Identifying and Overcoming Bursitis of the Knee

Pes anserine bursitis if often confused with meniscal tears of the knee since they have similar symptoms.  Both conditions are characterized by pain on the inside part of the knee.  However, a key differentiator of bursitis is that pain is 2 to 3 inches below the joint line.  Pes anserine bursitis also coincides with tenderness of the sartorious muscle.  On the other hand, meniscus pain is usually on the joint line.  Severe meniscus tears result in catching or locking of the knee at end ranges of flexion and extension.

Pes anserine bursitis occurs most commonly in young people involved in athletic activity, middle-aged women getting back to exercise, and people aged 50 to 80 years who have osteoarthritis of the knee.  The pes anserine bursa is a small, fluid-filled sac located 2 to 3 inches below the knee joint on the inside of the lower leg. It lies beneath 3 tendons that attach to muscles of the thigh, and prevents the tendons from rubbing on the shinbone (tibia). The term “bursitis” describes a condition where the bursa has become irritated and inflamed.

Pes anserine bursitis usually develops over time. It can be due to faulty squatting or running mechanics or repetitive activity. It is a common condition that affects athletes and non-athletes alike.  Some factors that can contribute to this type of bursitis include incorrect training techniques, a lack of core/lower body stability or mobility, and sudden increases in running volume.  Other factors that can contribute to this type of bursitis include valgus positioning of the knee (ie, a “knock-knee” position where the knees angle inward) during squats and lunges, stiff hamstrings, flat feet, or excessively high arches.

Some movements that can be painful in the presence of  pes anserine bursitis include running walking, steps, squats, and lunges. In addition, there may be increased symptoms first thing in the morning or after a prolonged bout of sitting (i.e. when muscles are stiff.)

In our physical therapy office, the first recommendation that we usually make is to take a short break from the aggravating activity. This allows for an environment for the inflammation to settle down and the region to heal. While taking a break usually helps with pain, we know for our patients to get back to the activities that they enjoy, we have to address the root of the issue.

In many cases, pes anserine bursitis is coupled with poor mobility of the hips and the ankle. This can be combined with weakness of the hip and the buttock muscles.  In addition, if there are imbalances at the core and hip muscles, the way an active person moves can be affected which may lead to faulty knee mechanics. However, the only way to know what is contributing to pain and injury is to perform a complete assessment.

When pain and stiffness is found via the assessment, our approach includes manual mobilization to alleviate pain and improve mobility. Pain improvements can be made very quickly with soft tissue mobilization and/or dry needling of the sartorius muscle.

If weakness is found, we teach activation exercises to help our clients better engage muscles that are not firing well. Once pain is controlled and muscles engage better, our next step is teaching our patients to develop core and lower body strength with resistance.

When addressed with a through physical therapy assessment and plan of care, inner knee pain and pes anserine bursitis is a conditions that can resolve without medications or procedures. However, any sort of repetitive activity with poor mechanics can become a more serious issue.  If you feel like you may be developing bursitis, the physical therapists at Movement Solutions would be glad to provide a through assessment and give you a diagnosis for your condition.  We can begin this process with a free 15-minute phone consultation to talk about how your knee is affecting you and discuss your treatment options.  If you prefer an office visit, we can offer a free Discovery Visit so we can assess your injury in person, provide you a diagnosis, and give you and expected time frame for recovery.  Whether you decide to have continued care with us or another office, we want to you to get back to you active way of life. Call us at (864)-558-7346 and ask how we can help.

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