Welcome to Orleans Physiotherapy's patient resource about Pes Anserine Bursitis of the Knee.
Bursitis of the knee occurs when constant friction on the bursa causes inflammation. The bursa is a small sac that cushions the bone from tendons that rub over the bone. Bursae can also protect other tendons as tissues glide over one another. Bursae can become inflamed and irritated causing pain and tenderness.
This guide will help you understand:
what part of the knee is affected
what causes this condition
how doctors diagnose this condition
what treatment options are available
Hear from some of our patients who we treated for Knee Pain
“
I had a knee and leg injury that required physiotherapy and I was fortunate to find an excellent physiotherapist Jagruti Asudani, who has offered a range of treatments at every stage of my recovery.... ”
“ I had a knee and leg injury that required physiotherapy and I was fortunate to find an excellent physiotherapist Jagruti Asudani, who has offered a range of treatments at every stage of my recovery. Thanks to her effective treatments and exercise plan I have had a successful recovery. I strongly recommend Jag if you are looking for a strong thorough physiotherapist. ”
“
Today I had my first meeting with Natasha Green for knee pain in 2 months (possible meniscus tear). I was nervous and Courtney the receptionist greeted me warmly and reassured me. Natasha explained to... ”
“ Today I had my first meeting with Natasha Green for knee pain in 2 months (possible meniscus tear). I was nervous and Courtney the receptionist greeted me warmly and reassured me. Natasha explained to me what she was going to do and how she was going to assess my injury. Her kindness, professionalism, clear explanations, and exercise recommendations made me realize that I was in good hands with her. Excellent physiotherapy treatment after the evaluation. Then, she sent me by email, in French, the exercises I have to do at home and explained to me what she will do at the next meeting. I already have my 2 appointments scheduled for next week! Dominique Guy ”
“
I can’t stress enough just how amazing Clint Dulude is as a human and a Physiotherapist. I went to him with legitimate, seriously painful conditions I didn’t know existed until they happened to... ”
“ I can’t stress enough just how amazing Clint Dulude is as a human and a Physiotherapist. I went to him with legitimate, seriously painful conditions I didn’t know existed until they happened to me. He 100% cured my patella-femoral in both knees and my tennis elbow in both arms in a totally reasonable amount of sessions (they don’t try to “upsell”you trying to make you come back more often) and the experience is just pleasant. Great staff, great tools and technology and more importantly - it works. Back there for plantar fasciitis treatment and have no doubt the shockwave treatment will work for me. ”
“
I have injured my knee helping my husband shovel the pathway last February. Covid-19 delayed my request for an X-ray. Clifton is great, and he is patience with me because I keep re-injuring my leg.... ”
“ I have injured my knee helping my husband shovel the pathway last February. Covid-19 delayed my request for an X-ray. Clifton is great, and he is patience with me because I keep re-injuring my leg. Love the clinic and strongly recommend anyone need help to see Clifton. In the spring I will take up his offer for my allergies by Auricular Acupuncture treatments. Thanks a bunch, Susan. ”
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I took my son at Orleans Physiotherapy for a knee injury. After one full treatment, his knee was 100% better. The level of care and attention was excellent. I can trust this place when faced with a... ”
“ I took my son at Orleans Physiotherapy for a knee injury. After one full treatment, his knee was 100% better. The level of care and attention was excellent. I can trust this place when faced with a painful injury that needs immediate treatment. Thank you OP. ”
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(Translated by Google) Today I had my first meeting with Natasha Green for knee pain in 2 months (possible meniscus tear). I was nervous and Courtney the receptionist greeted me warmly and reassured... ”
“ (Translated by Google) Today I had my first meeting with Natasha Green for knee pain in 2 months (possible meniscus tear). I was nervous and Courtney the receptionist greeted me warmly and reassured me. Natasha explained to me what she was going to do and how she was going to assess my injury. Her kindness, professionalism, clear explanations, and exercise recommendations made me realize that I was in good hands with her. Excellent physiotherapy treatment after the evaluation. Then, she sent me by email, in French, the exercises I have to do at home and explained to me what she will do at the next meeting. I already have my 2 appointments scheduled for next week! Dominique Guy (Original) Aujourd'hui, j'ai eu ma première rencontre avec Natasha Green pour douleur au genou depuis 2 mois (possibilité d'une déchirure au ménisque). J'étais nerveuse et Courtney, la réceptionniste m'a accueilli chaleureusement et ma rassurée. Natasha m'a expliqué ce qu'elle allait faire et comment elle allait évaluer ma blessure. Sa gentillesse, son professionnalisme, ses explications claires, et recommandations d'exercices m'ont fait réaliser que j'étais entre bonne mains avec elle. Excellent traitement de physiothérapie apres l'évaluation. Ensuite, elle m'a envoyé par courriel, en français, les exercises que je dois faire a la maison et ma expliquer ce qu'elle va faire à la prochaine rencontre. J'ai déjà mes 2 rendez-vous planifié pour la semaine prochaine ! Dominique Guy ”
