Over the years, I’ve had people come to me complaining of pain pretty much right where the Pes Anserinus Tendon/Bursa (PATB) should be.
However, I really wish I was!!
How profitable would that be!?)
The use of an MRI is often needed to establish exactly what the injury is and where exactly to treat the injury.
Location of Pes Anserinus Bursitis (PATB)
As you can see from the diagram to the right, the Pes Anserinus is located just below the knee on the inside of the shin bone.
This particular image is showing the inside of the right leg.
The rough looking bit to the left of it and slightly above is the tibial tuberosity; the bony attachment point for the quadriceps group.
The pes anserinus is a combination of the tendons of sartorius, gracilis and semitendinosus.
The first 2 muscles help to make up the ‘groin’ group, while semitendinosus is one of the 3 hamstring muscles.
If you look closely, you can see a blue looking bursa between the tendon and the bone. Due to its position on the leg, injury can occur to both the bursa and the tendon, making a diagnosis a little more challenging.
What Causes It?
The bursa can become irritated if the inside hamstrings (semimembranosus and semitendinosus) are tight, or if the individual is ‘knock kneed’.
Another factor that could contribute would be the supination at the sub-talar joint.
Repetitive deceleration of the knee can be a contributing factor to this type of injury.
So those involved in fartlek training which is hilly in nature will be more at risk. For those who don’t know what fartlek training is, it is a combination of different speeds, gradients and effort levels.
Tri-planar movement which we should all adhere to.
For example, the constant acceleration to get up one side of the hill will have to be met with a deceleration on the opposite side.
It’s this deceleration which forces the 3 muscles to act as brakes and it tugs on the attachment on the shin bone causing friction, and eventual discomfort.
As with most other injuries, an increase in training intensity and/or volume could also be a contributing factor to the onset of PATB.
Jumping sports such as volleyball, basketball or various track and field events can also be the cause of PATB. The constant, repetitive loading of the legs that is typical in these types of activities can contribute to pain.
In a past article, I wrote about various types of swimming strokes and the effects that they have on the body.
The one stroke that I criticised was the breast stroke.
Personally, this type of stroke I mostly associate with retired people on a sunshine holiday. Paddling around the pool in circles at a leisurely pace.
If done correctly, this stroke is one of, if not the most demanding strokes in swimming. It requires a huge amount of technique, strength and skill to do it effectively.
Another factor which must be considered is the range of movement in the joints involved such as the hips, and shoulders.
Most people don’t have the ideal flexibility in these areas due to poor postures, which leads to compensations and eventually dysfunctional movement patterns.
I’m not a swimming expert by any means. I leave that stuff to my girlfriend (who is a swim instructor), but all it takes is a bit of common sense to know that not all people can do this type of stroke well.
Swimming while holding a kick board out in front and doing a basic flutter kick would be a much better way to exercise.
How Do You Know If You Have PATB?
Do you have any of the following?
- The area is tender to touch
- There are signs of swelling
- Painful to stretch the hamstrings (particularly on the inside)
- Isometric contractions (holding) of the hamstrings are painful (i.e. a bridge exercise)
- modify activity levels, depending on the severity of the injury
- The onset of therapeutic exercises are important so reducing inflammation or decreasing any pain or swelling is priority. NSAID’s would be recommended, as well as relative rest, ICE, and the relevant mode of electrotherapy. If problem is severe, a cortisone injection may be the best choice.
compensations, leading to new dysfunctions.
Tape and Braces
The tendon might need support at its attachment down on the shin bone. This is particularly true as the exercise becomes more intense and dynamic in nature.
Bomechanical factors such as GAIT analysis, movement patters specific to the activity causing the onset, and food alignment should all be considered.
By correcting any faulty movement patterns, there will be less stress going through the body and a decreased risk of injury.
There are a lot of circumstances which can contribute to PATB, however if you manage your fitness regime well, you should be able to dodge that bullet.
Drop me a note if you’re struggling with this and we might just come up with the solution.
Keep Your Knees Pain Free
Category: Knee Injury Rehabilitation