BONE BRUISING

All the tissues in our body can bruise. We’ve all had one. Sometimes heavy compression on joints can damage the surfaces of bones causing bleeding inside the bone surface. In simple terms, this is a bone bruise where the bone is injured but not fractured.

 

I mostly see this in the bones of the foot or knee damaged by clients during sport or from jumping onto hard surfaces, especially with a straight knee.

 

Bone bruises are usually extremely painful initially and most people have had an x-ray by the time they get to see me because a fracture has been suspected.

 

Unfortunately they can be very slow to resolve, mostly because they are on the surfaces that we weight bear on. To explain:


Imagine you get a heavy knock on the bone of your shin. It really hurts but after a few days you don’t notice it. But then imagine every time you took a step someone gave you a good poke right on the spot of the knock  – it would stay sore, wouldn’t it?

 

That is what happens with bone bruises, they keep getting irritated because you’re walking on them.

 

The good news is they almost always resolve completely, even if slowly.


The best treatment, as always, is to respect pain and to maintain good joint range around where the injury is. That’s where a good physio (one with manual skills!) can be of value.

By Brendan Dax October 27, 2025
Bursitis is one of the many causes of impingement pain of the shoulder, giving restriction and pain when lifting the arm. Bursae are small sacks of fluid and when inflamed in the shoulder, take up too much space, getting squashed when raising your arm causing painful pinching. Like all musculoskeletal problems, this is a problem of mechanics. Something doesn’t move properly. From a manual physiotherapy perspective, bursitis, like all shoulder impingement problems usually responds well to joint mobilisation. In all my years of treating shoulder impingement almost all presentations have associated neck/upper back spinal joint stiffness. Manual mobilisation (loosening up) of the neck/back and shoulder joints will always yield improvement, unless there is structural damage. Having seen 100s of acute onset (within the previous two days) shoulder problems in the industrial sector, I can assure you that most of them come in with chronic, stiff upper backs that they’ve had for ages. True bursitis usually responds as well to a guided Cortisone injection. Bear in mind if the neck and shoulder joints are still stiff the jab may not solve the problem. If you have shoulder pain that has not responded to injection and/or seeing a Physio who just uses machines and/or exercises, consider manual physiotherapy from someone like me, before we all retire!
July 1, 2025
Pain on the side of the hip from bursitis or gluteal tendon inflammation is an annoying problem often more so at night because lying on it frequently disturbs people’s sleep. It is a reasonably common problem for me to see. Tendons and bursae degenerate as we age and weakness in hip musculature can be a cause. But it can happen to anyone. Guided steroid injections can help, but most people respond well to soft tissue manipulation. The lower back should definitely be assessed and (usually) treated manually as related spinal joint stiffness frequently contributes to the issue. The hip joint should also be assessed and treated if necessary. Exercises can be helpful but need to match the pathology so an Ultrasound image might be needed give a diagnosis.