Welcome to Momentum Health'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
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Still going to momentum health and still love it! Jason is the physiotherapist/ owner and he is absolutely amazing. I dislocated my knee a couple months back and he helped me tremendously! ”
“ Still going to momentum health and still love it! Jason is the physiotherapist/ owner and he is absolutely amazing. I dislocated my knee a couple months back and he helped me tremendously! ”
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The folks at Momentum have been excellent supporting me through my knee surgery recovery. They always listen and respond to my symptoms and encourage my progress. In addition they are helping get... ”
“ The folks at Momentum have been excellent supporting me through my knee surgery recovery. They always listen and respond to my symptoms and encourage my progress. In addition they are helping get ready for my next knee surgery. From reception to all the folks in the back, they are friendly and welcoming! I feel like the old show cheers ' ... where everyone knows your name.' Keep up the great work -- I am a good reference -- my wife is going to come by for some physio. ”
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I recently attended a GLA:D program for education and exercise for osteoarthritis at Momentum Health in Seton in Calgary, Alberta. I was under the care of Dr. Teac Engen 2 times a week for 7 weeks of... ”
“ I recently attended a GLA:D program for education and exercise for osteoarthritis at Momentum Health in Seton in Calgary, Alberta. I was under the care of Dr. Teac Engen 2 times a week for 7 weeks of education exercises for the hips and knees. During that time, I learned valuable resistance training to help build up the areas around the hip and knee joints. The sessions were professionally carried out and I was treated with kindness and understanding. Dr. Engen created an environment for me to excel. He communicated through word and action. He lead by example and allowed me to discuss my feelings openly. He seeks input and involvement from others. He recognizes the contributions of others. I am comfortable going back to the program in the future if I need additional help. Sincerely Linda Rogers ”
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Russ, Mark and Safia were extremely knowledgeable and helpful in helping me with the GLAD program. Anybody with arthritis in the knees, or the hips should go to Monument health at Deerfoot City and... ”
“ Russ, Mark and Safia were extremely knowledgeable and helpful in helping me with the GLAD program. Anybody with arthritis in the knees, or the hips should go to Monument health at Deerfoot City and check out the GLAD program. ”
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Mark and his team were amazing. I came to their office with an uncomfortable sensation on my right knee that it was solved prior to my race last May. ”
“ Mark and his team were amazing. I came to their office with an uncomfortable sensation on my right knee that it was solved prior to my race last May. ”
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I would highly recommend Mark and Safia at Momentum Health for physiotherapy. I received treatment over 6 months for a WCB claim involving wrists, elbows and knees. They took the stress out of the WCB... ”
“ I would highly recommend Mark and Safia at Momentum Health for physiotherapy. I received treatment over 6 months for a WCB claim involving wrists, elbows and knees. They took the stress out of the WCB claim process and continued with thorough reviews to make sure treatment was complete and did not end prematurely. They assessed my condition, developed a treatment plan, and then patiently helped me carry it out. They selected and taught me exercises appropriate to my level of recovery and gave feedback through all the stages. I also received in clinic treatment including muscle release, heat and dry needling. To top it off, the atmosphere in the clinic was always friendly and happy, so treatment became the highlights in my week. They seemed to care for the whole person not just the physical condition in need. Thank you Mark and Safia! ”
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Just had to share my experience with my chiropractic care here at Momentum. Last week my back went out and I was suffering with terrible sharp, excruciating nerve pain. I had been to Momentum for... ”
“ Just had to share my experience with my chiropractic care here at Momentum. Last week my back went out and I was suffering with terrible sharp, excruciating nerve pain. I had been to Momentum for physio and the knee Glad program, but not for chiropractic care. So I called them up and told them about my back pain and they felt I needed an adjustment by one of their chiropractors. I went in and met with Dr. Denis Simons and had my first adjustment. I found him to be an ultimate professional and he quickly found out what needed to be done. After my second adjustment I was completely rid of the extreme nerve pain! I couldn’t believe it! I did the dance of joy! I will continue to see Dr. Denis for any chiro needs I may have in the future. Highly recommend him! ”
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Participated in GLA:D hip knee clinic. Excellent program and well supervised exercise routines and instruction. Suggest anyone with hip-knee issues to look at program earlier rather than later. ”
