Two adjacent bones create a joint, and most of them are mobile and require complex structures to prevent wear down of the bony ends. The bursa is one of such structures, which surrounds the articulations and contain liquid that provides cushioning and reduces friction.
Pes anserine bursitis is the inflammation of a very specific bursa that serves as a cushion between the tibia and the tendons of the hamstring. This bursa is located deep within the knee, and it usually accumulates excessive fluid, applying pressure upon the adjacent structures and causing knee pain.
But what causes pes anserine bursitis, how can you detect this condition and what can you do about it?
Causes of pes anserine bursitis
Most cases of bursitis result from overuse or constant friction between two or more articulations. Therefore, this is a common problem in runners and other athletes. More specifically, pes anserine bursitis is usually caused by one of these factors or a combination:
- Tension in the hamstring muscle: Sustained tension in the hamstring muscle is a common cause of pes anserine bursitis because the hamstring tendons are in close contact with this bursa. This tension appears, for example, if you run uphill for a very long time.
- Inappropriate training techniques: Athletes with pes anserine bursitis usually have in common an inappropriate technique or the habit of not stretching before a run.
- Obesity: It is a risk factor for pes anserine bursitis because all of the excess weight is loaded upon the knee articulation.
- Osteoarthritis of the knee: It is another important risk factor. Most older adult patients and some athletes with pes anserine have developed osteoarthritis of the knee.
- Medial meniscus tear: Any tearing of the medial meniscus can cause instability of the knee articulation, leading to pes anserine bursitis.
- Violent movements of the knee: In some cases, very violent movements of the leg or knee can cause pes anserine bursitis, especially when it involves an out-turning of the knee.
Signs and symptoms of pes anserine bursitis
As mentioned above, one of the main symptoms of pes anserine bursitis is knee pain. This knee pain is located precisely at the center of the tibia (shinbone), 2 or 3 inches below the lower end of the knee joint. It is described as a deep pain, that develops on the inside of the knee. It increases when you’re climbing stairs or exercising your legs, and usually improves with rest and ice. Other aggravating movements include squatting, kicking, pivoting, and performing quick movements from one side to the other.
The pain is usually spontaneous, and the region of the knee may or may not appear swollen. It is almost always tender, though. Additionally, your doctor may need to evaluate your gait to evidence gait deviations, and you might also experience a decrease in muscle strength on the affected side. The range of motion and biomechanics of the knee are also affected, which can be evaluated by a specialist in a physical exam.
As you can see, the symptoms are not very specific. They can also overlap with another knee condition. Thus, sometimes pes anserine bursitis remains undetected. However, it is estimated that 100 people out of 10,000 may develop bursitis, and it is accompanied by osteoarthritis in 90% of the cases.
What can you do about it?
Treatment for pes anserine bursitis should include anti-inflammatory medications such as ibuprofen or aspirin, but may also require anesthetic injections or steroids into the bursa. This treatment approach is more effective to treat pain but should be applied by a specialist.
There is much you can do at home if you suspect or were diagnosed with pes anserine bursitis:
- Rest: This is perhaps the most important advice. Remember that the pes anserine bursa is associated to your hamstring muscle. As such, any hamstring activity can contribute to the inflammation and pain. So, discontinue any activity that targets the hamstring muscle.
- Ice: Along with rest, doctors recommend ice to reduce the pain and control the inflammation. You can apply cold temperatures 4 times a day for 20-minute sessions, but be careful not to apply ice directly to the skin. Use a towel or piece of fabric instead, or buy one of those gel compresses you can place in the refrigerator and then place over the affected area.
- Physical therapy: You should rest but that doesn’t mean you should do nothing at all. Ask your doctors what type of exercise he recommends. You may be recommended to undergo physical therapy with special exercises and sometimes ultrasound treatments.
- Weight loss: If you’re overweight or obese, consider losing weight as a long-term approach to relieve pes anserine pain symptoms.
In some cases, pes anserine bursitis does not improve with the treatment measures described above. After trying every other alternative without significant improvements, your doctor may also recommend an orthopedic surgery.
This OSMO Patch and the necessary adequate rest will provide an effective and complementary way to support your relief of inflammation and pain associated with pes anserine bursitis.
Conclusion
Pes anserine bursitis is an inflammatory condition of the bursa that surrounds the tibia and the tendons of the hamstring. It is usually triggered by repetitive motions or underlying conditions of the knee, especially osteoarthritis.
The main symptom is knee pain, located below the articulation of the knee, and aggravated with exercise that involves the hamstring muscle. It can be relieved by resting the articulation, applying ice, and using over-the-counter anti-inflammatory drugs such as ibuprofen. However, serious cases may require steroid injections in the articulation and sometimes an orthopedic surgery.
For long-term relief of pes anserine bursitis, it is recommended to maintain a healthy weight, stretch before running and activating the hamstrings, and strengthening the quadriceps muscle to counter the effects of a tense hamstring.
References:
Mohseni, M., & Graham, C. (2019). Pes Anserine Bursitis.
Rennie, W. J., & Saifuddin, A. (2005). Pes anserine bursitis: incidence in symptomatic knees and clinical presentation. Skeletal radiology, 34(7), 395-398.