“
I am thrilled to say how pleased I am with the amazing, professional, knowledgeable and always up-to-date staff at Orleans Physiotherapy from the front desk staff to the health care professionals. I... ”
“ I am thrilled to say how pleased I am with the amazing, professional, knowledgeable and always up-to-date staff at Orleans Physiotherapy from the front desk staff to the health care professionals. I had gone to see them 15 years ago for a back issue and later a knee issue. I am now there for neck, shoulder, arm pain. Natasha Green is one of the newer members on the team and I cannot say enough about her expertise, compassion and knowledge. She uses techniques that work magic on my pain - dry needling, manual therapy (where she pinpoints precisely the area of need), laser etc. And of course, Orleans Physiotherapy follows all Covid protocols to ensure everyone is safe. I highly recommend Orleans Physiotherapy! ”
“
Went to Orleans Physio due to a knee/hip injury. Celine is easy to talk to, she understands and makes you feel like you are important and that she wants to get you and your body working better. She... ”
“ Went to Orleans Physio due to a knee/hip injury. Celine is easy to talk to, she understands and makes you feel like you are important and that she wants to get you and your body working better. She takes the time to ask how you are doing and modifies the treatment when there are improvements. It is a warm and friendly atmosphere. Celine is the best! ”
“
I was referred for physio because of arthritis in my knee. I had pain and difficulty walking. Even through this pandemic, I had a prompt phone call from Clifton and he sent me a series of exercises... ”
“ I was referred for physio because of arthritis in my knee. I had pain and difficulty walking. Even through this pandemic, I had a prompt phone call from Clifton and he sent me a series of exercises that would help...and it did. After 2 weeks of exercises, I am pain free and can go back to my usual activities and exercises. This was a free service. In previous years, both my husband and I did require services from Orleans Physiotherapy and we were always very pleased and our issues were resolved. ”
“
I have been seeing Clint at Orleans Physiotherapy on and off for several years for different problems either for shoulder issues. back issues or knee issues and I had always received excellent care.... ”
“ I have been seeing Clint at Orleans Physiotherapy on and off for several years for different problems either for shoulder issues. back issues or knee issues and I had always received excellent care. Most important. I have always recover with the help of the treatments and the exercises.I am now seeing Clint for knee issues and in spite of the pandemic I feel safe as the staff take all the safety measures necessary to protect their clients. The receptionists are polite, knowledgeable and will do their best to accommodate my schedule. ”
“
Over the past year I have had two experiences with Orleans Physiotherapy - one for a torn rotator cuff in my shoulder; the other for an injured knee. In both cases the care provided by Orleans... ”
“ Over the past year I have had two experiences with Orleans Physiotherapy - one for a torn rotator cuff in my shoulder; the other for an injured knee. In both cases the care provided by Orleans Physiotherapy was top notch. Even during when they were closed during the first part of the pandemic they went out of their way to reach out and suggest exercises to help. Staff are friendly and personable. Very highly recommended ”
“
Staff is extremely friendly and professional! Prayusha has helped me so much with my knee issues . She is very professional, friendly and I would highly recommend her . ”
“ Staff is extremely friendly and professional! Prayusha has helped me so much with my knee issues . She is very professional, friendly and I would highly recommend her . ”
“
I am very happy with the results I got from my physiotherapy treatments for my knee. I went from barely being able to walk on my leg to being fully functional in a short period of time All the staff I... ”
“ I am very happy with the results I got from my physiotherapy treatments for my knee. I went from barely being able to walk on my leg to being fully functional in a short period of time All the staff I came into contact with were pleasant, friendly and helpful. My physiotherapist, Janik, was calm, pleasant and very professional. I would not hesitate to go there again. ”
The pes anserine bursa is the main area affected by this condition. The pes anserine bursa is a small lubricating sac between the tibia (shinbone) and the hamstring muscle. The hamstring muscle is located along the back of the thigh.
