Playing it Smart with Pes Anserine Bursitis of the Knee

Pes Anserine Bursitis
Pes Anserine Bursitis

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:

  1. Are you certain of your diagnosis of pes anserine bursitis or are there other injuries the source of these symptoms?
  2. Are all of the surrounding knee structures stable and intact?
  3. What activity do you believe is causing this pain and what can I do to prevent it in the future?
  4. 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.

Quad Strengthening to Prevent Knee Injuries

Develop Strong Quads like Spiderman

If you want to keep your knees happy, make your quadriceps (quads) a top priority.  The good news is this…the goal of having healthier and stronger quads may not be as difficult as you might think!

Leg strengthening and preventative knee care are of great concern for today’s athletes. Knee injuries represent approximately 51% of NFL injuries.  Similar percentages are found in most sports at every level of athletics.

If your objective is to prevent injuries, safe quad strengthening is a great place to start.

To create a new level of quad appreciation, you should better understand the muscle group. This will require a quick anatomy lesson.

Anatomy 101 – Your Quads

The word quad means “four” and that is based on the fact that you have four muscles that make up this muscle group located on the front of your thigh.

  1. Rectus Femoris
  2. Vastus Lateralis
  3. Vastus Medialis
  4. Vastus Intermedius

The Mighty Four
All four muscles’ distal insertions attach to the upper half of the patella or kneecap. The bottom part of the kneecap is connected to the patella tendon, which attaches to the upper front of the shinbone or tibia. Therefore, when the quads contract, they pull the patella in an upward direction, which extends the knee. This is exactly what happens when you run, jump, or kick a ball.

Injury Prevention and Performance Enhancement

The benefits of strong and lean quads are two-fold. First, they prevent injuries. The quads play a major role in protecting the knees in most athletic events.

Preventative sports medicine will help you stay on the field instead of spending your time at the doctor’s office or on the sidelines watching your friends having all the fun.

Secondly, a well-toned quad enhances your ability to perform. Whether it is in the gym or on a tennis court, stronger quads help you move more effectively with less pain.

There are many myths related to exercise. Your quads and knees are no exception. The exercise options for quad strengthening activities range from squats to free weights to lunges and box jumps, just to name a few. Here are some simple and proven tips that will safely and effectively give you the results you need.

Tips for Safe Quad Strengthening

  1. Leg extensions, presses and squats. Perform leg extensions, presses and squats within the knee range of 20 degrees from full extension to 90 degrees of flexion or bending.  This middle range is extremely effective if avoiding excessive compressive stress on the articular cartilage is your objective.
  2. Always stay in the pain free zone. If you experience pain during any exercise, decrease the motion to a pain-free range.
  3. Slow and controlled. Perform all movements in a slow and controlled manner.  If knee pain is experienced at any time during the exercise, assess the technique and/or the amount of weight being used.
  4. Short and sweet. Keep the rest phases between all sets and all exercises short.  You need to create the “burn” or fatigue of the quads in order to overload the muscles and accomplish muscle strengthening.

In summary, the strongest muscle group in your body is your quads and that is for good reason.

Newton’s Third Law

Did you know that Sir Isaac Newton’s mixed martial arts cage fighting career was cut short because of a quad strain?  Me neither…but if Mr. Newton was as smart as they say he was, I feel certain that he would have been a disciplined athlete who realized how important it is to take care of his quads.

Newton’s Third Law states: “For every action there is an equal and opposite reaction.” Therefore, when an athlete’s body comes in contact with the ground while running or a soccer ball when kicking, the body has to absorb that force and distribute that energy elsewhere.

When I watch our Jag players run, I am always amazed to see the amount of force and stress being applied to their knees by the reaction to both gravity and the ground. When a 330 lbs football player is running on grass, his foot is experiencing up to 2600 pounds per square inch of force. That’s seven to eight times his body weight!

You may be asking: “What does any of this have to do with injury prevention and my quads?” My answer? Everything.

The #1 shock-absorbing mechanism in your entire lower extremity is controlled lengthening of your quads. By implementing a safe and effective quad strengthening program, you will be well on your way to minimizing the likelihood of a knee injury and enhance your athletic performance.

I hope that you are as excited as I am about Mike Ryan Fitness and the amazing injury prevention and sports medicine tips that we can share to help YOU to stay healthy and happy!

