What is Pes Anserine Bursitis? The Symptoms & Treatment Options

Pes anserine bursitis (intertendinous bursitis) is a painful knee condition usually felt around the lower and inner part of the knee. The bursa (fluid-filled sac) between the pes anserine (sartorius, gracilis and semitendinosus) becomes inflamed due to overuse, such as running or sports.

According to the Royal Australasian College of Physicians, up to 35% of Australian adults will develop pain in their knees.[1] Of those with knee pain, approximately 2.5% may experience pes anserine bursitis, according to MRI studies.[2] Older women are significantly more likely to develop this condition compared to men.[2]

In Latin, pes anserinus means ‘goose foot.’ This describes the shape of the tendons from the sartorius, gracilis and semitendinosus as they attach into the inner front part below the knee. Underlying these tendons is the pes anserinus bursa which helps the tendons glide over the surrounding structures without catching.

Read on to understand what you should know about pes anserine bursitis; the risk factors, treatment options and expected recovery time.

What is Pes Anserine Bursitis?

Pes anserine bursitis (intertendinous bursitis) is a painful knee condition usually felt around the lower and inner part of the knee. The bursa (fluid-filled sac) between the pes anserine (sartorius, gracilis and semitendinosus) becomes inflamed due to overuse, such as while running or playing sports.

So what is a bursa?

Bursa are fluid-filled sacs that act as a cushion to prevent friction between the bones and other soft tissues.

Pes anserine bursitis occurs when the bursa becomes inflamed due to irritation. Inflammation causes excessive fluid build-up, resulting in swelling and increased pressure in the knee.

It is usually caused by overuse injuries or stress on the bursa. Pes anserine bursitis is common among runners and people with osteoarthritis.

This article will discuss everything you need to know about symptoms, causes, treatments and how you can prevent pes anserine bursitis.

What are the symptoms of pes anserine bursitis?

Symptoms of pes anserine bursitis include pain on the inside of the knee that worsens when running or taking stairs. People may also experience pain at the front of the knee and tenderness and swelling around the area.

Common symptoms of pes anserine bursitis

• Knee pain

• Swelling

• Tenderness

• Pain when bending or straightening the knee

• Pain when performing weight-bearing activities such as walking, sitting down or climbing stairs.

What causes pes anserine bursitis?

Pes anserine bursitis is caused by overuse of the tendons of the hamstring muscles, which attach to the bone just below the knee joint. Repetitive use of the muscles and tendons leads to irritation of the bursa, resulting in pain and inflammation.

Common causes of pes anserine bursitis

• Obesity

• Inefficient running techniques

• Muscle tightness

• Osteoarthritis

• Meniscus tears

• Direct trauma to the inside part of the knee

Sports that increase your risk of pes anserine bursitis

Sports that require constant use of the leg muscles can cause repetitive friction and increase the risk of inflammation of the pes anserine bursa.

• Cycling

• Running

• Swimming

• Football

• Soccer

• Long-distance running

There are a lot of factors that can cause pes anserine bursitis. Other underlying conditions in the knee, such as cartilage damage, can also present with the same symptoms. It is best to have your knee checked for an accurate diagnosis.

How is pes anserine bursitis diagnosed?

Pes anserine bursitis can be frustrating. Pain and swelling around the knee joint can limit your mobility and prevent you from doing what you love to do.

There are several options available when it comes to diagnosing your knee pain as pes anserine bursitis. One of the more common and most recommended by Australian GPs is an assessment from a physiotherapist.

Physiotherapists are highly qualified experts in the field of rehabilitation. They can assess and diagnose musculoskeletal injuries and provide the appropriate treatment for knee injuries.

Assessment from a physiotherapist is similar to visiting a GP. Your consultation will start with a mini-interview about your injury, and your physiotherapist will ask you questions about the details of your knee pain.

After establishing the background of your condition, your physiotherapist will perform a physical assessment and movement screens to determine other factors that might be contributing to your injury and rule out other conditions.

The initial evaluation typically lasts for about 30 to 60 minutes. Your physiotherapist will then create a specific treatment plan based on your assessment to help you recover from injury.

From here, your physiotherapist will give you the details of your treatment program.

This will include:

• Number of treatment sessions

• List of exercises you need to do at home

• Strategies to manage the pain and to prevent worsening of the condition

• Timeline of your total recovery.

How is pes anserine bursitis treated?

Pes anserine bursitis can cause a variety of symptoms that can affect the quality of your life. Pain and limitation in movements of your knee can prevent you from performing your daily activities.

