A bursa is a small fluid-filled sac that reduces friction where tendon or skin passes over bone, and bursitis means it has become painful and inflamed. The two sites diagnosed most often, the outer hip and the shoulder, are now usually understood as tendon problems with the bursa involved secondarily, which is why loading the tendon works better than treating the sac. Most bursitis settles in six weeks to three months, and the lateral hip is the slow one, typically taking three to six months.
Where the pain sits at the outer hip and the buttock is also involved, the overlapping causes are separated in PhysioHub’s guide to buttock muscle pain.
Ranked by how often each is diagnosed, with what is usually actually going on and how long it takes.
| Site | Where it hurts | Usually driven by | Typical timeline |
|---|---|---|---|
| 1. Greater trochanteric | Outer hip, worse lying on that side | Gluteal tendinopathy, plus compression from crossing legs and hanging on one hip | 3 to 6 months |
| 2. Subacromial | Outer upper arm, worse reaching overhead | Rotator cuff related shoulder pain | 6 weeks to 3 months |
| 3. Olecranon | Point of the elbow, a visible swelling | Direct pressure or a knock, occasionally infection or gout | 2 to 6 weeks |
| 4. Prepatellar | Front of the kneecap, a soft swelling | Prolonged kneeling | 2 to 6 weeks |
| 5. Retrocalcaneal | Back of the heel, above where the Achilles inserts | Achilles loading and footwear pressure | 3 to 6 months |
The two at the top account for most bursitis diagnoses and are the two where the name is misleading. The three below them are genuine bursal problems, usually caused by direct pressure, and they behave much more like the word suggests.
This is a documentary review of published trial evidence and clinical practice rather than a diagnosis of your hip or shoulder. The five sites were chosen on how frequently each is diagnosed in UK practice, and ranked in that order.
The sources read were the LEAP randomised trial, published in the BMJ in 2018, which compared education plus exercise against corticosteroid injection and against a wait-and-see approach in 204 people with gluteal tendinopathy; its published protocol; and a 2022 systematic review and meta-analysis of corticosteroid injection for greater trochanteric pain syndrome. Evidence checked in August 2026.
The reframing described here is well established rather than novel. Imaging and surgical studies of the painful lateral hip consistently find gluteus medius and minimus tendinopathy rather than isolated bursal inflammation, which is why the term greater trochanteric pain syndrome has largely replaced trochanteric bursitis in specialist practice.
Two honest limits. The evidence base is strongest at the hip and the shoulder and thin at the elbow, knee and heel, where practice rests largely on clinical experience. And no treatment costs are quoted here, because prices were not verified for this review.
Point to it with one finger. Bursitis is usually tender over a small, specific area, and that spot maps closely onto which bursa is involved.
Ask what position makes it worse. Lying on the side points to the hip. Reaching overhead points to the shoulder. Kneeling points to the front of the knee. Shoe pressure points to the heel.
Look for visible swelling. The elbow and the front of the knee produce an obvious lump, because those bursae sit just under the skin. The hip and shoulder bursae are deep and never look swollen.
Check for heat and redness. A hot, red, rapidly swelling bursa at the elbow or knee, particularly with a break in the skin or a fever, can be infected and needs same-day medical assessment.
Ask how long it has been going on. Weeks after an obvious knock behaves differently from months of gradually worsening pain with no clear cause, and the second is far more likely to be a tendon.
What it is
Pain over the bony point of the outer hip, now usually called greater trochanteric pain syndrome. In most cases the primary problem is tendinopathy of the gluteus medius and minimus tendons where they attach to that bony point, with the bursa irritated alongside it.
Who it affects
Most commonly women in their fifties and sixties. The classic complaint is being unable to lie on that side at night, plus pain going upstairs and after sitting with legs crossed.
What actually helps
Progressive loading of the gluteal tendons, combined with removing compression. Compression is the part people miss: crossing the legs, standing hanging on one hip and sleeping with the top leg dropped forward all squash the tendon against the bone. A pillow between the knees at night changes more than most exercises do.
What the evidence supports
The LEAP trial compared education plus exercise, corticosteroid injection and a wait-and-see approach. At eight weeks, 77% of the education and exercise group reported being at least moderately better, against 58% for injection and 29% for wait-and-see. At 52 weeks the exercise group was still ahead, at around 80% against roughly half in each of the other two groups.
Limits and cautions
This is the slowest site on the list. Three to six months is normal and twelve months is not unusual in long-standing cases. Injection gives faster short-term relief and worse one-year outcomes than exercise, which is the trade-off worth understanding before choosing.
