Bursitis Treatment: Does Massage, Acupuncture or Physio Help?

What is Bursitis?

Bursitis is irritation or inflammation of a bursa. A bursa is a small, fluid-filled sac found where a muscle or tendon slides across a bone. Bursae reduce friction between moving surfaces and help joints move smoothly.

When a bursa becomes inflamed, it swells and increases friction with the tendon it protects. The tendon next to an inflamed bursa is often irritated as well.

Causes of bursitis include:

• overuse of the joint
• repetitive strain
• a direct knock or fall
• prolonged pressure, infection, or inflammatory conditions such as rheumatoid arthritis or gout

Common places for bursitis include:

• hip (trochanteric bursitis)
• shoulder (subacromial bursitis)
• knee
• elbow (olecranon bursitis)
• Achilles (retrocalcaneal bursitis)

A doctor or physiotherapist can usually diagnose bursitis through a physical examination. Signs include local tenderness, swelling, sometimes redness and warmth, and pain with certain movements. Ultrasound can confirm the diagnosis if needed.

What Causes Bursitis?

Bursitis is most common in middle-aged and older adults. With age, tendons and bursae tolerate less load, so repeated pressure on one joint is more likely to irritate a bursa.

Activities that can lead to bursitis include:

• repetitive-motion sports such as golf, tennis and skiing
• poor posture that loads one area more than others
• a sudden increase in training or activity
• outdoor tasks such as gardening, raking and shovelling
• kneeling or leaning on the elbows for long periods

These activities don’t guarantee bursitis. The risk rises when the same movement is repeated for long periods, especially with poor technique or after a sudden jump in activity.

How to Prevent Bursitis

Prevention depends on where the bursitis occurs.

• Elbow and knee: bursitis often follows repeated knocks or pressure. Padding, kneeling mats and not leaning on the elbows reduce the risk.
• Achilles: shoes that rub over the back of the heel can irritate the bursa. Well-fitted footwear helps.
• Hip: hip bursitis usually develops when the muscles supporting the hip are weak, so the bursa and nearby tendons are repeatedly compressed. Strengthening the gluteal muscles, and avoiding long periods lying on the sore side or sitting with the legs crossed, can help.
• All sites: build up training load gradually and take breaks from repetitive tasks.

Is Massage Good for Hip Bursitis?

Gentle massage of the muscles around the hip can ease pain and tightness, but deep massage directly over an inflamed bursa can make bursitis worse. The same applies to bursitis in the shoulder, knee and elbow.

A trained physiotherapist or massage therapist can work on the surrounding muscles, such as the gluteals and outer thigh, while avoiding pressure over the bursa itself. Massage on its own doesn’t treat the cause of bursitis, so it works best as part of a program that includes strengthening and load management.

Massage should be avoided over an area that is hot, red or very swollen, as these can be signs of infection.

Can Acupuncture Help Bursitis?

Some people find acupuncture eases bursitis pain in the short term, but research on acupuncture for bursitis specifically is limited.

Acupuncture involves inserting fine needles at specific points on the body. It may reduce pain and muscle tension, which can make exercise easier. It isn’t a stand-alone treatment, because it doesn’t address the muscle weakness or overload that often causes bursitis. Anyone considering acupuncture should see a registered practitioner and continue an exercise-based program alongside it.

Does Dry Needling Help Bursitis?

Dry needling may reduce pain and muscle tension around a bursa, but there is little research on dry needling for bursitis specifically.

Dry needling uses fine needles similar to acupuncture, but targets tight bands within muscles (trigger points) rather than acupuncture points. Some physiotherapists use it as one part of treatment. Like acupuncture, it works best alongside exercise rather than on its own.

Is Physio Good for Bursitis?

Yes. Physiotherapy is one of the most effective treatments for bursitis, and exercise-based physiotherapy has the strongest evidence for hip pain.

A physiotherapist assesses the affected joint, then builds a program that usually includes:

• Load management. Changing aggravating activities, positions and postures to reduce pressure on the bursa while it settles.
• Strengthening. Weak muscles are often part of the reason bursitis develops. Progressive strengthening, such as gluteal exercises for the hip or rotator cuff exercises for the shoulder, reduces compression on the bursa.
• Restoring movement. Range-of-motion exercises and hands-on techniques to ease stiffness.
• Education. Advice on sleeping positions, sitting, footwear, and returning to sport or work.

For hip pain, a large Australian trial found a physiotherapist-led program of education and exercise gave better results than a corticosteroid injection at both 8 weeks and 12 months.

Treatment of Bursitis

Most bursitis settles with conservative treatment. A typical approach is:

1.  Relative rest. Reduce activities that aggravate pain, without stopping movement altogether.

2.  Ice. Short periods of ice during a painful flare-up can help with pain and swelling.

3.  Pain relief. A pharmacist or GP can advise on over-the-counter options.

4.  Physiotherapy. A strengthening and load management program addresses the cause and reduces the chance of recurrence.

5.  Corticosteroid injection, if pain persists. Injections can reduce pain in the short term. For hip pain linked to gluteal tendinopathy, the LEAP trial (Mellor et al., BMJ 2018) found education plus exercise led by a physiotherapist gave better overall results than an injection at 8 weeks and 12 months.

Hip bursitis is now often called greater trochanteric pain syndrome (GTPS), because the pain usually involves the gluteal tendons as well as the bursa. This is one reason strengthening is central to treatment.

Septic (infected) bursitis is different. If the area is hot, red and swollen, or there is a fever, see a doctor promptly, as it may need antibiotics or drainage.