Welcome to Cambie Physiotherapy and Health Clinic'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
“
I am having a very pleasant experience at Cambie Physiotherapy Clinic . Mr. Tarunbeer Kang, my physiotherapist, is extremely professional and knowledgeable! He helped me to understand my injury and... ”
“ I am having a very pleasant experience at Cambie Physiotherapy Clinic . Mr. Tarunbeer Kang, my physiotherapist, is extremely professional and knowledgeable! He helped me to understand my injury and provided best care. Also, he could constantly adjust the treatment plan based on the condition of my injured knee and leg. Now my leg and knee feel much better.
Besides, Ms. Amanjot and Ms.Amandeep and other staffs in the clinic are very nice and friendly. They are always ready for my appointments, greet warmly to the clients, and help me do the physiotherapy.
I would highly recommend. ”
“
I have a car accident resulted in lots of knee pain and can't bend my knee joints. I came to cambie physio, luckily I met Hardeep Mann, she figured out I have arthritis and plantar femoral syndrome... ”
“ I have a car accident resulted in lots of knee pain and can't bend my knee joints. I came to cambie physio, luckily I met Hardeep Mann, she figured out I have arthritis and plantar femoral syndrome right away and start treating me right away, I recover quickly and able to move around freely without pain. I am a nure and I have experience working with trauma patients before. I can tell Hardeep is very knowledgeable and patience, she helps me to go through this difficult time. The office ladies are very helpful for set up appointments and arranging the right person to see me. I will highly recommend this place and see Hardeep ”
“
This clinic has been amazing in helping my knee recover from some muscle issues. After a few weeks I was able to start making proper use of it again in BJJ. I will continue using this clinic in the... ”
“ This clinic has been amazing in helping my knee recover from some muscle issues. After a few weeks I was able to start making proper use of it again in BJJ. I will continue using this clinic in the future should I have any further injuries
I highly recommend coming here if you need physio. The staff and therapy are top notch! ”
“
Dr. Tarunbeer Kangaroo is very patient and nice person. He takes care of your issue and try his best to help you out. I got a knee pain recently, and after few session, I feel much more better. The... ”
“ Dr. Tarunbeer Kangaroo is very patient and nice person. He takes care of your issue and try his best to help you out. I got a knee pain recently, and after few session, I feel much more better. The place is also easy to access as well. ”
“
INCREDIBLE! I got there with a lot of pain in my knee due a calcification and tendinopathy in the Patelar tendon in the left knee, was struggling for over a year with the injury visited lots of... ”
“ INCREDIBLE! I got there with a lot of pain in my knee due a calcification and tendinopathy in the Patelar tendon in the left knee, was struggling for over a year with the injury visited lots of physios and Doctors and no one could help me, but when I got here physio Hardep Kaur told me she will do everything to help me with my knee, and she explained everything to me about the treatment and procedures because she want it to help me to go back to my activity which is being a professional badminton player, We start with shock wave therapy and manual treatment, after 6 sessions I am almost pain free and my knee feeling amazing good I started doing my activity a couple of days ago and I can only say THANK YOU for everything because I’m Feeling incredible good with no pain patients and doing what I love again without pain thanks to Cambie Physiotherapy at no5 road and thanks to my physio Hardeep kaur for helping me and being so nice to me,taking care of my health and being incredible human caring about the patients, now cambie physiotherapy and Hardeep Kaur Mann will be my place forever Thanks you so much ”
“
INCREDIBLE! I got there with a lot of pain in my knee due a calcification and tendinopathy in the Patelar tendon in the left knee, was struggling for over a year with the injury visited lots of... ”
“ INCREDIBLE! I got there with a lot of pain in my knee due a calcification and tendinopathy in the Patelar tendon in the left knee, was struggling for over a year with the injury visited lots of physios and Doctors and no one could help me, but when I got here physio Hardep Kaur told me she will do everything to help me with my knee, and she explained everything to me about the treatment and procedures because she want it to help me to go back to my activity which is being a professional badminton player,
We start with shock wave therapy and manual treatment, after 6 sessions I am almost pain free and my knee feeling amazing good I started doing my activity a couple of days ago and I can only say THANK YOU for everything because I’m
Feeling incredible good with no pain patients and doing what I love again without pain thanks to Cambie Physiotherapy at no5 road and thanks to my physio Hardeep kaur for helping me and being so nice to me,taking care of my health and being incredible human caring about the patients, now cambie physiotherapy and Hardeep Kaur Mann will be my place forever
Thanks you so much ”
“
Friendly staff!! injured my knee and they’ve helped a lot!!! very knowledgeable. I’ve been seeing Tarunbeer Kang and he’s very helpful and professional!!! 100% recommend ”
“ Friendly staff!! injured my knee and they’ve helped a lot!!! very knowledgeable. I’ve been seeing Tarunbeer Kang and he’s very helpful and professional!!! 100% recommend ”
“
I have been visiting the clinic, Richmond location, for the last few weeks. Very professional and friendly staff. Dr. Tarunbeer Kang is very knowledgeable and competent. His recommendations was very... ”
“ I have been visiting the clinic, Richmond location, for the last few weeks. Very professional and friendly staff. Dr. Tarunbeer Kang is very knowledgeable and competent. His recommendations was very helpful Aman made me feel comfortable during treatments. Direct billing is very convenient.. Very flexible hours. My knee injury is getting much better. Thank you! ”
“
I have been visiting the clinic, Richmond location, for the last few weeks.
