A bursa is a sac of fluid which sits on top of prominent bony areas in the body. It acts as a smooth, cushion-like pulley for muscles and tendons as they glide across regions of the body. You can imagine without the bursa, the muscles would have to pass across solid bone which would be very painful, with lots of friction, so bursa’s jobs are to solve this problem, reducing friction and allowing muscles to glide easily as the contract.
Bursitis is a painful condition affecting these structures, in which they become inflamed. An inflamed bursa will usually come on when there is altered mechanics around the joint, which leads to an overloading of the bursa. The most common sites for bursitis are in the shoulder, hip and elbow, but you have bursae all over the body so it is possible to get bursitis in most joints.
If the mechanics of a joint change due to weakness or tightness, the amount of friction caused by the muscle passing over the top of the bursa can increase. If this happens long enough then the bursa can become inflamed at which point it becomes the painful condition, bursitis. Another cause of bursitis is blunt force trauma. Falling or landing on a bursa can cause inflammation which can take many months to settle completely.
To avoid painful cortisone injections, which can simply act to mask the problem, rather than solve the problem, physiotherapy can help identify the underlying cause of the pain, and work to solve the mechanisms of pain, rather than masking it with painkillers or cortisone. If you have had multiple cortisone injections, and your pain keeps coming back time and time again, then cortisone is not the solution.
My principle is that if a single cortisone does not keep pain at bay for longer than a year, it is very likely that there is other contributing factors to your pain. As explained, bursitis is often caused by biomechanical dysfunction, and physiotherapy is often required to identify and solve these. Choosing physiotherapy is to choose a long-term, effective and natural resolution to yours symptoms. This means the cause of the pain is addressed and not just the symptom- when you solve the underlying cause of the symptom with physiotherapy, you stay pain free for good.