Bursitis of the Hip, Knee and Shoulder: Causes and Treatment

If you've ever struggled to lie on one side at night because the outside of your hip feels bruised, or winced kneeling to tie a shoe, or found that reaching overhead sends a sharp catch through your shoulder, you may have met bursitis. It's common, it's often misunderstood, and in most cases it responds well to sensible, well-paced management.

What is bursitis?

A bursa is a small, fluid-filled sac that sits between bone and the soft tissues around it, such as tendons, muscle and skin. Its job is simple: to reduce friction and let things glide smoothly. You have dozens of them around the body.

Bursitis means a bursa has become irritated and inflamed. It swells, becomes sensitive to pressure, and hurts when it's squeezed or rubbed. The three most common places we see it are:

• Hip: usually the bursa on the outer point of the hip (trochanteric bursitis). It causes pain on the outside of the hip that can spread down the thigh, and it's often worse when lying on that side, climbing stairs or after sitting for a long time.
• Knee: either at the front, over the kneecap (sometimes called "housemaid's knee"), or on the inner side just below the joint. Front-of-knee bursitis often appears as visible swelling after kneeling.
• Shoulder: the subacromial bursa, which sits under the bony tip of the shoulder. Pain tends to show up when lifting the arm out to the side or overhead, and it can ache at night.

Why does it happen?

Bursae usually become irritated for one of two reasons: repeated friction or direct pressure. Sometimes it's a sudden knock or fall.

In everyday life, that might look like:

• Increasing running mileage or hill work too quickly
• Long hours at a desk with poor shoulder or hip support
• Lots of kneeling, for example gardening, tiling or DIY
• Repetitive overhead activity, such as swimming, painting or lifting weights
• A change in footwear, training surface or technique

There's an important nuance here. Particularly at the hip and shoulder, bursitis rarely occurs entirely on its own. The tendons right next to the bursa, such as the gluteal tendons at the hip or the rotator cuff at the shoulder, are often irritated too, and sometimes weak or overloaded. The bursa then takes the blame, but it may be a symptom of a bigger picture. That's why simply resting and hoping it goes away often leads to a flare-up when you return to activity.

Less commonly, bursitis can be linked to inflammatory conditions such as rheumatoid arthritis or gout, or to infection. If a swollen joint is hot, red, very painful and you feel unwell or feverish, don't wait. Seek urgent medical advice the same day.

What actually helps?

Calm things down first. For the first few days or weeks, reduce the specific things that provoke it rather than stopping everything. That might mean:

• Avoiding lying directly on the sore hip, and putting a pillow between your knees when on your side
• Using a cushioned kneeling pad, or avoiding prolonged kneeling
• Keeping your arm below shoulder height for a short period if overhead movement is painful
• Not sitting with your legs crossed if you have hip pain, as this can compress the tissue on the outside of the hip

Ice or a heat pack can both give short-term comfort, so use whichever you find more soothing. If you're able to take anti-inflammatory medication, speak to a pharmacist or your GP first to check it's suitable for you.

Then load it sensibly. This is where most lasting improvement comes from. Once the irritation settles, gradual strengthening of the surrounding muscles and tendons helps them cope with the demands you place on them. For the hip, that often means glute strengthening and improving control through the pelvis. For the shoulder, it's rotator cuff and shoulder blade work. Progressive strength and conditioning is a key part of recovery, rather than an optional extra.

Look at the cause. A physio will look at how you move, how you train, and how your day is set up. Sometimes a modest tweak, such as shortening your stride, changing your desk set-up or spacing out hard sessions, makes a real difference.

Consider other options if it's stubborn. Where there's an associated tendon problem that hasn't settled with exercise, treatments such as shockwave therapy may be worth discussing. In some cases, your GP or a specialist may suggest an injection, and your physio can help you decide when that conversation is worth having.

How physiotherapy fits in

The aim of physiotherapy is to work out what is really driving the pain, because bursitis can look very similar to other problems. Hip pain can come from the lower back, the joint itself or the tendons. Shoulder pain can come from the neck. A proper assessment rules these in or out, so that your treatment is aimed at the right thing.

From there, we'd typically combine hands-on techniques to ease pain, clear advice on what to modify and what to keep doing, and a graded exercise plan you can follow at home. Most people notice their symptoms easing within a few weeks of consistent work, though tendon involvement can mean recovery takes a little longer. That's normal, and it's worth being patient with.

When to get it checked

Many mild cases settle with a short period of activity adjustment. It's worth getting assessed if:

• The pain has lasted more than a few weeks without improving
• It's disturbing your sleep or stopping you training or working
• You've had the same flare-up more than once
• You're not sure whether it's bursitis or something else

If that sounds familiar, you're welcome to book an assessment at our Vauxhall clinic. We'll find out what's behind the pain and put together a clear plan to get you moving comfortably again. If you're covered by Bupa, AXA or Vitality, we can talk you through how that works when you book.