Pes Anserine Bursitis

Explanation of Diagnosis

Pes anserine bursitis is irritation and inflammation of a small fluid-filled sac (the bursa) on the inner side of the knee, where several tendon structures meet. It often develops after repetitive stress, overuse, or changes in walking, running, stairs, or training surfaces. Common symptoms include aching or tenderness along the inner knee, pain with stairs or standing up from a chair, and sometimes mild swelling or warmth. It may feel worse when the knee is bent for long periods or after a heavier-than-usual activity day.

Specific Work Modifications

• Avoid prolonged standing; shift positions often and sit when possible every 20 to 30 minutes.
• Limit frequent stair climbing and carry loads that force you to use the painful leg more.
• Choose supportive, cushioned footwear and consider adding an insert if your shoes feel worn or unstable.
• Use a knee-friendly desk setup: keep your knee position comfortable and avoid deep knee bending for long stretches.
• If your job involves kneeling, use a kneeling pad and take short breaks rather than staying in one position.
• When walking between tasks, take shorter steps and slow down during flare-ups.

Specific Activity Modifications

• Reduce running, jumping, and quick direction changes until inner-knee pain is clearly calming.
• Swap high-impact workouts (running, plyometrics) for low-impact options like cycling with moderate resistance or swimming.
• Limit long-distance walking and deep knee flexion activities (deep squats, lunges, and long holds) during a flare.
• On stairs, use a slower pace and hold a rail when needed; consider alternating step patterns only if it feels comfortable.
• If cycling aggravates symptoms, raise the seat slightly and shorten sessions to pain-free ranges.

Recommended Supplements

• Omega-3 fish oil, 1 to 2 grams per day of combined EPA and DHA, may help support a more balanced inflammatory response.
• Curcumin (turmeric extract), 500 to 1,000 mg per day, may help with inflammation-related discomfort for some people.
• Vitamin D3, 1,000 to 2,000 IU per day if you are often low or have limited sun exposure, may support musculoskeletal health.

Recommended Nutrition and Hydration

Diet Recommendations

• Aim for a diet rich in colorful vegetables, fruits, and lean proteins to support tissue repair.
• Include healthy fats (olive oil, nuts, fatty fish if tolerated) to help overall inflammation balance.
• Choose whole grains and high-fiber foods to support general recovery and energy.
• If weight-bearing symptoms are an issue, gradual weight optimization through sustainable eating can reduce load on the knee over time.

Hydration Tips

• Drink regularly throughout the day and especially before and after activity to keep tissues and joints supported.
• Use fluids consistently rather than “catch-up” drinking after you’re already thirsty.

Home Exercise Prescription

Do these exercises about 4 to 6 days per week, stopping any activity that sharply increases pain.

1. Gentle pain-free range of motion for the knee: Sit and slowly bend and straighten the knee within a comfortable range, 10 to 15 repetitions.
2. Isometric knee contraction (pain-limited): With the knee slightly bent, tighten the thigh muscle without moving the knee, hold 10 seconds, repeat 8 to 12 times.
3. Calf wall stretch: Place hands on a wall, stretch the calf with the back leg straight, hold 20 to 30 seconds each side, repeat 2 to 3 times.
4. Hamstring stretch (gentle): Sit with the leg comfortably extended and hinge forward slightly until you feel a mild stretch, hold 20 to 30 seconds each side, repeat 2 times.
5. Hip abductor activation (side-lying or standing): Lift the painful-side hip slightly away from midline without rolling the body, hold 5 to 10 seconds, repeat 8 to 12 times.
6. Optional low-grade mobility: Gentle walking in short, pain-free intervals around your home, 3 to 10 minutes total, as tolerated.

Helpful Books

• "The Knee Owner’s Manual" written by Brett Sears, PT
• "Return to Life Through Contrology" written by Joseph Pilates (for foundational movement principles)
• "Explain Pain" written by David Butler and Lorimer Moseley
• "Move Your DNA" written by Katy Bowman