The human body contains 160 bursae throughout the body, with 11 typically located around the knee joint. These small fluid-filled sacs help prevent friction between soft tissues and bones. The bursa protects the knee from normal wear and tear of everyday life by acting as a cushion from bumps to the knee.
Bursae serves to prevent stress to the sartorius, gracilis, and semitendinosus muscles. These muscles act as the knee flexors and are also responsible for the internal rotation of the tibia. (1)
An inflammation or irritation to this bursa can result in bursitis. The most common cause for this condition is prolonged or repetitive motions that put pressure on the knees.
The stress to the muscles can also be a result of an anatomic deformity from arthritis in an overweight individual.
The pressure on the knee joint can be a result of a repetitive motion in sports or a hobby that involves kneeling on hard surfaces. Also, household activities that involve being on your knees result in the joint being overused.
This results in the knee bursae to get inflamed, which leads to extra fluid in the sac. The extra fluid causes excess pressure on the nearby tissues.
Furthermore, an inflammation of the tendon linking the muscle to the bone could lead to tendinitis.
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The different types of bursitis depend on the specific bursa that is affected. The most common type is where the bursa at the front of the knee is inflamed. (2) (3) Bursitis is usually noticed with old age and is one of the most common sports injuries.
A swollen knee joint, with tenderness and restricted movement of the knee could mean knee bursitis. However, these symptoms are quite common in arthritis and diabetic neuropathy.
It is important to know the difference between these conditions for proper management.
How is Bursitis Different from Arthritis?
Although the symptoms of arthritis and knee bursitis are quite similar, with pain around the knee joint, it is important to understand the differences between them for proper management and treatment.
Arthritis is termed as a degenerative joint disease, whereas bursitis is caused by repetitive overuse of joints or minor injuries.
The similarities between the two are the risk factors. Poor lifestyle, overweight, older age and a history of arthritis in the family are risk factors for both bursitis and arthritis.
The differences include the site of pain and the time taken to heal. Arthritic pain is noticed near muscles or bones, while bursitis pain is seen to be further from the joints. Also, the recovery time for bursitis is usually several weeks. However, arthritis lasts for a long time.
The long-term management of both conditions can be undertaken with self-care techniques. Regular exercising with focus on knee strength can prevent these conditions.
Your knee health can also be improved with the help of supplements, healthy diet, and use of protective braces while kneeling.
What Causes Knee Bursitis?
The bursa acts as a cushion for the knee flexors. An infection or a repeated trauma causes the bursa to get inflamed leading to the synovial cells getting multiplied.
The multiplication of synovial cells results in an increased collagen and fluid formation. (4)
Repetitive Friction: The fluid-filled sac near the knee joint can swell up because of repetitive friction. This friction and excessive pressure on the bursa is a result of movements such as kicking and jumping.
Knee bursitis is commonly noticed on the inner side of the knee or over the kneecap. The risk of repetitive friction is noticed in sports activities such as volleyball, football, and wrestling. These activities pose as a risk factor for knee bursitis as they are prone to frequent falls on the knee.
Prolonged kneeling can also increase the probability of being affected by the knee disorder. Kneeling on hard surfaces for a long time results in a frequent and sustained pressure on the kneecap.
People associated with plumbing, gardening, and other activities that involve prolonged kneeling can develop knee bursitis.
Traumatic injuries: A septic bursa is usually caused by a traumatic injury resulting in an open wound. Conditions such as bacteremia or septic arthritis could also cause an infected bursa.
Infection is usually noticed in patients with diabetes mellitus, skin disease, and alcoholism. Diabetic patients need to be careful and check their body for any cuts or wounds regularly.
Obesity and osteoarthritis have been known to be risk factors for bursitis of the inner side of the knee.
Knee Bursitis Symptoms
Knee bursitis is a painful knee condition, with the location and intensity of the pain depending on the type of bursa affected.
A sufferer can complain of a combination of the below symptoms. In cases where there are no symptoms, knee bursitis can be identified by a noticeable swelling or a lump over the knee.
