Guest Blog from Michael @ Move Osteopathic Group – Shoulder Bursitis & How to manage it!

Today I also have a post from an Osteopath, Michael, @ Move Osteo who will be talking about Shoulder Bursitis and how to manage it.
Hi guys, firstly a big thanks to Laura for the opportunity to share a blog with you all. My name is Michael and I am an osteopath @ Move Osteo in Heidelberg. I have been an osteopath for over 10 years now and I divide my time between working in practice as well as teaching within the osteopathy program @ RMIT.
Today we will be looking at a condition which is clearly becoming more prevalent in today’s society, and that is shoulder bursitis. The shoulder in general is quite a complex area due to its anatomy and function. Almost every activity of daily living or exercise routine will involve the shoulder to some degree.
When sore or injured it can be a difficult region to self-manage at home and often needs external help from a health professional. In this blog we will specifically look into sub-acromial bursitis, or inflammation of the sub-acromial bursa.

So what is a bursa anyway?

Well we have heaps of them around our body. They are fluid filled sacks often found in areas between bone and tendon. Their primary role is to allow for smooth fluid glide between these structures as the associated area of the body engages in movement.
Common areas where they can become inflamed (hence the term bursitis) are the shoulder as well as the hip. They often present as a deep ache in nature, and can be quite bothersome at night time, especially when laying on it.

What is the relevant anatomy?

The sub-acromial bursa lies in the sub-acromial space which is a small area that exists under the acromion (which is a bony projection at the top of your shoulder). Some other structures travel through this area and can become irritated. This can lead to what is commonly termed as an “impingement syndrome”.

So how do they develop?

Well there are primary, secondary and tertiary reasons.
  • Primary reasons are those that develop quickly and are the result of direct trauma to the area (such as a fall, a knock, getting in the way of a kettlebell swing etc).
  • Secondary reasons which are the most common (and take longer to develop) involve:
    • Poor movement patterns of the shoulder and arm (with contributory factors from the ribs, neck or thoracic spine). With repetition, certain movements can lead to bursitis, tendonitis and often both.
    • Poor scapular positioning as well as postural factors in the neck, ribs and thoracic spine. A common presentation I see is the typical desk worker with rounded shoulders and an increase in curvature/hunching of their thoracic spine (mid to upper back). Often these patients are weekend warriors and do a lot of high repetitions with exercise or house work such as painting. Over time they can set themselves up for injury.
  • Tertiary factors include concurrent conditions that the patient has which may be initiating or amplifying an inflammatory response- such as arthritis, hormonal imbalances etc.


So where to from here?

Well first and foremost you need some patience. The blood supply to a bursa is quite minimal compared to muscle, therefor the repair time is longer. Expect a minimum of 6-8 weeks for recovery.
One may opt for a scan and immediate cortisone injection or a course of anti-inflammatory medication. This may sound reasonable but don’t forget this bursa has inflamed for a reason so although we may be masking the pain through medication, the actual cause of pain is not being addressed. If you can handle the pain then that’s great- let your body do its thing (it knows how to heal). However if it is too debilitating and effecting your quality of sleep then please discuss your options with your GP (medication/cortisone) or natural therapist (anti-inflammatory style diet/supplementation).
The best option: have it looked at. Your movement patterns and positioning of your shoulder/scapula, neck, back and ribs need to be addressed to quieten the stress that is going thru that sub-acromial region. This can be done with hands on therapy and/or specific strengthening to target any weak structures. Advice can also be given on self-management strategies at home to optimise the healing process and hopefully speed things up.
If your recovery isn’t progressing as well as it should then yes a scan may be in order and this is best referred by your GP. Commonly an ultrasound is performed.

Do I need to stop exercising?

Absolutely not! But you will need to modify what you do to maintain pain free function. Be sure to let Laura know immediately so that she can tweak your program. Yes – you may get out of burpees, but you won’t avoid those max effort wall sits ?
In general whether it be at home or work, keep it moving but be sure to keep it within pain free ranges. You may find tasks overhead a little difficult.

Parting words

The most important take home message is that although the bursa is inflamed and sore, it is doing it’s job (so things are perfectly working fine, and your body is not failing you!). The second important take home (and this is generally speaking) is that pain is a good thing and a sign that your body is functioning properly: it is a way to say something is wrong OR that there is a future perceived threat in the horizon.
So yes although it is unfortunate to be sore and potentially sidelined from what you love doing, it is your body’s way of saying “hey we need some rest” or “hey you’re not using that correctly”.
The key is to work out why it is inflamed in the first place – if we are able to track “cause” then treatment and the management of it will be most efficient….and this is probably where you need a little bit of help.
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