Pes Anserinus Syndrome

with Rehab

ExitCare ImageThe pes anserine, also known as the goose's foot, is an area of the shinbone (tibia) near the knee joint where the tendons of three of the muscles of the thigh insert into the bone. These muscles are important for bending the knee and bringing the leg across the body. Just underneath the three tendons that attach at the pes anserinus exists a fluid filled sac (bursa) that is meant to reduce the friction between the tendons and the tibia. Pes anserinus syndrome is a condition that is characterized by inflammation of the bursa (bursitis) and/ or tendonitis (inflammation of the tendon) and may cause severe pain in the lower portion of the inner (medial) side of the knee.

SYMPTOMS

  • Pain and inflammation over the lower portion of the medial side of the knee.

  • Pain that worsens as the duration of an activity increases.

  • Pain that worsens when bending the knee, especially against resistance.

  • A crackling sound (crepitation) when the tendon or bursa is moved or touched.

CAUSES

Bursitis and tendonitis are usually characterized as overuse injuries. Common mechanisms of injury include:

  • Stress placed on the knee from a sudden increase in the intensity, frequency, or duration of training.

  • Direct trauma to the upper leg (less common).

RISK INCREASES WITH:

  • Endurance sports (distance running or triathletes).

  • Making changes to or beginning a new training program.

  • Sports that place stress on the muscles that insert at the pes anserinus, such as those that require pivoting, cutting, or jumping.

  • Improper training.

  • Poor strength and flexibility

  • Failure to warm-up properly before activity.

  • Improper knee alignment ( knock knees).

  • Arthritis of the knee.

PREVENTION

  • Warm up and stretch properly before activity.

  • Allow for adequate recovery between workouts.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness.

  • Learn and use training methods that will reduce the stress placed on the pes anserinus.

  • Arch supports (orthotics) may be helpful for those with flat feet.

PROGNOSIS

If treated properly, then the symptoms of pes anserinus syndrome usually resolve within 6 weeks.

RELATED COMPLICATIONS

  • Persistent and potentially chronic pain if the condition is not treated properly.

  • Re-injury if activity is resumed before the injury is allowed to heal completely, or if one resumes improper training habits.

TREATMENT

Treatment initially involves the use of ice and medication to help reduce pain and inflammation. The use of strengthening and stretching exercises may help reduce pain with activity. These exercises may be performed at home or with a therapist. Individuals who have flat feet may find benefit in wearing arch supports in their shoes. Some individuals find that compression bandages or knee sleeves help reduce symptoms. Your caregiver may recommend a corticosteroid injection to help reduce inflammation. If symptoms persist, despite conservative treatment for greater than 6 months, then surgery may be recommended.

MEDICATION

  • If pain medication is necessary, then nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen, or other minor pain relievers, such as acetaminophen, are often recommended.

  • Do not take pain medication for 7 days before surgery.

  • Prescription pain relievers may be given if deemed necessary by your caregiver. Use only as directed and only as much as you need.

  • Corticosteroid injections may be given by your caregiver. These injections should be reserved for the most serious cases, because they may only be given a certain number of times.

SEEK MEDICAL CARE IF:

  • Treatment seems to offer no benefit, or the condition worsens.

  • Any medications produce adverse side effects.

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Pes Anserinus Syndrome

These exercises may help you when beginning to rehabilitate your injury. Your symptoms may resolve with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

ExitCare Image STRETCH – Hamstrings, Supine

  • Lie on your back. Loop a belt or towel over the ball of your right / left foot.

  • Straighten your right / left knee and slowly pull on the belt to raise your leg. Do not allow the right / left knee to bend. Keep your opposite leg flat on the floor.

  • Raise the leg until you feel a gentle stretch behind your right / left knee or thigh. Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

ExitCare Image STRETCH - Hamstrings, Doorway

  • Lie on your back with your right / left leg extended and resting on the wall and the opposite leg flat on the ground through the door. Initially, position your bottom farther away from the wall than the illustration shows.

  • Keep your right / left knee straight. If you feel a stretch behind your knee or thigh, hold this position for __________ seconds.

  • If you do not feel a stretch, scoot your bottom closer to the door, and hold __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

ExitCare Image STRETCH - Hamstrings/Adductors, V-Sit

  • Sit on the floor with your legs extended in a large "V," keeping your knees straight.

  • With your head and chest upright, bend at your waist reaching for your right foot to stretch your left adductors.

  • You should feel a stretch in your left inner thigh. Hold for __________ seconds.

  • Return to the upright position to relax your leg muscles.

  • Continuing to keep your chest upright, bend straight forward at your waist to stretch your hamstrings.

  • You should feel a stretch behind both of your thighs and/or knees. Hold for __________ seconds.

  • Return to the upright position to relax your leg muscles.

  • Repeat steps 2 through 4.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRETCH - Hamstrings, Standing

  • Stand or sit and extend your right / left leg, placing your foot on a chair or foot stool

  • Keeping a slight arch in your low back and your hips straight forward.

  • Lead with your chest and lean forward at the waist until you feel a gentle stretch in the back of your right / left knee or thigh. (When done correctly, this exercise requires leaning only a small distance.)

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

ExitCare Image STRETCH - Adductors, Lunge

  • While standing, spread your legs

  • Lean away from your right / left leg by bending your opposite knee. You may rest your hands on your thigh for balance.

  • You should feel a stretch in your right / left inner thigh. Hold for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRETCH - Adductors, Standing

  • Place your right / left foot on a counter or stable table. Turn away from your leg so both hips line up with your right / left leg.

  • Keeping your hips facing forward, slowly bend your opposite leg until you feel a gentle stretch on the inside of your right / left thigh.

  • Hold for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTHENING EXERCISES - Pes Anserinus Syndrome

These exercises may help you when beginning to rehabilitate your injury. They may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Progress the resistance and repetitions only as guided.

ExitCare Image STRENGTH - Hamstring, Curls

  • Lay on your stomach with your legs extended. (If you lay on a bed, your feet may hang over the edge.)

  • Tighten the muscles in the back of your thigh to bend your right / left knee up to 90 degrees. Keep your hips flat on the bed/floor.

  • Hold this position for __________ seconds.

  • Slowly lower your leg back to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

OPTIONAL ANKLE WEIGHTS: Begin with ____________________, but DO NOT exceed ____________________. Increase in 1 lb/0.5 kg increments.

ExitCare Image STRENGTH - Hip Adductors, Straight Leg Raises

  • Lie on your side so that your head, shoulders, knee and hip line up. You may place your upper foot in front to help maintain your balance. Your right / left leg should be on the bottom.

  • Roll your hips slightly forward, so that your hips are stacked directly over each other and your right / left knee is facing forward.

  • Tense the muscles in your inner thigh and lift your bottom leg 4-6 inches. Hold this position for __________ seconds.

  • Slowly lower your leg to the starting position. Allow the muscles to fully relax before beginning the next repetition.

Repeat __________ times. Complete this exercise __________ times per day.