- Kiley Holmes, PT
Pes Anserine Bursitis: The common cause of knee pain that no one talks about
Nobody ever talks about pes anserinus pain, but it’s a real thing that people regularly have unnecessary surgery for.
The Pes Anserinus is located on the inside of your knee, just below your joint line. It is a fluid-filled sac, not unlike the hip bursa, and you should be treating it pretty much exactly the same way.
Pes anserinus is Latin for goose's foot - it actually does look like a goose's foot during dissection. It is a spot on your bone where three muscles, the gracilis, semi-tendinosis, and sartorius all attach - a fluid-filled sac protects those tendons from being irritated by the bone. It's an excellent design, otherwise, that bone would rub up and fray the tendons. It’s great until one of those muscles gets tight/weak and the tendon puts pressure on the bursa and irritates it. This causes that spot on your knee to become painful to any further pressure.
Obviously the course of action is to decrease the pressure of the bursa as well as getting rid of the irritation that originally caused the bursitis. Ice massage and an unloading tape to the Bursa should decrease the pain quickly.
Now that you have taken the pressure off of the bursa you have to figure out why this happened in the first place. There are usually two reasons why this happens:
There is something physically pushing on that Bursa. For instance, you have been wearing a band around that portion of your knee pinching the Bursa (ie. Patellar Tendon Brace), or you had a massage where they really went after that area with some sort of cross friction massage.
Or, more likely, there's some sort of movement issue.
When you take a step forward your foot should be slightly rotated out, not a lot, to the untrained eye it should look straight. However, if the muscles that bring your leg forward are weak your foot will end up toed out significantly more than its supposed to, this is so that you can use your sartorius, gracilis, and semi-tendinosis to walk. It's usually quite easy to catch - they almost kick their foot to the side propelling their leg forward. Often times if this is the case going up the stairs is the worst, the patient literally takes their knee to the side to come up the stairs.
The question is why is this happening, for some reason you're not able to raise your leg up in front of you. It's quite simple, either its mobility, strength, or coordination.
You need to look at your hip or your knee, and your ankle.
For the hip it's easiest to just check flexion by bringing your hip to your stomach, if you're able to bring it up all the way without pain without having to bring it to the side you're fine.
Can you straighten out your knee completely and bend it completely without pain, if so, you can rule out the knee.
For your ankle, keep your foot flat on the ground and see how far you can bring your knee forward, you should be able to bring your knee over your toes without trouble.
Laying on your back with your opposite knee bent lift your leg up to match your bent knee ten times keeping your knee straight and toes facing the ceiling holding for five seconds each time. If you struggled at all with this work on your strength before moving forward, luckily this little exercise is a great way to start.
If you have all of the hip, knee, and ankle mobility and strength, then it has to be coordination. This is going to require a mirror and a lot of patience.
Start with the ball against the wall exercise, by putting a ball between the boniest part of your hip and the wall. Then bring the opposite leg closer to the wall to allow the leg to be right under your hip. Lastly hike your hip to bring the foot closer to the wall off of the ground.
From there you can start with hip flexion/extension and move onto marches all with the leg closest to the wall. Once you feel comfortable with keeping your hip hiked through the exercises you are ready to start practicing stepping, pay close attention to the mirror.
Let me know how these exercises help!
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