Most people hear the word bursitis and immediately think of inflammation, pain, and frustration — a problem to be “fixed” with rest, ice, or yet another cortisone injection.
But what if bursitis isn’t the problem at all? What if it’s the body’s way of whispering that something deeper needs to change?

At its core, bursitis is a message about mechanics — about how we move, how we load, and how we listen to the feedback our body gives us. And that’s exactly where Pilates comes in.

What Is Bursitis?

Bursa are tiny, fluid-filled sacs that sit between bones, tendons, and ligaments. Their job is to reduce friction and cushion the joints — like little gliding pads that make smooth movement possible.

We have them in our major joints: shoulders, hips, knees, elbows, and heels. When those joints are well-organised and moving in harmony, you don’t even know your bursa exist. But when joint mechanics become compromised — when bones are rubbing instead of gliding — those small sacs become irritated and inflamed. That inflammation is bursitis.

In other words, bursitis is rarely about the bursa itself. It’s about how we move.

Repetitive strain, sudden overload, or poor alignment can all trigger bursitis. Think swimmers lifting overhead with poor shoulder rhythm, hikers tackling long hills without hip strength, or office workers sitting for hours and then “getting fit” overnight.
The pattern is the same: poor mechanics → friction → inflammation → pain.

The Quick Fix That Isn’t

One of the most common treatments for bursitis is a cortisone injection. It’s marketed as a miracle fix — a fast way to reduce pain and inflammation.
But here’s the truth: pain relief isn’t the same as healing.

Cortisone is a synthetic form of cortisol, our body’s natural stress hormone. In small, rhythmic doses, cortisol helps us wake up, move, and repair. But when we flood the system with synthetic cortisone, we override the body’s natural rhythm.

The pain might disappear temporarily, but the mechanics — the real issue — remain unchanged.
Worse, repeated cortisone injections can weaken tendons, thin cartilage, and disrupt collagen integrity, leaving joints less stable over time.

It’s like silencing a fire alarm without addressing the smoke.

Clients often tell me, “The injection worked for a few months, and then the pain came back.”
That’s because the underlying problem — movement dysfunction — was never resolved. Without re-educating the body’s mechanics, bursitis simply returns, often worse than before.

Why Pilates Works

If bursitis is a messenger, Pilates is the language it’s speaking.

Our method was designed to restore balance, improve joint placement, and refine the way the body moves — exactly what’s needed to address the root cause of bursitis.

1. Mechanics Before Movement

In Pilates, we teach alignment before load. For someone with bursitis, this might mean:

• Modifying range of motion

• Shortening the lever (knees-in-straps instead of feet-in-straps)

• Changing their relationship to gravity (lying down rather than standing)

By creating space in the joints and restoring rhythm between bones, we remove the friction that causes irritation.

2. Multi-Directional Movement

Bursitis often stems from repetitive motion in one direction. Pilates gives fascia what it craves — variability.
Controlled, multidirectional movement keeps fascia supple and hydrated.
We use open- and closed-chain exercises, adjustable springs, and movement that explores the whole range of motion — because fascia and joints thrive on variety, not repetition.

3. Fascia Hydration

Healthy fascia glides; dehydrated fascia sticks.
Movement keeps fascia hydrated, but so do gentle rolling, spiraling, and bouncing.
Tools like Franklin balls or soft foam rollers can support this process, along with proper hydration and anti-inflammatory nutrition — turmeric, ginger, garlic, and omega-3s.

4. Nervous System Regulation

Chronic pain is a stressor. The longer pain persists, the more dysregulated the nervous system becomes — and the harder it is to heal.
Breath-led Pilates, vagus-nerve techniques, and mindfulness help rebalance the stress response.
When the body feels safe, it can finally repair.

5. Strength with Sensitivity

Pilates allows us to dose strength progressively.
Springs can assist movement when pain is high, then provide load as stability improves.
We don’t avoid load — we titrate it. Controlled resistance builds the scaffolding for long-term resilience.

Reframing Bursitis: The Body Isn’t Broken

When a client comes in with bursitis, my goal isn’t just to ease their pain — it’s to help them understand that their body isn’t weak or broken. It’s wise.

The inflammation is communication. It’s the body saying, “Pay attention. Move differently. Create space.”

As Pilates professionals, our role isn’t to silence those messages but to interpret them and guide our clients back to balance through intelligent movement.

This is the work — patient, curious, deeply respectful — that separates Pilates from exercise. It’s not about the quick fix. It’s about longevity, freedom, and trust in the body’s design.

Final Thoughts

If you or your clients are dealing with bursitis, remember: the goal isn’t to eliminate pain overnight. It’s to listen to what the pain is teaching you.

With the right approach — thoughtful, fascia-focused, and nervous-system aware — Pilates doesn’t just help bursitis heal. It helps the body learn from it.

Because the body isn’t a problem to be solved.
It’s a conversation to be understood.

About the Author
Katie Crane is the founder of Pilates Pro Academy, host of The Pilates Lounge Podcast, and creator of The Pilates Professional — a platform dedicated to education, integrity, and leadership in the Pilates industry.