Pes Anserine Tendinopathy / Bursitis
Pes anserine injuries are often difficult to distinguish from a Medial Collateral Ligament (MCL) injury due to their close proximity and the possibility of a positive result for MCL injury on a valgus stress test in cases of pes anserine injury.
Symptoms of Pes Anserine Tendinopathy
- Pain over the inner, lower knee.
- Pain on climbing stairs is commonly reported.
- Localised swelling.
- Pain on contracting the hamstrings (bending the knee against resistance).
- Pain on stretching the hamstrings.
- Tightness in the three associated muscles.
Pes Anserine Explained
The Pes Anserine (sometimes called Pes Anserinus or the Goose's foot) is the combined tendon of the Semitendinosus (one of the hamstring muscles), Sartorius (the strap like muscle which crosses the front of the thigh) and Gracilis (one of the long groin muscles). They attach together to the Tibia (shin bone) on the inner part of the lower knee.
In this area there is also a bursa, called the anserine bursa which lies between this combined tendon and the Tibia bone underneath. This bursa may become inflamed due to repetitive friction in sports such as cycling, running and swimming (especially breaststroke). This results in bursitis. Tendinopathy (sometimes called tendonitis) can also occur at the combined tendon and the two injuries may occur in unison.
Treatment of Pes Anserine Tendinopathy
Treatment should be 2-fold to include treating the symptoms and correcting the cause of the injury.
Treating the symptoms is done via conservative methods such as:
- Rest from aggravating activities.
- Cold therapy to ease pain and inflammation.
- Anti-inflammatory medication may be recommended.
- Stretching the hamstring muscles and also the quads and groin muscles if necessary.
- A therapist may apply electrotherapy such as ultrasound.
- Sports massage therapy may be useful to treat the hamstrings.
- If these treatments fail, corticosteroid injections have been shown to be effective.
The second phase of treatment should be to consider what may have caused the injury and to correct the problem. It may be something as simple as having tight hamstring muscles and in which case these should be stretched regularly and sports massage applied to improve elasticity.
Other common causes include:
- Obesity.
- Overpronation.
- Valgus knee deformity - where the knee falls inwards.