It is recommended to get medical advice if knee bursitis is a result of an underlying condition such as arthritis. If the symptoms include fever and chill, it is most likely a result of an infected bursa.
Pain: Bursitis can cause knee pain usually aggravated by activity. The pain can appear suddenly in case of a trauma or be noticed gradually. The location of the pain depends on the specific bursa that is affected.
Inflammation: The swelling of the bursa can result in inflammation around the knee. This inflammation can cause discomfort and affect your daily activities.
Tenderness: The fluid-filled sac when inflamed can result in tenderness and warmth on touch.
Restricted knee motion: An inflammation of the knee bursae can affect the ability to straighten or bend the knee.
Instability: Certain types of bursitis can make the knee unstable resulting in a wobbly walk.
Fever: A septic bursitis is a result of an infection. Such conditions are associated with a fever and chills.
Ankle Discoloration: A ruptured cyst could leaf fluids down the leg resulting in a painless bruising around the ankle.
Disturbed Sleep: The pain and discomfort associated with bursitis affect sleep patterns. Reduced sleep is however linked to an increased sensitivity to pain. It is important to get proper sleep for pain management.
Most of these symptoms can be remedied with self-care techniques. It is advised to avoid any trauma-related activities till the time the knee is not in perfect health.
In case the bursitis symptoms continue for two to three weeks with intense pain, it is recommended to consult a doctor for appropriate treatment.
Rarely, bursitis sufferers complain of complications with the following symptoms.
- High level of bruising or rash in the knee.
- Disabling knee pain.
- Sudden knee pain.
- Fatigue and loss of appetite.
If an injury is causing the knee pain, it is important to rule out cartilage and ligament tears as the cause.
Types of Bursitis
Bursae in the knee are usually categorized into those located near the patella – prepatellar bursa, suprapatellar bursa, and the superficial and deep infrapatellar bursae.
The other category includes the bursae that are not located close to the patella. These include the gastrocnemius-semimembranosus bursa, iliotibial bursa, pens anserine bursa, and the tibial and fibular collateral ligament bursae. (5)
The types of bursitis depend on the specific bursa affected. The location of the pain is usually an indication to the affected bursa, however, imaging techniques such as MRI serve as a helpful tool to identify the affected bursa.
Location of Symptoms: Front of the kneecap
An inflammation of the bursa at the front of the knee cap results in prepatellar bursitis.
This condition results in an inflamed and swollen bursa leading to pressure on the adjacent parts of the knee.The common causes for this condition can be categorized into prolonged kneeling, previous injury, and underlying conditions.Prolonged kneeling causes irritation to the bursa, which results in it producing too much fluid. This condition is commonly seen in gardeners and plumbers. These frequent positioning of the knee on a hard surface causes mini traumas to the joint resulting in bursitis.A direct blow to the knee can also cause prepatellar bursitis. Sports such as football, basketball, and wrestling can cause direct blows or falls on the knee.
An injury to the knee can lead to a damage to the prepatellar bursa. This can further result in blood filling the bursa and inflammation of the lining.Underlying conditions such as gout, rheumatoid arthritis, and knee osteoarthritis also make an individual more prone to suffer from this painful condition.A bacterial infection could lead to the bacteria getting inside the sac resulting in an infected or septic bursitis. Such infections are a result of knee injuries such as puncture wound, scrape or an insect bite.
A septic bursitis, which is noticed as a cause in 20% of knee bursitis cases, can result in redness and fluid on the knee.
Septic bursitis is also likely to be seen in people with suppressed immune systems, such as those suffering from cancer, diabetes, and alcoholism. (6)Symptoms include tenderness, pain and swelling at the front of the kneecap, and pain with activity.An inflamed bursa can be treated at home with self-care techniques such as rest and ice. However, an infected bursa needs medical intervention.
A fever or chill associated with the condition is usually a sign of infection.A medical procedure to remove the bursa is suggested if the chronic swelling causes disability.If the bursitis is caused due to an underlying condition, it is important to treat the condition along with a treatment plan for bursitis.
