Pes Anserine Bursitis: Anatomy, Symptoms and Diagnosis
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James McCormack is a Physical Therapist who specializes in knee, foot & ankle injuries. www.james-mccormack.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com
Pes anserine bursitis is a condition of inflammation and pain at the inside of the front of the knee. Pes anserine means goose foot in Latin and this anatomical structure is so-called due to its appearance as it is the attachment of three tendons into the shin bone. The bursitis condition is inflammation of a protective bursa that lies between the tendons and the shin bone. The primary role is to prevent friction of the moving bone on the soft tissue of the tendons.
There are several options for treating a pes anserine bursitis. A good starting point is to see a physical therapist to assess the symptoms you are having and give you a diagnosis. Once you have an accurate clinical diagnosis you can begin treatment.
The typical healing time for pes anserine is 6-8 weeks. Different factors will affect the healing time such as how effective treatment is and other conditions or specific biomechanics that the individual has, such as genu valgus or osteoarthritis.
Physical therapists are able to offer a range of treatments that can be effective for recovery from pes anserine bursitis. Manual therapy is a hands-on therapy that might include massage or joint manipulations, aimed to relax the muscles inserted into the pes anserine. That is the sartorius, gracilis and semitendinosus muscles. This will reduce compression of the bursa. Some therapists who are also trained in acupuncture or dry needling might use these treatments for a similar effect of relaxation on the muscles. As well as providing you with the stretches to continue working on relaxing and lengthening the muscles at home.
There is a wide variation in how people move. How we walk and run can have a big impact on pressure and stress at different joints. The pes anserine is stressed more if the knee moves inwards. This will be increased with repetitive activities such as walking, running, or any landing movement on that leg. The three muscles that insert into the pes anserine can become overloaded and tight if there is poor stability at the knee or hip. Therefore, it may be helpful to assess strength and control and work on improving this at the hip, knee, or ankle joints.
Getting to the root cause of movement patterns that increase the risk of injury, is a great way to reduce the risk of developing an injury, as well as fixing an existing injury. The inward movement at the knee can be caused by weakness of muscles around the knee but also weakness of muscles around the hip or foot.
Muscles around the hip control movement of the thigh bone on the pelvis. These muscles include the glues which can rotate the thigh bone out and keep the thigh bone straight in relation to the pelvis, as well as extend the thigh backward. Some people naturally have an angle from their pelvis inwards to their knee, this is called a Q angle. This can cause the knees to come together, called genu valgus.
Others can have poor stability of the foot and ankle which can cause excessive pronation and the inward roll of the foot. Too much movement or a lack of control of that movement will result in poor control at the knee, encouraging inwards movement.
Further advice on specific exercises for pes anserine bursitis can be found here.
A knee support can be helpful to control excessive inward movement at the knee and a knee brace can also increase your proprioception, which is the awareness of the movement at a joint. Careful selection of well-fitting knee support with no straps across the front of the knee below the joint is essential as the pressure of the brace can add compression and further irritation to the bursa.
The best knee brace for pes anserine bursitis. This brace offers support against inward movement of the knee, and the elastic compression increases proprioception of the knee.
For pes anserine bursitis, massage is a very effective treatment. It will relax and lengthen muscles, to reduce the pressure on the bursa under the tendons. Massage may be done as part of your physical therapy treatment or with a massage therapist. This may include deep tissue or sports massage and the release of trigger points in the muscle.
Pes anserine bursitis recovery can be aided with the use of tape. Either ridged tape or elasticated tape such as Kinesio tape can be applied to the knee. The aim can be to offload pressure from the pes anserine and the bursa, or to correct the movement of the knee, to reduce the inward or valgus postures.
Using ice on hot and inflamed tissues such as pes anserine bursitis will have a cooling effect that will feel soothing. Ice will numb the area by reducing the conduction speed of the nerves. In contrast, heat will increase the blood circulation to the area which, if there is inflammation, will already be heightened. Therefore, heat is less effective. However, heat applied to tight muscles can help to relax them. So, using heat further up the leg on the main part of the muscle can be helpful.
As pes anserine bursitis is an inflammatory condition, medications that have an anti-inflammatory effect can help with recovery.
In some cases, symptoms may not settle or improve with physical therapy, massage, using ice, using tape or a knee brace, or exercises. In these cases, a cortisone injection into the bursa can be helpful. This targeted steroid injection reduces the inflammation of the bursa and can break the cycle of irritation and inflammation. These injections are usually done by a sports doctor, knee consultant, or specialist physical therapist with the use of ultrasound to guide the correct location of the injection into the bursa. These injections are very safe but do have a negative side effect on some tissues, such as tendons. Therefore, the correct location of the injection is essential to prevent any damage to the surrounding tissues.
This is not medical advice. We recommend a consultation with a medical professional such as James McCormack. He offers Online Physiotherapy Appointments for £45.