PES ANSERINE BURSITIS

Pes Anserine Bursitis:

             Pes anserine bursitis (tendinitis) involves inflammation of the bursa at the insertion of the pes anserine tendons on the medial proximal tibia.

The pes anserine or goose's foot is composed of the sartorius, gracilis, and semitendinosus tendons.The superficial medial collateral ligament inserts onto the proximal tibia deep to the pes insertion.Symptoms include medial pes swelling, pain to touch, warmth, and pain with hamstring activation.

The cause is usually overuse. Treatment involves modification of activities, icing, and stretching. Conservative treatment usually resolves this condition. 

Signs and symptoms

Acute trauma to the medial knee, athletic overuse, chronic mechanical (pes planus) process or degenerative process.

Pain, tenderness, and localized swelling over the medial knee.

Worse on ascending and possibly, descending stairs and when rising from a seated position; typically deny pain with walking on level surfaces.

May have chronic, refractory pain in setting of arthritis or obesity. More common in sports requiring side-to-side movements and cutting. May have coexistent medial collateral ligament pathology (tenderness superior and posterior to the pes bursa).

Bilateral symptoms in one third of patients.

Physical Examination:

a) Observation - Localized swelling present

b) Palpation

• Tenderness over the proximal medial tibia at the insertion of the pes anserine, approximately 2 to 5 cm distal to the anteromedial joint line.
• Bursa usually not palpable unless effusion and thickening present.
• Crepitus over the bursa occasionally present.
• Absence of joint line pain.
• Exostosis (a benign outgrowth of cartilaginous tissue on a bone) of the tibia may contribute to chronic symptoms in athletes.

c)Range of motion - May have pain with resisted internal rotation, resisted flexion, and valgus stress (especially in athletes). 

Exercises for pes anserine bursitis

Stretching of Quadriceps: This can be performed in either standing, or laying on your front. Pull the foot of the injured leg towards your buttock until you can feel a gentle stretch on the front of the thigh. To increase the stretch, tilt your hips backwards. Hold for 20-30 seconds and repeat 3 times.
Stretching of sartorius, gracilis, and semitendinosus tendons is very useful.

Calf Stretch: 

Keep your right leg forward, foot flat on the floor, and extend your left leg straight back, placing your heel flat on the floor. Don't bend your back knee. Lean into the wall until you feel thestretch in the calf of the straight leg. Hold for 30 seconds and switch sides

Butterfly stretch- seated adductor stretch. Passive and active stretching can promote an important reduction in the tension on the anserine bursa.

Heel Slides- Slowly begin to slide your heel toward your buttocks, keeping your heel on the floor or bed. Your knee will begin to bend. Continue to slide your heel and bend your knee until it becomes a little uncomfortable and you can feel a small amount of pressure inside your knee. Hold this position for about 6 seconds.

Isometric Hamstrings- 

Aim: The aim of this exercise is to start strengthening the hamstrings and prevent wasting.

Technique:The patient lies on their front with the knee slightly bent. The therapist grasps around the back of the ankle. The athlete tries to bend their knee against the therapists resistance. Start with a gentle contraction and gradually increase force as pain allows. The knee should not move. 

Isometric Quadriceps:

EXERCISES FOR PES ANSERINE BURSITIS