Bursitis (Hygroma): a Physiotherapist’s Complete Guide

Do you have bursitis (also known as hygroma) in your shoulder, knee, foot or hip?

My physiotherapist’s answers to all the questions you probably have about healing time, causes and treatments!

♻️ Last update: February 10, 2025
👩‍⚖️ Declaration of financial interests: none directly related to the subject. My complete declaration of financial interests is available in the legal notice section.
Written by Nelly Darbois, physiotherapist and scientific editor

Is bursitis serious?

Bursitis is the inflammation of a small fluid-filled pocket called the bursa, which helps reduce friction between bones and tendons or muscles.

They can be found all over the body. But bursitis occurs most often :

1. shoulder (subacromial-deltoid bursitis);
2. knee (prepatellar bursitis);
3. foot (retrocalcaneal bursitis);
4. elbow (olecranon bursitis);
5. hip (trench bursitis).

It’s quite common, although sometimes you never hear about it until you’re touched!

In most cases, bursitis is not serious. It can be painful and uncomfortable, but this usually passes, sometimes even without treatment.

1 in 10,000 people develop bursitis of the knees or elbows. In 1 out of 3 cases, this inflammation is caused by bacteria.

Why you have bursitis and others don’t: the causes

Certain occupations or sports are associated with a higher risk of bursitis:

• tilers: their work often requires them to kneel on hard floors, so it’s not uncommon for them to develop knee bursitis;
• housekeepers, carpenters, roofers and gardeners;
• people who work a lot with computers;
• volleyball, tennis and golf players.

Germs, such as bacteria, can also enter the bursa, causing inflammation. This can happen following an injury – but it’s often difficult to know how bacteria got into the bursa.

This is known as septic bursitis. Septic bursitis is rarer, and is usually treated with antibiotics.

Sometimes, inflammatory diseases such as rheumatoid arthritis, ankylosing spondylitis and gout also spread to the bursa, causing bursitis.

Middle-aged men are often affected. This is probably due to the fact that they more frequently occupy jobs associated with a higher risk of bursitis.

How long does it take for bursitis to heal?

There are no studies tracking the evolution of pain and discomfort in people newly diagnosed with bursitis, to see how it evolves with or without treatment.

In my experience, bursitis can sometimes disappear in 2/3 weeks, without any specific treatment, and never return.

But more often than not, the pain lasts longer than a month. Often, the pain will fluctuate for a few months, before finally disappearing altogether.

I know it’s frustrating not to have a precise answer to the question “how long will my bursitis last?”, but it’s a reality: nobody can predict that, even with a full physio check-up.

How can bursitis be treated (as quickly as possible)?

In this article, I’ll tell you what we know about the effectiveness of different treatments in general.

Depending on the location of your bursitis, one treatment or another may be more appropriate: you can subscribe to the blog newsletter to be notified of future articles that I will publish more specifically on each bursitis!

Partial or total rest

The more you move the joint where the inflamed bursa is located, the greater the likelihood of further inflammation and persistent pain.

This is why we often suggest resting the painful joint in the event of a burse.

This rest does not have to be total. For example, fortunately you don’t have to stop walking if you have bursitis in your knee!

In fact, you need to find the right balance between overdoing it – which can aggravate inflammation – and underdoing it.

Physiotherapists are trained to help you do just that. In my opinion, it’s the most important thing a physiotherapist can do to help you.

Medicines and cold

In the case of septic bursitis, oral antibiotics are most often prescribed.

In other forms, painkillers such as paracetamol or anti-inflammatory drugs (NSAIDs) are sometimes prescribed. Their purpose in this case is not to cure, but to relieve pain.

Applying cold can also relieve pain.

Analgesic physiotherapy

Physiotherapy is often prescribed for bursitis. Treatment is generally based on the following 2 points:

• relieve your pain at the moment, by applying cold, TENS, massage, sometimes shockwave therapy, etc. ;
• accompany you as you rest and gradually resume activity. This sometimes means doing exercises, but above all it means helping you find the right dose of activity.

Exercises, strengthening, stretching

The exercises performed in the case of bursitis are not intended to accelerate healing , but rather to :

• avoid complications such as stiffening and loss of muscle strength;
• regain strength or flexibility in the event of prolonged immobilization due to pain;
• gradually reintroduce stress on the inflammatory zone.

They will, of course, depend very much on the precise location of your bursitis, and any difficulties you may be experiencing in using this area.

That’s why I can’t give you typical exercises! On the other hand, your physiotherapist will probably be able to give you more personal advice 🙂

See also: examples of exercises for shoulder tendon pain.

Splints, knee pads

If you work or garden on your knees a lot, you could try using knee pads to prevent the risk of recurrence of knee bursitis. This will prevent friction and inflammation.

Splints for other parts of the body may also be relevant during the resting phase, if you can’t find a comfortable position without them.

This is only to relieve the pain temporarily, but will not cure the bursitis itself.

Infiltrations

If the bursitis does not improve, or returns despite the measures taken, corticosteroid injections aresometimes performed in the bursa, without any real proof of their efficacy.

They are usually carried out by rheumatologists or sports physicians.

A systematic review including several studies concludes that for aseptic elbow bursitis (the most common), infiltrations do not improve recovery and expose to more complications (Sayegh 2014).

Surgery

If conservative management (= no surgery) fails, some surgeons may propose an operation.

In most cases, the bursa is completely removed, with or without endoscopy. This is called a bursectomy.

In studies (Brown 2022) carried out on people suffering from knee bursitis, 8 out of 10 who underwent surgery were pain-free 1 year after the operation. However, it would be interesting to compare this figure with the recovery of people treated without surgery, as they too can evolve well!

Can you work with bursitis?

There is no absolute contraindication to working with bursitis.

On the other hand, if the pain is increased by certain movements performed at work, then it’s often more reasonable to stop for a few days or weeks, while the inflammation subsides.

Your doctor can prescribe time off work, not your physiotherapist.

Ideally, you should be able to adapt the way you work, or the pace at which you work, so as not to awaken or accentuate the bursitis. Your physiotherapist can help!

And sports?

It’s more or less the same answer as for work: there’s no absolute contraindication to practising a particular sport with bursitis.

But if you feel that sport wakes up or aggravates the pain, then it’s better to choose :

• reduce the frequency, duration or intensity of your workouts;
• suspend your sporting activities for a few days or weeks, then resume them more gradually, adapting your training load to how you feel.

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That’s all I wanted to say on the subject! Any questions or comments? See you in comments!