The first time you get bursitis, it can be a bit of a shock.
It usually happens like this. All of a sudden you notice your knee is swollen, perhaps alarmingly so. It may also be tender, red and stiff to move. It’s pretty miserable. And quite unpleasant-looking. And now you want to know what’s happening, and why and – most importantly – how to treat it.
What is a bursa?
Unless you experience bursitis, you may not even be aware that you have things called bursas (or bursae, depending on your dictionary). Bursas are thin ‘sacs’ that sit between tissues, bones and joints in your body. You have them in places like your hips, shoulders, elbows, ankles – and of course your knees. Their function is to protect bone and tissues, and reduce friction.
Bursitis is what happens when one of those sacs becomes irritated. In response it fills with fluid, causing the sac to swell and become inflamed. You could describe it as a kind of defence mechanism against trauma, providing extra cushioning to protect the underlying tissue or bone.
What causes bursitis?
By far the most common reason for bursitis is an injury to the area around those sacs, often due to a repetitive movement. So anyone who does a lot of kneeling, particularly on a hard surface – that’s tilers, carpet layers, gardeners – is going to be more vulnerable. Traditionally the condition was, and often still is, known as Housemaid’s Knee or Clergyman’s Knee due to the repetitive kneeling (sanitary or spiritual!) that can provoke it.
Will it go away naturally?
Normally, yes it will. Though in some cases it may take a few weeks. The first thing to do with bursitis is rest. Give your knee a break from whatever it was doing. Avoid other activities that tax the joint, especially repetitive ones, such as squatting. The second line of attack is anti-inflammatory pain relief such as ibuprofen, if you’re able to take it. These two things should help the swelling to ease so that the fluid begins to reduce.
What if it still doesn’t go away?
Firstly, make sure you protect yourself before resuming any kneeling activities. Use kneepads or a gardener’s kneeling mat to reduce the risks of another flare up. But if your bursitis persists, there are other things we can do to help. Steroid injections are sometimes used – though not routinely, since they can have a weakening effect on the tissues. Another option for a serious case of prepatellar bursitis (at the front of the kneecap) might be a bursectomy, where parts of the tissue are carefully removed during keyhole surgery. Mr Bailey wrote a short paper on this some years ago, which you can read if you have a particular interest in the detail here.
Could it be anything else?
Possibly. The main thing to be wary of is infection. Sometimes bacteria get into the bursa or the knee generally and cause problems, or indeed a case of bursitis. Here the thing to watch out for is a higher degree of pain and hot, red skin (the heat is your body attempting to fight off the infection). There may also be systemic features, such as shivers, shakes and a temperature. If you get these symptoms, see a doctor as soon as possible. If they do diagnose an infection, it’s likely that you’ll be prescribed antibiotics to treat it. Other possible causes of a swollen knee are gout, osteoarthritis, or an inflammatory condition like rheumatoid arthritis – these are things we can eliminate quickly if you come in for treatment with us.
Are you getting persistent swelling in your knee? If so, it would be a good idea to have it properly investigated. You can do that here in the clinic by booking an appointment with us. We’ll make sure you’re seen, examined and treated as soon as possible.