What is pes anserine bursitis? This ailment, while not extremely common, can be quite painful. It is the result of inflammation of the pes anserine bursa, which is located just below and to the inner side of the knee. A bursa is a fluid filled sac that acts as a cushion and is located close to most major joints of the human body.
This is a location vulnerable to repeated injury in athletes due to the fact that several ligaments, tendons, and muscles all meet in this same general knee area. This area of ‘high traffic’ can become aggravated with overuse. A typical mechanism of injury is a direct blow to the per anserine area at the upper inner tibia just below the knee. As you know, there is very little protection in this area with no muscle bellies or large fat stories to buffer the trauma.
The MCL, semitendinosus, sartorius muscle, and gracilis muscle all meet at the proximal tibia where this important bursa is located. They each provide support and alignment during body movement. The pes anserine bursa acts as a lubrication device, which minimizes the stress to the underlying tissue during interaction of the knee and all the surrounding tissue. This allows for proper body mechanics and weight distribution with all activities involving the lower extremity.
Sign and Symptoms of Pes Anserine Bursitis
Pes anserine bursitis is most common in long distance runners. Failing to properly stretch is a main cause but this condition also occurs in athletes who tend to contact the ground with their foot rotated outward. Even the slightest outward rotation of the lower limb during contact with the ground causes poor weight distribution and strains the inner thigh muscles and knee ligaments.
The following are symptoms of pes anserine bursitis:
- Pain at the inside of the knee with repetitive knee movement (usually while extending the knee or climbing stairs).
- Palpable swelling, warmth and tenderness on the inside of the knee 2-3 inches below the jointline. Often the pain associated with a bursitis can be minimal and the athlete reports that it “looks a lot worse than it feels”.
- Redness over and around the area of the per anserine.
- Pain located just below the inside joint line of the knee, which increases with resisted knee flexion and/or adduction (pulling the legs together).
- Knee weakness associated with activities.
Professional Treatment for Pes Anserine Bursitis
Do not underestimate this injury. Take the necessary time off to allow for a full recovery prior to returning to your activities. One of the most common mistakes athletes make with this injury is not allowing for ample time to allow for sufficient healing before subjecting the tissue to high level stress. When this happens, the symptoms return much worse than previously experienced as you enter into the world of “chronic bursitis” and let’s just say that is not a fun place to be!
The following are my treatment recommendations for this condition:
- Rest affected area by minimizing the activity associated with the cause the ailment.
- Apply ice packs for 10-15 minutes 3-4 times daily.
- Utilizing the necessary therapy modalities to decrease pain and reduce swelling.
- Regularly stretch the knee, thigh muscles, and hips to promote relaxation of the area. Remember to breathe!
- Proper diagnosis from your primary physician may require a referral for an x-ray an/or special test. Pain caused by pes anserine bursitis can mimic that of a stress fracture of the proximal tibia with endurance athletes.
Asking the Right Questions Like a Pro
Here’s what a smart pro athlete would ask his/her sports medicine specialists to ensure a fast and safe return to sports:
- Are you certain of your diagnosis of pes anserine bursitis or are there other injuries the source of these symptoms?
- Are all of the surrounding knee structures stable and intact?
- What activity do you believe is causing this pain and what can I do to prevent it in the future?
- Would you evaluate my lower extremity biomechanics to see if I have a leg length discrepancy, alignment problem or foot pathology that is a contributing factor to my injury?
Elite Sports Medicine Tips from Mike Ryan
- Take a Timeout – In order to prevent any further aggravation to the knee take time off NOW so you can enjoy your sport next week.
- Stretch It Out – Stretching works wonders for the body and proper healing of an injury such as this where muscles and tendons are involved.
- Refill The Ice Tray – By now you may want to purchase additional ice trays after all of the icing that you will be doing! Ice is a great vasoconstrictor and it quickly reduces swelling. Apply the ice to the inside of the knee.
- Baby Steps – After you feel you are healthy once again do not go out and run a half marathon! Start small and avoid obstacles such as hills and high intensity workouts while your leg strength and flexibility improves.