The goal of Gemini Physical Therapy Spine & Sports Rehabilitation treatment for overuse injuries such as pes anserine bursitis is to reduce the strain on the injured tissues. Stopping the activity that brings on or aggravates the symptoms is the first step toward pain reduction.
Bedrest is not required but it may be necessary to modify some of your activities. This will give time for the bursa to quiet down and for the pain to subside. Our Physical Therapist will advise you to avoid stairs, climbing, or other irritating activities. This type of approach is called relative rest.
We may recommend the use of ice and anti-inflammatory medications in the early, inflammatory phase. The ice is applied three or four times each day for 10-15 minutes at a time. Ice cubes wrapped in a thin layer of toweling or a bag of frozen vegetables applied to the area work well.
Our Physical Therapists often instruct athletes to perform an ice massage. A cup of water is frozen in a Styrofoam container. The top edge of the container is torn away leaving a one-inch surface of ice that can be rubbed around the area. The Styrofoam protects the hand of the person holding the cup while applying the ice massage. The pes anserine area is massaged with the ice for 3-5 minutes or until the skin is numb. Caution is advised to avoid frostbite.
Over-the-counter nonsteroidal antiinflammatory drugs (NSAIDs) such as Ibuprofen may be advised. In some cases, the physician will prescribe stronger NSAIDs. Our Physical Therapist can also use a process called iontophoresis. Using an electric charge, an antiinflammatory drug can be pushed through the skin to the inflamed area. This method is called transdermal drug delivery. Iontophoresis puts a higher concentration of the drug directly in the area compared to taking medications by mouth. This process does not deliver as much drug as a local injection.
Improving flexibility is a key part of the prevention and treatment of this condition. Your Physical Therapist will advise that you perform hamstring stretches at least twice a day for a minimum of 30 seconds each time. Holding the stretch for a full minute has been proven even more effective. Some patients must perform this stretch more often – even once an hour if necessary.
Do not bounce during the stretch. Hold the position at a point of feeling the stretch but not so far that it is painful or uncomfortable. Deep breathing can help ease the discomfort. Try to stretch a little more as you breathe out.
Quadriceps strengthening is also important. This is especially true if there are other areas of the knee affected. The quadriceps muscle along the front of the thigh extends the knee and helps balance the pull of the hamstrings.
Some times our Physical Therapists recommend a special type of exercise program called closed kinetic chain (CKC), performed for about six to eight weeks, to assist with quadriceps strengthening. The CKC may include single-knee dips, squats and leg presses. Resisted leg-pulls using elastic tubing are also included. This exercise program is gradually progressed during the eight-week session.
Prognosis for Pes Anserine Bursitis
Pes anserine bursitis is considered a self-limiting condition. This means it usually responds well to treatment and will resolve without further intervention. Athletes may have to continue our program of hamstring stretching and CKC quadriceps strengthening on a regular basis.
Athletes may return to sports or play when the symptoms are gone and are no longer aggravated by certain activities. Protective gear for the knee may be needed for those individuals who participate in contact sports. During our rehab process, activity level and duration are gradually increased. If the symptoms don’t come back, the athlete can continue to progress to full participation in all activities.
At Gemini Physical Therapy Spine & Sports Rehabilitation, our goal is to help speed your recovery so that you can more quickly return to your everyday activities. When your recovery is well under way, regular visits to our office will end. Although we will continue to be a resource, you will be in charge of doing your exercises as part of an ongoing home program.
If the bursa is removed, you follow the same steps of rehab and recovery outlined under Nonsurgical Treatment.
Gemini Physical Therapy Spine & Sports Rehabilitation provides services for Physical Therapy in Merrimack Valley.