Pes Anserine bursitis

March 23, 2024

Had pes anserinus in right knee for 3 months now. Been diagnosed + had an ultra sound scan showing it as mild bursitis.
Left knee shows the same, but no pain in that one.
The condition slowly buikt up for months leading up to my current state.
Had physio and doing on going stretches etc…but still not right and today lifted something and the pain has come back with a vengeance. I’ve had enough of the loss of mobility and booked myself in for a cortisone injection under ultra sound into the bursa sack to try to relieve the pain.
Is this a good idea?

March 23, 2024

Hi Graham – yes, as long as you’ve failed at doing decent rehab/physio.

Steroids get a pretty bad rap (deservedly so) when injected into joints but into soft tissue like bursa it’s seen as a means to an end.

The steroid acting life is only 2 weeks at best but the pain relieving effect will last for much longer. However you will need to get to grips with why you got (bilateral) PB and make sure you address the cause and not just get rid of the symptoms.

Might be worth trialing some orthotics, no stretches and some decent gluteal based rehab for hip control and not knee function.

The Guru

Guru Responded
March 23, 2024


Thanks for getting back to me.

Yes, the corrosion injection is guided into the bursa directly under ultra sound guidance for a curacy. Been told that a small amount might affect the tendons as they are only millimetres away from the bursa, but as a one off injection, won’t affect things.

Been diagnosed with mkld pes anserinus bursitis, but had it now for 3+ months. Had a few physio sessions and been doing stretching and a little strengthening and felt that things were improving u til yesterday when I lifted a heavy item and it just seemed to aggravate things all over again and I’m now so fed up with the pain it causes that I want it to be rid of it and prepared for the risks it Carrie’s although I understand that most people respond well with it.

It only hurts when I move awkwardly or lean over on that knee. Generally ok walking, but since yesterday, I have started to feel it again.

Does one injection normally resolve the issue alongside physio?

Kind regards


March 23, 2024

All depends on what’s causing the PB – if it’s an underlying mechanical issue like with poor foot posture or hip control and you don’t correct it hence the orthotics or glutes work, then I suspect it’ll slowly creep back.

Having it guided is great to keep away from the tendons but you’ll still need to address the cause….

guru-profile Guru Responded
March 23, 2024

Thanks for that. With me, its tight leg muscles with me, as I’ve been told. Need to stretch more. Left knee showed up the same amount of bursitis but much looser and less tight, presumably why that side is ok.

March 23, 2024

OK – here’s the nub of it…

I probably think you’ve got stiff muscles and not tight muscles.

I know that sounds pedantic and contradictory but hear me out…

If you done lots of stretching for your tight muscles and they are still tight then this shows the stretching hasn’t done anything because the muscle is stiff and not tight.

After all, the definition of madness is doing the same thing over and over again, and expecting a different result.

A stiff muscle is a protective muscle and we commonly see this with things like muscle spasm. When your back is painful the muscle stiffens up to protect the joints underneath it.

I think you may have the same type of analogy here where you have a joint which possibly moves too much. I’d imagine the rotation around your knee and so your muscles stiffen up to protect it. Now these muscles will feel tight but they are protectively stiff around the joint.

Therefore think of getting better control of your hip or your foot to control your knee rotation as mentioned before will give you a much better longer term outcome.

Makes sense!

The Guru

guru-profile Guru Responded
April 11, 2024

I have now had this Pes Anserinus bursitis for 4 months in right knee. Had it diagnosed by a consultant, a few private physiotherapists and under an ultrasound scan. Just yesterday, an NHS physio confirmed the condition again and said I need to concentrate more on strengthening exercises particularly as the pain seems to happen when the leg is fully extended. Doesn’t seem to hurt when bent such as walking up and down stairs, kneeling etc….

I am still considering a cortisone injection into the bursa in the hope that it will remove any further irritation and hopefully never return. Am I just wishful thinking?

This is the worst injury I’ve ever sustained and quite limiting. It has been confirmed as mild bursitis, but it just does not wan

April 11, 2024

All makes lots of sense – and probably after 18 months or so having an injection might be a good idea as on the face of it all conservative treatment has failed.

The jab will settle the pain but I doubt it will get why you’ve still got it.

I would question the rationale behind getting stronger – it’s almost as if you’re weak it’s a problem, whereas if you’re strong you’ll be fine. There are plenty of strong people out there with exactly the same problem, and they don’t need to get any stronger.

Instead turn this around by thinking of control of strength, not just strength. Driving a really powerful car around tight bends is very tricky compared to small car.

Pain at end range is because the bursa gets compressed because you have uncontrolled extension not weak extension. Think about closing a door – you can do it gently or slam it shut. In both occurrences the door is shut but one makes a lot of noise and needs a degree of force (strength) the other needs control of just enough to close it.

This is exactly what you need to do with your end range extension – learn to control it, don’t just straighten you your knee.

Simple physio, done well!

The Guru

guru-profile Guru Responded

Have more questions?

If you're struggling with Knees issues then we'd love to help. We offer appointments within 24 hours whether face to face at one of our London Physio Clinics, virtually or if you’d prefer we can arrange a home visit.

Request An Appointment

We aim to get back to you within an hour

How should we contact you?