Bursitis and Tendinitis: How to Tell Them Apart and Treat Them Right

When your shoulder aches after lifting, your knee hurts when you kneel, or your heel burns after a long walk, it’s easy to blame "arthritis" or just call it "overuse." But if you’ve been dealing with this kind of pain for weeks, you might actually have bursitis or tendinitis-two very different problems that look similar but need totally different treatments.

What’s the Difference Between Bursitis and Tendinitis?

Bursitis and tendinitis both cause joint pain, but they affect completely different parts of your body. Think of it this way: your joints aren’t just bone meeting bone. Between the bones, muscles, and tendons, there are tiny fluid-filled sacs called bursae (say: bur-see). These act like shock absorbers, letting things slide smoothly without friction. When one of these sacs gets inflamed, that’s bursitis.

On the other hand, tendinitis happens in the tendons-the tough, rope-like tissues that connect your muscles to your bones. When those get irritated from repeated motion or sudden strain, they swell and hurt. So bursitis is about the cushion, and tendinitis is about the cable.

Common spots for bursitis: the shoulder (subacromial), elbow (olecranon), hip (trochanteric), and front of the knee (prepatellar). For tendinitis, it’s usually the rotator cuff in the shoulder, the Achilles tendon in the heel, or the patellar tendon just below the kneecap.

How Do You Know Which One You Have?

It’s not always obvious. Many people think they have rotator cuff tendinitis when they actually have bursitis. In fact, studies show that in 65% of shoulder pain cases, both are happening at the same time.

Here’s how to tell them apart:

• Bursitis pain feels more like a deep, dull ache around the joint. It often gets worse when you lie on the sore side at night. The area might feel swollen, warm, or even look puffy. Pressing on the spot usually hurts more than moving the joint.
• Tendinitis pain follows the line of the tendon. If your Achilles tendon is inflamed, you’ll feel it along the back of your ankle when you push off your foot. The pain usually spikes during specific movements-like raising your arm overhead or climbing stairs-and fades when you rest.

One key clue: if you get relief from a cortisone shot, it’s more likely bursitis. Studies show 78% of bursitis patients improve within four weeks after an injection. For tendinitis? Only 52% do. And in some cases, injecting a tendon can actually make it weaker.

Why Misdiagnosis Makes Things Worse

Getting the wrong diagnosis doesn’t just mean wasted time-it delays real healing. A 2023 study found that people who were misdiagnosed took three times longer to recover. Why? Because treatments for bursitis and tendinitis are opposites in key ways.

For example, if you have acute bursitis and start doing strengthening exercises too soon, you’ll irritate the already swollen bursa. That’s like poking a balloon that’s about to pop. On the flip side, if you have tendinitis and just rest and ice it, you’ll miss the one thing that actually fixes it: eccentric strengthening.

Eccentric strengthening means slowly lowering a weight while the muscle is under tension. For Achilles tendinitis, that’s doing heel drops: standing on a step, raising up on both feet, then lowering down slowly on just the sore foot. Do 180 reps a day for 12 weeks-and yes, it’s grueling. But research shows 68% of people see lasting improvement with this method, compared to just 41% with injections alone.

What Works: The Real Treatment Plan

Most cases of both conditions don’t need surgery. In fact, fewer than 5% of patients ever do. The key is starting with the right conservative approach.

First 7-10 days: Rest the joint. Don’t stop moving completely, but avoid anything that hurts. Apply ice for 15-20 minutes, 3-4 times a day. Use a frozen water bottle for rolling over the Achilles or shoulder-it’s easier to control pressure than an ice pack.

NSAIDs (like ibuprofen): Fine for short-term relief (no more than 10-14 days). They help with swelling, but they won’t fix the root problem. Long-term use can mess with your stomach or kidneys.

For bursitis: After the first week, gentle movement helps. Try slow shoulder circles or hip abductions without resistance. Cortisone injections can be very effective-but only if the bursa is the main issue. Don’t get more than 2-3 in a year. Too many can damage surrounding tissue.

For tendinitis: This is where patience pays off. Start range-of-motion exercises after the first week. Then move into eccentric training. For shoulder tendinitis, that means controlled downward movements with light dumbbells. For the knee, step-downs from a low platform. For the heel, the Alfredson protocol (180 heel drops daily) is gold standard. It takes 3-4 months to see full results, but the pain stays gone longer than with any shot.

What Doesn’t Work (And Why)

Many people try the wrong things because they’re easy or popular.

• Stretching alone: Stretching a tendon that’s already inflamed can make it worse. You need to strengthen it, not just pull on it.
• Heat therapy too early: Heat feels good, but it increases swelling in the first week. Save it for after the inflammation settles.
• Over-the-counter braces: They might feel supportive, but they don’t fix movement patterns. If your posture or technique is causing the problem, a brace just hides it.
• Waiting for the pain to go away: Tendinitis doesn’t heal on its own. If you ignore it, you risk a full tear. A ruptured Achilles tendon requires surgery and months of rehab.

Real People, Real Results

On Reddit’s r/PhysicalTherapy, one user shared how he thought he had a rotator cuff tear. After six months of pain, a physical therapist diagnosed bursitis. He stopped lifting weights, started ice rolling, and corrected his desk posture. Within six weeks, the pain was gone.

Another user, a runner with chronic Achilles pain, tried rest, stretching, and even PRP injections. Nothing worked. Then she found the Alfredson heel drop protocol. She did 180 reps every day for 16 weeks. She didn’t run for three months. But when she started again, she didn’t have a single flare-up in two years.

And on MyHealthTeams, 73% of users who used frozen water bottles for ice rolling said it was more effective than regular ice packs. Why? Better control. You can roll it directly over the inflamed spot without numbness or cold burns.

When to See a Doctor

You don’t need to rush to the ER for this. But if:

• The pain lasts more than two weeks despite rest and ice
• You can’t move the joint without severe pain
• You notice redness, fever, or the area feels hot to the touch
• You heard a pop or felt sudden weakness

…then get it checked. Ultrasound is the best first imaging tool-it’s accurate, fast, and doesn’t use radiation. MRI is overkill unless you suspect a tear.

Prevention Is Easier Than You Think

These conditions aren’t random. They’re caused by repeated stress. So prevention is about changing how you move.

• If you sit at a desk all day: adjust your chair so your shoulders stay relaxed, not hunched. Use a forearm rest if you type a lot.
• If you run or walk: replace your shoes every 300-500 miles. Worn-out soles change your stride and overload tendons.
• If you play sports: warm up properly. Don’t jump into high-intensity movements cold.
• If you kneel at work (plumbers, gardeners, cleaners): use knee pads. A 2023 NIOSH study found construction workers who used pads had 40% less bursitis.

And here’s a simple rule from physical therapists: if an exercise hurts more than a 3 out of 10, stop. You’re not building strength-you’re causing damage.

The Bigger Picture

These aren’t just "old person problems." In 2022, over 387,000 U.S. workers missed time because of bursitis or tendinitis. Musicians, painters, cashiers, and office workers are all at risk. The good news? Most cases respond well to the right plan-no surgery, no drugs, just time and smart movement.

What’s changing now? Wearable tech like the Apple Watch can detect abnormal movement patterns before pain even starts. A 2023 Stanford study showed it spots tendinitis risk with 89% accuracy. That means in the near future, you might get a notification: "Your shoulder motion looks off. Try this stretch."

For now, though, the best tool you have is awareness. Know what’s inflamed. Know what to avoid. And know that healing isn’t about pushing through pain-it’s about working with your body, not against it.