By Max Webster-Green
Shoulder bursitis is a common issue our physios treat here at PhysioMotion. Here are some of the common questions we get asked about shoulder pain, and shoulder bursitis in particular. We’ve also included a suggested programme for strengthening your shoulders at home.
Bursitis is the inflammation of a bursa, a fluid-filled sac that reduces friction between two structures in the body. There are a number of bursae in the shoulder joint, but the largest one is between the top of the shoulder blade and the tendons of the rotator cuff muscles. It’s called the subacromial bursa.
Shoulder bursitis can be caused by weak or tight muscles around the shoulder, repetitive overhead movements, trauma, or by conditions like gout or arthritis. Bursitis can cause pain, but many people can have bursitis and be pain free. Other structural changes in the shoulder, such as rotator cuff tears or shoulder impingement, can also be pain free. This suggests that you don’t always need surgery to improve pain if you have these conditions.
Exercise prescribed by a physiotherapist can improve shoulder pain and is the only universally recommended treatment. It is also helpful if the pain has made you fearful of movement, as a physio can teach you less painful ways of moving. Depending on the cause of the pain, physiotherapy might include exercise, manual therapy and education.
There are no exercises that you must avoid when you have a shoulder bursitis or rotator cuff related pain. Certain movements or exercises may be painful at first, but this doesn’t mean they are damaging.
A physiotherapist will identify the movements that are painful, demonstrate less painful ways of moving and prescribe exercises that gradually restore your shoulder’s full function. Strengthening exercises can improve shoulder pain, and a physiotherapist can provide a strengthening programme with your current pain and goals in mind.
In the case of shoulder bursitis, we would never massage the bursa directly but rather work on the tissues surrounding it.
Massage is one of the manual therapies used in physiotherapy to improve pain and function following shoulder injuries. However, can we truly say it helps? The evidence suggests it may improve shoulder pain, but it’s uncertain.
It may improve pain by desensitising areas of your body that are painful and by activating pain inhibitory pathways to decrease the pain. This may provide you with some temporary relief. According to the evidence, it probably isn’t releasing trigger points, breaking down knots or lengthening tissue, but you don’t need to achieve these things to reduce pain. Evidence suggests it may have similar effects to exercise, and we recommend it’s used in conjunction with exercise and education in a comprehensive management plan.
You can do physiotherapy exercises at home to improve your shoulders’ range of motion, strength and control. Although physiotherapy exercises can help to build a healthy shoulder, they do not replace the need for an assessment and specific treatment provided by a physiotherapist if you have a shoulder injury or pain.
The shoulder consists of several muscles, including four rotator cuff muscles. The rotator cuff provides stability and assists with all movements of the shoulder. The rotator cuff muscles can’t be strengthened in isolation because they work in conjunction with your other shoulder muscles – the deltoid, rhomboids and trapezius. To strengthen the rotator cuff muscles, follow a programme that includes compound shoulder movements as well as movements that will target specific rotator cuff muscles.
The programme should consist of rotator cuff “isolation” exercises (external rotation, shoulder elevation and internal rotation) and compound exercises (pushing, pulling and overhead movements). These should be performed 2 to 3 times a week, for a minimum of 12 weeks. Below is a list of exercise examples for each category as well as an example of programming in the week.
2 to 4 x 6 to 12 reps
2 to 4 x 8 to 15 reps • Resistance band external rotation • Dumbbell scaption • Resistance band internal rotation
2 to 4 x 6 to 12 reps
2 to 4 x 8 to 15 reps
Contact a physiotherapist if you notice any new pain or worsening of your symptoms.