Inner Knee Pain and Pes Anserine Bursitis

Pes anserine bursitis is a common cause of inner knee pain. It affects a small fluid-filled sac (bursa) on the inside of the knee where three tendons meet the shin bone. Pain is usually felt a few centimetres below the joint line on the inner side of the knee, especially with stairs, hills, running, or getting up from a chair.

A related problem, pes anserine tendinopathy, involves irritation of the same tendons. In day-to-day practice, bursitis and tendinopathy often occur together, so many people experience a mixture of bursal and tendon pain.

What Is the Pes Anserinus?

The term “pes anserinus” means “goose foot”. It describes the fan-shaped insertion of three muscles onto the upper inner shin bone (tibia):

• Sartorius
• Gracilis
• Semitendinosus (one of the hamstring muscles)

These muscles help bend the knee, rotate it slightly inwards, and support the leg when you walk, run, or change direction. Between their tendons and the bone sits the pes anserine bursa, which allows the tendons to glide smoothly.

What Is Pes Anserine Bursitis and Tendinopathy?

Pes anserine bursitis occurs when the bursa on the inner knee becomes irritated and inflamed. This can cause localised pain, warmth, and tenderness.

Pes anserine tendinopathy involves irritation or overload of the three tendons that insert into the pes anserinus. Because the tendons and bursa sit so close together, symptoms often overlap, and the term “pes anserine syndrome” is sometimes used to describe this cluster of problems.

Common Symptoms

People with pes anserine bursitis or tendinopathy often report:

• Inner knee pain a few centimetres below the joint line
• Pain walking up or down stairs or hills
• Pain when rising from a chair, squatting, or kneeling
• Localised tenderness to touch on the inner knee
• Mild swelling or a feeling of fullness at the inside of the knee
• Stiffness after rest or first thing in the morning
• Discomfort when lying on the affected side with the knees together

The pain may be sharp with certain movements, and dull or aching at rest. Some people also notice weakness or a feeling that the knee does not fully trust them on uneven ground.

Causes and Risk Factors

Pes anserine bursitis and tendinopathy usually develop due to a combination of load, biomechanics, and individual factors. Common contributors include:

• Repetitive activities such as running, brisk walking, or climbing stairs
• Rapid increases in training volume or intensity
• Poor lower limb biomechanics including knock knees or valgus knee position
• Hip and knee muscle weakness or muscle imbalances
• Knee osteoarthritis and other degenerative joint changes
• Higher body weight, which increases load on the inner knee
• Unsuitable or worn-out footwear, especially for runners
• Occupations or sports that involve frequent kneeling

Your physiotherapist will also consider health conditions such as diabetes and long-standing knee osteoarthritis, which have been linked with higher rates of pes anserine pain.

How Pes Anserine Bursitis Is Diagnosed

In most cases, pes anserine bursitis is diagnosed through a detailed history and physical examination. A physiotherapist will:

• Ask about the pattern of your knee pain and aggravating activities
• Palpate the inner knee to locate tender points
• Test hip, knee, and ankle strength, flexibility, and control
• Assess knee movement and joint irritability
• Review your walking or running pattern when relevant

Imaging such as ultrasound or MRI is sometimes used to rule out other causes of inner knee pain. However, many people do not need scans, because the diagnosis is primarily clinical.

Physiotherapy Treatment for Pes Anserine Bursitis

Most people respond well to non-surgical treatment. Physiotherapy aims to settle your symptoms, address the causes, and guide your safe return to activity.

Settle Pain and Irritation

• Load modification to reduce stress on the inner knee while symptoms are high
• Ice or heat as appropriate for pain relief
• Advice on short-term activity changes, including stairs and hills
• Soft tissue techniques, joint mobilisation, and taping if indicated
• Discussion with your GP about medication options if required

Restore Strength, Control, and Flexibility

Your rehabilitation program is usually tailored to your goals and current fitness. It may include:

• Progressive strengthening of the quadriceps, hamstrings, and hip muscles
• Specific exercises targeting adductors and hamstring control
• Hamstring and inner thigh stretches, if tightness contributes to symptoms
• Balance and proprioception training to improve knee stability
• Core and pelvic control exercises to support better lower limb alignment

Some people also benefit from exercise physiology input to support longer-term conditioning and weight management where needed.

