Understanding Pes Anserinus Bursitis: Healing Through Targeted Physical Therapy
In Latin, “pes anserinus” (which means “goose’s foot”) describes the conjoined tendons of the sartorius, gracilis, and semitendinosus as they insert on the anteromedial proximal tibia1. The pes anserinus bursa lies beneath the conjoined tendons. Periodically, the bursa acts as a cushion between the medial collateral ligament (MCL) and the conjoined tendons2. The bursal sac under the pes anserinus becomes inflamed when someone has pes anserine bursitis. This condition primarily affects middle-aged and overweight women. The hallmark of pes anserinus bursitis is discomfort at the pes anserine insertion, which is usually brought on by stair climbing or getting up from a seated posture. Repetitive stress or direct damage to the pes anserine bursa are common causes of pes anserine bursitis. Excessive pressure from tight hamstrings causes mechanical and friction-based inflammation of the bursa. The inflammation may get worse after direct damage. The ailment is intimately linked to several knee diseases that can cause hamstring spasms, including patellofemoral arthritis, suprapatellar plical irritation, and Osgood-Schlatter syndrome. Inflammation of the pes anserine bursa usually results from pre-existing knee conditions, especially osteoarthritis. Tissue damage is caused by mechanical stress, which is made worse by motions like climbing or descending steps. Localized inflammation of these tendinous structures may result from disturbances to the medial meniscus or MCL in the knee joint, and this inflammation may spread to the anserine bursa3.
If you are suffering from pes anserinus bursitis you may feel
- Pain at medial & posterior side of knee joint.
- Difficulty in stair climbing & descending.
- Presence of swelling.
- Deviations in gait3.
A comprehensive assessment is the first step a physical therapist will do to identify Pes Anserinus Bursitis. Talking about your past medical history, your present symptoms, and any activities that could have caused or exacerbated the pain are all included in this. After that, the therapist will do a physical examination to see whether there is any swelling, pain on the medial (interior) side of the knee, or restrictions in strength or range of motion. Also physical therapist will use lower extremity functions scale for outcome measures. Also checking for hamstrings tightness is important in this condition. The goals of physical therapy treatment for Pes Anserinus Bursitis usually include lowering inflammation and discomfort while also treating the underlying causes of the condition. Mostly treatment starts with ice application and activity modification. The goal is to reduce or temporarily avoid activities that place excessive strain on the knee and aggravate the condition. A personalized strategy will be developed by a physical therapist based on your individual symptoms, degree of activity, and any underlying biomechanical problems. The regimen may start with pain relief techniques like applying ice and doing light stretches, then go on to specific strengthening exercises for the quadriceps, hamstrings, and other muscles surrounding the knee. One of the first and most successful treatments for Pes Anserinus Bursitis pain and inflammation management is ice application. In order to limit swelling and numb the afflicted region to relieve discomfort3. Stretching activities are essential for treating Pes Anserinus Bursitis because they increase knee flexibility and relieve stress in the surrounding muscles. The hamstrings, quadriceps, and adductors are important muscles to stretch since tension in these regions can put more strain on the pes anserinus region. According to Bernadry j hamstrings stretching is 85% to 90% beneficial in initial stage. Along with this strengthening exercises will play an important role in this condition. since they lessen strain on the injured region and aid in strengthening stability around the knee. To improve overall alignment and lessen the pressure on the pes anserinus tendons, the emphasis is on strengthening the muscles that support the knee joint, specifically the quadriceps, hamstrings, core and glutes muscles. According to patil A et al; one of strongest muscle in the body is the gluteus, and strengthening it together with the other core muscles will assist in stabilization of the pelvis, rectify the knee biomechanically, and lessen excessive loading on the knee. So, Physical therapy provides a thorough and efficient method of treating Pes Anserinus Bursitis. With the right guidance and commitment, you can regain your mobility and enjoy a pain-free, active lifestyle once again.
References:
1. Alvarez-Nemegyei J, Canoso JJ. Evidence-Based Soft Tissue Rheumatology IV: Anserine Bursitis. J Clin Rheumatol. 2004 Aug;10(4):205-6
2. Cohen SE, Mahul O, Meir R, Rubinow A. Anserine bursitis and non-insulin dependent diabetes mellitus. J Rheumatol. 1997 Nov;24(11):2162-5
3. Mohseni M, Mabrouk A, Li DD, et al. Pes Anserine Bursitis. [Updated 2024 Jan 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532941/#
4. Bernardy, J. (2009). Quad Strengthening and Hamstring Stretching as a Treatment of Pes Anserine Bursitis.
5. Patil, A., Dass, B., Hotwani, R., Kulkarni, C. A., Naqvi, W. M., & Wadhokar, O. C. THE BIO-MECHANICAL CORRECTION EXERCISES IN PES ANSERINE BURSITIS. Knee, 2, 5.
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