How Professional Athletes Successfully Treat Knee ITB Syndrome

Running With ITB Syndrome

Iliotibial band syndrome (ITBS), or Illiotibial band tendonitis, is a frustrating and troubling injury.  Because of it’s common mechanism of injury involves repetitive knee flexion and extension, it is often associated with runners.

Personally, ITB syndrome has proved to be one of the most difficult injury that I’ve dealt with as an athlete.

The IT band is a sheath of dense fibrous connective tissue which originates on its upper end to the tensor fascia latae muscle on the upper outer thigh.  The ITB extends down the lateral thigh and inserts into the outer surfaces of both the fibula and tibia bones of the shin. The function of the IT band is to help extend the knee joint, externally rotating the upper leg along with abducting of the hip.

Illiotibial band tendonitis is usually a result of the ITB being inflamed with excess friction of the ITB passing over the lateral epicondyle (the bony ridge on the outer distal thigh bone) of the femur (thigh bone).  With a repetitive knee movement like running or secondary trauma, the rubbing of this tissue over the hard bony ridge will result in inflammation and movement discomfort.

Signs and Symptoms of Runner’s Knee/Iliotibial Band Syndrome

  • Pain on the outside of the knee above, at or below the lateral knee joint line.
  • An increased tenderness with palpation(note: palpation is a method of clinical examination using gentle pressure of the fingers to detect growths, changes and unusual tissue reactions)of the iliotibial band.
  • An inability to squat through a full range of motion because of lateral distal thigh pain and weakness.
  • Knee pain normally aggravated by running, particularly downhill.
  • Pain during flexion or extension of the knee with both the foot on and off the ground.

How to Professionally Treat Iliotibial Band Syndrome

  • Apply cold therapy with ice bags, ice massage or ice bath.
  • Rest the knee and lower extremity from running, quad strengthening and painful activities.
  • Implement self myofascial mobilization and massage techniques such as rolling the thigh, lateral thigh and calves.
  • Aggressive flexibility of the IT band and the entire lower extremity including the ankle, great toe and low back.
  • Lateral knee and thigh massage is an effective treatment to reduce painful ITB tightness.
  • Assessing leg length and foot biomechanics bilaterally.  It is common to trace the source of lateral knee pain to a leg length difference or excessive pronation involving one leg.(Pronation means that the feet roll inward and cause the ankles to turn in.)
  • A thorough analysis of the athlete’s training program

Asking the Right Questions With Lateral Knee Pain

When faced with runner’s knee or Illiotibial band tendonitis, the wise professional athlete who wants to safely return to his/her sport and avoid further injury will ask his sports medicine specialist the following questions:

  1. Are you certain of the diagnosis?
  2. Do I need an MRI to rule out any other problems?
  3. What are the best options with treating this injury?
  4. What can I expect with this injury for the next 2, 4 and 6 weeks?
  5. Who do you consider to be the expert knee rehab specialist in this area?
  6. Will I be given a detailed rehabilitation protocol to direct my rehab for both my therapist and me?

Tips For Successful Iliotibial Band Treatment

  • Minimize the Damage – Illiotibial Band Syndrome is not an injury that you can just grit your teeth and run through.  Be smart early and avoid creating additional injuries.
  • Look Elsewhere – IT band tendonitis is often a result of a mechanical problem elsewhere.  Look above: hip & low back…..or below:…arch, ankle or great toe.  Don’t forget to look at your shoes!
  • Ice is Your Friend – It’s a reality check:  Ice hurts but it’s exactly what you need for this injury.  The Pro’s will tell you that ice is their best teammate.  Stop complaining and do what you know you need….ICE and lots of it.
  • Lighten up, Coach! – An athlete suffering from IT Band Syndrome is usually training very hard.  A common theme with this injury is that you do not have enough recovery time during the week or you are progressing too aggressively with your workouts.  Getting your coach, which sometimes refers to YOU, to work with you on this is a key step in getting this painful injury in your rearview mirror. A thorough analysis of your athlete’s workout plan is a great start.
  • How Long? – This may be one of the toughest injuries to put a recovery timeframe on.  The downtime from lateral knee pain associated with IT Band Syndrome is significantly reduced if you treat the injury early and modify painful activities while treating the injury as noted above.