Most bursa problems are usually local, acute pains exacerbated by repetitive movements or direct pressure, which can also develop into a referred, more generalised, dull pain over a larger area. Some can also develop to become red and swollen, which may on occasion be associated with infection.

They develop slowly rather than suddenly due to repetitive activity (e.g. running, lifting) or from continued local pressure (e.g. leaning on elbows, kneeling or sitting). Initially the pain is more of an irritation, but can quickly become debilitating. If left untreated, the condition can become chronic and very difficult to deal with.

Treatment options can either be chemical, physical or both. As an osteopath, I will be concerned with the physical (structural and functional) aspects that have caused the pain and will then try to remedy them. In my experience, many cases of bursitis can be improved very quickly with a good chance of avoiding recurrence. Of course, there are some that will be far more difficult, which may eventually require surgery if not treated appropriately or early enough.

A case of trochanteric bursitis ('hip bursitis') was presented to me recently in clinic. The lady in question had seen an osteopathic colleague of mine initially, whom had then referred her to an orthopaedic surgeon where she underwent a number of corticosteroid injections.

As the symptoms of the bursitis were still not resolving to a satisfactory level, she was then referred to me for a further osteopathic opinion and treatment.

On questioning, I had discovered that both of my colleagues had been treating the bursa locally and had not investigated the wider musculo-skeletal factors involved. After my examination, I had found a number of dysfunctional areas:

Although the descriptions above can be further expanded upon, the main principal to understand is the osteopathic evaluation. This lady had lower back joints, which were either very stiff or very loose and consequently her loose joints worked harder and were over-used and fatigued more quickly. To combat this, the buttock muscles were working harder to try to stabilise and aid the painful spinal joints, which in turn made the muscles tighter and decreased blood flow. These tighter buttock muscles then pressed harder on the bursa... and created the bursitis.

Also, the loose and sore spinal joints would tend to affect the spinal nerves, which in this case happened to tighten the buttock muscles, which then pressed harder on the bursa... and created a bursitis.

The findings were simple enough in this case, as the cause of the bursitis was the chronic buttock muscle tension and it's relation to the bursa with a predisposition from the lower back. Osteopathic treatment followed to all of the affected areas. As the symptoms had been persisting for two years, there was a great deal of work to be done, often meaning that the chronic tissues were very sore initially after treatment.

Within six sessions, their was a significant improvement for the patient for the first time in two years.

The above example outlines a good osteopathic approach that seemingly few fully appreciate. Although medication can be a quick way to control pain and can sometimes help, it is rare that simply "rubbing or injecting the sore bit" will fix a structural or functional problem entirely.

The image above is courtesy of Blue Cross Blue Shield of Rhode Island .

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Copyright © Marc Jones - Osteopath (UK), Osteopathy Vancouver 2003 onwards