Very professional and friendly staff.
Dr. Tarunbeer Kang is very knowledgeable and competent. His recommendations was very... ”
“ I have been visiting the clinic, Richmond location, for the last few weeks.
Very professional and friendly staff.
Dr. Tarunbeer Kang is very knowledgeable and competent. His recommendations was very helpful
Aman made me feel comfortable during treatments.
Direct billing is very convenient..
Very flexible hours.
My knee injury is getting much better.
Thank you! ”
“
Tarunbeer and his team are very knowledgeable, friendly people and Tarunbeer helped me in easing my knee pain The place is very clean with easy access and plenty of parking and have extended hours ”
“ Tarunbeer and his team are very knowledgeable, friendly people and Tarunbeer helped me in easing my knee pain The place is very clean with easy access and plenty of parking and have extended hours ”
“
If you are in any sort of joint pain, NAVJOT is the person to go to. I have had a bad knee pain for the past 3 years and few visits, exercise and correct treatment later I am literally out of pain.... ”
“ If you are in any sort of joint pain, NAVJOT is the person to go to. I have had a bad knee pain for the past 3 years and few visits, exercise and correct treatment later I am literally out of pain. Reasonable charge and in-depth knowledge. Navjot had a perfect plan for my recovery and perfect assessment of my pain. Thank you Navjot :) One of the best physiotherapist I met! ”
“
Great service all around. Tarunbeer Kang really takes the time to listens and suggests everything that might help with great expertise. My knee injury is recovering well ”
“ Great service all around. Tarunbeer Kang really takes the time to listens and suggests everything that might help with great expertise. My knee injury is recovering well ”
“
Excellent clinic. Very professional and friendly staff from minute one. My physiotherapist Hardeep was attentive and I felt safe trusting his guidance. Asked lots of questions and did through testing... ”
“ Excellent clinic. Very professional and friendly staff from minute one. My physiotherapist Hardeep was attentive and I felt safe trusting his guidance. Asked lots of questions and did through testing paid attention to my answers and questions. My LCL knee problem has been getting better now. I recommend this Physio clinic. ”
“
Tarunbeer and his team are very knowledgeable, friendly people and Tarunbeer helped me in easing my knee pain
The place is very clean with easy access and plenty of parking and have extended hours ”
“ Tarunbeer and his team are very knowledgeable, friendly people and Tarunbeer helped me in easing my knee pain
The place is very clean with easy access and plenty of parking and have extended hours ”
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 Cambie Physiotherapy and Health Clinic, 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 Cambie Physiotherapy and Health Clinic have treatment options that will help speed your recovery, so that you can more quickly return to your active lifestyle.
Cambie Physiotherapy and Health Clinic provides physiotherapist services in Richmond.
Our Treatment
Non-surgical Rehabilitation
The goal of Cambie Physiotherapy and Health Clinic 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 Cambie Physiotherapy and Health Clinic, 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.
Cambie Physiotherapy and Health Clinic provides services for physiotherapy in Richmond.
Surgery
Surgery is rarely needed for pes anserine bursitis. The bursa may be removed if chronic infection cannot be cleared up with antibiotics.
