04/02/2025
KNEE PAIN? IT COULD BE PES ANSERINE BURSITIS...
Its only when you experience knee pain that you realise how important your knees are to everyday life. Whether your up and down a ladder working on a roof or simply getting out of your office chair, if the movement causes pain in the knee it can be debilitating making it difficult to focus on anything else other than your knee.
Many people think the worst case scenario when they experience knee pain, saying to themselves 'oh no here I am headed for a knee operation or replacement!'
The truth is there are many reasons why someone might experience knee pain some of which could be a thickening of the patella tendon and/or patella tracking. It could be a tendon strain or ligament sprain. Of course as we age there is always the potential for osteoarthritis to occur and we as humans have a tendency to think of the worst case scenario first and foremost.
I used to work with a Doctor of exercise physiology in a rehabilitation clinic in Nedlands WA and he once said to me, 'Mark, ALWAYS conservative measures first!' In other words what he meant by this is that to start with, we don't crack an egg with a sledge hammer because in many, many cases the source of pain is caused by something less sinister than first thought such as a myofascial dysfunction. Myofascial dysfunction is a dysfunction within the muscle or facia or both and if left untreated can cause musculoskeletal physiological changes and dysfunctions.
Every moving joint in the human body has what is known as a bursa. Bursae are fluid filled sacks that reduce friction from the movement of tendons and instead of a tendon rubbing directly on the bone of the joint, the bursa provides a cushion surface for the tendon to glide over. Any bursal inflammation caused by infection must be treated by your GP.
If a person has shortened, tight muscles and these muscles are used regularly on a daily basis, the tendons attached to those muscles will potentially cause constant abnormal pressure on the bursa of a joint. This bursa will naturally become aggravated and eventually could become inflamed being one potential cause of bursitis.
Many people who have bursitis are prescribed treatment with corticosteroid injections to reduce the inflammation, only to have the inflammation return in the same bursa sometime in the future. More often than not this is because we are treating the symptom and not the cause. There is a reason a bursa is becoming inflamed and it could very well be that a shortened, tight muscle or group of muscles is putting pressure on that bursa.
There are 3 muscles that insert or attach on the tibia just below and inside the knee joint (medially). The 3 tendons of gracilis, satorius and semitendinosus insert on the tibia to form the 'pes anserin insertion'. This name is derived from the latin meaning of 'gooses foot' and the anserine bursa protects these tendons against friction.
If you are experiencing persistent medial knee pain (and infection is not suspected) it could very well be that one or all of the pes anserine muscles are to blame and your first port of call should be to ensure these muscles and tendons are not dysfunctional. Remedial treatment can consist of myofascial release, myofascial trigger point work and muscle mobilisation techniques. Oh and of course effective hydration in our hot climate is a must!
I hope you found this post informative and helpful :-)
Take care and look after yourself and each another.
Mark