“ Participated in GLA:D hip knee clinic. Excellent program and well supervised exercise routines and instruction. Suggest anyone with hip-knee issues to look at program earlier rather than later. ”
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The staff here are fantastic! From the ladies at the front all the way to the physiotherapists. I had the pleasure of working with Leah as I navigated my recovery from ACL surgery. She was super kind... ”
“ The staff here are fantastic! From the ladies at the front all the way to the physiotherapists. I had the pleasure of working with Leah as I navigated my recovery from ACL surgery. She was super kind and supportive and every time I came in she had new exercises for me to try and really worked with understanding how I functioned and what would benefit me. Not just giving me the standard exercises. I appreciate the time she took to recognize when an exercise worked for me and when it didn’t. This even meant researching in between appointments to find new studies or techniques to try. I highly recommend the clinic, especially Leah. ”
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I have been enrolled in the GLA:D Knee/Hip program since April 19th and have been delighted with the progress. I have bone on bone on the lateral portion of my right knee and have found over the weeks... ”
“ I have been enrolled in the GLA:D Knee/Hip program since April 19th and have been delighted with the progress. I have bone on bone on the lateral portion of my right knee and have found over the weeks that I am getting stronger and definitely have less crepitus. I was able to hike Grassy Lakes; the more challenging side too. Today Dr. Carpino has started to work on other areas. He is competent, very knowledgeable, and a truly kind, caring Chiropractor. ”
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I am very appreciative that I joined the Gla:d program, it taught me what I needed to know regarding my knee pain. The classes were educational, interactive, and fun & challenging at the same time.... ”
“ I am very appreciative that I joined the Gla:d program, it taught me what I needed to know regarding my knee pain. The classes were educational, interactive, and fun & challenging at the same time. Giancarlo Carpino is an excellent instructor, very kind and patient, very likeable and knowledgeable. You know this is his passion, and that he cares deeply about a person's well being. Worth the time and money spent to attend. ”
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Moustafa Korayem, Physiotherapist I had a wonderful experience under your care. Your treatments have made a difference and tremendous amounts of relief from my chronic knee pain. Thank you ”
“ Moustafa Korayem, Physiotherapist I had a wonderful experience under your care. Your treatments have made a difference and tremendous amounts of relief from my chronic knee pain. Thank you ”
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I can't even begin to say how thankful I am to the team of Momentum Health. I wasn't able to get more than 4hours of sleep per night for a couple of years, I finally went to see Dr. Denis Simmons and... ”
“ I can't even begin to say how thankful I am to the team of Momentum Health. I wasn't able to get more than 4hours of sleep per night for a couple of years, I finally went to see Dr. Denis Simmons and he took a complete different approach than any other chiropractor I have seen before, my mid and upper spinal section wasn't moving they way it should i guess which caused my lower back to hurt, so he focused on a different section of my spine than previous chiropractors. it made a huge change, all of a sudden i was able to get a full nights of sleep. Then i started physio with Nathan Albinati, even no where near of sporting grey hair, he has a ton of knowledge which made me gain more strength in my core. i also had previously very painful experience with dry needling but he sure knows what he is doing. we switched over working on my repaired ACL now and i feel even his assessment is way more thorough than i have had before. Laura at the reception is always kind and welcoming. If you haven't tried this place, you have to! ”
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I cannot say enough good things about Dr. Carpino. He is courteous, inspiring, and committed. He is a consummate professional who gently leads his patience to do their best to exceed their goals. I... ”
“ I cannot say enough good things about Dr. Carpino. He is courteous, inspiring, and committed. He is a consummate professional who gently leads his patience to do their best to exceed their goals. I had the good fortune to benefit from his stewardship in the GLA:D programme. My knees are now better than they have been in years as is my mobility. Kudos and thanks to Dr. Carpino. Andrew Frank Johnson ”
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 Momentum Health, 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 Momentum Health have treatment options that will help speed your recovery, so that you can more quickly return to your active lifestyle.
Momentum Health provides physiotherapist services in Calgary.
Our Treatment
Non-surgical Rehabilitation
The goal of Momentum Health 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 Momentum Health, 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.
Momentum Health provides services for physiotherapy in Calgary.
Surgery
Surgery is rarely needed for pes anserine bursitis. The bursa may be removed if chronic infection cannot be cleared up with antibiotics.
