Physical Therapy for Pes Anserine Bursitis and Tendonitis

If you have knee pain, you may benefit from the skilled services of a doctor of physical therapy (DPT) to help you manage your pain and return to your previous level of function. Pain on the inside, or medial, part of your knee may be a condition called pes anserine bursitis and tendonitis.

What Is the Pes Anserine?

The pes anserine is an anatomical name for the place where three tendons insert into your shin bone. The tendons form the shape of a goose's foot, and the name pes anserine translates to "goose foot." Three tendons make up the pes anserine insertion. These are:

• The sartorius tendon
• The gracilis tendon
• The semitendinosis tendon of your hamstring

The three tendons that comprise the pes anserine arise from three different areas of your hip, and they perform three different actions to your knee and thigh. This makes accurately assessing and treating pes anserine tendonitis and bursitis challenging.

Underneath the three tendons of the pes anserine is a bursa, a fluid-filled sac that helps the tendons glide and slide over your shin bone easily. This bursa may become inflamed and irritated, causing pes anserine pain.

Where It's Felt

When you have pes anserine bursitis or tendonitis, pain is usually felt on the inner aspect of your knee joint, just below the joint line. Sometimes, the pain wraps around to the medial and front part of your shin bone.

Causes

Pes anserine bursitis is usually caused by repetitive stress and strain to the pes anserine insertion. This typically occurs in runners who have increased their training intensity too quickly, but it may also occur in athletes as an overuse injury.

Occasionally, pes anserine irritation can occur from a direct blow to the inner aspect of your knee.

Physical Therapy

If you are having pain in the inside part of your knee/leg, and suspect you have pes anserine bursitis, your healthcare provider may refer you to a physical therapist for evaluation and treatment. You may also be able to visit your PT via direct access, which means you can directly go to a PT for treatment without a prescription from a physician.

Components of the PT evaluation for pes anserine problems include, but are not limited to:

• History taking. Your physical therapist will ask you questions about how your pain began, how it is changing, and about what activities increase or decrease your symptoms. Your PT should also ask you about previous episodes of medial knee pain and about other treatments you have tried for your pes anserine bursitis.
• Palpation. Palpation involves using hands to touch anatomical structures during a PT evaluation. Your PT will palpate the area of your pes anserine to determine if the bursa and tendons are inflamed.
• Knee and hip range of motion (ROM) measurements. Your physical therapist may use a goniometer to measure the ROM of your knee and hip joints.
• Flexibility measurements. Typically, tightness in hamstrings, hip, or thigh muscles may predispose you to pes anserine problems. Your physical therapist may measure the flexibility of various muscle groups to assess if tightness may be causing your pes anserine bursitis.
• Measurement of lower extremity strength. Occasionally, weakness in your hip muscles may place your knee in an awkward position during running, walking, or jumping. This position of your knee may increase stress and strain around your pes anserine and can lead to irritation there.
• Balance assessment. A decrease in balance and proprioception awareness may place increased stress around your knee joint, and this stress may irritate the pes anserine tendons and bursa, leading to medial knee pain. Your PT will perform special tests to evaluate your balance and determine if this may be contributing to your problem.

Once your physical therapist gathers information about your condition during the initial evaluation, a focused treatment plan can be implemented to help you decrease your pain and return to your previous level of activity.

Treatments

Your physical therapist can offer many different treatments to manage your pes anserine bursitis and tendonitis. These may include:

Exercises. Exercise is one of your main tools to manage your pes anserine bursitis. Your PT will likely have you perform exercises in the clinic, and he or she may prescribe a home exercise program for you to work on during your rehab. Typical exercises for pes anserine bursitis include:

• Flexibility exercises. The pes anserine insertion is from three different muscles, so your flexibility exercises may include different stretches. Typically, stretches for your hamstrings, hips, and thighs, and your groin are recommended to help improve the mobility of the muscles and tendons that comprise the pes anserine.
• Strengthening exercises. During your PT evaluation, your therapist may have discovered different muscle groups that may be weak and that may be contributing to your problem. He or she may prescribe exercises to strengthen muscles around your knee (like the short arc quad). Hip strengthening exercises may be necessary to help you better control the position of your thigh and knee to minimize stress around your pes anserine.
• Balance exercise. If your therapist feels that poor balance and proprioception may be contributing to your pes anserine bursitis, he or she may prescribe specific exercises to help you improve your balance. You may use a BAPS board or wobble board in the PT clinic, and specific balance exercises may be prescribed for your home exercise program.

Physical modalities. Your physical therapist may help manage your pes anserine pain using physical modalities like ice or heat. Sometimes, ultrasound may be used to help improve local circulation around your pes anserine. 

Caution should be used with passive physical modalities—many studies have shown little or no effect in using these treatments. If your PT does use passive treatments for your pes anserine, make sure that he or she also includes active treatments, like exercise, that you can do to manage your condition.

Activity modification. Your physical therapist can tell you what to do when you have pes anserine bursitis, and he or she can also tell you what to avoid. By modifying your activities, and temporarily stopping the activity causing your problem, you can quickly get rid of your pain. Your PT can also help you devise a plan to return to your normal activity level without causing your pes anserine pain to return.

If you have pes anserine bursitis or tendonitis, your physical therapist is a great resource to help you manage your pain and to implement strategies to keep the pain away. He or she can help you quickly and safely return to your previous level of activity if you are dealing with pes anserine bursitis.