Pes anserine bursitis or tendonitis (PATB)

What is it?

Pes anserine bursitis/tendonitis is a painful, inflammatory condition affecting the tendons and/or lubricating sac (bursae) between your shinbone and the hamstring tendons at the inside of your knee; typically caused by stress to the area. Specifically, the pes anserinus is the area where the tendons of 3 muscles (sartorius, gracilis, and semitendinosus) come together. The three tendons merge together in the skin of the bone on the inside surface of the shinbone. The term, pes anserinus means "goose´s foot" in Latin - owing to the webbed-foot pattern the three tendons make when they meet.

About the Pes Anserine

These three muscles are the dominant knee flexors; they influence the rotation of the tibia and protect the knee against rotary stress. Inflammation of the bursae or tendons serving these muscles usually develops due to overuse, trauma, or degradation typically from:

• Tight hamstrings
• Obesity
• Poor sport technique, including improper warm-up, excessive hill work, increased mileage
• Biomechanical issues, such as foot rolling, out-turned knees
• Osteoarthritis
• A medial meniscus tear

Causes

Pes anserine bursitis and tendonitis is common in athletes (particularly runners), overweight individuals, and often, people with osteoarthritis of the knee. The symptoms of pes anserine bursitis include:

• pain located 2 to 3 inches below the kneecap
• swelling in front of the kneecap (prepatellar) or underneath the kneecap (infrapatellar)
• Pain increasing with exercise or climbing stairs
• Pain and often warmth and tenderness when touched
• Pain when bending or straightening the knee.
• Pain that radiates to the back and inside of the thigh
• Visible swelling and/or redness of the tendon sheaths (tendonitis)

It is generally agreed that hamstring tightness is the most common cause of pes anserine bursitis/tendonitis. Athletes and non-athletes alike need to ensure their hamstrings are properly warmed-up and stretched before they place any stress on their knee; from extensive hill running to simply climbing stairs. If you are susceptible to PATB or are suffering from it now, you need to take steps to prevent re-injury or ensure recovery.

Prevention

To prevent pes anserine bursitis/tendonitis, it is important to first eliminate any of the underlying factors contributing to the condition. Ask your doctor or physical therapist to take a look at your gait and your posture to see if there any biomechanical issues that need to be addressed. Secondly, get advice from your physical therapist or trainer on setting a training schedule that fits your ability. Thirdly, but most importantly Stretch and warm up your hamstrings! The easiest and gentlest way to warm-up this area is by using an Inferno Wrap™.

To treat inflamed pes anserine tendons or bursa, you should discontinue the activity impacting the knee immediately and take steps to reduce the inflammation through a URICE treatment protocol; that is Ultrasound, Rest, Ice, Compression, and Elevation. As the inflammation subsides introduce stretching and strengthening exercises aimed at reducing the hamstring tightness and building up the quadriceps in order to better support your knee.

Treatment

Ultrasound is an excellent tool for reduction of swelling and pain when treating the injury. If treatment does not require surgery, rest the area, apply ice for 10-20 minutes at a time for at least 3 times a day. Do this to the injured area for the first day up to 3 days. Moist heat may be used after the acute swelling is improved and rest prevents further muscle injury. Ice will reduces initial inflammation and swelling and the moist heat circulates blood through the area to speed the healing process. This can be further helped by the use of ultrasound applications over the affected area, as it reduces swelling quickly and increases blood flow to the area, helping the tendon heal more quickly.

If stitching of the tendon is required, do not use ultrasound on the area until all scabbing or wounds on the skin surface are gone. On this occurs, regular ultrasound use will "work" the tendon, increasing its flexibility and softening scar tissue in the area.

The trick to any tendon injury is getting it to heal with minimal scar tissue formation and with as much realignment of tendon fibres as possible - something both Radiant Heat Therapy and portable ultrasound is great at! Even with optimum healing there is always less elasticity in a previously injured tendon. The trick is to make sure you heal this the best you can, that way your chance of reinjury down the road is much lower than average.

Our Cold Compression Wraps are recommended as the best by the Mayo Clinic, several professional sports organizations, and countless medical professionals. That's why we sell them, because they are the best. We have noticed over time that our customers are so fond of our cold wraps that they are frequently coming back and ordering a second one - this way they can cool one while wearing the other. The wraps are becoming very popular with baseball and soccer trainers, and the wraps can be conveniently stored in a cooler for quick application on the field when needed.