There are three tendons of the hamstring: the semitendinosus, semimembranosus, and the biceps femoris. The semitendinosus wraps around from the back of the leg to the front. It inserts into the medial surface of the tibia and deep connective tissue of the lower leg. Medial refers to the inside of the knee or the side closest to the other knee.
Just above the insertion of the semitendinosus tendon is the gracilis tendon. The gracilis muscle adducts or moves the leg toward the body. The semitendinosus tendon is also just behind the attachment of the sartorius muscle. The sartorius muscle bends and externally rotates the hip. Together, these three tendons splay out on the tibia and look like a goosefoot. This area is called the pes anserine or pes anserinus.
The pes anserine bursa provides a buffer or lubricant for motion that occurs between these three tendons and the medial collateral ligament (MCL). The MCL is underneath the semitendinosus tendon.
Overuse of the hamstrings, especially in athletes with tight hamstrings is a common cause of goosefoot. Runners are affected most often. Improper training, sudden increases in distance run, and running up hills can contribute to this condition.
It can also be caused by trauma such as a direct blow to this part of the knee. A contusion to this area results in an increased release of synovial fluid in the lining of the bursa. The bursa then becomes inflamed and tender or painful.
Anyone with osteoarthritis of the knee is also at increased risk for this condition. And alignment of the lower extremity can be a risk factor for some individuals. A turned out position of the knee or tibia, genu valgum (knock knees), or a flatfoot position can lead to pes anserine bursitis.
Symptoms
What does the condition feel like?
The patient often points to the pes anserine as the area of pain or tenderness. The pes anserine is located about two to three inches below the joint on the inside of the knee. This is referred to as the anterior knee or proximedia tibia. Proximedia is short for proximal and medial. This term refers to the front inside edge of the tibia.
Some patients also have pain in the center of the tibia. This occurs when other structures are also damaged such as the meniscus (cartilage). The pain is made worse by exercise, climbing stairs, or activities that cause resistance to any of these tendons.
Diagnosis
When you visit Orleans Physiotherapy, we will take a history and do a physical examination. A history and clinical exam will help our physiotherapist differentiate pes anserine bursitis from other causes of anterior knee pain, such as patellofemoral syndrome or arthritis. We will also assess hamstring tightness. This is done in the supine position (lying on your back). Our physiotherapist will flex (bend) your hip to 90 degrees. Your knee is then straightened as far as possible. The amount of knee flexion is an indication of how tight the hamstrings are. If you can straighten your knee all the way in this position, then you do not have tight hamstrings.
Some patients may be referred to a doctor for further diagnosis. Once your diagnostic examination is complete, the physiotherapists at Orleans Physiotherapy have treatment options that will help speed your recovery, so that you can more quickly return to your active lifestyle.
