Knees Hurting You? 8 Exercises for Pes Anserine Bursitis
Key takeaways:
Pes anserine bursitis involves inflammation of a fluid-filled sac (bursa) at the inner side of the knee.
It causes pain with knee bending, going up and down stairs, and standing up from a chair.
Conservative treatments including rest, ice, pain medication, and targeted exercises help in the majority of cases. Steroid injections or fluid aspiration may be recommended in chronic cases.
Table of contents
You may not have heard of the pes anserine. This funny-sounding tendon, which means “goose’s foot” in Latin, is made of the joining of three tendons on the inner side of the knee. It resembles the three-webbed toes of a goose. When these tendons get irritated, they cause friction to the underlying bursa, resulting in pes anserine bursitis.
Pes anserine bursitis causes pain, inflammation, and discomfort with specific movements. But the good news is that pes anserine bursitis often goes away with targeted exercises and rest from aggravating activities. Stretches and leg-strengthening moves can ease symptoms and improve mobility.
What is pes anserine bursitis?
The pes anserine is a large tendon formed from the tendons of three different thigh muscles — the sartorius, gracilis, and semitendinosus. The pes anserine, along with these muscles, stabilizes the inner side of the knee and protects it from rotational stress.
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The pes anserine lies directly on top of the pes anserine bursa. Bursae are small fluid-filled sacs that provide cushioning between tendons and bones. They reduce friction with movement. When the pes anserine is irritated, it can inflame the underlying bursa, causing bursitis.
Symptoms of pes anserine bursitis include pain, tenderness, and swelling. These symptoms are specifically located at the inner side of the shinbone 4 to 5 centimeters below the knee. Pes anserine bursitis becomes aggravated with repeated knee bending, running, and going up and down stairs.
Pes anserine bursitis exercises and stretches
Pes anserine bursitis is usually a mechanical problem, meaning it’s due to how the leg moves. Resting and stretching the muscles that attach to the pes anserine can help ease tension. Strengthening exercises for the hip and thigh muscles can also help fix muscle imbalances. This can take pressure off of the pes anserine tendon.
1. Hamstring stretch
The semitendinosus is a hamstring muscle that attaches to the pes anserine. When the muscles that attach to the pes anserine become too tight, they can place increased tension on the pes anserine. This can irritate the underlying bursa and cause or worsen bursitis symptoms. Stretching the hamstrings, along with other muscles, can reduce strain. Try the following supine hamstring stretch to ease tension.
Step 1: Lie on your back with your knees bent and your feet flat on the floor.
Step 2: Lift one leg up to bring your knee closer to your chest. Grab under your thigh with both hands.
Step 3: While holding your thigh, slowly extend your leg up to the ceiling to straighten your knee.
Step 4: Hold for 30 seconds, feeling the stretch in the back of your leg.
Step 5: Repeat 3-5 times on each side.
2. Hip adductor stretch
The gracilis is another muscle that attaches to the pes anserine. This muscle belongs to the adductors, a group of muscles along the inner thigh. Stretching the adductors can also help reduce strain at the pes anserine.
Step 1: Sit on the floor with your legs extended straight out in front of you.
Step 2: Spread your legs to form a V with them. Keep your toes pointing toward the ceiling.
Step 3: Reach forward and place your hands on the floor between your legs. Hinge at your hips to lean your body forward while maintaining a neutral spine.
Step 4: Hold for 30 seconds, feeling the stretch in your inner thighs.
Step 5: Repeat 3-5 times.
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3. Calf stretch
Sometimes connective tissue from the pes anserine attaches to the top of the calf muscles. Stretching the calves can help maintain good flexibility to reduce pulling around the knee and pes anserine.
Step 1: Sit on the floor with your legs extended straight in front of you.
Step 2: Loop a towel around the ball of your foot while holding the ends in both hands.
Step 3: Use the towel to pull your foot back toward you. Keep your knee straight.
Step 4: Hold for 30 seconds, feeling the stretch in the back of your knee and calf.
Step 5: Repeat 3-5 times on each side.
4. Prone knee bend
This exercise strengthens the hamstrings to bend the knee. Increased hamstring strength can help reduce strain at the pes anserine.
Step 1: Lie face down on your belly with your legs straight.
Step 2: Draw your belly button toward your spine to engage your core.
Step 3: Slowly bend one leg, bringing your heel toward your buttocks. Do not rotate your hips or body.
Step 4: Hold for a few seconds, then slowly lower your leg to the starting position.
