The pes anserine bursa is a small, fluid-filled sac located 2 to 3 inches below the knee joint on the inside of the lower leg. It lies beneath 3 tendons that attach to muscles of the thigh, and prevents the tendons from rubbing on the shinbone (tibia). The term "bursitis" describes a condition where the bursa has become irritated and inflamed. This condition is usually painful and associated with some swelling in the affected area. Certain positions, motions, or disease processes can cause increased friction or stress on the bursa, leading to the development of bursitis.

Pes anserine bursitis can be caused by:

• Repetitive activities, like squatting, stair climbing, and other work or household activities that are often repeated.
• Incorrect sports training techniques, such as a lack of stretching, sudden increases in run distances, or too much uphill running.
• Obesity.
• Osteoarthritis of the knee.
• Valgus positioning of the knee (ie, a “knock-knee” position where the knees angle inward).
• Turning the leg sharply with the foot planted on the ground.
• Injury, such as a direct hit to the leg.
• Tight hamstring (back of the thigh) muscles.
• A tear in the cartilage of the knee.
• Flat feet.

With pes anserine bursitis, you may experience:

• Pain and swelling on the inside of the lower leg, 2 to 3 inches below the knee joint. This pain may also extend to the front of the knee and down the lower leg.
• Pain when touching the inside of the lower leg, 2 to 3 inches below the knee joint.
• Pain when bending or straightening the knee.
• Pain or difficulty walking, sitting down, rising from a chair, or climbing stairs.

Your physical therapist will conduct a thorough examination that includes taking your health history as well as asking you detailed questions about your injury, such as:

• How and when did you notice the pain?
• Did you feel pain or hear a "pop" when you injured your leg?
• Did you turn your leg with your foot planted on the ground?
• Did you change direction quickly while running?
• Did you receive a direct hit to the leg while your foot was planted on the ground?
• Did you see swelling around the knee in the first 2 to 3 hours following the injury?
• Does your knee feel like it is buckling or “giving way” when you try to use it?

Your physical therapist also will perform special tests to help determine the likelihood that you have pes anserine bursitis. Your therapist may:

• Gently press on the inner side of your knee to see if it is painful to the touch.
• Assess the range of motion you have at the knee and hip, as well as the strength of some of the muscles at these joints.
• Observe how you are walking, squatting, and performing other functional and sports-specific tasks as appropriate.

To provide a definitive diagnosis, your physical therapist may collaborate with an orthopedic physician or other health care provider, who may order further tests, such as an x-ray, to confirm the diagnosis and to rule out other damage to the knee.

Your physical therapist will work with you to design a specific treatment program that will speed your recovery, including exercises and treatments that you can do at home. Physical therapy will help you return to your normal lifestyle and activities.

The First 24 to 48 Hours

If you see a physical therapist within 24 to 48 hours of your injury, your therapist may advise you to:

• Rest the area by avoiding walking or any activity that causes pain.
• Apply ice packs to the area for 15 to 20 minutes every 2 hours.
• Consult with a physician for further services, such as medication or diagnostic tests.

Personalized Treatment

Depending on your condition and goals, your rehabilitation plan may include treatments to:

Reduce pain and swelling. Your physical therapist may use different types of treatments to control and reduce your pain and swelling, including ice, heat, ultrasound, electrical stimulation, taping, exercises, and hands-on therapy, such as massage.

Improve motion. Your physical therapist will choose specific activities and treatments to help restore normal movement in the knee and leg. These might begin with "passive" motions that the physical therapist performs for you to gently move your leg and knee joint, and then progress to active exercises that you do yourself.

Improve flexibility. Pes anserine bursitis is often related to tight hamstring (back of the thigh) muscles. Your physical therapist will determine if your hamstring muscles or any other leg muscles are tight, and teach you how to stretch them.

Improve strength. Certain exercises will aid healing at each stage of recovery. Your physical therapist will choose and teach you the correct exercises and equipment to steadily restore your muscle strength and power. These may include using cuff weights, stretch bands, weight-lifting equipment, and cardio-exercise equipment, such as treadmills or stationary bicycles.

Improve balance. Regaining your sense of balance is important after an injury. Your physical therapist may teach you exercises to improve your balance skills.

Speed recovery time. Your physical therapist is trained and experienced in choosing the best treatments and exercises to help you heal, return to a normal lifestyle, and reach your goals faster than you are likely to do on your own.

Return to activities. Initially, your physical therapist may recommend that you reduce or eliminate activities that aggravate your condition for a period of time. Your physical therapist will discuss your goals with you and set up a treatment program to help you meet them in the safest, fastest, and most effective way possible. You may learn specific exercises, work retraining activities, and sport-specific techniques and drills to help you achieve your own unique goals.

Other Treatment Options

Studies have shown that some patients who do not respond to conservative treatment, such as physical therapy, may benefit from medical therapy. Your physical therapist may recommend that you discuss other treatment options with your physician, including surgery. Although surgery is rarely prescribed for pes anserine bursitis, it sometimes is needed. If surgery is required for your condition, you will follow a recovery program over several weeks guided by your physical therapist. Your physical therapist will help you minimize pain, regain motion and strength, and return to normal activities in the safest and speediest manner possible.

Your physical therapist can recommend a home-exercise program to strengthen and stretch the muscles around your knees, upper legs, and abdomen to help prevent the onset or recurrence of pes anserine bursitis. These may include strength and flexibility exercises for the legs, knees, and core muscles.

To help prevent a recurrence of the injury, or prevent its onset if you seek guidance before injury, your physical therapist may advise you to:

• Learn correct knee positioning when participating in athletic activities.
• Follow a consistent flexibility and strength exercise program, especially for the leg and hip muscles, to maintain good physical conditioning.
• Practice balance and agility exercises and drills.
• Always warm up before starting a sport or heavy physical activity.
• Avoid sudden increases in running mileage or uphill running.
• Wear shoes that are in good condition and fit well.
• Maintain a healthy weight.
• Treat and manage diabetes very closely.
• Wear orthotics to reduce flat feet and valgus (knock-knee) positioning of the lower extremities.
• Wear a knee brace to support the knee and reduce strain on the inside of the joint.

All physical therapists are prepared through education and experience to treat pes anserine bursitis. However, you may want to consider:

• A physical therapist who is experienced in treating people with orthopedic injuries. Some physical therapists have a practice with an orthopedic focus.
• A physical therapist who is a board-certified clinical specialist or who has completed a residency or fellowship in orthopedic or sports physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to your condition.

You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when you're looking for a physical therapist (or any other health care provider):

• Get recommendations from family and friends, or from other health care providers.
• When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people who have your type of injury.
• Be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.