A common complaint, especially among ladies with arthritis in their knees, is pain along the inside of the joint. There are three major muscles which attach there and, as at many muscular attachment sites in the body, there is a large bursa there which can become inflamed causing severe pain.

The pain of pes anserine bursitis is not to be confused with arthritis pain. Typical arthritis pain is sometimes characterized as an achy stiffness rather than a pain, per se. Especially first thing in the morning, your joints feel like they need to be oiled. It takes greater effort to move them, rubbing them helps them feel better and, after a few hours and maybe a warm shower, they feel much better.

The pain of pes anserine bursitis is different. The pain is more superficial; it feels like it is in the tissues alongside the knee rather than in the joint itself. The tissues are very tender to the touch, may feel warm and you may notice a pocket of swelling just below and to the inside of the knee.

To say that you have pes anserine bursitis is not to say that you do not have arthritis in your knee. Sometimes that is the case. In fact, in one study 41 out of 68 patients who were presumed to have arthritis in their knees were actually found to have pes anserine bursitis alone. On the other hand, the chronic inflammation in an arthritic knee along with muscle weakness and sometimes joint deformity contribute to the development of bursitis. Some studies show that 75 percent of folks with degenerative changes in their knees also develop bursitis.

Pes anserine bursitis is more common in women than in men and very common among the obese. It is very common in diabetics though we’re not entirely sure why. One study showed out of 94 diabetics studied, 91 percent of the women had pes anserine bursitis as did 9 percent of the men. Interestingly enough, pes anserine bursitis normally occurs on the right side, but a full third of folks with the condition on one side will develop it on the other.

Lest my younger readers think they are exempt from this particular problem, pes anserine bursitis is very common among running athletes. Soccer and basketball players who do a lot of side-to-side or cutting movements are susceptible. Swimmers can also develop the problem. In fact, another name for pes anserine bursitis is “breast-stroker’s knee.” Athletes need to pay particular attention to the condition since it may indicate an underlying problem with the medial collateral ligament, the ligament which keeps the lower leg from sliding outward.

The pain of pes anserine bursitis can be worse when using stairs, especially when climbing up. You probably have significant pain when you are getting up out of a chair or when getting in or out of the car. Once you are in motion, the pain is not so bad when walking unless you start climbing a hill. Nighttime can also be a problem since lying on your side with your knees resting against each other can be very painful.

Pes anserine bursitis is diagnosed by pressing directly over the bursa, which is about an inch or two below the joint line slightly toward the front from the middle of the knee. Usually there is no significant pain when you are simply swinging the leg forward and back in knee flexion and extension.

As a rule, there aren’t any special studies you need to determine whether you have pes anserine bursitis. X-rays will not show the condition although it certainly will show the degenerative changes of arthritis. An MRI will identify the bursitis, but that is a very expensive test to identify a problem a skilled clinician can discover through palpation and other special tests.

If you think you have pes anserine bursitis, you can try treating it yourself. Because bursitis is an inflammatory condition, you’ll need to take something anti-inflammatory. If your tummy will tolerate them, you can try over the counter medications like aspirin, ibuprofen or naproxen sodium taken according to package directions.

Ice massage is an effective treatment to reduce the localized inflammation. Fill a handful of little water cups with water and put them in the freezer. Twice each day, take down one of your ice cups, peel back the edge of the cup to expose the ice and spend seven minutes rubbing the ice over the painful area.

In between ice applications and before you go to bed at night, slather your knee with a counter-irritant like Ben Gay, Deep Heat or Icy Hot. My personal preference is the smelly stuff, since the unscented varieties don’t seem to work as well for me, but you should use whichever product offers you that soothing, tingling sensation. The warmth these products produce comes from increased circulation in the area. More blood in the area means faster healing. While the warmth of increased circulation is helpful, I would caution you against using a heating pad. Applying heat to an already inflamed area might feel good at the time, but can aggravate the problem.

If you have tried treating your knee diligently for 10 days and there is no improvement, it is time to see the doctor for a referral to your physical therapist. Physical therapy is usually quite successful with pes anserine bursitis. While you are here, we will teach you the stretches and strengthening exercises you will use to help ensure you don’t have a relapse.

ABOUT THE WRITER:

Jackie Randa is a physical therapist who owns Back on Track in Barstow. She can be contacted at jranda@aol.com.