pes anserine bursitis:
Pes anserine bursitis is an inflammatory condition affecting the pes anserine bursa, located on the medial side of the knee just below the joint line. This condition results in pain, swelling, and tenderness, often exacerbated by repetitive knee movements, direct pressure, or overuse. It is commonly seen in athletes, particularly runners, as well as individuals with osteoarthritis or biomechanical abnormalities.
Anatomy:
The pes anserine region is where three muscles—sartorius, gracilis, and semitendinosus—insert onto the anteromedial tibia. The pes anserine bursa lies between these tendons and the underlying medial tibial surface, reducing friction and providing cushioning. The area plays a crucial role in knee stability and movement, particularly during activities involving knee flexion and rotation.
Physiology and Function:
The pes anserine bursa facilitates smooth movement between the tendons and tibia, reducing stress and friction. The pes anserine tendons contribute to medial knee stability, knee flexion, and internal rotation. Proper coordination of these muscles is essential for maintaining functional knee biomechanics, especially in activities such as running, squatting, and pivoting.
Mechanism of Injury:
Pes anserine bursitis can develop due to:
- Overuse and repetitive stress from activities like running, cycling, or stair climbing.
- Poor biomechanics leading to excessive strain on the pes anserine region.
- Muscle imbalances, particularly weakness or tightness in the hamstrings, quadriceps, or hip stabilisers.
- Direct trauma to the medial knee, such as falls or blows.
- Obesity, increasing pressure on the knee joint and surrounding structures.
- Underlying knee conditions like osteoarthritis, which alter movement patterns and contribute to bursa irritation.
Risk Factors:
Several factors predispose individuals to pes anserine bursitis, including:
- Athletic participation in sports that involve repetitive knee bending (e.g., running, basketball, skiing).
- Improper footwear that affects gait mechanics.
- Poor lower limb alignment, such as genu valgum (knock-knees) or excessive foot pronation.
- Weak or tight hamstrings, leading to compensatory movement patterns.
- Rapid increases in training intensity without adequate adaptation.
- Pre-existing knee pathology, such as osteoarthritis or meniscal injuries.
Signs and Symptoms:
Individuals with pes anserine bursitis commonly present with:
- Pain and tenderness on the medial side of the knee, just below the joint line.
- Swelling and localized warmth over the pes anserine region.
- Pain with knee flexion and extension, particularly during weight-bearing activities.
- Discomfort when climbing stairs, squatting, or running.
- Morning stiffness or pain after prolonged periods of inactivity.
- Tenderness on palpation of the pes anserine bursa.
Physiotherapy Management:
A structured physiotherapy approach is essential for managing pes anserine bursitis effectively. Key strategies include:
- Pain and Inflammation Management
- Rest and activity modification to reduce stress on the affected area.
- Ice therapy to manage swelling and inflammation.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) as recommended by a physician.
- Compression techniques to minimise swelling.
- Manual Therapy
- Soft tissue mobilisation and massage to reduce muscle tightness.
- Myofascial release targeting the hamstrings, sartorius, and gracilis.
- Joint mobilisations if knee or hip dysfunction is contributing to symptoms.
- Exercise Rehabilitation
- Stretching exercises for the hamstrings, quadriceps, and hip adductors.
- Strengthening exercises for the glutes, core, and lower limb stabilisers to improve biomechanics.
- Eccentric training to enhance tendon resilience and function.
- Biomechanical Correction
- Gait analysis and correction of movement patterns.
- Footwear assessment and orthotic recommendations if necessary.
- Hip and core stabilisation exercises to reduce excessive medial knee strain
- Return-to-Activity Plan
- Progressive loading of activities to prevent recurrence.
- Sport-specific drills to ensure readiness for return to play.
- Education on injury prevention strategies, including proper warm-up and cool-down routines.
References:
- Saba, E. K. A. (2022). “Efficacy of neural prolotherapy versus local corticosteroid soft tissue injection for treatment of chronic anserine bursitis: a prospective randomized clinical trial.” Ain-Shams Journal of Anesthesiology, 14, Article 3.
- Saggini, R., Di Stefano, A., Dodaj, I., Scarcello, L., & Bellomo, R. G. (2015). “Pes Anserine Bursitis in Symptomatic Osteoarthritis Patients: A Mesotherapy Treatment Study.” Journal of Alternative and Complementary Medicine, 21(8), 480-484.
- Glencross, P. M. (2023). “Pes Anserine Bursitis: Practice Essentials, Anatomy, Pathophysiology.” Medscape.
- Kang, I., & Han, S. W. (2016). “Pes Anserine Bursitis: An Underdiagnosed Cause of Knee Pain in Middle-Aged and Older Patients.” American Family Physician, 93(3), 170-171.
- “Pes Anserinus Bursitis.” (n.d.). Physiopedia.
