Bursae are small fluid-filled sacs lined with synovial membrane that are usually located in or close to joints. They function to reduce friction created by the movements of skin, tendons, and muscles over rough bony surfaces.

Mechanism of Injury

Bursae may become inflammed as a result of:

• excess frictional rubbing (overuse) 
• direct trauma

Bursitis is an irritation or inflammation of a bursa sac. As a protective mechanism, bursae swell in order to limit movements that increase both friction and subsequent pain.

Commonly affected are the bursae in the:

• shoulder
• elbow (olecranon bursitis)
• side of the hip (trochanteric bursitis)
• knee (patellar bursitis)
• heel (calcaneal bursitis)

Areas commonly affected in soccer players are:

• ischial tuberosity (where your hamstring muscle attaches)
• patella (kneecap)
• retrocalcaneal (heel)

The associated inflammation can persist for days, weeks, or months. These injuries are annoying but seldom serious. If the bursa is not treated properly or is not protected over the long run, calcium like deposits can occur and subsequent degeneration of the bursa can lead to permanent reduction in function.

Signs and Symptoms

• Immediate pain and point tenderness
• Swelling (occasionally spontaneous without pain) which can be very prevalent
• The injured area feels warm to touch
• Range of motion is within normal limits but limited due to pain

On-Site Management

P.R.I.C.E. PROTECT: primary goal of treatment is to protect the area from further trauma. REST: be sure to rest the body to promote healing. ICE: immediate icing for 10-20 minutes along with anti-inflammatory medication will reduce the inflammation. COMPRESSION: important NOT to apply pressure to the area because it will only make it worse. ELEVATE: if possible, elevate the body part to promote circulation of blood towards heart, this can be done while icing.

Referral. If the bursa is chronically inflamed, physician referral is needed as aspiration of the bursa itself is occasionally required. MRI and Ultrasound may confirm diagnosis.

Rehabilitation. Physiotherapy is often helpful to control inflammation and address decreased flexibilty and weakness in the hip. Pulsed ultrasound and iontophoresis are modalities that could be used to control inflammation and pain.

Return to Activity. In some cases, the athlete may return to playing soccer if he/she feel they are not limited in function. Activity should be discouraged, however, to prevent the bursitis from becoming chronic. If the athlete does return to playing soccer, the area must be properly protected.

Prevention. Since the primary cause of Bursitis includes overtraining and/or direct trauma to the affected area, protection for areas commonly impacted should be devised.

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