Knee Bursitis

Knee bursitis is a clinical condition where one or more bursae in the knee joint become inflamed.  Bursae are small, fluid-filled sacs that cushion and reduce friction between bones and soft tissues.

 The knee joint has on average 14 bursae. The friction likely to occur, between muscle, tendon, bone and skin. Any of these can become inflammed and give pain when compressed through muscle contraction or direct palpation along with swelling and stiffness in the knee joint.

Causes

• Repetitive movements: Activities like kneeling, squatting, or frequent bending can stress the knee.
• Injury or trauma: A direct hit or excessive pressure can trigger inflammation.
• Infection: Bacterial infections can cause bursitis, leading to redness and warmth.
• Underlying conditions: Arthritis, gout, or other joint issues may contribute to knee bursitis.

 Symptoms

• Swelling around the knee
• Pain or tenderness, especially when moving or applying pressure
• Warmth and redness in the affected area
• Limited mobility due to discomfort

Types

The most common type of bursitis are the Pre patellar bursitis, Pes anserine bursitis and Semimembranosus bursitis.

The prepatellar bursitis: Here the bursa usually injured by falling onto the anterior aspect of the knee, or by pronged kneeling (housemaid’s knee). Haemorrhage into the bursa can cause inflammatory reaction and increased fluid volume. Enlargement is noticeable and the margins of mass are well defined, differentiating  the condition from general knee effusion or subcutaneous haematoma. Knee flexion may be limited, the bursa being compressed as the skin covering the patella tightens.

Semimembranosus bursitis: Here  pain and swelling may arise  over the lower posteromedial aspect of knee joint. Pain may be worsen by hamstring or gastrocnemius contraction against resistance and in activities involving intense action of these muscles, such as sprinting and bounding.

Pes anserine bursitis: Here pain and swelling may arise over the metaphyseal area of tibia, sometimes referred to the medial joint line. The bursa may be injured direct trauma or by overuse of the pes anserine tendons.
One condition often refer to as ‘bursitis’ is a Baker’s cyst. This is actually a posterior herniation of the synovial membrane into the bursa lying between semi-membranosus and the medial head of gastrocnemius.The cyst can be palpated medial side of the popliteal space beneath the medial head of gastrocnemius.

Physiotherapy  Management

  1. Pain and Swelling Management for knee bursitis

• Ice Therapy: Applying ice to the affected area can reduce swelling and numb the pain.
• Compression: Using an elastic bandage or knee sleeve can help manage swelling.

2. Manual Therapy

• Soft Tissue Massage: Techniques to relieve muscle tension and improve blood flow around the knee.
• Joint Mobilization: Gentle movements to improve joint function and reduce stiffness.

3. Stretching Exercises

• Hamstring Stretches: To relieve tension behind the knee.
• Quadriceps Stretches: To loosen the muscles in the front of the thigh.
• Calf Stretches: To improve flexibility and reduce strain on the knee.

4. Strengthening Exercises

• Quadriceps Strengthening: Exercises like straight leg raises or wall slides to strengthen the muscles around the knee.
• Hamstring Strengthening: Exercises such as hamstring curls to support knee stability.
• Hip Strengthening: Exercises like clamshells or lateral leg raises to improve overall lower body strength, which supports the knee.

5. Range of Motion Exercises

• Heel Slides: To improve knee flexibility.
• Gentle Bending and Straightening: To maintain and improve the range of motion in the knee joint.

6. Activity Modification and Education

• Posture and Technique: Teaching proper techniques for activities that stress the knee.
• Ergonomic Advice: Modifying activities or positions to avoid aggravating the condition.

7. Modalities

• Ultrasound Therapy: Using sound waves to reduce inflammation and promote healing.
• Electrical Stimulation: Techniques like TENS (Transcutaneous Electrical Nerve Stimulation) for pain relief.

8. Bracing or Support

• Knee Braces or Sleeves: To provide support and reduce strain on the knee joint.

9. Gait Training

• Improving Walking Mechanics: To reduce impact on the knee and improve overall movement patterns.