If you're experiencing pain when reaching overhead, lifting your arm or sleeping on one side, an irritated bursa may be contributing to your symptoms. The good news is that shoulder bursitis usually responds very well to physiotherapy, activity modification and progressive rehabilitation.
At The Addison Physiotherapy, we commonly see shoulder bursitis in gym-goers, swimmers, tradespeople and active individuals. Our focus is on identifying why the bursa has become irritated and addressing the underlying cause, rather than simply treating the inflammation.
Key Takeaways
- Shoulder bursitis is irritation of the fluid-filled sac that cushions the shoulder.
- It commonly develops alongside rotator cuff tendinopathy.
- Most people recover without injections or surgery.
- Progressive rehabilitation is more effective than prolonged rest.
- Early treatment helps prevent persistent shoulder pain.
What causes shoulder bursitis?
A bursa is a small fluid-filled sac that reduces friction between tissues. In the shoulder, the subacromial bursa sits between the rotator cuff tendons and the roof of the shoulder.
Shoulder bursitis develops when this bursa becomes irritated, usually because of repeated overload rather than a single injury.
Common causes include:
- Repetitive overhead lifting
- Increasing gym training too quickly
- Swimming or throwing sports
- Rotator cuff weakness
- Poor shoulder mechanics
- Falls or direct impact to the shoulder
In many cases, the bursa isn't the primary problem. Instead, it's reacting to excessive load caused by an underlying rotator cuff issue.
What are the symptoms of shoulder bursitis?
People commonly experience:
- Pain when lifting your arm overhead
- Pain reaching away from your body
- Pain lying on the affected shoulder
- Pain when putting on a shirt or jacket
- Aching after activity
- Difficulty sleeping due to shoulder pain
Many people notice a painful arc, where lifting the arm becomes sore between shoulder height and overhead before easing again.
When should I see a physiotherapist?
It's worth booking an assessment if:
- Your shoulder pain has lasted longer than one to two weeks.
- Pain is affecting your sleep.
- You're avoiding work, sport or the gym.
- Shoulder movement is becoming restricted.
- Symptoms continue to worsen despite resting.
Early assessment can help determine whether the bursa is the primary source of pain or whether another shoulder condition is contributing.
Do I need imaging?
Usually, no.
Ultrasound and MRI commonly show bursal thickening, but these findings don't always explain your symptoms. Many people have imaging changes without any pain.
Imaging may be appropriate if:
- You experienced significant trauma.
- Symptoms aren't improving with rehabilitation.
- A larger rotator cuff tear is suspected.
- Surgery or an injection is being considered.
Most cases can be diagnosed through a thorough physiotherapy assessment.
How is shoulder bursitis treated?
Successful treatment focuses on reducing irritation while improving the shoulder's ability to tolerate load.
Treatment usually includes:
Education
Understanding why the bursa has become irritated and how to avoid repeatedly aggravating it.
Load Management
Temporarily modifying activities such as overhead lifting while maintaining as much normal movement as possible.
Progressive Strengthening
Improving the strength of the rotator cuff and shoulder blade muscles to reduce stress on the shoulder.
Return to Activity
Gradually returning to work, gym or sport once symptoms and strength improve.
Passive treatments may help reduce discomfort in the short term, but long-term improvement comes from restoring shoulder strength and function.
Can I keep exercising?
Usually, yes.
Completely resting the shoulder often leads to stiffness and weakness. Instead, exercises may need to be modified while the shoulder settles.
For example, reducing overhead pressing or temporarily changing certain gym exercises can often allow you to continue training without significantly aggravating symptoms.
Your physiotherapist will help determine which exercises are appropriate and when it's safe to progress.
How long does recovery take?
Recovery varies depending on the severity of the injury and how long symptoms have been present.
