Can physical therapy help with bursitis?

Physical Therapy for Bursitis: Effective Treatment Approach

Physical therapy is strongly recommended for the treatment of bursitis and should be considered a first-line intervention due to its effectiveness in reducing pain and improving function. 1

Types of Bursitis and Physical Therapy Interventions

Trochanteric Bursitis

• Conservative therapy including stretching exercises focused on the lower back and sacroiliac joints should be initiated as first-line treatment 2
• Physical therapy interventions should emphasize active exercises rather than passive modalities for better long-term outcomes 1
• Supervised exercise programs show greater effectiveness than passive interventions such as massage, ultrasound, or heat application 1

Calcaneal Bursitis (Haglund's Deformity)

• Physical therapy is recommended as part of initial treatment options along with open-backed shoes and orthoses 1
• Weight-bearing restrictions should be maintained until evidence of healing, followed by progressive rehabilitation 3
• Stretching exercises should be implemented once appropriate to restore range of motion and strength 3

General Bursitis Management

• A structured rehabilitation program combined with relative rest, ice, compression, and elevation facilitates the healing process 4
• Land-based physical therapy interventions are conditionally preferred over aquatic therapy due to greater accessibility, though both can be effective 1
• Active physical therapy that educates patients in self-management using independent exercise programs is more beneficial than passive modalities 1

Evidence for Physical Therapy Effectiveness

• Multiple controlled trials provide moderate-quality evidence supporting physical therapy's efficacy for bursitis 1
• Physical therapy has been shown to improve disease activity and physical functioning in patients with inflammatory conditions that may cause bursitis 1
• For chronic microtraumatic bursitis, conservative treatment including physical therapy should address the underlying cause 5

Treatment Algorithm

1. Initial Phase:

   • Relative rest, ice application, and activity modification 4, 6
   • NSAIDs for pain and inflammation control 1, 4
   • Begin gentle stretching exercises 2

2. Progressive Phase:

   • Supervised exercise program focusing on active interventions 1
   • Gradual strengthening of surrounding muscles 3, 6
   • Address biomechanical issues contributing to bursitis 4

3. For Persistent Symptoms:

   • Consider corticosteroid injection if no improvement after 6-8 weeks of conservative therapy 1, 2
   • Continue physical therapy even after injection 6
   • Surgical options only for refractory cases not responding to comprehensive conservative management 6, 7

Important Considerations

• Physical therapy should be initiated once appropriate following acute inflammation to prevent recurrence 3, 4
• Symptom resolution with conservative therapy including physical therapy ranges from 49% to 100% 7
• Bursal aspiration of microtraumatic bursitis is generally not recommended due to risk of iatrogenic infection 5
• For bursitis associated with inflammatory disorders (e.g., rheumatoid arthritis), physical therapy should be combined with treatment of the underlying condition 5

Physical therapy represents a cornerstone of bursitis treatment with strong evidence supporting its use for pain reduction and functional improvement, making it an essential component of management before considering more invasive interventions 1, 6.