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Shoulder Bursitis – what is it and how is it treated?

Shoulder bursitis most commonly refers to inflammation of the subacromial bursa, which is a fluid filled sac, that sits at the outer-front aspect of the shoulder. Subacromial bursitis, is one of the most common complaint

s we see in the clinic, and it typically presents as tenderness at the outer aspect of the shoulder, more so when raising the arm, which confines the subcromial space, where the bursa is located. (1)

What is the bursa? Why is it sore?

The bursa is a thin, lubricated cushion, and acts as a barrier at points of friction, between bones and surrounding soft tissue structures. There are about 160 of them around the body, and they vary in size depending on location and the nature of the forces being applied across it. The bursa sac is made up of synovial membrane, which both produces and maintains the synovial fluid within the bursa. (2,3)

The subacromial bursa sits below a bony structure of the shoulder, called the acromion, and provides a cushion barrier between the bone and the rotator cuff muscles that run directly below it. (3)

Bursitis (or inflammation of the bursa), occurs when the synovial membrane  becomes inflamed, causing it to thicken and produce an excess of synovial fluid, causing the bursa to swell and become painful. The most common causes for this are excessive friction on the bursa, a direct injury, or an underlying inflammatory condition, such as rheumatoid arthritis. You can also get bone spurs (osteophytes) that grow down from the bottom of the acromion, narrowing the subacromial space that the bursa and rotator cuff tendons sit within. (3)

When the subacromial bursa becomes irritated, it can thicken and cause what it sometimes referred to as Shoulder Impingement Syndrome, which is a painful pinching of the soft tissue structures that sit in the small space between the acromion and the shoulder ball-and-socket joint. This space is call the subacromial space. The tendons of the rotator cuff muscles can also become inflamed, resulting in tendonitis, which contributes to the pain. (4)


How is shoulder bursitis treated?

Most patients generally respond well to a combination of stretches and rehabilitation

exercises provided by their health practitioner, to strengthen the muscles that support and control movement at the shoulder. This helps treat the current bursitis and tendonitis, and minimise the risk of future irritation. Manual therapy techniques including joint mobilisation/manipulation and soft tissue techniques are also often incorporated into most treatment plans.

In the initial phase, rest from activities that are causing aggravation, such as lifting, reaching and overhead work is helpful. Your practitioner can also advise you on activity modification, or changing the way you perform repetitive tasks, in order to reduce irritation on the bursa and tendons. Your doctor may also prescribed you an anti-inflammatory medication to reduce the inflammation and swelling of the bursa. In some cases, a corticosteroid injection (anti-inflammatory) into the bursa, in conjunction with an aspiration (or draining) of the bursa can be beneficial. (5)

Surgery (acromioplasty) may be considered in cases where there is significant bone spurs impinging on the bursa and tendons, that is not improving with conservative treamtment. Surgery will generally include removing part of the acromion and sometimes the bursa itself, such that there is more space for the soft tissue structures. (6)


Will it happen again?

Subacromial bursitis is very common, and can often recur, if the causative factors haven’t been addressed. Most bursae will settle with anti-inflammatories, but it is important to correct postural and movement patterns that are causing it to become aggravated in the first place. If there is significant spurs, and conservative measures are not resolving it, then symptoms will likely recur until this is surgically addressed.

If you are suffering from bursitis, feel free to book an appointment at the clinic for a full assessment and appropriate course of treatment.



  1. Luime JJ, Koes BW, Hendriksen IJ, Burdorf A, Verhagen AP, Miedema HS, Verhaar JA. Prevalence and incidence of shoulder pain in the general population; a systematic review. Scand J Rheumatol. 2004;33(2):73-81. Review. PubMed PMID: 15163107.
  2. van Holsbeeck & Strouse. Sonography of the shoulder: evaluation of the subacromial-subdeltoid bursa. AJR Am J Roentgenol. 1993 Mar;160(3):561-4. PubMed PMID: 8430553.
  3. Anastasios Papadonikolakis, Mark McKenna, Winston Warme, Brook I. Martin, Frederick A. Matsen, III; Published Evidence Relevant to the Diagnosis of Impingement Syndrome of the Shoulder. The Journal of Bone & Joint Surgery. 2011 Oct;93(19):1827-1832.
  4. National Institute of Arthritis, Musculoskeletal and Skin Diseases, “Shoulder Problems.” May 2010. Accessed March 8, 2012.
  5. Codsi MJ. The painful shoulder: when to inject and when to refer. Cleve Clin J Med. 2007 Jul;74(7):473-4, 477-8, 480-2 passim. Review. PubMed PMID: 17682625.
  6. Donigan JA, Wolf BR. Arthroscopic subacromial decompression: acromioplasty versus bursectomy alone–does it really matter? A systematic review. Iowa Orthop J. 2011;31:121-6. PubMed PMID: 22096430; PubMed Central PMCID: PMC3215124.

