A bursa is a flat, fluid-filled sac that lies where tendons and muscles glide against bone, and that lets them glide without friction. When it is irritated, by repeated pressure (kneeling, elbows on the table, side-lying on a hard mattress), friction from a tight or overloaded tendon, a blow, or an inflammatory disease, it fills with fluid and becomes bursitis: a tender, often swollen spot that hurts on pressure, with certain movements and at night when you lie on it. The most common are trochanteric bursitis on the outside of the hip (almost always linked to the gluteal tendons), prepatellar bursitis in front of the kneecap ("housemaid's knee"), pes anserinus bursitis on the inside of the knee, subacromial bursitis in the shoulder (part of impingement), olecranon bursitis on the tip of the elbow ("student's elbow", a soft ball behind the elbow) and retrocalcaneal bursitis at the Achilles attachment. Most bursitis heals in weeks once the pressure is removed and the tendon irritating it is strengthened; rest in itself rarely heals it. A bursa that is warm, red, growing quickly or comes with fever may be infected and should be assessed the same day. Cupping is done on the muscles around the bursa to reduce the pull and tension, never directly on an inflamed bursa, which swells more from suction. Here is where it sits, how to tell them apart, what helps and how to cup.
Where is it? The most common types of bursitis
| Bursa | Recognised by | Common cause | Guide |
|---|---|---|---|
| Outside of the hip (trochanteric) | Tender over the bony knob of the hip, pain lying on the side, on stairs and standing up after sitting; radiates down the outside of the thigh | Overloaded or weak gluteal tendons (gluteus medius), uneven loading, running, side-lying on a hard mattress; most often women over 40 | Trochanteric bursitis |
| In front of the kneecap (prepatellar) | A soft, swollen cushion on top of the kneecap, tender to kneel, often not very painful to walk | Kneeling work (floors, gardening), a blow to the knee; infection if it turns red and warm | Swollen knee |
| Inside of the knee below the joint line (pes anserinus) | Tender at a spot 2–3 cm below the joint line on the inside, worse on stairs and at night when the knees meet | Running, osteoarthritis, overweight, tight hamstrings | Knee pain |
| Shoulder (subacromial) | Pain lifting the arm sideways between 60 and 120 degrees, lying on the shoulder, reaching behind | Impingement under the acromion, overloaded rotator cuff tendons, overhead work | Impingement, Shoulder pain |
| Tip of the elbow (olecranon) | A soft, round swelling behind the elbow, often almost painless, sometimes plum-sized | Elbows on the table, a blow; gout and infection are other causes | Elbow pain |
| Heel (retrocalcaneal) | Tender and swollen just in front of the Achilles attachment, worse with shoes with a hard heel counter and uphill | Achilles overload, a prominent heel bone (Haglund's), tight shoes | Achilles tendinopathy |
| Sitting bone (ischial) | Pain in the buttock when sitting, especially on hard surfaces | Prolonged sitting, running, tight hamstrings | Piriformis, Tailbone pain |
Infected bursa: what you mustn't miss
The bursae at the elbow and kneecap lie just under the skin and can become infected (septic bursitis) through a small wound, a graze or without a visible entry point. Signs: the skin over the bursa is red and warm, the swelling grows quickly over one to two days, it hurts to move the joint, you have fever or chills, or there is a wound nearby. This is an infection that needs antibiotics and sometimes drainage, the same day, via your doctor or emergency care. Gout can give a similar picture (acute, very tender, red) and is treated differently; the doctor sometimes drains fluid to tell them apart. Never cup, massage or heat a red, warm bursa.
When should you seek care?
- The same day: red, warm, rapidly growing swelling, fever, or bursitis after a wound; swelling with severe pain and inability to move the joint.
- Within one to two weeks: problems that haven't improved in four to six weeks with offloading and exercises, night pain that disturbs sleep, recurring bursitis in the same place, or bursitis in several places at once (can be rheumatic disease or gout).
The doctor can drain fluid (and culture it), give a cortisone injection for pronounced symptoms (effective short term for hip and shoulder, but doesn't strengthen the tendon and shouldn't be repeated many times) and refer you to a physiotherapist.
What helps: remove the pressure and strengthen what pulls
- Remove the pressure that irritates: knee pads or a cushion when kneeling, no leaning elbows on the table, sleep on the other side or with a pillow between the knees and a softer mattress for the hip, shoes with a soft or open heel counter for the heel, no sitting cross-legged for the hip, a seat cushion for the sitting bone.
- Keep moving but remove the provocation for two to three weeks: for the hip no stairs two at a time, hill running or deep lunges; for the shoulder no overhead work; for the knee no deep squats. Walk, cycle, swim.
- Strengthen the tendon and the muscles that load the bursa; that is what heals long term. Hip: side-lying leg raises, hip bridges, lateral walks with a band, single-leg balance (see trochanteric bursitis). Shoulder: external rotation, shoulder blade depression, light pressing (see shoulder exercises). Knee: thigh and hamstring strength (see leg exercises). Heel: eccentric calf raises. Three times a week for eight to twelve weeks.
