Physical Therapy in Congress Park, Denver Downtown, Central Park, and Highlands Area for Knee
Welcome to Atlas Physical Therapy'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
“
Alex and his staff recently helped me with a knee injury and frozen shoulder. A couple years ago they helped me after my neck surgery. I am very pleased with the results and highly recommend their... ”
“ Alex and his staff recently helped me with a knee injury and frozen shoulder. A couple years ago they helped me after my neck surgery. I am very pleased with the results and highly recommend their services. ”
“
By far the best physical therapists I have ever gone to! Alex and Kate have fixed everything that has come up from foot issues, to knee problems to all the tiny little things that happen during... ”
“ By far the best physical therapists I have ever gone to! Alex and Kate have fixed everything that has come up from foot issues, to knee problems to all the tiny little things that happen during training or just life in general. Lexi and Emma are awesome at making sure im doing exercises correctly and making it fun at the same time. With the help of everyone at Atlas Physical Therapy I was able to complete my first ultramarathon and look forward to completing many other ridiculous goals. ”
“
Very professional people! Nikhil and Frank were respectful and yet personable in my time with them. I went in with a hurt knee that kept me from running. They were very conscientious about my desire... ”
“ Very professional people! Nikhil and Frank were respectful and yet personable in my time with them. I went in with a hurt knee that kept me from running. They were very conscientious about my desire to run again and worked hard to that end. I recommend them highly. ”
“
I have been going to Atlas Physical Therapy for years, alas for different body parts. Each time I have gone, for various body parts (knee, shoulder, and now hip), Atlas has been there for me. You... ”
“ I have been going to Atlas Physical Therapy for years, alas for different body parts. Each time I have gone, for various body parts (knee, shoulder, and now hip), Atlas has been there for me. You won't regret it. Hope to (not) see you there - to your health! ”
“
Brett, will and the team were great to work with. I was rehabbing a knee injury and that were very knowledgeable, helpful and accommodating to my schedule to ensure I got the treatment and care... ”
“ Brett, will and the team were great to work with. I was rehabbing a knee injury and that were very knowledgeable, helpful and accommodating to my schedule to ensure I got the treatment and care needed. After a few sessions I saw great improvement in my knee and back to normal now. We highly recommend based on knowledge and skill alone but also super friendly fun and supportive staff along the way. ”
“
Brett, Will, and the entire Atlas team made my experience a great one. When I began therapy, my knee pain was preventing me from doing the activities I love, but within just a few weeks of treatment,... ”
“ Brett, Will, and the entire Atlas team made my experience a great one. When I began therapy, my knee pain was preventing me from doing the activities I love, but within just a few weeks of treatment, my pain was reduced by at least 75%. Brett and Will did a great job not only challenging me to make progress quickly, but made the experience fun. On top of that, Atlas uses an app for your home exercises that makes your exercises easier to do and rewards you for consistency. Highly recommend! ”
“
I am a runner and runners sometimes get hurt! Alex has magic hands. The man has helped me get through plantar fasciitis on both feet, hip and knee issues and a pulled hamstring! All while keeping it... ”
“ I am a runner and runners sometimes get hurt! Alex has magic hands. The man has helped me get through plantar fasciitis on both feet, hip and knee issues and a pulled hamstring! All while keeping it fun and just being an amazing coach. If something ails you- go see him! He has magic hands and will get you back on track in no time ”
“
Forever grateful for this place and getting my knee back up in order after repeat injuries. I recommend seeing like for any PT needs. Great place for overall recovery in addition to dry needling. I... ”
“ Forever grateful for this place and getting my knee back up in order after repeat injuries. I recommend seeing like for any PT needs. Great place for overall recovery in addition to dry needling. I hope not to spend much time back here but in case I do, it’s handy to have a trusted PT near work in downtown. ”
“
I went to Atlas PT for what ended up being a torn meniscus. While we worked on heeling/getting stronger I had two friends who also torn their meniscus and quickly opted surgery. I had my moments... ”
“ I went to Atlas PT for what ended up being a torn meniscus. While we worked on heeling/getting stronger I had two friends who also torn their meniscus and quickly opted surgery. I had my moments where I wanted to do the same but Alex was super patient with me, making sure I understood my options and then supported me with whatever I choose. Lexi was great as well, showing me new strength building exercises and always took the time to answer questions I had about workouts outside of PT.I will always recommend Atlas PT to friends and family. They are knowledgeable and willing to work around your schedule (early mornings, and some early evenings.) ”
“
Andrea and Nate were such an amazing team in helping me recover from my dislocated kneecap. They are patient, kind, encouraging, and truly cared in helping me make progress in my recovery. They helped... ”
“ Andrea and Nate were such an amazing team in helping me recover from my dislocated kneecap. They are patient, kind, encouraging, and truly cared in helping me make progress in my recovery. They helped me go from 2 crutches, to 1 crutch, to no longer wearing a knee brace/tape, and finally being able to walk normally again within 4 months. I would highly recommend this team to anyone!
