Knee pain is common in runners. However, if your pain is inside your knee, you might have pes anserine bursitis or lower hamstring tendonitis. What does pes anserine tendinitis mean, and how do you manage it?
What is the pes anserine bursitis?
Pes Anserine means ‘goose’s foot. It is where the three tendons on the inside of your knee attach to the lower leg. These three tendons of attachment look like a ‘goose’s foot. These three tendons are the sartorius, gracilis, and semitendinosus. Bursitis is just another term for paratendonitis. Therefore, we should treat this condition as tendon swelling or pes anserine tendinitis.
How Does Lower Pes Anserinus Tendinitis Present?
Generally, pes anserine pain is felt at the inside bottom part of the knee, just below the inside (medial) part of the joint. Sometimes, the pain moves up toward the lower hamstring muscles. The pain typically worsens with activity but often becomes worse after training. Occasionally, people report localised swelling at the inside of the knee.
When assessing your knee, it is essential to rule out other causes of pain inside your knee. Additional causes of knee pain on the inside include stress fracture, torn meniscus, patellofemoral arthritis, fat pad impingement, and pain referred from the hip or spine. Remember, not all pain inside your knee is pes bursitis.
Sometimes, pain can be caused by another tendon inside your knee, known as the semimembranosus tendon.
Often, we suggest investigations to confirm changes in pes anserine tendinitis and exclude other causes. Generally, we choose MRI to determine the cause.
Pes Anserine Tendinitis vs. Medial Meniscal Tear
Both conditions cause pain on the inside of the knee. However, in general, there are significant differences between these two conditions. Firstly, pes bursitis usually occurs gradually due to overload, whereas a medial meniscal tear can happen after a twisting injury. Secondly, the pain of pes bursitis is generally lower inside the knee compared to a medial meniscal tear, where the pain is higher at the medial joint line. Sometimes, a meniscal tear causes swelling, locking, or giving way. Generally, most experienced doctors can distinguish between these two conditions.
Pes Anserine Bursitis Causes
This condition is typically caused by repetitive overload of the tendons, resulting in swelling and pain. Patients often report a change in the usual intensity or frequency of running or participating in sports. Sometimes, a fall onto the inside of the knee causes swelling and pain in the pes anserinus.
How to Fix Lower Hamstring Tendonitis
Physiotherapy is the mainstay of treatment for pes anserine tendinitis. Typically, exercise therapy encompasses flexibility, strength, and balance training. Stretches to increase flexibility include exercises for the hamstrings, hips, and thighs. Strengthening often focuses on the knee and hip. Balance exercises on a wobble board or uneven surfaces may help. Finally, correcting lifting and squatting patterns is also essential.
Activity modification is also a crucial component in alleviating symptoms. For example, as symptoms improve, you can gradually resume more running or team sports exercises.
Anti-inflammatory treatments, such as ibuprofen and ice, can help alleviate inflammation.
Finally, shockwave therapy may be beneficial if other simple treatments are not effective.
Is a Pes Anserine Bursitis Injection Helpful?
Yes, an injection can be helpful if you have tried simple treatments without success.
A cortisone injection can help alleviate pain, allowing you to continue with your treatment and sport.
An ultrasound-guided pes bursal injection should be considered for the following patients:
- Pain not improving with physiotherapy or rehab exercises
- Severe night pain
- Pain with low-load activities such as walking or stair climbing
- Pain is preventing you from training for an upcoming marathon or running event
The key with an injeciton is to place the cortisone deep into the pes bursal tendons between the tendons and the tibia bone. Injection should be performed with ultrasound guidance to enhance accuracy and minimise side effects.
After a cortisone injection for pes bursitis, you should rest from activity for about a week. You can restart rehab exercises after a week and run after approximately ten days.
For further details on the pros and cons of cortisone injections, please refer to this recent blog.
How Long Does Pes Anserine Bursitis Take to Heal?
Like most tendon problems, pes bursitis can be slow to recover, taking 3-6 months to recover fully. However, in some cases, early recovery, defined as fewer than six weeks, is possible.
Hamstring tendonitis after TKR
Lower hamstring tendonitis is seen after a total knee replacement (TKR). Generally, it is difficult to know whether pain after a TKR is due to a problem with the implant or another issue, such as infection or tendon swelling. Therefore, we suggest you see your surgeon before considering a tendon as the cause of pain after a TKR.
Other Commonly Asked Questions on Pes Bursitis:
Can I run with pes anserine bursitis?
Yes. But it would be best if you undertook rehab exercises simultaneously.
Will a knee cap brace help with pes anserine tendinitis?
Overall, we recommend trying a kneecap brace for this condition. A brace provides support to the kneecap, which can improve pain from pes bursitis.
Is swimming good for pes anserine tendinitis?
Any aerobic activity that improves the conditioning of the pelvis and lower limb muscles will help pes anserine tendinitis. However, we suggest avoiding breaststroke, as this stroke places more load on the pes bursa tendons.
What about PRP injections for pes bursitis?
PRP, or platelet-rich plasma, is a standard treatment for joints and tendons. We spin blood from your arm to separate the cells from the plasma. Then, we split the plasma and injected it into the target under ultrasound. Although there is no evidence for its use in pes anserine bursitis, we would consider using PRP in cases that fail other treatments, including cortisone injections.
Final Word from Sportdoctorlondon About Pes Anserine Bursitis
Pes anserine bursitis causes pain on the inside of your knee. It is essential to rule out other causes, such as a meniscal tear or a stress fracture. You should always start with simple treatments, followed by an ultrasound-guided cortisone injection if there is no improvement. If you’re thinking about an injection, you should always do your homework first. We recommend finding a doctor who is experienced in ultrasound and injections.
Great information on a non biased platform with no agenda to sell you anything. really good and trustworthy advice from someone who clearly has our best interest at heart.
thanks Doc.
Thanks Lorenzo
Great post, we share this with our patients all the time, would be even better if you could include some stretching and exerceses for them to do 😉
Thanks for the feedback. Yes I agree – more practical exercise points and fewer medical interventions. I’ll make these changes soon. Thanks Lorenzo