5 Easy Stretches for the Busy Office-Worker

I see a lot of desk-bound office workers at the clinic, who often present with similar symptoms of neck and shoulder pain, and stiffness in the mid to upper back. The human frame is designed to move, and long hours in one fixed position are not going to help things!

Here are 5 easy stretches that you can do while at work, to keep mobility in the neck and upper back:

1. The Chin Tuck

No, this is not a cosmetic plastic surgery procedure. The chin tuck is a postural position of the neck that takes load off some of common pain generating structures in the neck, as well strengthening the stabilising muscles of the neck, that encourage good posture.

Simply tuck your chin back a few centimetres, to represent a ‘double-chin’. Try not move your head downwards, but more a backwards sliding position. You can add to this, by having your head against a headrest and pushing into it with light pressure. This will help to strengthen the neck muscle.

2. Scapular Setting:

This is another important postural position, that reduces load on the neck, and encourages activation of the upper back muscles, that support the shoulder blades. In a seated position with your elbows by your side, gently draw your shoulder blades back and down together. You should feel the muscles at the base of the shoulder blade working. Be sure avoid shrugging your shoulder blades upwards.

3. Shoulder Rolls:

Move your shoulders in a backwards circular pattern as shown. This helps to improve mobility in the shoulder girdle, and also resets the muscles at the top of your shoulders (upper trapezius), if you find yourself hunching.

Slow, wide circles generally work best.

4. Upper Trapezius Stretch:

Sit on one hand with your palm facing up, ensuring you are sitting up straight and not slouched. Turn your head 45 degrees to the opposite side. With your other hand, grasp the back of your head and lightly pull down, such that you are looking towards your armpit. You should feel a stretch across the top of your shoulder. By altering how much you turn your head, you can target slightly different muscles.

5. Upper Back Rotation:

In the seated position, rotated your upper body as far you can, keeping your pelvis straight. You can hold onto the side of your chair to get some extra stretch. Repeat this slowly from side to side a few times, to keep movement in the thoracic spine. Turning your head to the same side also helps with overall mobility in the upper spine.

4 Simple Exercises to Improve Your Core Stability

There are countless rehab exercise programs floating around, promising to improve core stability and cure low back pain, much of which all revolve around the same basic principles. That is, strengthening the transverse abdominus, gluteals, and lumbar extensor muscles, that aid in supporting and controlling movement in the lumbopelvic region. It has been shown that this can reduce low back pain, and it should make an integral part of your treatment regime. (1) (2)

Core stability exercises don’t need to be hard and complicated. In fact, I have found clinically,  that people get better improvements with exercises that are simple and easy to perform, and therefore more likely to be done on a regular basis! There is actually still some uncertainty in the research as to the effectiveness of specific core stability exercises over general exercise for reducing low back pain. (3) (4)

Here are 4 core stability exercises that I get all of my patients with lower back pain performing, especially if I suspect there is a deficiency in activation of the core muscles.

1. Anterior Pelvic Tilt (Transverse Abdominus Activation)

The transverse abdominus can be a difficult muscle to contract, and performing a pelvic tilt can be a helpful way to get it firing. Lie on your back with bent knees and your feet flat on the floor. Try to pull your bellybutton down towards your spine, while at the same time clenching your buttock muscles. You should feel your tail bone rolling up off the floor. Hold this for a 10 seconds, relax and then repeat. You should be able to perform this while still breathing. It is helpful to also perform this during day-to-day activities such as sitting at the desk and walking.