Why it ranks first
It is the most commonly diagnosed bursitis, the most commonly misnamed, and the one where getting the reframing right changes the treatment most.
What it is
Pain in the outer upper arm on reaching overhead or behind, attributed to the bursa that sits between the rotator cuff tendons and the bony arch above them. As at the hip, the tendon is usually the primary problem and the bursa is reactive.
Who it affects
Anyone who has increased overhead work or loading recently, and anyone over 40, in whom the cuff tendons are more commonly involved. Painting a ceiling, a new gym programme and a house move are the classic precipitants.
What actually helps
Progressive rotator cuff loading, starting below the painful arc and building into it. Full detail is in what physiotherapy for a rotator cuff injury involves, and the umbrella term now used for this presentation is covered in rotator cuff related shoulder pain.
What the evidence supports
Exercise achieves outcomes comparable to subacromial decompression surgery in trials of this presentation, which is why surgery has fallen sharply out of favour for it. Injection provides short-term relief and does not improve longer-term outcomes over exercise.
Limits and cautions
A shoulder that cannot be lifted at all after a fall, or that is losing range in every direction rather than just hurting, is a different problem and needs assessing rather than loading.
Why it ranks second
It is nearly as commonly diagnosed as the hip, and it settles considerably faster.
What it is
A visible, often quite dramatic swelling over the point of the elbow, sometimes described as looking like a golf ball. The bursa here sits directly under the skin, which is why it is so obvious.
Who it affects
People who lean on their elbows, on desks, car doors or workbenches, and anyone who has taken a direct knock to the elbow. It also occurs in gout and in rheumatoid arthritis.
What actually helps
Removing the pressure, which usually means changing a habit rather than doing an exercise. Elbow padding at work, and avoiding leaning on it. Most settle within two to six weeks once the irritation stops.
What the evidence supports
Aspiration of the fluid is commonly requested and commonly followed by refilling, so it is generally reserved for diagnostic purposes where infection is suspected rather than done for comfort alone.
Limits and cautions
This is the site where infection matters most. A hot, red, exquisitely tender elbow bursa, particularly with a graze or cut over it or with a fever, needs same-day medical assessment, because septic bursitis requires antibiotics and sometimes drainage.
Why it ranks third
It is genuinely a bursal problem rather than a tendon one, it is visually alarming and usually straightforward, and it carries the highest infection risk on this list.
What it is
A soft, fluid swelling directly over the kneecap, historically called housemaid’s knee. The bursa lies between the skin and the front of the patella.
Who it affects
Anyone who kneels for extended periods: flooring and carpet fitters, plumbers, gardeners, tilers, and people laying laminate over a weekend.
What actually helps
Stopping the kneeling long enough for it to settle, then returning with knee pads. Cold helps the discomfort in the first few days. Two to six weeks is the usual timeframe.
What the evidence supports
The mechanism here is direct repeated pressure, and removing that pressure is the treatment. There is no strengthening programme that protects a bursa from being knelt on.
Limits and cautions
As at the elbow, infection is a genuine possibility given how superficial this bursa is, and the same warning signs apply. Swelling inside the knee joint itself is a different problem: joint swelling makes the whole knee puffy and limits bending, while prepatellar swelling sits in front of the kneecap and leaves bending relatively free.
Why it ranks fourth
It is less common than the three above, and it is the most clearly occupational and the most straightforwardly preventable.
What it is
Pain at the back of the heel just above where the Achilles tendon attaches, from the bursa that sits between the tendon and the heel bone. It frequently coexists with insertional Achilles tendinopathy.
Who it affects
Runners increasing hill work or speed, people who have changed footwear, and anyone with a prominent upper heel bone that shoe backs press against.
What actually helps
Reducing compression first: shoes with a soft or cut-away heel counter, a small heel raise to reduce tension at the insertion, and avoiding stretching the calf hard, which compresses the bursa against the bone rather than helping. Then progressive Achilles loading through a limited range.
What the evidence supports
Insertional Achilles problems respond differently from mid-portion ones, and the key difference is that end-range dorsiflexion compresses the insertion. Loading through a reduced range is the standard adaptation.
Limits and cautions
The instinct to stretch the calf hard makes this site worse, which is the single most common self-management error here. Recovery is slow, typically three to six months.
