Pes Anserine bursitis – both knee for over 1.5 years

March 15, 2018


I developed pain in both knees medial on the tibia bone October 2016 while riding and doing yard work.  I have taken off riding pretty much since then, even taking off pretty much everything for months at a time.

I have seen two PT’s for exercises, a chiropractor (who did stretches and electric stimulation) and two different orthopedic doctors.

The first doctor just said continue doing what I was doing (take it easy but don’t stop exercising and it should go away in six months), The second doctor gave me two steroid shots, just got one a week ago, and said, I am not doing any harm and continue to exercise.

I am very frustrated at the length of issue.  I read and read that this is not a big deal but for some reason I can’t get over this.  I had Achilles issues on the right heel several years

before,  This issue did not resolve after 1 year PT and I ended up having a series of surgeries (3) and at least that stopped the chronic consistent stinging pain that I was experiencing with that (4 years of work).

It still hurts when I work out with it but it settles down and is much better  as long as I don’t rub it.  I don’t know what to do with the knees.  Got any ideas?

I am desperate.


March 15, 2018

Hi Tom

Super frustrating  – and thanks for allowing me into the mix!

Without knowing why, any sort of passive intervention will be pretty useless as it won’t solve the why, and you must get this answered in a language that you understand.

Taking your other achilles stuff off line (you just had duff Physio (sorry) or you’ve got some weird collagenous issue (which I strongly doubt) but we’ll stick to your knees) PAB is due to a few common things.

Compression (riding – but why start now?), poor eccentric control of bending your knee or incorrect load management are the top 3 causes. Because of what you’ve had done to date, you need to address the loading and control issue. You need to get your tendon stronger to take load, compression and control of the way you use your knee, especially when up in the saddle.

I’d certainly stay away from any stretches, or rubbing or poking or needles.

As you’ve got bilateral symptoms I would also get your back assessed to make sure you do not have a central cause – poor glutes, internally rotated femurs, poor inner range quads, isometric sartorial, gracilis and semi T, eccentric hamstring loading…it’s getting a longer list than than I’d like online.

Where about in the UK are you? I’m sure I could get you in front of someone who can assess all of the about and set you on your way.

Don’t expect overnight success but you need to trust someone who makes sense and can help plot your return to pain free riding.

The Guru

Tom gets straight back….

Sorry but I do not live in the UK, I live in America. So you think no stretching? That is hard because that relieves my pain, so I have been doing yoga etc, and have been advised by my Physical Therapists to do stretches.

The Guru has more advice…

Yes – absolutely stop stretching.

The definition of madness is doing the same thing time and time again and expecting a different outcome.

It’s totally pointless continually stretching tissue as it doesn’t address why it’s tight and needs to be stretched. Yoga is great for mind/body connection and movement but it’s pretty poor for resolution of MSK pain – it’s at best a temporary pain reliever.

Feeling better is not the same as getting better, and you want to do the latter.

…..I’d probably guess that you’ve got stiff protective tissue (not right and dysfunctional) which is stiff because it protective of over loaded tissues. It certainly doesn’t need to be stretched – stabilised and controlled, yes. Stretched, no.

Good Luck.

Guru Responded

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