Pes anserine bursitis arises due to undue stress
being placed on the area at which the tendons of
gracilis, sartorius, and semitendinosus muscles
attach to the tibia
Examination
Local pain is usually reported at the location
of the bursa itself (where the muscles attach
to the tibia) and palpation of the joint line
above the bursa should reveal no pain
(unless there is another active condition).
The bursa itself is usually not palpable
unless effusion and thickening are present,
however the attachment site of the muscle
can be easily found by palpating the tendon
of the semitendinosus muscle and following
it to its insertion onto the tibia.
Usually, no pain is reproduced with
flexion and extension alone; however,
resisted internal rotation and resisted flexion
of the knee may provoke symptom s.
Valgus stress (outward movement of
the lower leg with the knee stabilised) may
reproduce pain and mimic medial collateral
ligament injuries. However, if the pain is
actually MCL-related then this is usually
posterior and superior (behind and higher)
to the pes anserine.
Proximal swelling in the pes anserine
tendons may indicate active tendonitis and a
snapping of the tendons may occur.
significantly contributing to the problem, it
is possible to provide maximal relief in the
shortest time.
Once symptoms are reduced to a
manageable level, the next step is to assess
the primary cause as to why the muscles
and the bursa may be symptomatic, i.e. what
is happening to cause the dysfunction in the
first place. Training intensity, training type,
footwear, weight gain, joint deterioration,
antagonist muscle activity and body
alignment may need to be considered for
more comprehensive management.
4
5
6
Rehabilitation
Initial management aims to reduce
symptoms. Once the three primary muscles
(gracilis, sartorius, and semitendinosus) are
tested for length and strength, the appropriate
taping (lengthening or strengthening), soft
tissue work, or other modality is provided
relative to these muscles. By being specific
with regards to the muscles that are most
24 | NETWORK AUTUMN 2015
Examples of strength testing for gracilis, sartorius
and semitendinosus muscles
Photos from upcoming Elsevier book Length, Strength and Kinesio Taping by Thuy Bridges
with the inappropriate load and becomes a
source of medial (inner) knee symptoms.
The incidence of pes anserine bursitis
increases with obesity, older individuals
with arthritis, and women more so than men
because of the increased angulation at the
hip and knees due to the broader pelvis.
Genu valgum (knock-knees) and pes planus
(fallen arches or ‘flat feet’) may predispose
the individual to medial knee problems
and degeneration of the knee is frequently
associated with pes anserine bursitis.