Bursae are small fluid-filled sacs that act as cushions between tendons and bones at a joint to aid smooth movement. Overuse and repetitive friction can cause a bursa to be become inflamed and movement of the associated joint will be painful–a condition known as bursae most susceptible to inflammation in runners are the trochanteric bursa at the hip the patellar bursae in the knee(see picture), and the retrocalcaneal bursa at the ankle. Poor running technique, biomechanical abnormalities, and unsuitable footwear can all cause bursitis. Bursae can also become infected, which can lead to chronic, or long-term, bursitis.
WHAT ARE THE SYMPTOMS?
There will be localized pain and tenderness of the bursa and surrounding area. There may be swelling and the skin may feel hot. Walking may be difficult, and running will aggravate the pain; if you continue running, you will experience ongoing pain. The pain may stay at the same level of intensity, or it may worsen. If any of the knee bursae are affected, kneeling is likely to be painful.
WHAT IS THE TREATMENT?
Stop any activity that cases pain. Apply the RICE treatment to the affected area and seek medical advice. Rest and pain-relief medication will be recommended, and you should continue applying ice to the injury for a few days. Your doctor may also suggest an X-ray to rule out other potential injuries and you may need to visit a physical therapist for treatment to build strength in the affected joint and prevent a recurrence. The physical therapist may suggest insoles or orthotics in your shoes if a biomechanical abnormality is the cause. If bursitis does not respond to rest, corticosteroid injections and/or surgery may be needed. If the skin over the joint is broken, bacteria can enter, spread to the inflamed bursa, and infection may develop. If infection is suspected, fluid may need to be drained from the bursa for analysis and antibiotics will be prescribed if it is confirmed.
WHEN CAN I RETURN TO RUNNING?
If the bursitis is in the hip or knee, you should be able to return to your training programme within one or two weeks, as long as there are no complications. Start with a reduced training programme and build up again; always stop if exercise causes pain. Recovery from retrocalcaneal bursitis can take up to three months. The recovery period for an infected bursa is unpredictable, and it can be up to two months before you can run again. If you have had surgery. you can expect to be fully fit withing one to two months of the operation following a prescribed rehabilitation programme.