Why it ranks fifth
It is the least commonly diagnosed of the five and the most often confused with the tendon problem sitting next to it.
| Site | Visible swelling | Usually a tendon problem | Main treatment | Infection risk | Timeline |
|---|---|---|---|---|---|
| Greater trochanteric | No | Yes | Loading plus removing compression | Very low | 3 to 6 months |
| Subacromial | No | Yes | Progressive cuff loading | Very low | 6 weeks to 3 months |
| Olecranon | Yes | No | Remove pressure | Meaningful | 2 to 6 weeks |
| Prepatellar | Yes | No | Stop kneeling, then pad | Meaningful | 2 to 6 weeks |
| Retrocalcaneal | Sometimes | Often | Reduce compression, load in shortened range | Very low | 3 to 6 months |
Read the second and third columns together and the pattern is clean. The bursae you can see are the ones that are genuinely the problem, and they get better quickly by removing pressure. The bursae you cannot see are usually reporting on a tendon next to them, and they take months because tendons take months.
If you cannot lie on that side at night and the outer hip is tender to touch, this is greater trochanteric pain syndrome. Put a pillow between your knees tonight, stop crossing your legs, and start loading the gluteal tendons.
If reaching overhead is the problem and the pain is in your outer upper arm, treat it as a rotator cuff loading problem rather than a bursa to be settled.
If there is an obvious lump on the point of your elbow and it is not hot, work out what you have been leaning on, and stop.
If a bursa is hot, red, rapidly swelling, or you feel feverish, seek same-day medical care. Septic bursitis is uncommon and it is the one situation here that does not wait.
If your heel hurts at the back and stretching the calf makes it worse, stop stretching it. Insertional problems are compressed by exactly the movement people use to treat them.
If you have been offered an injection for a lateral hip, it is worth knowing that in the LEAP trial it beat doing nothing at eight weeks and lost to exercise at both eight weeks and one year.
What has changed in clinic over the past decade is the number of people arriving with a scan report naming a bursitis and expecting the treatment to be aimed at the bursa. The report is usually accurate: there genuinely is fluid in that bursa. What it does not say, because an image cannot, is that the fluid is a consequence rather than a cause, and that the tendon it sits against is the thing that has been overloaded.
The practical difference is what happens next. Treating the sac means rest, ice and an injection, and it produces a hip that feels better for six weeks and then goes back to how it was. Treating the tendon means a loading programme and, at the lateral hip, a set of unglamorous positional changes that people find surprisingly hard: no crossed legs, no standing hanging on one hip, and a pillow between the knees. The positional half is often what unlocks the loading half, because a tendon being compressed for eight hours a night does not respond to twenty minutes of exercise.
Where a bursitis diagnosis has not settled with rest and you want the tendon assessed properly, the musculoskeletal pain and injuries service is the route to that.
How long does bursitis take to heal?
It depends heavily on the site. Olecranon and prepatellar bursitis usually settle in two to six weeks once the pressure causing them stops. Subacromial pain typically takes six weeks to three months. Greater trochanteric and retrocalcaneal problems take three to six months, because the underlying tendon rather than the bursa is what is healing.
What is the fastest way to settle bursitis?
Remove whatever is compressing the bursa, which is often a position or a habit rather than an activity. For the elbow and knee that means stopping leaning or kneeling. For the outer hip it means not crossing the legs, not standing on one hip, and using a pillow between the knees at night. That change alone frequently does more in a fortnight than treatment aimed at the bursa itself.
Is bursitis the same as tendinopathy?
They are different tissues, and at the outer hip and the shoulder they usually occur together, with the tendon as the primary problem. That is why specialists increasingly use greater trochanteric pain syndrome and rotator cuff related shoulder pain instead of naming the bursa, and why the treatment is progressive tendon loading.
Should I have a steroid injection for bursitis?
It gives faster short-term relief and worse longer-term outcomes than exercise at the lateral hip. In the LEAP trial, education plus exercise beat injection at eight weeks and was still well ahead at one year. Injection is a reasonable choice when pain is preventing you from starting a loading programme, used as a way into rehabilitation rather than instead of it.
Can bursitis get infected?
Yes, most often at the elbow and the front of the knee, where the bursa lies just under the skin and a graze can introduce bacteria. A bursa that is hot, red, rapidly swelling and exquisitely tender, especially with a fever or broken skin over it, needs same-day medical assessment.
Should I stretch a joint with bursitis?
Not usually, and at the back of the heel and the outer hip stretching actively makes things worse by compressing the tendon against the bone. Loading through a comfortable range builds tolerance; pulling into end range compresses the tissue that is already irritated.
Does bursitis show up on a scan?
Yes, ultrasound and MRI show bursal fluid readily. The limitation is that bursal fluid is also found in people with no pain at all, and the scan cannot tell you whether the bursa is the cause or a consequence of a tendon problem alongside it. That is why the treatment decision comes from examination rather than from the report.
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