Step 5: Complete three sets of 10 repetitions.
5. Adductor squeeze
This exercise strengthens the adductors of the inner thigh. As with the hamstrings, improving your adductor strength can reduce strain at the pes anserine.
Step 1: Lie on your back with your knees bent and your feet flat on the floor.
Step 2: Fold a pillow in half and place it in between your knees.
Step 3: Gently press your lower back toward the floor to engage your abs.
Step 4: Squeeze your thighs together into the pillow.
Step 5: Hold this position for 5-10 seconds, then relax.
Step 6: Complete three sets of 10 repetitions.
6. Prone hip extension
Strengthening the glute muscles of the hips can help restore balance. This can prevent the hamstrings, in particular, from working too much and straining the pes anserine.
Step 1: Lie face down on your belly with your legs straight.
Step 2: Draw your belly button toward your spine to engage your core.
Step 3: Slowly lift one leg up toward the ceiling. Keep your leg straight with your toes pointing down. Do not rotate your hips or body.
Step 4: Hold for a few seconds before you lower your leg to the starting position.
Step 5: Complete three sets of 10 repetitions.
7. Side-lying leg lifts
This exercise works the outer glute muscles that stabilize the hip and knee. Strengthening these muscles can also help decrease muscle imbalances by preventing the adductors from overworking. This helps ease tension from the pes anserine.
Step 1: Lie on your side with your hips stacked. Keep your legs straight with knees extended.
Step 2: Bend your arm to support your head in your hand, or rest your head on your arm on the floor.
Step 3: Keeping your top leg straight, slowly raise it toward the ceiling. Do not rotate your hips, and keep your toes pointed forward.
Step 4: Hold your leg for a few seconds at the top. Then, slowly lower your leg back down to the starting position.
Step 5: Complete three sets of 10 repetitions.
8. Chair squats
This exercise works your quadriceps and gluteal muscles together. Proper strength in these muscle groups is needed to decrease muscle imbalances that can lead to pes anserine bursitis.
Step 1: Stand in front of a chair with your feet hip-width apart.
Step 2: Engage your core by contracting your abdominal muscles. Maintain a neutral spine throughout the entire exercise.
Step 3: Shift your weight back and lower your hips down toward the seat of the chair. Keep your knees aligned with your ankles.
Step 4: Stop to hover your hips above the seat of the chair. Hold for 1-2 seconds.
Step 5: Squeeze your glutes and extend your knees to stand back up.
Step 6: Complete three sets of 10 repetitions.
Pes anserine (knee) bursitis treatment
Conservative (nonsurgical) treatment helps relieve most cases of pes anserine bursitis. In addition to the exercises mentioned here, rest from aggravating activities is important. Cut down on your volume and intensity of exercise until your pain improves.
Other treatments to consider for pes anserine bursitis include:
Physical therapy or corrective exercises
Ice or cold therapy to reduce pain and swelling
Over-the-counter medication for pain relief
If knee pain continues despite these treatments, it’s best to see your primary care physician or an orthopedic specialist. They can make sure nothing else is going on in your knee and perhaps suggest other treatment options.
The bottom line
Pes anserine bursitis results from inflammation of the fluid-filled sac under the pes anserine tendon. This large tendon is located at the inner side of your knee and can be irritated when muscles are out of balance. Strengthening and stretching the muscles of the hips and knees can correct these mechanical issues. Improving your overall hip and leg strength can also correct muscle imbalances to prevent symptoms from coming back.
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References
American Academy of Orthopaedic Surgeons. (n.d.). Foot and ankle conditioning program.
American Academy of Orthopaedic Surgeons. (n.d.). Knee conditioning program.
American Council on Exercise. (n.d.). Seated straddle stretch.
Baptist Health. (2020). Hip adduction with pillow [video]. YouTube.
Brigham and Women's Hospital, Department of Rehabilitation Services. (2009). Standard of care: Pes anserine bursitis.
Curtis, B. R., et al. (2019). Pes anserinus: Anatomy and pathology of native and harvested tendons. American Journal of Roentgenology.
Good Exercise Guide. (2014). Prone knee bend exercise [video]. YouTube.
Lee, J.-H., et al. (2014). Pes anserinus and anserine bursa: Anatomical study. Anatomy & Cell Biology.
Mohseni, M., et al. (2018). Pes anserine bursitis. StatPearls.
Vadgaonkar, R., et al. (2021). Dimensions of pes anserinus of the lower extremity, an anatomical study with its surgical implications. Anatomy & Cell Biology.