There are several options when it comes to treating pes anserine bursitis. One of the more common and the treatment option referred to by Australian GPs the most frequently is physiotherapy.

Following an initial consultation, your physiotherapist will be in the best position to determine your treatment plan. Pes anserine bursitis is an injury that physiotherapists come across regularly, and the process of treating it is straightforward.

A combination of treatment protocols such as manual therapy, pain modalities, and specific movement exercises will be given to you by your physiotherapist.

Your treatment will focus on controlling inflammation, restoring your mobility and improving the strength of the muscles that support your knee.

Depending on the severity of your pes anserine bursitis, a physiotherapist may provide you with a combination of the following types of treatments:

• Manual therapy - Hands-on treatment used to improve movement and reduce pain and swelling.

• Therapeutic Exercises - Exercises given to correct impairments and improve function and restore the strength of the knee.

• Stretching Exercises - Techniques used to lengthen your muscles, decrease tension and improve range of motion of the knee joint.

• Advice and Education - Professional advice to help you manage the pain and improve your recovery.

• Soft Tissue Massage - A gentle form of hands-on treatment to reduce pain and swelling.

• Strength and Conditioning - Used to optimise recovery and return to a pre-injury state.

Physiotherapy treatment can last for about 30 to 60 minutes. Most patients can feel the difference in just a single session.

Next step - Creating a treatment plan made for you

Your physiotherapist will create a detailed treatment plan that will guide you step-by-step based on your treatment goals to maximise your recovery.

Self-care for pes anserine bursitis

If you think you have pes anserine bursitis, here are the best things you can do and avoid.

Things to do:

1. Rest

The key to controlling the inflammation of the pes anserine bursa is to rest. Limit your activities such as climbing stairs and sports participation. Rest is one of the most critical aspects of your recovery.

2. Use Cold Compress

Cold compress reduces the swelling and pain. Apply a cold compress for at least 15 minutes every 4 hours to reduce inflammation.

3. Elastic Bandaging

An elastic bandage around the knee can help prevent swelling. Just be careful not to increase friction around the area.

Things to avoid:

1. Avoid activities

Limit your activities, such as climbing stairs, and sports participation for a few weeks or until the swelling subsides. Your physiotherapist will guide you towards your recovery and when to return to your usual routine.

Do I need a specialist or surgery?

Surgery is rarely required in the case of this injury. However, if symptoms are not improving then an X-ray of your knee can help rule out severe conditions such as fractures and osteoarthritis. An MRI can also be done to see the extent of damage to other areas of the knee.

Patients can also benefit from steroidal injections in the area of the bursa to control pain and inflammation. This will be prescribed and performed by a medical doctor.

Your doctor may refer you to physiotherapy for further assessment and help you recover faster.

What is the recovery time / prognosis for pes anserine bursitis?

Patients with pes anserine bursitis can make a full recovery within 6 to 8 weeks, depending on the severity of the injury.

Compliance with physiotherapy can significantly improve the overall outcomes of patients and accelerates recovery.

Rest and gradual return to function are essential in the full recovery of patients with pes anserine bursitis.

Can pes anserine bursitis be prevented?

Guaranteeing prevention can be impossible, however there are some things you can do to reduce the likelihood. These tips for prevention are also useful treatment options if you are already in pain.

• Strengthening your leg muscles – increasing the strength of your muscles allows them to be more resilient to injuries.

• Stretching your hamstrings – stretch your hamstrings, quads and calves to prevent tightness.

• Balance exercises - improving the strength of the glutes, core, and leg muscles can effectively enhance your joint mechanics and help reduce the risk of injury.

• Correct your training errors - have your running mechanics assessed by a running coach or your physiotherapist. Avoid sudden increases in running or cycling mileage and uphill running.

• Maintain a healthy weight - maintaining a healthy weight reduces the stress on the knee joints.

Outlook and the main takeaways

Pes anserine bursitis can be a frustrating condition that may cause you to be inactive for at least a few weeks. Pain and swelling around the knee can limit your mobility.

Sufficient rest and optimised treatment is the key to recovering from pes anserine bursitis. Book a consultation and have your knee assessed by a physiotherapist today!

Anatomy of the pes anserine bursa

A bursa is a thin, fluid-filled sack found between bones and other soft tissues around the joints. It serves as a cushion and stops the bones from rubbing against other soft tissues.

The pes anserine bursa is located inside the knee joint between the shinbone and the pes anserine muscles.

Pes anserine muscles or goose feet are the insertions of the following muscles:

• Sartorius

• Gracilis

• Semitendinosus