This is a really nice, fun office that made me feel good about going in every appointment. I also appreciate Cat's kindness and stellar customer service at the front desk. ”
“
It was all my fault, I waited until my knee tendonitis was so bad I could barely walk. At my age (63) you would think I should know better. But the team at Atlas did a remarkable job of putting me... ”
“ It was all my fault, I waited until my knee tendonitis was so bad I could barely walk. At my age (63) you would think I should know better. But the team at Atlas did a remarkable job of putting me back together. After the third visit I felt substantial improvement. They gave me some new stretches to do on a daily basis, and made some minor modifications to my current exercise program that will prevent this from reoccurring. Of course it was completely up to me to do the stretches and exercises, Luke and Hanna can’t do them for me. But by following their directions I am fully back on my feet and enjoying the summer. ”
“
I worked with Andrea and Nate for almost 3 months to rehab after a meniscectomy. They were great from start to finish, always taking the time to assess progress and constantly tweaking my workout... ”
“ I worked with Andrea and Nate for almost 3 months to rehab after a meniscectomy. They were great from start to finish, always taking the time to assess progress and constantly tweaking my workout regimen to continue challenging me. As an expert Andrea would explain what was going on with my muscles and ligaments and help me understand how certain motions can hurt/help. Nate was fun to talk with while going through the exercises and always took time to make sure the weight and # of repetitions was just right. Highly recommend this place and will be coming back when my other knee needs work, haha. ”
“
My first PT experience was at Atlas! I tore my left ACL during a ski accident a few years ago and decided to get it replaced a year ago. Luke is the bomb and had me up and walking in a month! Also... ”
“ My first PT experience was at Atlas! I tore my left ACL during a ski accident a few years ago and decided to get it replaced a year ago. Luke is the bomb and had me up and walking in a month! Also gives the best advice for what you can/cant do and what you should focus on. Unfortunately I had a year long string of bad luck and tore my right ACL in a bike accident and had replacement surgery and then had my meniscus touched up a few months later. My year long recovery has been at Atlas and they haven’t let me down! Their times are always flexible and the people there are super fun and make the recovery process something to look forward to every week. Matt and Abby were also really fun and helpful and were great at keeping spirits up. I will definitely be coming back!! (fingers crossed I don’t tear anything else though!) ”
“
I opted out of surgery after a traumatic knee injury and the team at Atlas has made my recovery both a successful and a positive experience. Shout out to Dillon, Tommy, and Lexi! Thank you! ”
“ I opted out of surgery after a traumatic knee injury and the team at Atlas has made my recovery both a successful and a positive experience. Shout out to Dillon, Tommy, and Lexi! Thank you! ”
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 Atlas Physical Therapy, we will take a history and do a physical examination. A history and clinical exam will help our Physical Therapist 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 Physical Therapist 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 Physical Therapists at Atlas Physical Therapy have treatment options that will help speed your recovery, so that you can more quickly return to your active lifestyle.
Atlas Physical Therapy provides Physical Therapist services in Congress Park, Denver Downtown, Central Park, and Highlands Area.
Our Treatment
Non-surgical Rehabilitation
The goal of Atlas Physical Therapy 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 Physical Therapist 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 Physical Therapists 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 Physical Therapist 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 Physical Therapist 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 Physical Therapists 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 Atlas Physical Therapy, 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.
Atlas Physical Therapy provides services for Physical Therapy in Congress Park, Denver Downtown, Central Park, and Highlands Area.
Surgery
Surgery is rarely needed for pes anserine bursitis. The bursa may be removed if chronic infection cannot be cleared up with antibiotics.
