When your shoulder aches after painting the ceiling, or your knee hurts when you kneel to garden, itâs easy to blame it on "aging" or "overuse." But those aches might not be general wear and tear-they could be bursitis or tendinitis. These arenât just buzzwords. Theyâre specific, common, and often misunderstood conditions that cause real pain and limit movement. And if you mix them up, you could end up making things worse.
Whatâs the Difference Between Bursitis and Tendinitis?
Bursitis and tendinitis both cause joint pain, but they affect different parts. Think of your joints like a machine. Tendons are the thick ropes that connect your muscles to your bones. When those ropes get inflamed, thatâs tendinitis. Bursae, on the other hand, are tiny fluid-filled sacs-like little cushions-that sit between bones, tendons, and muscles. When those sacs swell up, thatâs bursitis.
You can have both at the same time. In fact, about 65% of shoulder pain cases involve both the rotator cuff tendon and the bursa next to it. But treating them the same way doesnât work. Injecting cortisone into a tendon might seem like a quick fix, but it can actually weaken it over time. Injecting it into a bursa? That often brings fast relief.
Hereâs how to tell them apart:
- Tendinitis pain follows the path of the tendon. If your Achilles tendon is inflamed, youâll feel it along the back of your ankle, especially when you push off your foot to walk or climb stairs.
- Bursitis pain feels more like pressure or swelling around the joint. If your hip bursa is inflamed, lying on that side at night will hurt like crazy.
Doctors use movement tests to spot the difference. If moving your arm in a certain way triggers sharp pain, itâs likely tendinitis. If pressing on the side of your elbow causes swelling and discomfort, itâs probably bursitis.
Where Do These Conditions Usually Happen?
Not all joints are equally likely to get inflamed. Your body has about 160 bursae, but only a few get bothered often. Same with tendons.
Most common bursitis sites:
- Shoulder (subacromial bursa)
- Elbow (olecranon bursa)
- Knee (prepatellar bursa)
- Hip (trochanteric bursa)
Most common tendinitis sites:
- Shoulder (rotator cuff tendons)
- Elbow (tennis elbow or golferâs elbow)
- Knee (patellar tendon)
- Ankle (Achilles tendon)
Why these spots? Because theyâre used constantly. If youâre a painter, youâre raising your arms all day-shoulder bursitis follows. If youâre a runner, your Achilles tendon takes 3-4 times your body weight with every step. Tendinitis shows up fast.
Age matters too. After 40, your tissues start losing elasticity. By 45-64, your risk of both conditions jumps sharply. Thatâs not because youâre "getting old." Itâs because your bodyâs repair system slows down, and repetitive motion adds up.
How Are They Diagnosed?
Donât assume. A lot of people self-diagnose and end up doing the wrong thing. Iâve seen patients with bursitis doing aggressive stretches meant for tendinitis-and making their pain worse.
Doctors start with a physical exam. Theyâll press on the area, ask you to move in specific ways, and check for swelling or warmth. If itâs unclear, imaging helps. Ultrasound is the go-to tool-itâs accurate 92% of the time for spotting inflamed bursae and torn tendons. MRI gives more detail but is expensive and often unnecessary.
Hereâs the catch: 40% of people over 50 show signs of bursitis or tendinitis on an MRI-even if they feel zero pain. That means an image alone doesnât diagnose you. Your symptoms do.
So if your doctor says, "Your MRI shows tendinitis," but you donât have pain during movement, donât panic. You might not need treatment at all.
Whatâs the Right Treatment?
Thereâs a clear step-by-step approach. Most people get better without surgery-less than 5% need it.
Step 1: Rest and Ice
Stop whatâs hurting you. Not completely-just enough to let the inflammation calm down. Ice helps reduce swelling. A frozen water bottle rolled over your elbow or ankle for 10-15 minutes, 3 times a day, is as effective as fancy ice packs. And it costs nothing.
Step 2: NSAIDs (Short-Term)
Medications like ibuprofen or naproxen can reduce pain and swelling. But donât take them for more than 10-14 days. Long-term use raises your risk of stomach bleeding and kidney problems. Use them to get through the worst few days, not as a permanent fix.
Step 3: Movement-But the Right Kind
This is where most people fail. Rest is good at first. But staying still too long makes your joint stiff and weakens your muscles. That sets you up for recurrence.
For tendinitis, eccentric exercises are the gold standard. For Achilles tendinitis, that means standing on your toes, then slowly lowering your heel down over 3-5 seconds. Do 3 sets of 15 reps, twice a day, for 12 weeks. Itâs boring. Itâs hard. But it works-68% of people see lasting improvement.
For bursitis, gentle range-of-motion exercises are enough. No heavy lifting. No deep squats. Just move the joint slowly through its full range without pain. A physical therapist can show you how.
Step 4: Injections (If Needed)
Corticosteroid shots work great for bursitis-78% of patients feel better in 4 weeks. But for tendinitis? Only 52% improve. And injecting a tendon carries a risk: it can tear. Thatâs why doctors limit injections to 2-3 per year, and only after conservative care fails.
Step 5: Advanced Options
If nothing works after 3-6 months, newer options exist. Platelet-rich plasma (PRP) injections show promise for chronic tendinitis. One 2023 study found PRP led to 67% improvement at 6 months, compared to 42% with cortisone. But PRP costs around $850 per shot-insurance rarely covers it.
Shockwave therapy is another option, especially for plantar fasciitis. It uses sound waves to stimulate healing. In German trials, it reduced pain by 58% after 12 weeks.
What Not to Do
Hereâs what makes recovery take longer:
- Ignoring pain during exercise. If itâs over 3 out of 10, stop. "No pain, no gain" doesnât apply here.
