don't over-strain.
  • Lifting properly. Bend your knees when lifting. Failing to do so causes extra stress on the bursae in the hips.
  • Wheeling heavy loads. Avoid carrying heavy loads, as doing so puts stress on the bursae in your shoulders.
  • Maintaining a healthy weight. Being overweight causes more stress on your joints.

What Happens If You Leave Bursitis Untreated?

What happens with untreated Bursitis depends on what is causing the condition in the first place. The condition may not disappear if Bursitis is not treated with rest and similar conservative measures. If the condition is due to crystal build-up in the joints, untreated Bursitis may result in permanent loss of motion in that joint. If the condition is because of a bacterial infection (septic Bursitis), the infection could spread to the rest of the body and become potentially life-threatening.

Are you looking for relief from a Bursitis flare-up? Please reach out to us today!

© 2025, John Hibbitts, M.D. All Rights Reserved.