Tibial Collateral Ligament Bursitis

with Rehab

Bursitis is a condition that involves inflammation of a bursa. A bursa is a fluid-filled sac that lies between soft tissue (i.e. ligaments, tendons, or skin) and a bone. The purpose of a bursa is to reduce friction that can lead to irritation and inflammation of the soft tissue or bone. The tibial collateral ligament bursa lies underneath the tibial collateral ligament of the knee. This ligament sits on the inside of the knee joint and helps hold the shinbone (tibia) and thigh bone (femur) in alignment. This bursa reduces friction between the tibial collateral ligament and the bones and cartilage of the knee joint. Bursitis often results in pain and/or a decrease in function of the affected joint.

SYMPTOMS

  • Pain, tenderness, and/or inflammation on the inner (medial) side of the knee.

  • Pain that gets worse with straightening (extension) of the knee.

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

CAUSES

Bursitis occurs when the bursa is irritated and causes an inflammatory response. However, it is unclear what causes irritation to the tibial collateral ligament bursa. This condition is most common in runners, tennis players, swimmers, and cyclists.

RISK INCREASES WITH:

There are no known risks for this condition.

PREVENTION

There are no known preventive measures for this condition.

PROGNOSIS

If treated properly, the symptoms of tibial collateral ligament bursitis usually go away within 6 weeks.

RELATED COMPLICATIONS

  • Longer healing time, if not properly treated or re-injured.

  • Chronic bursitis, resulting in recurring symptoms.

TREATMENT

Treatment first involves resting from any activities that aggravate the symptoms, and the use of ice and medicines to reduce pain and inflammation. The use of strengthening and stretching exercises may reduce pain with activity. These exercises may be performed at home or with a therapist. Your caregiver may recommend the use of a compressive knee sleeve, to be worn during activity to reduce symptoms. A corticosteroid injection may also be recommended to reduce inflammation. These injections often include lidocaine, which functions both as a treatment and a diagnostic tool.

MEDICATION

  • If pain medicine is necessary, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often recommended.

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

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

  • Corticosteroid injections may be given by your caregiver. These injections should be used only for the most serious cases, because they may be given only 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, and immediately after activity that aggravates your symptoms. Use ice packs or an ice massage.

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

SEEK MEDICAL CARE IF:

  • Treatment does not seem to help, or the condition gets worse.

  • Any medicines produce negative side effects.

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Tibial Collateral Ligament Bursitis

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

  • Restoring tissue flexibility helps return normal motion 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 - 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 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.

  • 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 knees. Hold for __________ seconds.

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

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

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

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

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

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.

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 - Adductors, Lunge

  • While standing, spread your legs apart, with your right / left leg backward and your opposite leg forward.

  • 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.

STRENGTHENING EXERCISES - Tibial Collateral Ligament Bursitis

These exercises may help you when beginning to recover from 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. Increase 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 knee cap 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, or 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 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 bends slightly.

  • 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 knee cap slide up or increased dimpling just above the knee. Your thigh may even shake a bit.

  • 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 between each repetition.

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

STRENGTH - Quadriceps, Wall Slides

Follow guidelines for form closely. Increased knee pain often results from poorly placed feet or knees.

  • Lean against a smooth wall or door and walk your feet out 18-24 inches. Place your feet hip width apart.

  • Slowly slide down the wall or door until your knees bend __________ degrees.* Keep your knees over your heels, not your toes, and in line with your hips, not falling to either side.

  • Hold for __________ seconds. Stand up to rest for __________ seconds between each repetition.

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

* Your physician, physical therapist or athletic trainer will alter this angle based on your symptoms and progress.