03/08/2020
🔈 PES ANSERINE BURSITIS
Pes Anserine Bursitis causes pain on the inner side of the knee, approximately 2-3 cms below the knee joint. It typically affects athletes especially runners and swimmers due to overuse, or overweight middle aged females due to increased pressure through the bursa.
Pain from pes anserine bursitis usually develops gradually rather than suddenly and tends to get worse with activities such as stair climbing and running. There are a number of things you can do to aid the healing process and stop the problem from coming back.
Here we will look at the causes and symptoms for pes anserine bursitis to help you make a full recovery.
➡️ What Is Pes Anserine Bursitis?
Pes Anserine Bursitis is when there is inflammation of the pes anserine bursa, causing medial knee pain.
The pes anserinus is an area on the medial (inner) side of the knee where three muscle tendons attach to the tibia (shin bone).
Pes anserinus means “goose’s foot” and it gets its name from the webbed-foot shape made by these three tendons where they join together forming one tendon and attach to the shin bone. From front to back they are:
The Pes Anserine Bursa sits underneath the conjoined tendon of sartorius, gracilis and semitendinosus.
1) Sartorius: the longest muscle in the body which runs across and down the front of the thigh helping to bend the knee and hip
2) Gracilis: a hip adductor (draws the leg inwards)
3) Semitendinosus: one of the three hamstring muscles that work together to bend the knee
Sitting underneath this conjoined tendon is the pes anserine bursa, a small sac filled with fluid. The bursa is there to reduce friction between the tendon and the tibia as the knee moves by providing cushioning and allowing smooth gliding movements of the tendon without any friction.
➡️ What Causes Pes Anserine Bursitis?
Repetitive stress or friction over the area results in inflammation of the pes anserine bursa. The bursa produces excessive fluid and thus swells, placing pressure on the surrounding structures. The most common causes of pes anserine bursitis are:
1) Repetitive Stress
Activities where the three muscles are being used repetitively, such as in running (particularly uphill), cycling, swimming (particularly breaststroke), and side-to-side movements can cause friction and pressure on the bursa.
2) Muscle Weakness/Tightness
Weakness and/or tightness in the hip and knee muscles can place increased tension on the pes anserine tendons which damages the tendon itself and increases pressure on the bursa. Tight hamstrings are a common cause of pes anserine bursitis.
3) Poor Training Techniques
Training errors such as sudden increases in distance or intensity, not warming up and inadequate stretching can over stress the area.
4) Other Medical Conditions
Joint inflammation associated with arthritis can cause swelling of the bursa. Studies have shown that approximately 20% of people with osteoarthritis of the knee suffer from pes anserine bursitis. People with Type 2 Diabetes or Osgood Schlatters are also more likely to develop bursitis.
5) Gender
Pes anserine bursitis is more common in women, due to a wider pelvis and the angle of the knee joint.
6) Altered Biomechanics
Subtle changes to the position of the leg bones and soft tissues, such as flat feet or a turned out foot can place extra pressure on the Pes Anserine region
7) Obesity
More weight goes through the area increasing the pressure on the bursa
8) Trauma
A direct injury such as a blow to the pes anserinus area can lead to swelling of the bursa
Pes anserine bursitis is often accompanied by tendonitis where small tears develop in the pes anserine tendon. It is hard to clearly distinguish between the two problems, but the causes, symptoms and treatment are basically the same for both.
➡️ Symptoms of Pes Anserine Bursitis
1) Pain
The most common symptom of pes anserine bursitis is pain and tenderness on the inner side of the knee approximately 2-3 inches below the joint.
Symptoms of bursitis tend to build up gradually rather than suddenly. People often complain it hurts more when they exercise or go upstairs, with resisted knee flexion or when they stretch their hamstrings.
2) Swelling
When the pes anserine bursa is inflamed, there will often be some swelling and redness over the area and the inner side of the knee may feel slightly warm to touch.
3) Sleep Disturbance
Sleep is often affected by knee bursitis, particularly if you sleep on your side with your legs together placing pressure on the bursa. You may be woken by pain when you roll over as you bend or straighten the knee. It can help to sleep with a pillow between your knees to provide some cushioning to the pes anserine bursa.
4) Weakness & Stiffness
Pain from pes anserine bursitis often limits movement so the knee gradually loses strength and range of movement. Stiffness and weakness develop which can then make it more painful to move.
Symptoms may develop suddenly if there has been a direct blow to the knee, but it is worth considering other possibilities such as an MCL sprain if the pain develops suddenly.
Treatment for Pes Anserinus Bursitis will be discussed in the next post, so stay tuned.