Activity, Sport, and Workplace Modifications

Your physiotherapist will help you adjust activities while the bursa and tendons settle. This may involve:

• Altering walking or running distances and surfaces
• Planning gradual return to hills, speed work, and sport
• Footwear review and, when appropriate, supportive insoles or braces
• Modifying kneeling or squatting tasks at work or home

Home Management Tips

Alongside physiotherapy, simple strategies may help you manage symptoms:

• Use an ice pack over the inner knee after activity if the area feels hot or swollen
• Avoid long periods of kneeling or deep squats during a flare
• Break up long walks with short rests on flat ground
• Follow your exercise program consistently, even when pain starts to improve
• Discuss weight management strategies with your health team if appropriate

Always check any new exercise or self-treatment with your physiotherapist, especially if your pain is sharp, persistent, or waking you at night.

Returning to Walking, Running, and Sport

Return to activity should be gradual and guided by symptoms. A typical progression may involve:

• Walking on flat ground without a flare of pain
• Introducing gentle inclines once flat walking is comfortable
• Adding short intervals of jog or run within a walking program
• Building speed, distance, and hills in stages
• Sport-specific agility, change of direction, and training drills

Many people can resume their preferred activities when load is increased step by step and strength keeps pace with demand.

Can Pes Anserine Bursitis Be Prevented?

Not all cases can be prevented, but you may reduce your risk by:

• Maintaining good hip and knee strength with regular exercises
• Addressing muscle imbalances before increasing training
• Wearing appropriate, supportive footwear for your activity
• Increasing running or walking load gradually over several weeks
• Including warm-up and cool-down routines in your training

People Also Ask: Pes Anserine Bursitis

Is pes anserine bursitis serious?
Most cases are not dangerous but can be very limiting and frustrating. Early assessment and a guided plan usually help symptoms settle more quickly.

Can pes anserine bursitis go away on its own?
Mild cases may improve with rest and simple changes. However, if the underlying strength or movement issues remain, pain often returns when you increase activity again.

Do I need surgery for pes anserine bursitis?
Surgery is rarely required. Most people improve with non-surgical management such as physiotherapy, load changes, and strengthening.

When Should You See a Physiotherapist?

Consider booking with a physiotherapist if you have:

• Inner knee pain for more than one to two weeks
• Pain that limits walking, stairs, work, or sport
• Recurring flares despite rest or simple home care
• Inner knee pain together with known knee osteoarthritis

A physiotherapist can assess your knee, identify contributing factors, and design an individualised plan to help you move more comfortably and confidently.

Related Knee Conditions and Resources

• Knee bursitis
• Patellofemoral pain
• Knee osteoarthritis
• Sports injury assessment
• Running and walking biomechanics

For general information on knee bursae and pes anserine bursitis, see the overview on the NCBI website: Pes Anserine Bursitis – StatPearls.

References

• Mohseni M, et al. Pes Anserine Bursitis. StatPearls. 2024.
• Hasan M. Knee Bursae: A Comprehensive Review of Clinical Evaluation and Management. 2025.
• Mohammadi-Kebar Y, et al. Frequency of pes anserine bursitis in patients with knee osteoarthritis. Int J Res Med Sci. 2023.
• Aicale R, Pellegrino R, Di Iorio A, et al. Comprehensive review of pes anserinus syndrome: etiology, diagnosis, and management. Eur J Musculoskelet Dis. 2024;13(3):60–69.
• Elwan M, et al. Comparing the efficacy of local corticosteroid injection, platelet-rich plasma, and shockwave therapy in pes anserine bursitis. 2023.

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