Pes Anserine Bursitis: Causes, Symptoms, and Treatment

What is Pes Anserine Bursitis?

The pes anserine bursa is a fluid-filled sac situated between the pes anserine tendons (from the sartorius, gracilis, and semitendinosus muscles) and the underlying tibia. This bursa reduces friction during movement, but repetitive stress, trauma, or other conditions can lead to inflammation and pain.

Causes of Pes Anserine Bursitis

Overuse or Repetitive Stress

• Activities that involve repetitive knee flexion and extension (e.g., running, cycling, or climbing stairs).

Improper Biomechanics

• Tight hamstrings or poor foot alignment (e.g., flat feet or high arches) may increase stress on the pes anserine area.

Acute Trauma

• Direct impact or prolonged pressure to the inside of the knee.

Underlying Medical Conditions

• Osteoarthritis in the knee.

• Obesity, increasing stress on the medial knee structures.

• Diabetes or rheumatoid arthritis.

Symptoms of Pes Anserine Bursitis

• Localized Pain: Pain on the inner knee, 2-3 inches below the joint line.

• Swelling: Mild to moderate swelling in the pes anserine region.

• Tenderness: Sensitivity to touch over the bursa.

• Pain During Activity: Discomfort while climbing stairs, walking, or running.

Diagnosing Pes Anserine Bursitis

Clinical Examination

• A detailed history and physical assessment to identify tenderness, swelling, and pain location.

Imaging Studies

• Ultrasound: Helps visualize inflammation or fluid in the bursa.

• X-Ray: Rules out knee joint abnormalities, such as arthritis.

• MRI: Occasionally used to assess the soft tissues and confirm diagnosis.

Treatment for Pes Anserine Bursitis

Non-Surgical Treatments

1. RICE Protocol

   • Rest: Minimize activities that worsen symptoms.

   • Ice: Apply ice packs to the affected area for 15-20 minutes several times daily.

   • Compression: Use knee supports to reduce swelling.

   • Elevation: Keep the knee elevated to alleviate swelling.

2. Physical Therapy

   • Stretching Exercises: Focus on hamstrings, quadriceps, and hip muscles to relieve tension on the bursa.

   • Strengthening Exercises: Strengthen surrounding muscles to improve joint stability.

   • Corrective Exercises: Address biomechanical issues like flat feet or overpronation with orthotics or exercises.

3. Medications

   • Non-steroidal anti-inflammatory drugs (NSAIDs) for pain and swelling.

4. Corticosteroid Injections

   • Reduces inflammation in severe or persistent cases.

Surgical Treatment

• Rarely required, but bursectomy (removal of the bursa) may be considered in chronic cases.

Recovery and Prognosis

• With appropriate treatment, most individuals recover within a few weeks to months.

• Ongoing strengthening and stretching can prevent recurrence.

Preventing Pes Anserine Bursitis

• Maintain a Healthy Weight: Reduces strain on the knee joint.

• Stretch Regularly: Focus on hamstrings, quadriceps, and calves.

• Wear Proper Footwear: Supportive shoes or orthotics to correct alignment issues.

• Gradual Progression in Activities: Avoid overloading the knee with sudden increases in intensity.

If you’re experiencing knee pain or suspect pes anserine bursitis, the team at Palms Physiotherapy & Allied Health can provide personalised care to support your recovery.