Pes Anserine Bursitis
Location of Symptoms: Inside of the Knee
The Pes Anserine bursitis affects the medial knee. The pes anserinus bursa is situated at the proximomedial aspect of the tibia.
This area also houses the location where tendons for the gracilis, sartorius and semitendinosus muscles attach. The pes anserinus bursa is necessary to reduce friction between the bone and the tendons by serving as a lubricant.The causes for this condition can be categorized into an underlying biomechanical problem such as tight hamstrings, contusion from a direct blow, and underlying conditions.Tight hamstrings are usually known as a factor for causing pes anserine bursitis. This condition is commonly noticed in runners, with those with improper training and sudden increase in distance and pace being prone to itHow to check for tight hamstrings?
Lie on the back and flex the hips to 90 degrees. If you can straighten the knee as far as possible in this position, your hamstrings are not tight.Tight hamstrings can be remedied with hamstring stretching exercises. It is important to not overstretch the muscles as it could aggravate the condition. A comfortable stretch should be the aim. Improving flexibility will make it easier to stretch the muscles.Activities such as dancing and running involve the repetitive use of the sartorius, semitendinosus and gracilis tendons. This could pose as a risk factor for pes anserine bursitis.Sports activities that involve direction changes such as basketball and football can also cause the bursa to get inflamed.People with underlying conditions such as osteoarthritis and overweight females are also at a risk of developing the condition. (7)The characteristic symptoms include a spontaneous pain in the knee during descending or climbing stairs.
Other symptoms include inner knee pain when bending or straightening the knee, swelling over the inside of the knee, and weakness in the knee.The inflammation and pain can be relieved by self-care techniques. However, a full rehabilitation program should be completed before resuming any sports activities.
Location of Symptoms: Behind of the Knee
A fluid-filled swelling at the back of the knee is called a popliteal or Baker’s cyst.
This condition is caused as a result of excess joint fluid being pushed into the tissue behind the knee.This excess synovial fluid is usually a result of underlying conditions such as osteoarthritis and rheumatoid arthritis. An injury resulting in a cartilage tear is also known to be a cause.This condition is visible as a bulge at the back of the knee, with fluid-filled bulge being soft and tender. The symptoms often are not associated with pain and the condition can go away on its own.In cases where symptoms are noticed, they include swelling behind the knee, slight pain, and tightness behind the knee.Treatment usually includes pain relief in the form of NSAIDs and self-care techniques. Treating an underlying condition should be important for arthritis and gout sufferers.In rare cases, the cyst ruptures and results in rapid swelling and redness along with swelling around the ankle. The ruptured cyst leaks fluid down to the ankle, which appears as a bruise at the ankle. (8)
Location of Symptoms: Front of the Knee
The inflammation of the deep infrapatellar bursa, which is situated between the upper front surface of the tibia and the patella tendon, can be a result of friction between the skin and the bursa. The superficial infrapatellar bursa serves as a cushion between the skin and the patella tendon. The condition can sometimes occur along with Jumper’s Knee.
The causes include excessive friction, excess stress and an injury from a direct blow to the knee.Activities such as climbing, hiking, and running involve bending of the knee. A high frequency of these activities can aggravate the infrapatellar bursa due to excessive friction. Frequent kneeling can often result is more stress to the joint than the bursa can handle. This excess pressure can cause swelling and the thickening of the bursa lining.Additionally, lack of any physical activity can make the muscles weak. This could make the knee unstable as it does have the muscle support to move correctly.
Such situations can affect the weight bearing abilities of the knee and can result in improper weight distribution. This excess stress can put pressure on the infrapatellar bursa.Symptoms include swelling and pain in the anterior side of the knee. The pain is often similar to that associated with a Jumper’s Knee condition. (9)Home treatments are usually useful to treat infrapatellar bursa, with rest recommended the moment you notice pain. RICE techniques are helpful to relieve pain and inflammation.
Location of Symptoms: Out side of the Knee
The bursa is situated at the distal part of the iliotibial band. It is located between the outer shin bone and the iliotibial band.
The causes for this condition include overuse and injuries to the knee.
