Shoulder Bursitis Physiotherapy: Treating Subacromial Bursitis

Shoulder bursitis — specifically subacromial bursitis — is one of the most common causes of shoulder pain in adults. The good news: physiotherapy is highly effective at treating it, and most cases resolve without cortisone injections or surgery.

What Is Shoulder Bursitis?

A bursa is a small fluid-filled sac that cushions tendons and bones against friction. The subacromial bursa sits between the rotator cuff tendons and the bony arch of the shoulder (the acromion). When this bursa becomes inflamed — from overuse, poor posture, repetitive overhead work, or a direct blow — it swells and causes pain with shoulder movement.

Subacromial bursitis frequently coexists with rotator cuff tendinopathy and shoulder impingement syndrome, as all three share the same cramped anatomical space. In most cases, treating the bursitis in isolation misses the bigger picture — the underlying mechanical cause must also be addressed.

Symptoms of Subacromial Bursitis

• Sharp pain with lifting the arm sideways between 60° and 120° (the "painful arc")
• Pain reaching overhead, across the body, or behind the back
• Pain lying on the affected shoulder at night
• Aching at rest that worsens with activity
• Weakness with overhead tasks

Bursitis pain is often more acute and severe than tendinopathy alone, because the inflamed bursa is very sensitive to compression.

What Causes Shoulder Bursitis?

The subacromial space is naturally narrow. Anything that further narrows this space or increases friction between the bursa and the overlying acromion will trigger inflammation:

• Rotator cuff weakness — weak cuff muscles allow the humeral head to ride upward and compress the bursa
• Scapular dyskinesis — poor shoulder blade control reduces subacromial space during arm elevation
• Thoracic spine stiffness — a stooped upper back increases impingement
• Repetitive overhead work — painting, swimming, throwing sports
• Acromion shape — some people have a hooked acromion (Type III) that is structurally more prone to impingement

How Physiotherapy Treats Shoulder Bursitis

Effective physiotherapy targets both the inflamed bursa and the mechanical factors driving it:

• Load management — identifying and modifying aggravating activities to allow the acute inflammation to settle
• Manual therapy — glenohumeral joint mobilisation and thoracic spine mobilisation to restore movement and reduce compression
• Rotator cuff strengthening — progressive resistance exercises to restore the dynamic stabilisation that keeps the humeral head centred
• Scapular control exercises — serratus anterior and lower trapezius strengthening to improve shoulder blade upward rotation during arm lifting
• Dry needling — targeting the infraspinatus, supraspinatus, and subscapularis trigger points
• Postural correction — addressing thoracic kyphosis and forward head posture that contribute to impingement

Timeline for Recovery

• Acute bursitis (less than 6 weeks): 4–6 sessions over 4–6 weeks
• Subacute bursitis (6–12 weeks): 6–8 sessions over 6–8 weeks
• Chronic bursitis (more than 3 months): 8–12 sessions over 8–12 weeks

When Is Cortisone Considered?

A cortisone injection into the subacromial space can rapidly reduce inflammation and pain — which is valuable when pain is so severe that it prevents participation in physiotherapy exercises. However, cortisone does not fix the underlying mechanical cause, and the bursitis will frequently return unless the contributing factors are addressed through rehabilitation. Physiotherapy after a cortisone injection is essential.