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.
Swelling on your kneecap
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 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.
Swelling below your kneecap
The infrapatellar bursa primarily consists of two bursae. One bursa sits superficially between the patella tendon (below the kneecap) and the skin. The second is 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 shin bone’s upper aspect (tibia). It usually affects middle-aged women and overweight individuals.
Swelling above your kneecap
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 and 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. Your bursa substantially reduces the friction between structures. They allow different tissues such as muscle, tendon, and skin to slide over bony surfaces without catching.
A bursa usually is very thin, but it 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 a knee blow.
- Frequent falls on the knee.
- Repeated pressure upon 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 are 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. A diagnosis is confirmed if there is localised swelling and you feel tenderness over the bursa when pressure is applied.
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.
More info: Bursitis Treatment
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 your symptoms persist for a prolonged period, your doctor may recommend aspirating the bursa. Alternatively, your doctor may also recommend an injection of a glucocorticoid steroid mixed with a local anaesthetic. If an 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, knee surgery aspects. 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 your time in a kneeling position. Ice after excessive kneeling can avoid an inflammatory response, which is the first stage of bursitis.
Pacing yourself during activities that entail repeated bending or squatting is also paramount. It is vital to ensure that you take regular rest breaks between bending or kneeling and alternating them with other less aggravating activities. 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 should be considered 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
- How Do I Know If my Knee Injury Is Serious?
- Is Surgery Needed For My Meniscal Injury?
- Is Surgery Needed For My ACL Injury?
- What Are The Symptoms Of A Torn Ligament In Your Knee?
- Why Does My Knee Hurt On The Inner Side?
- Is Walking Good For Knee Pain?
- What Can I Do To Relieve Knee Pain?
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 knee physiotherapist.
Acute Injury Signs
Acute Injury Management.
Here are some warning signs that you have an injury. While some injuries are immediately evident, others can creep up slowly and progressively get worse. If you don't pay attention to both types of injuries, chronic problems can develop.
For detailed information on specific injuries, check out the injury by body part section.
Don't Ignore these Injury Warning Signs
Joint pain, particularly in the knee, ankle, elbow, and wrist joints, should never be ignored. Because these joints are not covered by muscle, pain here is rarely of muscular origin. Joint pain that lasts more than 48 hours requires a professional diagnosis.
If you can elicit pain at a specific point in a bone, muscle, or joint, you may have a significant injury by pressing your finger into it. If the same spot on the other side of the body does not produce the same pain, you should probably see your health professional.
Nearly all sports or musculoskeletal injuries cause swelling. Swelling is usually quite obvious and can be seen, but occasionally you may feel as though something is swollen or "full" even though it looks normal. Swelling usually goes along with pain, redness and heat.
Reduced Range of Motion
If the swelling isn't obvious, you can usually find it by checking for a reduced range of motion in a joint. If there is significant swelling within a joint, you will lose range of motion. Compare one side of the body with the other to identify major differences. If there are any, you probably have an injury that needs attention.
Compare sides for weakness by performing the same task. One way to tell is to lift the same weight with the right and left sides and look at the result. Or try to place body weight on one leg and then the other. A difference in your ability to support your weight is another suggestion of an injury that requires attention.
Immediate Injury Treatment: Step-by-Step Guidelines
- Stop the activity immediately.
- Wrap the injured part in a compression bandage.
- Apply ice to the injured part (use a bag of crushed ice or a bag of frozen vegetables).
- Elevate the injured part to reduce swelling.
- Consult your health practitioner for a proper diagnosis of any serious injury.
- Rehabilitate your injury under professional guidance.
- Seek a second opinion if you are not improving.
Article by John Miller
Elite Sports Injury Management
You probably already know that a sports injury can affect not only your performance but also your lifestyle. The latest research continues to change sports injury management considerably. Our challenge is to keep up to date with the latest research and put them to work for you.
How we treated you last year could vary significantly from how we treat you this year. The good news is that you can benefit considerably from our professional knowledge.
What Should You Do When You Suffer a Sports Injury?
Rest from painful exercise or a movement is essential in the early injury stage. "No pain. No gain." does not apply in most cases. The rule of thumb is - don't do anything that reproduces your pain for the initial two or three days. After that, you need to get it moving, or other problems will develop.
Ice or Heat?
We usually recommend avoiding heat (and heat rubs) in the first 48 hours of injury. The heat encourages bleeding, which could be detrimental if used too early. In traumatic injuries, such as ligament sprains, muscle tears or bruising, ice should help reduce your pain and swelling.
Once the "heat" has come out of your injury, you can use heat packs. We recommend 20-minute applications a few times a day to increase the blood flow and hasten your healing rate. The heat will also help your muscles relax and ease your pain. If you're not sure what to do, please call us to discuss your situation specifically.
Should You Use a Compressive Bandage?
