What is Knee Bursitis?
Knee bursitis can cause pain above, on or below your patella (kneecap). The knee consists of up to 11 bursae. Your knee bursae most commonly subjected to inflammation are your: prepatellar bursa, infrapatellar bursa, pes anserinus bursa and suprapatellar bursa.
The prepatellar bursa lies just above the kneecap between the skin and the kneecap. Prepatellar bursitis, “housemaid’s knee”, is derived from being a condition that was commonly associated with individuals whose work necessitated kneeling for extended periods. Prepatellar bursitis is common in professions such as carpet layers, gardeners, roofers and plumbers.
The infrapatellar bursa primarily consists of two bursae. One bursa sits superficially between the patella tendon (below the kneecap) and the skin. The second referred to as the deep infrapatellar bursa sandwiched between the patella tendon and tibia bone (shin). It can occur conjunctively with a condition called “Jumper’s Knee”, which involves repetitive strain and irritation to the patella tendon, often from jumping activities.
The third most common knee bursitis, pes anserinus, occurs in the lower, inside part of the knee near the upper aspect of the shin bone (tibia). It usually affects middle-aged women and overweight individuals.
Suprapatellar bursitis occurs above the kneecap. The suprapatellar bursa extends superiorly from beneath the patella under the quadriceps muscle. It is vulnerable to injury from both acute trauma and repeated microtrauma. Severe injuries are from direct trauma to the bursa via falls directly onto the knee, as well as from overuse injuries, including running on soft or uneven surfaces, or from jobs that require crawling on the knees, such as carpet laying.
What is Bursitis?
A bursa is a thin sack filled with synovial fluid, the body’s natural lubricating fluid. This slippery sack allows different tissues such as muscle, tendon, and skin slide over bony surfaces without catching. Your bursa substantially reduces the friction between structures.
A bursa usually is very thin, but they can become inflamed and irritated. This inflammation is what is known as bursitis.
What Causes Knee Bursitis?
There is a myriad of factors that can contribute to knee bursitis. The most common ones include:
- Direct trauma or blow to the knee.
- Frequent falls on the knee.
- The repeated pressure on the knee (e.g. from activities that entail prolonged periods of kneeling) or repetitive minor trauma to the knee.
- Knee Arthritis, thus bursitis, can be associated with such conditions as gout, rheumatoid arthritis, and osteoarthritis.
What are the Symptoms of Knee Bursitis?
The symptoms of knee bursitis include:
- A swelling over, above or below the kneecap.
- Limited motion of the knee.
- Redness and warmth at the site of the bursa.
- Painful movement of the knee.
Knee bursitis swelling is within the bursa, not the knee joint. People often call any swelling of the knee joint “water on the knee,” but there is an essential difference between fluid accumulation within the bursa and the knee joint.
Symptoms of knee bursitis aggravated by kneeling, crouching, repetitive bending or squatting, and symptoms can be relieved when sitting still.
How is Knee Bursitis Diagnosed?
Your physiotherapist will provide you with a thorough quiz of your medical history and a physical examination of your knee to determine if you have knee bursitis. If there is localised swelling and you feel tenderness over the bursa when pressure is applied, a diagnosis is confirmed.
Concerning scans, an MRI or Ultrasound is the most effective for a definitive diagnosis of knee bursitis.
What is the Treatment of Knee Bursitis?
The diagnosis is relatively simple. Your physiotherapist will also undertake a biomechanical analysis to determine the cause of your bursitis. Factors may include muscle weakness, tightness, pain inhibition, leg length discrepancy, training techniques and more.
Many patients with knee bursitis start to feel better within a few weeks of the injury. Your physiotherapy treatment will aim to:
- Reduce pain and inflammation. The application of electrical modalities, ice, therapeutic taping and education regarding activity modification
- Normalise your knee joint range of motion.
- Strengthen your knee muscles: quadriceps and hamstrings.
- Strengthen your lower limb: calves, hip and pelvis muscles.
- Normalise your muscle lengths.
- Improve your proprioception, agility and balance.
- Improve your technique and function, e.g. walking, running, squatting, hopping and landing.
- Minimise your chance of re-aggravation.
Anti-inflammatories or NSAIDs are also used in combination with physiotherapy to help alleviate the pain and swelling. If the bursa becomes infected or if your symptoms persist for a prolonged period, your doctor may recommend that the bursa is aspirated. Alternatively, your doctor may also recommend an injection of a glucocorticoid steroid mixed with a local anaesthetic. If infection occurs, you may require antibiotics.
Knee Bursa Surgery?
In particularly stubborn cases, surgical removal of the bursa is an option.
Risks of surgery include infection, persistent instability and pain, stiffness, and difficulty returning to your previous level of activity. The good news is that more than 90% of patients have no complications post-surgery.
Post-operative knee rehabilitation is one of the most important, yet too often neglected, aspects of knee surgery. The most successful and quickest outcomes result from the guidance and supervision of an experienced physiotherapist.
How Can You Prevent Knee Bursitis?
Knee bursitis is best prevented by maintaining flexible thigh muscles and reducing the amount of time you are in a kneeling position. Ice after excessive kneeling can avoid an inflammatory response, which is the first stage of bursitis.
Pacing yourself during activities which entail repeated bending or squatting is also paramount. Ensuring that you take regular rest breaks between periods of bending or kneeling and alternating them with other less aggravating activities is vital. Mainly, you aim for an appropriate balance between rest and exercise. Weight-management can play a role in the pressure exerted on lower limb joints, and thus should be something considered as a long-term preventative measure.
Common Causes - Knee Pain
Knee pain can have many origins from local injury, referred pain, biomechanical issues and systemic issues. While knee pain can appear simple to the untrained eye, a thorough assessment is often required to ascertain the origin of your symptoms. The good news is that once a definitive diagnosis is determined, most knee pain quickly resolves with the correct treatment and rehabilitation.
Knee Ligament Injuries
- Knee Ligament Injuries
- ACL Injury
- PCL Injury
- MCL Sprain
- LCL Sprain
- Posterolateral Corner Injury
- Superior Tibiofibular Joint Sprain
Knee Meniscus Injuries
- Chondromalacia Patella
- Fat Pad Syndrome
- Patella Dislocation
- Patellofemoral Pain Syndrome
- Osgood Schlatter’s Disease
- Sinding Larsen Johansson Syndrome
Knee Tendon Injuries
- Corked Thigh
- Thigh Muscle Strain
- Hamstring Strain
- ITB Syndrome
- Popliteus Syndrome
- Muscle Strain (Muscle Pain)
- DOMS – Delayed Onset Muscle Soreness
Children’s Knee Conditions
Other Knee-Related Conditions
- Runner’s Knee
- Plica Syndrome
- Stress Fracture
- Overuse Injuries
- Restless Legs Syndrome
For specific information regarding your knee pain, please seek the assistance of a healthcare professional with a particular interest in knee condition, such as your physiotherapist.