The shoulder bursa is a fluid-filled sac that acts as a cushion to prevents the shoulder tendons from rubbing on the bone above the bursa. Shoulder bursitis happens when the bursa becomes inflamed and irritated. Repetitive reaching, lifting, and throwing may lead to shoulder bursitis. Middle-aged people and older adults are especially prone to shoulder bursitis. Other shoulder conditions like impingement syndrome, rotator curr tendonitis, and biceps tendonitis can occur alongside shoulder bursitis.
There are many factors that increase the risk of developing shoulder bursitis. These include playing sports that require repetitive shoulder activity (e.g. softball, tennis, golf, and weightlifting). In addition, weakness in the rotator cuff and muscles of the upper back, shoulder stiffness, poor technique during exercise, sudden increases in exercise volume, and age-related body changes can also lead to shoulder bursitis.
Other contributing causes of bursitis include:
- Poor posture
- Trauma (being hit, or falling on, the side of the shoulder)
- Shoulder surgery
- Bone spurs
The symptoms of shoulder bursitis may include:
- Pain on the outer side or tip of the shoulder
- Pain when applying pressure on the tip of the shoulder
- Pain when lying on the affected shoulder
- Pain that worsens when lifting the arm to the side
- Pain with certain movements
- Pain when pushing or pulling open a door
When it comes to overcoming shoulder bursitis, the first common-sense recommendation is to take a short break from any activity that aggravates the shoulder. This allows for an environment for irritation to subside. If pain persists, hand-on therapy can be effective for calming down an irritated bursa quickly. As the pain subsides, you can address the root causes of shoulder bursitis so the pain does not return once you get back to activity. Oftentimes, shoulder bursitis comes with poor mobility of the lats and upper back. This can be combined with weakness of the rotator cuff, lats, and other upper back muscles. In addition, postural imbalances may lead to faulty overhead shoulder mechanics. The best way to know what has caused your shoulder bursitis is to have an assessment performed.
If you have a weakness, learning how to activate muscles that are not firing well is crucial. Shoulder packing exercises are a good place to start. Packing refers to drawing the shoulder blade down away from your ear. Packing can be done with body weight, bands, or with a partner. One of the most basic exercises to work on shoulder packing is called the Prone I. In addition, developing rotator cuff control is important. Exercises like kettlebell rotations and the bottom-up kettlebell hold in a 90/90 arm position may be good places to start. However, if the shoulder is very irritated, isometric (arm stationery) shoulder exercises at a wall or beam may need to be performed during the first 1-2 weeks.
Once you learn how to activate your shoulder muscles, the next step is restoring movement. The shoulder is a ball and socket joint and is designed to move in three dimensions through full ranges of motion. However, if your shoulder has been in pain for more than a few weeks, you may have lost some normal shoulder movement. Performing exercises like a scapular wall slide, supine pullover, and reach, roll, and lift can help you restore normal shoulder motion. It's important that you're continuing to focus on engaging the upper back muscles during these exercises so you can get back as much normal mobility as possible.
Once you have learned to activate your muscles and have restored movement, you need to develop strength to keep shoulder bursitis from becoming a recurring problem. Strength is best developed when exercising in patterns of movement. Shoulder strengthening should involve pushing and pulling movements while bearing weight. Basic strength training movements include ring rows and push-ups. These can be made easier or more challenging by changing the height of the rings or by performing pushups from an incline or decline. Advanced strength training exercises include the kettlebell armbar, the Turkish-get up, and military presses. If you can generate tension through your shoulders muscle while maintaining good technique, these types of exercises will help you build a rock-solid shoulder that is resistant to injury.
Most of the aforementioned exercises can be found in our video library.
When addressed with thorough specialized physical therapy, overcoming shoulder bursitis is possible. However, ignoring pain and continuing to perform repetitive activities with poor mechanics could lead to more serious shoulder problems down the road.
If you're concerned about shoulder bursitis and it's keeping you from activities like tennis or golf, hunting, yard work, swimming, backpacking, or carrying your grandchildren, the physical therapists at Movement Solutions would be glad to help you.
We offer a free guide on relieving shoulder pain that can give you further insight into shoulder problems and help kickstart your recovery. If you’re interested in physical therapy but have questions, we are available for a free 15-minute phone consultation so you can have them answered before booking an appointment.
If you want to book an appointment, you can get started with a shoulder pain consultation. This will be an opportunity to obtain clarity about your shoulder pain and foster confidence that we can help you. If you feel like working together is a good fit, we can then discuss the next step.
If you’re in pain and unsure about what to do, call us at (864) 558-7346 and ask how we can help.