Image taken from Physitrack®

2. The Dead Bug

While lying on your back, bring your legs up in the air with your hips and knees both bent to 90 degrees. Bring your arms up, pointing straight up vertically over your head. Ensuring you keep your back flat, slowly lower your opposite arm and leg away from each other towards the floor. Make sure nothing else moves as this motion occurs. Return back to the starting position and perform on the opposite side.

Image taken from Physitrack®

3. The Bird Dog

Get into an all-fours position on your hands and knees, with your hands directly under your shoulders, and knees under your hips. Tighten your abdominal core muscles. Extend your opposite arm and leg out straight from your body, ensuring to keep good control in your torso. Avoid twisting in the hips and pelvis. Bring them back in, and repeat on the opposite side. This can be a difficult exercise in the beginning, and in a lot of cases I start with people just elevating one arm or leg at a time, until core strength and motor control improves.

Image taken from Physitrack®


4. The Side Bridge on Knees

Start lying on your side and push yourself up onto your elbows. Bend your knees and lift at the hips until your body is in a straight line running from head to knees. Hold this position for as long as possible, then slowly lower and repeat.

Please keep in mind, these exercises may not be suitable for everyone. It is advisable to consult your chiropractor or other health professional before starting any new exercises. How many repetitions to perform is different for everyone, but generally try starting with 2 sets of 8-10 reps.

For more information on low back pain and how core stability training may help, feel free to contact me at the clinic for more information.


1. Akuthota, Venu, Andrea Ferreiro, Tamara Moore, and Michael Fredericson. 2008. Core stability exercise principles. Current sports medicine reports 7, no. 1: 39-44.
2. Hodges, P W. 2003. Core stability exercise in chronic low back pain. Orthop Clin North Am 34, no. 2: 245-254.
3. Education, Field Coaching, and Exercise Science. 2012. On rethinking core stability exercise programs. Australasian Musculoskeletal Medicine: 9-14.
4. Wang, Xue Qiang, Jie Jiao Zheng, Zhuo Wei Yu, Xia Bi, Shu Jie Lou, Jing Liu, Bin Cai, et al. 2012. A Meta-Analysis of Core Stability Exercise versus General Exercise for Chronic
Low Back Pain. PLoS ONE 7, no. 12.
Images taken from Physitrack®

I have hip bursitis. What is it, and what do I do about it?

When people talk of having hip bursitis, it is most commonly the greater trochanteric bursa, which located on the boney knob near the top and at the outside of the femur (thigh bone). The bursa is a fluid filled cushion that reduces friction between the boney knob and the tendons and muscles that run over, and control your hip movement.

Hip bursitis occurs when this bursa becomes inflamed, and apart from local pain in the area, it can radiate pain down the outside of the thigh. People generally have difficulty walking, climbing stairs, getting up from seated positions, and lying on the affected hip. Research over time has suggested that hip bursitis is usually the result of another problem around the hip joint, often a damaged muscle or tendon. If tendons have become thickened or under more tension, this can increase friction across the bursa, causing inflammation. DIrect trauma onto the bursa, such as with a fall, can also trigger hip bursitis.

In summary, symptoms may consist of:

* Pain and tenderness at the outside of the hip

* Pain worse with prolonged inactivity

* Pain worse with repetitive activity

* Pain radiating down the outside of the thigh

* Pain at extreme range of motion of the hip

In rare cases, the bursa can turn septic, meaning it is infected. This will generally present as redness, warmth and swellling over the area, in conjunction with a fever. If you have these symptoms, seek medical attention urgently for further testing and antibiotic treatment if necessary.

Often the diagnosis will be made by your chiropractor, physiotherapist or GP, based on physical examination findings. Prior to treatment, an ultrasound me be need to confirm the diagnosis and asses for any other conditions at the hip joint that may be contributing to your symptoms, such as a muscle or tendon injury.

Treatment for Hip Bursitis:

The goal of treatment is to control the inflammation of the bursa and correct any causative factors that aggravating it in the first place. Getting the inflammation under control may consist initially of rest and activity modification, applying ice to the bursa, and taking some anti-inflammatory medications.

Manual therapy treatments such as the that provided by your chiropractor or other health provided may also help to settle pain, and reduce tension from muscles lying across the bursa. They will also address causative factors such and posture, poor hip stability and other biomechanical triggers that may be initiating the bursitis. Management usually focuses on a program of strengthening and conditioning exercises of the muscles that control stability and proper biomechanical motion at the hip joint.

