What is included in the conservative management of pes anserine bursitis?

Updated: May 08, 2018
  • Author: P Mark Glencross, MD, MPH, FACOEM, FAAPMR; Chief Editor: Milton J Klein, DO, MBA  more...
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Answer

Rest, including cutting back or eliminating the offending activities, is essential to treatment. Along with the use of nonsteroidal anti-inflammatory drugs (NSAIDs), it represents first-line treatment.

Physical therapy is beneficial and often is indicated for patients with pes anserine bursitis. Rehabilitative exercise for persons with significant medial knee stress follows general physiatric principles for knee disorders and includes the following:

  • Stretching and strengthening of the adductor, abductor, and quadriceps groups (especially the last 30° of knee extension using the vastus medialis)

  • Stretching of the hamstrings

Thus, patients with pes anserine bursitis need to work on both a hamstring stretching program and a concurrent closed-chain quadriceps and pelvifemoral strengthening program. Such programs can usually be taught to the patient by an athletic trainer or physical therapist. Patients should understand that to gain the maximum benefit from this program, they must stretch their hamstrings frequently during the day, sometimes hourly. The quadriceps strengthening program is recommended in most patients because of other concurrent pathology in the knee.

A regular program of hamstring stretching and quadriceps strengthening usually results in alleviation of the pain from pes anserine bursitis in approximately 6-8 weeks. Addition of a nonsteroidal anti-inflammatory drug (NSAID) may help to alleviate some of the pain at this time. In addition, and an ice massage may help to reduce inflammation. Ice in foam cups can be applied and rubbed directly on the patient’s skin (ice massage) for up to 10 minutes at a time; other forms of cryotherapy (eg, cold packs) also may be used.


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