A hobby or work activity that involves kneeling for a prolonged time could lead to inflammation of the iliotibial bursa.
Sports injuries such as direct blows to the knee are also a common cause for this condition.
MRI is a helpful tool to diagnose this condition, as it is often misdiagnosed as iliotibial band syndrome. The iliotibial band is a band of fibrous tissue running from the pelvis to the knee.
MRI scans identify bursitis as a localized fluid collection adjacent to the iliotibial tendon.The treatment plan is same as those for the other types of bursitis, with rest and a gradual increase in activity.
Knee Bursitis Treatment
It is important to note that the healing period for knee bursitis is a few weeks.
The pain and inflammation are usually seen to reduce in the time period, however, athletes should focus on hamstring stretching and quadriceps strengthening before increasing the intensity of the activity.
Knee bursitis is known as self-limiting condition, which makes it respond well to treatment. However, complete healing is a time-consuming process and needs patience.
The treatment plan for knee bursitis should focus on the following areas.
Reduce Pain and Inflammation
RICE: Rest, Ice, Compression and Elevation should be the first step of treatment post an indication of knee bursitis.
Ice packs are helpful in providing comfort when applied right after the knee pain, however, they fail to offer relief from bursitis that developed a while ago.
Medications: Pain relievers and anti-inflammatory medications can be used to reduce swelling and provide comfort.
Knee Support: Knee bursitis can make it painful to straighten and bend the knee. It is important to have an unrestricted movement of the knee before resuming any strenuous activity.
Knee braces and knee pads are helpful tools to support the knee. These support agents can be used to ensure that the weight of the body is evenly distributed and not focused on the hips or knees.
Athletes can also wear a protective gear such as knee brace as a precautionary measure to avoid further injury to the area.
Elevating the knee while wearing a knee sleeve can help reduce the inflammation.
Invasive Treatment: If the pain and inflammation continue for a long time and the self-care techniques do not provide comfort, a doctor might suggest these treatment options for bursitis.
Steroid: A corticosteroid injected into an affected bursa can ease inflammation. This strong dose of steroid results in a rapid decline in the inflammation, however, the injection site can remain painful for a few days.
Aspiration: Drawing fluid from the bursa into a syringe can treat inflammation and reduce swelling. Post the injection, a patient is advised to wear a knee immobilizer to reduce the chance of swelling recurring. The injection site can remain painful for a few days.
Surgery: This is usually a last resort to manage bursitis and recommended when the condition results in a disability. The surgical procedure will remove the affected bursa, with the patient able to resume physical activity post a rehabilatory program.
Treat Underlying Conditions
Arthritis and gout patients can suffer from bursitis too. As the bursitis is related to these underlying conditions, it is important to treat them along with a bursitis treatment plan.
Understanding your medical history and identifying triggers for bursitis is necessary before starting a treatment plan.
Stay Fit: Lack of activity and an unhealthy diet could lead to knee bursitis. Overweight females are known to be more prone to suffer from this condition.
Include a warm-up session before starting an exercise regime and ensure that the intensity suits your body. Body flexibility can be built with yoga and stretching exercises.
While exercising, knee pads can be worn to ensure that the knee stays protected from the hard surface. Start with less intensive exercises such as jogging or cycling before initiating an equipment-based workout.
A healthy diet full of nutrients will keep your body protected from diseases. Include proteins in the form of eggs and fish as well calcium in your diet to keep your bones healthy.
Home Remedies & Natural Therapy
Most of these natural treatments do not have any adverse effects on the body. However, skin irritation if noticed should prompt halting the treatment.
Massage is usually known to boost circulation but the pressure on the joints needs to be correctly applied. A qualified massage therapist can help you understand the correct pressure and direction of the massage for your condition.
Make sure to not exert too much pressure on the affected joint as it could aggravate bursitis.
Essential Oils: Frankincense and peppermint oil are known to reduce inflammation and boost circulation. These oils can be applied during a massage or added to bath water.