Orleans Physiotherapy provides physiotherapist services in Orleans.
Our Treatment
Non-surgical Rehabilitation
The goal of Orleans Physiotherapy treatment for overuse injuries such as pes anserine bursitis is to reduce the strain on the injured tissues. Stopping the activity that brings on or aggravates the symptoms is the first step toward pain reduction.
Reducing Inflammation
Bedrest is not required but it may be necessary to modify some of your activities. This will give time for the bursa to quiet down and for the pain to subside. Our physiotherapist will advise you to avoid stairs, climbing, or other irritating activities. This type of approach is called relative rest.
We may recommend the use of ice and anti-inflammatory medications in the early, inflammatory phase. The ice is applied three or four times each day for 10-15 minutes at a time. Ice cubes wrapped in a thin layer of toweling or a bag of frozen vegetables applied to the area work well.
Our physiotherapists often instruct athletes to perform an ice massage. A cup of water is frozen in a Styrofoam container. The top edge of the container is torn away leaving a one-inch surface of ice that can be rubbed around the area. The Styrofoam protects the hand of the person holding the cup while applying the ice massage. The pes anserine area is massaged with the ice for 3-5 minutes or until the skin is numb. Caution is advised to avoid frostbite.
Over-the-counter nonsteroidal antiinflammatory drugs (NSAIDs) such as Ibuprofen may be advised. In some cases, the physician will prescribe stronger NSAIDs. Our physiotherapist can also use a process called iontophoresis. Using an electric charge, an antiinflammatory drug can be pushed through the skin to the inflamed area. This method is called transdermal drug delivery. Iontophoresis puts a higher concentration of the drug directly in the area compared to taking medications by mouth. This process does not deliver as much drug as a local injection.
Increasing Flexability
Improving flexibility is a key part of the prevention and treatment of this condition. Your physiotherapist will advise that you perform hamstring stretches at least twice a day for a minimum of 30 seconds each time. Holding the stretch for a full minute has been proven even more effective. Some patients must perform this stretch more often – even once an hour if necessary.
Do not bounce during the stretch. Hold the position at a point of feeling the stretch but not so far that it is painful or uncomfortable. Deep breathing can help ease the discomfort. Try to stretch a little more as you breathe out.
Strengthening Exercises
Quadriceps strengthening is also important. This is especially true if there are other areas of the knee affected. The quadriceps muscle along the front of the thigh extends the knee and helps balance the pull of the hamstrings.
Some times our physiotherapists recommend a special type of exercise program called closed kinetic chain (CKC), performed for about six to eight weeks, to assist with quadriceps strengthening. The CKC may include single-knee dips, squats and leg presses. Resisted leg-pulls using elastic tubing are also included. This exercise program is gradually progressed during the eight-week session.
Prognosis for Pes Anserine Bursitis
Pes anserine bursitis is considered a self-limiting condition. This means it usually responds well to treatment and will resolve without further intervention. Athletes may have to continue our program of hamstring stretching and CKC quadriceps strengthening on a regular basis.
Athletes may return to sports or play when the symptoms are gone and are no longer aggravated by certain activities. Protective gear for the knee may be needed for those individuals who participate in contact sports. During our rehab process, activity level and duration are gradually increased. If the symptoms don’t come back, the athlete can continue to progress to full participation in all activities.
At Orleans Physiotherapy, our goal is to help speed your recovery so that you can more quickly return to your everyday activities. When your recovery is well under way, regular visits to our office will end. Although we will continue to be a resource, you will be in charge of doing your exercises as part of an ongoing home program.
Post-surgical Rehabilitation
If the bursa is removed, you follow the same steps of rehab and recovery outlined under Nonsurgical Treatment.
Orleans Physiotherapy provides services for physiotherapy in Orleans.
Surgery
Surgery is rarely needed for pes anserine bursitis. The bursa may be removed if chronic infection cannot be cleared up with antibiotics.
