Pes anserine bursitis

What it is

Three tendons - sartorius, gracilis and semitendinosus - converge and attach together on the inner shin a few centimetres below the knee joint, with a bursa beneath them. Irritation of that bursa or of the tendon attachment produces well-localised pain in a specific and recognisable spot.

The location is what distinguishes it. Meniscal and arthritic pain is at the joint line; this is a few centimetres below it, on the inner shin. Getting that distinction right avoids a great deal of unnecessary imaging and inappropriate treatment.

What it feels like

• Pain on the inside of the knee, two to five centimetres below the joint line
• Tender to press on a very specific small area
• Worse going up and down stairs and getting out of a chair
• Worse at night with the knees touching
• Aching after walking rather than sharp pain during it

What causes it

Most people have more than one of these at once, and they feed each other. Read the list looking for the two or three that sound like your week rather than for the one true answer — the ones that describe you are the ones worth acting on.

Friction and compression at the tendon attachment

Three tendons converge at one small point with a bursa beneath. Repetitive knee flexion and extension produces friction there, which is the basic mechanism.

Knee osteoarthritis

Strongly associated. Altered knee mechanics in an arthritic knee change how these tendons load, and pes anserine pain is very common alongside medial compartment arthritis.

Being overweight

One of the most consistent associations, through both mechanical load and altered knee alignment.

Knock knees or a valgus alignment

Increases the tension in the medial structures and the load at the attachment. It is a common finding in people with this problem.

Tight hamstrings and adductors

Two of the three tendons come from those groups. Tightness increases the tension at the shared attachment continuously.

A sudden increase in walking, running or cycling

The usual precipitant in athletes. Volume increases beyond the tissue tolerance at a small, highly loaded attachment point.

Weak hip abductors

A knee that falls inward under load increases the strain on the medial structures. It is the same hip weakness that features in most knee problems.

Diabetes

Associated with a higher incidence, along with several other soft tissue conditions.

Being treated as something else

It is frequently attributed to a meniscal tear or to arthritis, both of which are common in the same population. The location of the tenderness settles it.

Who tends to get it

• People with knee osteoarthritis, in whom it very often coexists
• Anyone carrying extra weight
• Middle-aged and older women, in whom it is most commonly diagnosed
• Runners, cyclists and swimmers doing breaststroke
• Anyone with knock knees or weak hip abductors

What makes it worse, and what settles it

The qFIT routine for this

Ready-made routineKnee Pain/Bulletproofing

qFIT already has this one built. It runs massage first, then stretching, then strength — the order that works on a body that is already sore — and every activity in it carries the reason it is there.

The button below opens your Checklist with this routine already selected, so instead of your whole list you land on just its Categories, Targets and Exercises, each with its checkbox, ready to tick as you work through them.

Have more than one problem? Tick yours under My Problems on My Profile and your Checklist's Routine list gains Recommended for my problems — every routine for the problems you picked, merged into one. Your picks stay private; that filter is the only thing they feed.

Get it checked if…

Warmth, redness and fever suggest septic bursitis - urgent

And whatever the body part: chest pain or unusual breathlessness on exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or one calf that is swollen, warm and painful. Any of those, stop and get assessed.

How it usually goes

Most cases settle over six to twelve weeks with stretching, hip strengthening and load management, and the pillow between the knees often produces relief within days. Where it coexists with knee arthritis, treating both together works better than either alone. Corticosteroid injection is effective for persistent cases. The most common reason it lingers is that it was treated as a meniscal or arthritic problem instead.

Prevalence basis: Knee clinic series

Others the same routine covers

These share the Knee Pain/Bulletproofing routine, so the work is the same. If one of them also sounds like you, that is a reason to expect more from it, not less.

This is general information, not a diagnosis, and it cannot examine you. If it matches you, use it to ask better questions of a clinician rather than to replace one.