Pes Anserine Bursitis is an inflammatory condition affecting a fluid-filled sac, or bursa, located on the inner side of the knee. This bursa sits beneath the tendons of the sartorius, gracilis, and semitendinosus muscles, forming a structure resembling a goose’s foot, which gives the condition its name. When irritated, the bursa swells, causing localized pain, tenderness, and sometimes puffiness below the knee joint line. Discomfort often increases with activities that involve bending the knee, such as climbing stairs or rising from a seated position. Recovery focuses on reducing inflammation and addressing underlying biomechanical causes to prevent recurrence.
Immediate Relief and Self-Care Measures
Initial management focuses on reducing acute pain and inflammation using conservative, non-prescription methods. The R.I.C.E. protocol (Rest, Ice, Compression, and Elevation) is the standard first-line approach. Rest involves avoiding activities that provoke pain, especially repetitive knee bending or high impact movements like running.
Applying a cold pack to the tender area for 15 to 20 minutes several times a day helps decrease swelling and numb the pain. Compression minimizes swelling, and elevating the leg above heart level encourages drainage. Over-the-counter Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), such as ibuprofen, can also manage pain and underlying inflammation.
Medical Interventions and Advanced Treatment Options
When self-care measures do not sufficiently resolve the symptoms, a healthcare provider may recommend more advanced interventions. A common second-line treatment is a corticosteroid injection, which delivers potent anti-inflammatory medication directly into the inflamed bursa. This targeted approach can provide significant and rapid relief lasting several months.
For cases with significant fluid accumulation, the physician may perform an aspiration, using a needle to withdraw the excess fluid. This procedure relieves pressure and can also test the fluid for infection or other conditions like gout. In rare, chronic cases that have failed to respond to conservative and injection therapies, surgical removal of the bursa (bursectomy) may be considered.
Physical Therapy and Targeted Rehabilitation Exercises
Physical therapy addresses the muscular imbalances and tightness that often cause bursitis. A regular program of stretching and strengthening is necessary to alleviate strain on the inner knee. Stretching the hamstring, quadriceps, and hip flexor muscles reduces tension placed on the pes anserine tendons.
Strengthening exercises for the muscles surrounding the hip and knee are important for stability and proper movement mechanics. These include side-lying leg lifts for the hip abductors and adductor squeezes for the inner thigh muscles. A physical therapist can also evaluate gait and foot mechanics, suggesting specialized orthotics or shoe inserts to correct alignment issues.
Strategies for Preventing Future Recurrence
Preventing the return of pes anserine bursitis requires integrating long-term lifestyle and activity modifications. Maintaining a healthy body weight is important because excess weight increases the mechanical load on the knee joint and soft tissues. This reduction in load decreases the risk of future inflammation.
Athletes, particularly runners, should avoid sudden increases in mileage or intensity, especially with hill running. Proper footwear, including custom or over-the-counter orthotics, is important for correcting biomechanical factors like flat feet or a valgus (knock-knee) alignment. Consistently performing warm-up routines and incorporating flexibility and strengthening exercises helps maintain muscular balance and joint health.