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 of the knee.  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.)

The first recommendation to overcome knee bursitis 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, in order to get back to the activities that you enjoy, you 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 have an assessment performed.

If pain persists, hands-one therapy can be effective to alleviate pain and improve mobility. Pain improvements can be made quickly with soft tissue mobilization and/or dry needling of the sartorius muscle.  Self-myofascial release can also be performed with a lacrosse ball or foam roller.

If weakness is present, learning activation exercises to engage muscles that are not firing well is key. Once muscles engage better, the next step is to develop core and lower body strength with resistance.  Learning how to integrate the core and hips into movements patterns like the hinge, squat, lunge, are necessary to keep ta bursitis issue from becoming a recurring problem.

When addressed with specialized physical therapy, hiking without knee pain is possible. However, any sort of repetitive activity with poor mechanics can develop into a more serious knee condition.  If you have concerns about knee pain and bursitis, the physical therapists at Movement Solutions would be glad to be a resource for you.

We offer a free guide on relieving knee pain that can give you further insight into knee problems and help kickstart your recovery.  If you’re interested in physical therapy but have questions, we are available for a free 15-minute phone consultation so you can have answers before booking an appointment.

If you’re considering physical therapy, you can also apply for a free Discovery Visit.  This is an opportunity to ask questions, obtain clarity, and foster confidence that we can help you.  If you’re in pain and unsure about what your next step should be, call us at (864) 558-7346 and ask how we can help.

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