Prepatellar Bursitis

with Rehab

Bursitis is a condition that is characterized by inflammation of a bursa. Bursa exists in many areas of the body. They are fluid filled sacs that lie between a soft tissue (skin, tendon, or ligament) and a bone, and they reduce friction between the structures as well as the stress placed on the soft tissue. Prepatellar bursitis is inflammation of the bursa that lies between the skin and the kneecap (patella). This condition often causes pain over the patella.

SYMPTOMS

  • Pain, tenderness, and/or inflammation over the patella.

  • Pain that worsens with movement of the knee joint.

  • Decreased range of motion for the knee joint.

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

  • Occasionally, painless swelling of the bursa.

  • Fever (when infected).

CAUSES

Bursitis is caused by damage to the bursa, which results in an inflammatory response. Common mechanisms of injury include:

  • Direct trauma to the front of the knee.

  • Repetitive and/ or stressful use of the knee.

RISK INCREASES WITH:

  • Activities in which kneeling and/or falling on one's knees is likely (volleyball or football).

  • Repetitive and stressful training, especially if it involves running on hills.

  • Improper training techniques, such as a sudden increase in the intensity, frequency or duration of training.

  • Failure to warm-up properly before activity.

  • Poor technique.

  • Artificial turf.

PREVENTION

  • Avoid kneeling or falling on your knees.

  • 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 proper technique. When possible, a have coach correct improper technique.

  • Wear properly fitted and padded protective equipment (knee pads).

PROGNOSIS

If treated properly, then the symptoms of prepatellar bursitis usually resolve within 2 weeks.

RELATED COMPLICATIONS

  • Recurrent symptoms that result in a chronic problem.

  • Prolonged healing time, if improperly treated or re-injured.

  • Limited range of motion.

  • Infection of bursa.

  • Chronic inflammation or scarring of bursa.

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, especially those of the quadriceps and hamstring muscles. These exercises may be performed at home or with referral to a therapist. Your caregiver may recommend kneepads when you return to playing sports, in order to reduce the stress on the prepatellar bursa. If symptoms persist despite treatment, then your caregiver may drain fluid out with a needle (aspirate) the bursa. If symptoms persist for greater than 6 months despite non-surgical (conservative) treatment, then surgery may be recommended to remove the bursa.

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.

HEAT AND COLD

  • Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or massage the area with a piece of ice (ice massage).

  • Heat treatment may be used prior to performing the stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or soak the injury in warm water.

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 - Prepatellar Bursitis

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.

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.

STRETCH - Quadriceps, Prone

  • Lie on your stomach on a firm surface, such as a bed or padded floor.

  • Bend your right / left knee and grasp your ankle. If you are unable to reach, your ankle or pant leg, use a belt around your foot to lengthen your reach.

  • Gently pull your heel toward your buttocks. Your knee should not slide out to the side. You should feel a stretch in the front of your thigh and/or knee.

  • Hold this position for __________ seconds.

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

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.

STRENGTHENING EXERCISES - Prepatellar Bursitis

  • 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.

STRENGTH - Quadriceps, Isometrics

  • Lie on your back with your right / left leg extended and your opposite knee bent.

  • Gradually tense the muscles in the front of your right / left thigh. You should see either your kneecap slide up toward your hip or increased dimpling just above the knee. This motion will push the back of the knee down toward the floor/mat/bed on which you are lying.

  • Hold the muscle as tight as you can without increasing your pain for __________ seconds.

  • Relax the muscles slowly and completely in between each repetition.

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

STRENGTH - Quadriceps, Short Arcs

  • Lie on your back. Place a __________ inch towel roll under your knee so that the knee slightly bends.

  • Raise only your lower leg by tightening the muscles in the front of your thigh. Do not allow your thigh to rise.

  • Hold this position for __________ seconds.

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

OPTIONAL ANKLE WEIGHTS: Begin with ____________________, but DO NOT exceed ____________________. Increase in1 lb/0.5 kg increments.

STRENGTH - Quadriceps, Straight Leg Raises

Quality counts! Watch for signs that the quadriceps muscle is working to insure you are strengthening the correct muscles and not "cheating" by substituting with healthier muscles.

  • Lay on your back with your right / left leg extended and your opposite knee bent.

  • Tense the muscles in the front of your right / left thigh. You should see either your kneecap slide up or increased dimpling just above the knee. Your thigh may even quiver.

  • Tighten these muscles even more and raise your leg 4 to 6 inches off the floor. Hold for __________ seconds.

  • Keeping these muscles tense, lower your leg.

  • Relax the muscles slowly and completely in between each repetition.

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

STRENGTH - Quadriceps, Step-Ups

  • Use a thick book, step or step stool that is __________ inches tall.

  • Holding a wall or counter for balance only, not support.

  • Slowly step-up with your right / left foot, keeping your knee in line with your hip and foot. Do not allow your knee to bend so far that you cannot see your toes.

  • Slowly unlock your knee and lower yourself to the starting position. Your muscles, not gravity, should lower you.

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