Pes anserine syndrome

If you are experiencing pain on the inside of your knee, or at the center of your shinbone, then you may be suffering from Pes Anserine Bursitis.

We guide you through the common causes and how you can start relieving and treating your pain.

Krista Bugden Human Kinetics & Rehab Exercise Expert

If the inside of your knee or the center of your shinbone is painful and feels even worse with movement, such as when using stairs, you might be experiencing a condition known as Pes Anserine Bursitis (PAB).

The good news is that only about 1% of the population will experience this problem, and there are several ways in which PAB can be treated. In the long-run especially, specific exercises that target this very type of knee discomfort will be extremely useful to keep the pain at bay.

Keep reading to figure out if you are displaying symptoms of PAB, which causes this type of discomfort, and most importantly, find out the best treatment options and methods for you.

What is Pes Anserine Bursitis?

Bursitis refers to an inflammation of the bursa or the fluid-filled sac that reduces friction between two structures, particularly at a joint, such as the knee. The human body has over one hundred bursae, that are located at the hips, knees, shoulders, and elbows. Since the bursae are located close to moveable structures, they can easily become irritated and inflamed, especially with repeated use.

Pes Anserine Bursa

In the case of pes anserine bursitis, the inflammation develops in the bursa located between the tendons attached to the hamstring muscles, the muscles on the back of your thigh, and the shin bone. When this bursa swells, it may place pressure on parts of the knee, creating pain and discomfort.

Frequently, this condition occurs in conjunction with pes anserine tendinopathy, or inflammation of the tendon. This may happen due to injury of the muscles or tendons, or again, from overuse.

The Signs & Symptoms of Pes Anserine Bursitis

If you have pes anserine bursitis, you might have one or more of the following symptoms:

  • Pain in the inner part of your knee, especially when straightening or bending your knee.
  • Inner knee pain when using stairs.
  • Weakness around the knee.
  • Swelling or tenderness, on or around the inner knee.
  • Limited range of motion due to swelling at the knee.

If you play sports or regularly participate in physical activity, you may also find it hard to perform these movements properly. If you’re experiencing any of the above signs or symptoms, avoid doing any movements that rely on your knees too much, and try resting your knee for a period of time to see if there are any improvements.

Inflamed bursa

If the pain persists, consider doing specific exercises that focus on strengthening the knee area. Injurymap can help you with this! Use Injurymap to track your pain, receive a customized treatment plan, and move towards a speedy recovery. However, if the pain persists or becomes severe, even after targeted exercises, this may be a sign that it’s time to see a doctor or a physical therapist. Learn more about the app here.

What Causes Pes Anserine Bursitis?

PAB is often caused by repeated use or overuse of the knee joint. It’s a fairly common condition in runners, especially when they amp up their training around competition time.

Other causes

  • Poor hip or knee movement and coordination.
  • Incorrect exercise or training techniques.
  • Tight hamstring muscles.
  • Obesity.
  • Osteoarthritis (a type of arthritis that only damages the cartilage and bone around the joints).
  • Other injuries, such as tendonitis, at the knee joint.
  • Muscle imbalances.
  • Improper footwear.
  • Inadequate warm-up or cool down when exercising.
  • Increase in sport intensity, duration, distance, or time, causing the joint and its structures to become overused

Whenever you experience pain, it’s best to halt your activity and rest. This can prevent your condition from becoming worse and allows your body some time to heal.

Recovery Time For Pes Anserine Bursitis

Typically, pes anserine bursitis will heal within 6-8 weeks or sooner, depending on its severity, adequate treatment, or rest. Typically, it is best to stop all activities that involve the knee until the injury has fully healed, and the bursa is no longer inflamed. Failure to do so may result in a longer recovery period, or even other injuries. In other words, there are no shortcuts when it comes to recovery and healing. Taking care of your body is a gradual process, but if you are patient and diligent with your exercises, you will see longer-lasting positive effects and changes to your body.

Treating Pes Anserine Bursitis

While you regain your strength, various treatment methods can help guide your recovery and help you get back in shape. When it comes to PAB, a combination of treatment methods is best. Keep reading to see which ones could work for you.

1. Rest

Rest is probably the first thing you should try. A simple rule to stick to: if it hurts don’t force it, all types of injuries require a certain amount of rest. This is where your body can do its job and heal the affected area. You may need to take a break from certain activities or sports until you’ve made a full recovery. Know that this is in your best interest, and will prevent your pain from worsening, and reduce your recovery time.

2. Ice it!

Ice can help decrease your pain, but remember, it is only a temporary fix. To get the most effective results, ice the affected area for 10-20 minutes at a time, leaving at least 45 minutes in-between applications. The standard recommendation is that you ice your knee three times per day at a minimum. To ensure that you do not stop the blood flow or damage your skin tissue place a cloth in between any ice pack or cold device, and your skin.

3. Over-the-Counter Pain Relievers

Anti-inflammatory and pain-relieving medications can be used during the initial onset of pain. It’s not recommended to take NSAIDs, such as ibuprofen, for longer than 10-14 days. They can cause gastrointestinal and other health issues. Many of these medications can help reduce your inflammation and thus, restore some range of motion.