- Anti-inflammatories (ibuprofen or naproxen for one to two weeks if you tolerate them, or topical gel) dampen fluid production in the acute stage; cold for 10–15 minutes a few times a day in the first days for a swollen kneecap or elbow.
- Cortisone injection for hip and shoulder when pain prevents the exercises; followed by training, otherwise it comes back.
- Don't stretch over an acutely tender hip bursa (side bends and "ITB stretches" increase compression against the hip knob); stretch the hamstrings and calf gently for pes anserinus and heel.
Cupping for bursitis: around, never on
An inflamed bursa is filled with fluid and irritated by pressure; suction directly on it increases swelling and pain. Cupping does help, however, on the muscles and tendons that pull across the bursa and create the friction: tight glutes and outer thigh at the hip, front and back of the thigh at the knee, trapezius, chest muscle and rotator cuff at the shoulder, calf at the heel. When they release, the pressure on the bursa decreases, and the exercises get easier. Keep 3–5 centimetres from the bursa itself, use light to medium suction, and don't cup at all if the area is red, warm or recently had cortisone (wait two weeks).
- Hip: the dynamic cup with oil over the gluteal muscles (2 minutes) and along the outside of the thigh from above the knee up to just below the hip knob (2 minutes), not over the knob itself; a static cup on the most tender point in gluteus medius above and behind the knob, 3 minutes.
- Knee: front thigh from above the kneecap upward (2 minutes) for prepatellar bursitis; inner thigh and hamstrings for pes anserinus; not over the kneecap or the swollen spot.
- Shoulder: the upper trapezius and the area over the shoulder blade (2 minutes), the chest muscle below the collarbone (1 minute), never on the top of the shoulder where the bursa lies. More in impingement.
- Elbow: the forearm and upper arm muscles, never on the soft swelling behind the elbow.
- Heel: the calf from the heel up toward the back of the knee (2 minutes) and lightly along the sides of the Achilles, not on the attachment itself.
- Finish with the strength exercises for your area while the muscles are warm. Programmes: the cupping programmes.
More situations in when to avoid cupping; with blood thinners, ask your doctor.
What is reasonable to expect?
Prepatellar and olecranon bursitis without infection: the swelling goes down in one to three weeks once the pressure is removed, but can remain soft and painless for months. Trochanteric bursitis: clearly better in six to twelve weeks with offloading and lateral hip strength; those who only get cortisone often see it return. Shoulder: eight to twelve weeks of rotator cuff training. Pes anserinus and heel: six to twelve weeks. Recurring bursitis almost always means the load or the strength hasn't been addressed.
Frequently asked questions
What does bursitis feel like?
A tender, often swollen spot over a bone, painful on pressure (lying on the hip, kneeling, leaning on the elbow) and with certain movements (lifting the arm sideways, stairs), and often at night. At the kneecap and elbow a soft, fluid-filled cushion is visible. Red, warm skin, rapidly growing swelling or fever suggest infection and should be assessed the same day.
Should you rest with bursitis?
Remove the specific pressure or movement that irritates the bursa, but keep moving otherwise: walk, cycle, swim. Rest in itself rarely heals it, because the cause is usually a weak or tight tendon pulling across the bursa; strength training for that tendon for eight to twelve weeks is what gives lasting relief.
How long does bursitis take to heal?
Superficial bursitis at the kneecap and elbow: one to three weeks for the swelling to go down once the pressure is removed. Hip, shoulder and heel: six to twelve weeks with offloading and strength training. A cortisone injection gives faster relief for hip and shoulder but no lasting effect without training.
Does cupping help bursitis?
Not on the bursa itself, which swells more from suction. But cupping the muscles and tendons that pull across it (glutes and outer thigh at the hip, front thigh at the knee, trapezius and chest muscle at the shoulder, calf at the heel) reduces the friction and pressure on the bursa. Keep your distance, light suction, and never on a red, warm area.
What is the difference between bursitis and tendinitis?
They often go together: the tendon gliding over the bursa is overloaded (tendinopathy), and the bursa is irritated by the friction (bursitis). At the hip it is the gluteal tendons and the trochanteric bursa, at the shoulder the rotator cuff and the subacromial bursa, at the heel the Achilles and the retrocalcaneal bursa. The treatment is the same: remove the provocation and strengthen the tendon gradually.
Related guides
- Inflammation in the body, muscles and tendons – what helps
- Hip pain at night – causes, sleeping position, exercises and cupping
Written by Curam. Last updated 17 October 2026. This is general self-care information and does not replace medical care. For sudden, severe or unusual symptoms, contact your doctor. Talk to your doctor before cupping if you are pregnant, take blood thinners or have a condition affecting skin, blood vessels or blood.