In cases were symptoms don’t settle, aspiration or drainage of the bursa, often in conjunction with a cortisone injection are often helpful.

If you are suffering with hip bursitis and need more information, feel free to contact us at the clinic to discuss how we can help.

Is My Headache Coming From My Neck?

There are various causes to headaches, but there is a specific type of headache called ‘cervicogenic headache’ that is caused by a problem in the upper cervical spine (neck).

Pain usually arises from the suboccipital region, with is under the base of the skull, at the back of the neck, and typically spreads up over the head. In some cases it can refer to behind the eye. Often symptoms will be exacerbated with certain neck movements of postures, such as leaning forward to read a computer screen. Often there will also be some associated neck pain, especially at the upper levels, as well as a reduction in range of motion in the neck.

There is some evidence that multiple structures in the neck (cervical spine) can be the source of pain referral to the head, and is generally centred around the C1, C2 and C3 vertebral levels. Such structures may include the various joints, discs, ligaments and musculature. Studies have shown that the C2/3 facet joints are the most common pain generators with cervicogenic headaches, and the incidence is higher in those with a previous whiplash injury.

Treatment depends on the specific pain generator, but cervicogenic headaches often respond well to usual chiropractic treatment, including spinal manipulation and mobilisation, trigger point therapy, and rehabilitation exercises to correct postural changes that may be aggrevating symptoms. Pain medication may also be of assistance to in the short term to control symptoms. In more severe, chronic cases, that are no responding to standard treatments, nerve blocks and facet joint injections may be required.

Is My Sleep Position Aggravating My Shoulder Pain?

I see a lot of patient’s in the clinic for treatment and rehabilitation of shoulder pain and this is a question I am often asked. In a lot of people, shoulder pain can arise from the rotator cuff, which is a group of muscles around the shoulder, that stabilise the ball and socket joint in a ‘cuff’.

If you are always laying on the same side (which we often do), then this constant pressure of the muscle tendons against the underlying bone can cause fraying and inflammation. This is known as rotator cuff tendonitis and can lead to impingement syndrome.

Symptoms often start off as pain in the front of the shoulder that can refer down as far as the elbow. Over time this can progress to weakness in the shoulder and difficulty perform tasks above 90 degrees.

Thankfully, in most cases, it can be treated quite effectively with a combination of manual soft tissue therapy, joint mobilisation and rehabilitation exercises to restrengthen the rotator cuff.

If you have shoulder pain that is not resolving, feel free to book an appointment at the clinic for a full assessment and treatment.

I’ve Been Told I Need Back Surgery – Can Chiro Help?

This is a question often asked by patients, and your chiropractor will need to do a full assessment on you to answer it accurately. If your specialist has told you that you will need surgery, then there is very good chance you will (at some point in time).

It is often helpful to categorise spinal surgery into two groups:

(1) Urgent surgery or where other treatment options are not an option

(2) Conditions where surgery will likely be needed at some point in time, but not urgent.

The second category is where chiropractic treatment may be beneficial in relieving your symptoms, improving function and perhaps reducing the need for surgery.

If we use low back pain as an example, in the absence of any severe neurological deficits or sinister causes for the pain, it is generally recommended to trial conservative, non-invasive treatment options first. Such treatment might include manual therapies (joint mobilisation, manipulation, soft tissue techniques), rehabilitation exercises to improve core stability and improve movement mechanics in the lower back, changes to workplace ergonomics and day-to-day activities, and also lifestyle modifications.

Depending on the nature of your condition and level of disability, many specialists will require that you do this prior to considering surgery.

There are several instances where prompt spinal surgery is indicated, these include:

* Cauda Equina Syndrome – this is a severe compression at the base of the spinal cord, often due to a very large disc herniation, and can cause bowel and bladder incontinence, along with numbness in the groin (saddle type distribution). This is a medical emergency, and people experiencing these symptoms should present to ED immediately.

* Severe spinal nerve root compression causing profound weakness in one of the limbs – when there is a large disc bulge in the spine, it can sometimes compress one of the nerves that travel down the arms and legs that control your muscles.