- Doing strengthening too early. If your bursa is swollen, doing squats or lunges will make it worse.
- Waiting too long to see a professional. The longer you wait, the more your body compensates-with bad posture, limping, or favoring one side. That creates new problems.
- Getting an MRI too soon. If youâve had pain for less than 4 weeks, imaging rarely changes treatment.
And please, donât take opioids for this. The CDC says 12.7% of tendinitis patients get them anyway-even though guidelines say they donât work for this kind of pain and increase addiction risk.
Real People, Real Results
On Redditâs r/PhysicalTherapy, a 52-year-old gardener shared how she fixed her hip bursitis: switched from kneeling to using a padded stool, did 10 minutes of ice massage daily, and avoided sleeping on her side. Within 6 weeks, she was back in the garden.
A runner in Melbourne posted about his 27-week recovery from Achilles tendinitis. He tracked his progress with the Victorian Institute of Sports Assessment questionnaire. Week 1: pain at 8/10. Week 12: 4/10. Week 27: 0/10. He didnât get a shot. He didnât take pills. He did eccentric heel drops-180 a day-every single day, even when it hurt.
These arenât miracles. Theyâre consistency.
Whoâs at Risk?
You donât have to be an athlete to get this. Repetition is the enemy.
- Construction workers: 18.4% develop bursitis from kneeling.
- Professional musicians: 22.7% get tendinitis from repetitive finger or arm motion.
- Office workers: Repetitive typing can cause elbow or wrist tendinitis.
- Homeowners: Painting, gardening, cleaning-any job that involves overhead motion or kneeling.
Women over 50 are more likely to get hip bursitis. Men are more likely to get Achilles tendinitis. Why? Differences in anatomy, muscle use, and activity patterns.
Can You Prevent It?
Yes. Hereâs how:
- Warm up and cool down. Five minutes of light movement before activity, stretching after.
- Use proper technique. If youâre lifting, squatting, or swinging a racket, form matters more than effort.
- Modify your workspace. Raise your monitor to eye level. Use a cushioned mat if you stand all day.
- Strengthen supporting muscles. Strong glutes reduce hip strain. Strong calves protect your Achilles.
- Listen to your body. That dull ache after work? Donât ignore it. Rest for a day. Ice it. Adjust your routine.
The most successful people donât wait until theyâre in pain. They build habits that protect their joints.
When to See a Doctor
You donât need to rush to the ER. But see a professional if:
- Pain lasts more than 2 weeks despite rest and ice.
- You canât move the joint without pain.
- Swelling, redness, or warmth spreads beyond the joint.
- You have a fever along with joint pain-this could be infection, not just inflammation.
Early diagnosis means faster recovery. Delayed diagnosis? Studies show patients with wrong treatment take 3.2 times longer to heal.
Can bursitis and tendinitis go away on their own?
Yes, often they can-especially if you stop the activity causing the problem and give your body time to heal. Mild cases usually improve in 2-6 weeks with rest, ice, and avoiding repetitive motion. But if you keep doing the same thing, the inflammation wonât go away. It can turn chronic, leading to long-term pain or even tendon tears.
Is cortisone injection safe for tendinitis?
Itâs not recommended as a first choice. Cortisone reduces inflammation but weakens tendons over time. Studies show it gives only 52% short-term relief for tendinitis, and repeated injections increase the risk of tendon rupture. For bursitis, itâs much safer and more effective. Always try physical therapy and rest first.
Why does my pain get worse at night?
Night pain is common with bursitis, especially in the hip or shoulder. When you lie down, pressure builds on the inflamed bursa. Also, at night, your body isnât distracted by movement, so you notice the pain more. Tendinitis pain is usually worse during activity, not at rest.
Can I keep exercising with tendinitis?
Yes-but only if you change what you do. Avoid the movement that hurts. For example, if your Achilles hurts, swap running for swimming or cycling. Once the pain drops below 3/10, start gentle eccentric exercises. These actually help heal the tendon. Pushing through pain will make it worse.
Are there home remedies that really work?
Absolutely. Ice massage with a frozen water bottle is one of the most effective and cheap tools. Posture correction, especially for shoulder and neck-related pain, helps a lot. Using a cushioned mat when kneeling prevents bursitis. And the "pain monitoring rule"-staying below 3/10 pain during activity-is used by top physical therapists and backed by patient success stories.
How long does recovery take?
Bursitis often improves in 4-6 weeks with rest and anti-inflammatories. Tendinitis takes longer-usually 12-16 weeks-because tendons heal slowly. Eccentric exercises need consistent effort over months. Rushing recovery leads to setbacks. Patience isnât optional-itâs part of the treatment.
Can I get bursitis or tendinitis from sitting too long?
Not directly. But sitting with poor posture can strain your hips, lower back, and shoulders over time. If youâre hunched over a keyboard, your shoulder bursa can get compressed. Your hip flexors tighten, which puts stress on the hip bursa. So yes-poor sitting habits can contribute, especially if youâre inactive all day.
Is tendinitis the same as tendinopathy?
Not exactly. "Tendinitis" means active inflammation. But in chronic cases-especially after 6-8 weeks-thereâs often little to no inflammation. Instead, the tendon has degenerated from overuse. Thatâs called tendinopathy. The treatment shifts from reducing inflammation to rebuilding tendon strength with eccentric exercises. Many doctors now avoid the term "tendinitis" for long-term cases.
Whatâs Next?
If youâve been living with joint pain, donât wait for it to get worse. Start with the basics: rest, ice, and stop what hurts. Track your pain on a scale of 1 to 10. If it doesnât improve in two weeks, see a physical therapist or sports medicine doctor. Donât guess. Get the right diagnosis. The right treatment isnât just about pain relief-itâs about getting your movement back, safely and for good.