Yes. A compressive bandage will help to control swelling and bleeding in the first few days. In most cases, the compressive dressing will also help support the injury as you lay down the new scar tissue. This early healing should help to reduce your pain. Some injuries will benefit from more rigid support, such as a brace or strapping tape. Would you please ask us if you are uncertain about what to do next?
Gravity will encourage swelling to settle at the lowest point. Elevation of an injury in the first few days is beneficial, especially for ankle or hand injuries. Think where your damage is and where your heart is. Try to rest your injury above your heart.
What Medication Should You Use?
Your Doctor or Pharmacist may recommend pain killers or an anti-inflammatory drug. It is best to seek professional advice as certain medications can interfere with other health conditions, especially asthmatics.
When Should You Commence Physio?
In most cases, "the early bird gets the worm". Researchers have found that the intervention of physiotherapy treatment within a few days has many benefits. These include:
- Relieving your pain quicker via joint mobility techniques, massage and electrotherapy
- Improving your scar tissue using techniques to guide the direction it forms
- Getting you back to sport or work quicker through faster healing rates
- Loosening or strengthening of your injured region with individually prescribed exercises
- Improving your performance when you return to sport - we'll detect and help you correct any biomechanical faults that may affect your technique or predispose you to injury.
What If You Do Nothing?
Research tells us that injuries left untreated take longer to heal and have lingering pain. They are also more likely to recur and leave you with either joint stiffness or muscle weakness. It's important to remember that symptoms lasting longer than three months become habitual and are much harder to solve. The sooner you get on top of your symptoms, the better your outcome.
What About Arthritis?
Previously injured joints can prematurely become arthritic through neglect. Generally, there are four main reasons why you develop arthritis:
- An inappropriately treated previous injury (e.g. old joint or ligament sprains)
- Poor joint positioning (biomechanical faults)
- Stiff joints (lack of movement diminishes joint nutrition)
- Loose joints (excessive sloppiness causes joint damage through poor control)
What About Your Return to Sport?
Your physiotherapist will guide you safely back to the level of sport at which you wish to participate. If you need guidance, ask us.
What If You Need Surgery or X-rays?
Not only will your physio diagnose your sports injury and give you the "peace of mind" associated, but they'll also refer you elsewhere if that's what's best for you. Think about it. You could be suffering needlessly from a sports injury. Would you please use our advice to guide you out of pain quicker? And for a lot longer.
If you have any questions regarding your sports injury (or any other condition), don't hesitate to get in touch with your physiotherapist to discuss. You'll find our friendly staff happy to point you in the right direction.
Acute Sports Injury Clinic
How to Best Care for Your Sports Injury?
There is never an excellent time for an injury. But we do know that most sports injuries occur over the weekend! That's why at PhysioWorks, we have established an Acute Sports Injury Clinic at a selection of our clinics on a Monday and Tuesday.
The acute sports injury consultation fee is significantly lower than a routine assessment and treatment consultation. In most cases, your private health will cover the full cost of your full acute injury physio assessment fee.
Why Use an Acute Sports Injury Clinic?
Your Acute Sports Injury Assessment Consultation allows us to provide you with:
- A quick and accurate diagnosis. One of our Sports Physiotherapist's or an experienced sports injury-focused Physiotherapist will confidently guide your new injury management.
- Early acute sports injury care, professional advice and education. What to do this week?
- Fast referral for X-rays, ultrasound or MRI scans to confirm your diagnosis.
- Prompt referral to Sports Physicians, GPs or Surgeons with whom we work if required.
- Immediate supply of walking boots, braces and rental crutches if needed.
- Low-cost professional service.
For more friendly advice or guidance, please call your nearest clinic to discuss your specific needs.
Article by Zoe Russell
Who is a Sports Physiotherapist?
Sports Physiotherapy is the specialised branch of physiotherapy which deals with injuries and issues related to spokespeople. Practitioners with additional formal training within Australia are Sports & Exercise Physiotherapists.
What is Sports Physiotherapy?
Sports injuries do differ from common everyday injuries. Athletes usually require high-level performance and demand placed upon their body, which stresses their muscles, joints and bones to the limit. Sports physiotherapists help athletes recover from sporting injuries and provide education and resources to prevent problems.
Each sports physiotherapist usually has sport-specific knowledge that addresses acute, chronic and overuse injuries. Their services are generally available to sportsmen and women of all ages engaged in sports at any level of competition.
Members of Sports Physiotherapy Australia (SPA) have experience and knowledge of the latest evidence-based practice, professional assessment and diagnosis of sports injuries, and effective hands-on management techniques and exercise protocols to assist recovery and prevent future damage. SPA members have access to the most recent advances in sports physiotherapy. You'll be pleased to know that most PhysioWorks physiotherapists and massage therapists have a particular interest in sports injury management.