* Unstable spinal fractures

* Spinal cord injuries

If your surgery falls into the non-urgent category, it is worthwhile consulting your local chiropractor to discuss whether non-surgical treatments may be suitable for you, or at least help with pain relief for your injury before or after any scheduled surgery.

5 things you want to know about chiro, but are too afraid to ask!

1. What is the ‘cracking’ noise with joint manipulation?

Although as chiropractors we provide a variety of different treatments, perhaps the one technique we are most identified by is spinal manipulation. This is a technique whereby a shallow but fast force is applied to a joint to restore joint movement and relieve pain in the region.

When spinal manipulation is performed, the applied force causes a small seperation or gapping of the fully encapsulated synovial joint. This in turns causes a reduction in pressure in the joint cavity, and gases dissolved in the synovial joint fluid form bubbles. These bubbles rapidly collapse back on themselves and result in a ‘clicking’ noise

2. What training do chiropractors do?

Chiropractors complete a 5-year university degree, and are required to continue yearly continued professional training and education, in order to maintain their government registration.

3. What is the difference between chiropractors and physiotherapists?

In terms of musculoskeletal treatment, the gap between the modern chiropractor and physiotherapist is becoming quite small. In general, chiropractors tend to use more ‘hands-on’ manual therapy techniques such as joint manipulation, mobilisation and soft tissue techniques, whereas physiotherapists tend to focus more on rehabilitation exercise training.

This is by no means a hard and fast rule and any good musculoskeletal practitioner (no matter what profession they belong to) should use a variety of treatment interventions to get you better. Neither profession owns any specific type of treatment, and your chiro or physio should use the recommended treatments based on the latest available research and clinical guidelines for your condition or injury.

4. Does it hurt?

This is a common concern amongst patients prior to any for of treatment from a health practitioner. Patients sometimes have concern in relation to spinal manipulation and whether it will be painful, but in most cases it is surprisingly gentle and pain-free. Some soft tissue techniques can cause mild discomfort during and immediately after treatment, but this generally settles over a short period of time. Your chiro should discuss any possible side effects of treatment with you prior to commencing.

5. Do I need a referral to see the chiro?

No, you do not need a referral, simply call the clinic for an appointment.

In some cases however, your GP may provide you with a referral to see the chiro for up to 5 visits covered by Medicare. If it is a Worker’s Compensation Claim then your GP may also provide you with a written referral to see the chiro with treatment expenses to be covered by your claim.

Winter Exercise Tips

It’s easy to let the exercise go by the wayside over winter. Here are some tips for keeping active over the cooler months…

1. Make the most of daylight hours – With limited daylight hours before and after work, look at ways to incorporate exercise into your daily routine. This might include a brisk lunch-time walk or a midday exercise class.

2. Plan an active winter holiday – A winter escape to a warmer location is a good way to avoid the worst of the weather, and to also plan some outdoor activities like hiking, cycling, kayaking and surfing.

3. Get an exercise partner – It can take a lot of determination to get out of bed on those cold, dark mornings. Having an exercise buddy is a great way to commit to an exercise plan.

What is Sciatica?

I often see patients at the clinic complaining of sciatica, which is commonly described as a shooting pain originating in the lower back or buttock and traveling down the leg to the foot. Sciatica is not a diagnosis itself, but more a symptom of an underlying condition, causing compression or irritation of the sciatic nerve.

The sciatic nerve is the largest nerve in the body, and is made up of a number of nerve roots that branch out from the spine in the lower back, and connect to form the sciatic nerve that runs down the back of the leg.

The most common causes of sciatica is a herniation or bulging of one of the discs in the lower back. As the disc bulges backwards it can compress or irritate one of the close lying nerve roots. Other causes include degenerative disc disease whereby bone spurs can compress the nerve root, spondylolisthesis which is a slippage of one vertebra on another secondary to a stress fracture, and spinal stenosis which is a narrowing of the spinal canal over time, often due to arthritic changes.

​If you are suffering from sciatica, the treatment will vary depending on what is causing it. Chiropractors are well trained in the diagnosis of these conditions, and following a thorough physical examination be able to provide appropriate treatment and further testing or imaging/scans as necessary. In most cases symptoms will settle with a course of manual treatment and exercises. Depending on the severity, co-management with your GP will be needed if symptoms fail to improve.