Pes Anserine Bursitis: Anatomy, Symptoms and Diagnosis
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It is frequent for runners to experience knee pain during and after running but it is not normal to have high levels of pain, and it is certainly not something you should just put up with. It can be difficult to differentiate between the aches and pains of having worked hard in your run session, and pains that might be the early indicators of injury. A good rule of thumb is that high pain, pain lasting more than 2-3 days or pain that is very different on one side compared to the other is not normal post exercise.
With symptoms that are very painful, uneven between your left and right knee, or a niggle that keeps coming on when you on you run, you should seek a medical professional. They can assess you and provide you with a diagnosis and treatment plan. Finding the cause and diagnosing the injury or condition is important to manage and resolve your symptoms, as well as preventing them continuing, deteriorating or reoccurring.
There are many different conditions that can cause inside knee pain that are running related. Part of the diagnostic process is determining what is the most likely cause of inner knee pain running for you. With your age, sex, health, strength, flexibility, training and running style. The most common cause of medial knee pain running are:
A tear or irritation to the medial meniscus will commonly have pain on the inside of the knee along the line of the joint, there may be slight swelling or the knee might generally feel a bit puffy. In most cases it will feel more painful to crouch or squat down and it may be more painful to walk on uneven ground, with hard shoes or bare feet. In more severe tears the knee joint might feel unstable, and it might give way or it can feel very stiff and lock. Read more about this condition in our related article: Medial Meniscus.
A medial collateral ligament tear or strain is also painful on the inside of the knee. This pain may be on the joint line but can also be slightly above or below as this is where the ligament runs. The worse the injury the more unstable the knee will feel. There might be low swelling which will be localised to the inside of the knee, of in a more severe sprain or sudden acute injury the swelling might be quite significant. Read more about this condition in our related article: MCL Injury.
A tendinopathy to the Pes Anserine tendons or an inflammation of the bursa will also present with inner knee pain at the knee. The area of pain will be further down on than the joint line at the top of the shin. You might feel a localised lump of swelling, heat and often redness in that specific area. It is less common to feel instability in the knee joint. Usually you will feel a lot of tightness along the inside of the thigh. This can be worse at the start of exercise and often will feel like it warms up and pain might ease during, up to a point then pain will worsen and is usually worse still after exercise. Read more about this condition in our related article: Pes Anserine Bursitis.
Osteoarthritis is a broad diagnosis that covers several different degenerative changes that can happen in the knee, such as meniscus irritation, osteophyte formation and degeneration of ligaments. It can affect the medial joint and cause pain there along the joint line. Osteoarthritis will often feel worse after more activities, often into the following day and it may feel stiffer after rest. Swelling is usually not specific but the whole knee might feel and look puffy.
The running styles that can excessively load the medial part of the knee and increase the risk of injuries to this area are those that have a pelvis drop (adduction at the hip), those that have over pronation (poor control at the foot and ankle), those that land on an excessively straight leg, or excessively bend the knee during mid-stance.
When the pelvis drops down to the opposite side of the standing leg it lengthens the lateral gluteal muscles and encourages an inward movement of the knee joint. This inward movement can put more strain and load on the structures on the inside of the knee.
The inward movement of the foot and ankle when walking is normal but it should be a small movement and well controlled. When the foot roles in too far it is called over pronation. This movement also causes the knee to move inwards and can put more pressure and load onto the structures on the inside of the knee. This running style is liked with overuse injuries that cause inner knee pain.
This is not medical advice. We recommend a consultation with a medical professional such as James McCormack. He offers Online Physiotherapy Appointments for £45.