4. Injections

For more painful types of pes anserine bursitis, your doctor may recommend a corticosteroid injection. This provides almost instant pain relief. However, again, this is a temporary solution and should be used in combination with other treatment options, such as exercise.

5. Exercise

Exercise is essential to help heal most injuries. When it comes to pes anserine bursitis, strengthening and stretching exercises can reduce your pain, improve function, and most importantly, prevent the injury from happening again. Strengthening exercises may focus on the muscles surrounding the knees and hips. Improper movement patterns or weakness of these muscles may lead to injury, including bursitis. The quadriceps, hamstrings, and glutes, are the major muscles that are worked on in a pes anserine bursitis rehab exercise program.

The hamstring muscles are also frequently targeted for stretching exercises, since they are located on the back of your thigh, and help to bend the knee. When the hamstrings become tight, they may pull on surrounding structures, leading to injury and pain. Hamstring stretches are therefore essential to any PAB rehab program.

So now you may be wondering, what does an actual pes anserine bursitis rehab exercise program look like?

Exercises for Pes Anserine Bursitis

  1. Hamstring stretch
    30 sec. x 3 sets

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    • Lie on your back.
    • Bend one leg and use both hands to grab your thigh.
    • Pull your thigh up against your chest, so that it's vertically over you.
    • Then, stretch the knee as much as possible.
    • You should feel a stretch in the back of your leg and knee.
    • Hold the position for 30 seconds and repeat 3 times on both legs.
  2. Hamstring stretch
    30 sec. x 3 sets

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    • Put one foot's heel on a chair.
    • Place the other foot, the foot on which you stand, parallel to the raised leg.
    • Lower the upper body down on the raised leg.
    • You should be experiencing a tightening in the back of your thigh, but at the same time make sure to not stretch your knee out to much.
    • Hold the position for 30 seconds and repeat 3 times on both legs.
  3. Hamstring strengthening with exercise band II
    15 reps x 3 sets

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    • Tie an exercise band to a solid object.
    • Stand with one leg in front of the other with the exercise band around the ankle of the front leg.
    • Stand on the opposite leg and support yourself by placing your hands on a chair if necessary.
    • Pull the leg with the exercise band backward as far as possible.
    • Perform 3 sets of 15 repetitions with each leg.
  4. Squat I
    10 reps x 3 sets

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    • Stand up in front of a chair without touching it.
    • Stand on both legs with your feet slightly apart.
    • Your toes should point straight ahead.
    • Bend your knees slowly to a point where you almost touch the chair.
    • Then slowly go back up.
    • Perform 3 sets of 10 repetitions.
  5. Glute exercise for pelvis stability
    10 reps x 3 sets

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    • Lie on one side.
    • Bend the lower leg to stay stable.
    • Use your arms as support.
    • The upper leg should be straightened out and a little backward in the hip.
    • Turn your toes downwards, and with your heel at the top position slowly lift the leg as far as possible.
    • Your foot should be kept slightly behind the back of the other legs foot.
    • Perform 3 sets of 10 repetitions with each leg.
  6. Glute exercise for pelvic balance
    10 reps x 3 sets

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    • Stand up with an exercise band around both legs at the ankle.
    • Put all your weight on one leg and make sure to keep your hip, knees and toes pointing in the same direction.
    • Lift the other leg, let your toes point forward and slightly inwards towards the other leg, so that your heel is pointing outwards.
    • With your heel pointing outwards, move your leg backwards and out.
    • Keep your body steady by tightening your abdominal muscles.
    • Gather your legs slowly, change leg and perform the same exercise to the other side.
    • Perform 3 sets of 10 repetitions with each leg.

Red Flags: When Should You See a Doctor?

If you’re experiencing a fever, chills, sweating, shortness of breath, or severe pain, seek medical attention. If your pain does not improve over time with treatment or gentle exercise, you should consider booking an appointment with your doctor, because you may have a condition that is more serious pes anserine bursitis. In rare cases, surgery may be required. Usually, this happens if an infection is present or another very serious condition is causing your bursitis.

Start Your Journey Toward a Pain-Free Life Today!

Now that you have found the best solution for you, how can you avoid feeling weak in the knees in the future? The answer is exercise: you must try to regularly stretch and strengthen the knee area, otherwise your muscles and joints will weaken over time and will be more prone to damage.

As we age, our body needs a push now and again, jump-start it first with easy exercises, and with time add different types of exercises and increase the number of sets in your routine.

Once you begin to see the results and to feel the difference it makes, you will appreciate your body and everything it does for you even more. You can do it, and you are not alone! We at Injurymap can help you.

Download the Injurymap app today and receive a treatment plan made just for you, so you can get back to doing all the activities that you loved once again.

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About the author

Krista Bugden has worked as a Rehab Exercise Expert at a physiotherapist clinic in Ottawa, Canada for the past 4 years. She has an Honours Bachelor Degree in Human Kinetics from the University of Ottawa. She uses her extensive knowledge in this area to educate others through well-researched and informative articles. Her passions include helping others and inspiring each person she meets to get the most out of their life.

Cover image (“Best Walking Shoes for Knee Pain for Women”) courtesy of Esther Max, CC BY 2.0, edits have been made to the original image.