Castor Oil Pack: A pack of cold-pressed castor oil can relieve pain associated with bursitis. The pack can be prepared by dipping wool or cotton in castor oil and placing in on the knee.
You can cover the wool or cotton with a heating pad to get relief from inflammation and pain.
Apple Cider Vinegar: Calcium deposits can cause persistent bursitis. These calcium deposits can be removed from the body by consuming a tablespoon of apple cider vinegar mixed in a glass of water.
Mustard Oil: Massaging the knee with mustard oil is known to reduce swelling and boost circulation.
Ginger: Known as natural pain reliever, ginger can be used in the form of ginger tea. It helps reduce pain and inflammation associated with bursitis.
White Willow Bark: White willow bark contains salicin, which is a precursor to the analgesic salicylic acid. The herb is known to possess anti-inflammatory and analgesic properties. It can be used in the supplement form.
Turmeric: The spice contains curcumin, which helps in reducing pain and inflammation.
Supplements: Vitamin C, Vitamin B12, and proteolic digestive enzymes supplements are helpful in reducing bursitis pain.
Knee Bursitis Rehabilitation Exercises
Any exercise should be undertaken with utmost care with proper shoes and equipment. Avoid repeating an exercise or posture if you feel pain or discomfort.
The stretching exercises are a good way to start build flexibility in the joints. Make sure that stretches are not damaging your injured knee. While lying on the back, make sure to choose a yoga mat or another firm surface.
Sit on a chair and keep your uninjured leg bent. The other leg should be in front of you with a slight bent.
Lean forward to feel a stretch in the thigh. Hold this position and repeat.
While lying on your back, keep your knees bent and foot planted on the floor.
Stretch the inside thigh muscles by spreading the knees apart slowly. Hold this position and repeat.
The following exercises can be added after the joint flexibility has improved. The bending and lifting positions should be carried out with utmost care. While bending the knee, the bend should not cause pain or discomfort.
While lying on the uninjured side, lift the injured leg by tightening the front thigh muscles.
Don’t stretch it too far as it might aggravate the condition. Repeat the motion for 1o times and ensure a slow pace is maintained.
Slide the heel of the foot slowly towards the buttock while sitting on a firm surface.
Pull the knees towards the chest while sliding the heel. Continue the motion for 10 repetitions.
It is advisable to start the rehabilatory program with these exercises before moving onto running or cycling.
It is important to note that knee bursitis symptoms tend to disappear after two weeks. However, resuming physical activity should be considered once the knee strength and flexibility improves
Risk Factors for Knee Bursitis
Overweight: Weight management is important to prevent knee conditions. As knees possess weight bearing abilities, being overweight puts more pressure on the knee than it is accustomed to.
Maintaining a healthy and nutritional diet helps keep the tissues and cartilages strong.
Gender: It is known that females are more prone to suffer from knee bursitis. This can be attributed to the wider hips that affect the alignment of the knee.
Arthritis: The degenerative condition is known to be a cause of knee bursitis.
Manual Workers: A job involving repetitive motion can put pressure on the knee and develop into bursitis.
Athletes: Running and jumping pose as a risk for bursitis. Proper technique and footwear could help avoid knee injuries.
Tips to Prevent Knee Bursitis
Knee bursitis can be prevented by following certain precautionary measures.
Gel Pads: Household activities can put pressure on the knees and lead to knee bursitis. This can be avoided by wearing knee gel pads as a protection from the hard surface.
Knee Support: Athletes are more prone to a direct blow to the knee. Knee pads protect the knee from an injury.
Ice Apllication: Applying ice on the knee after exercising stops the bursa from getting aggravated.
It is important to note that a septic bursa can spread to other joints, bones or blood if not treated in a timely manner.
It is advised to prevent this complication by consulting a doctor if a redness or rash is associated with bursitis.
An antibiotic course usually is able to halt the infection, post which a bursitis treatment plan can be followed.
The symptoms of knee bursitis can be quite similar to that of arthritis, gout, and diabetic neuropathy. It is important to understand the exact cause and location of the knee pain before diagnosing and treating it.
Diagnosis of bursitis can be undertaken by asking questions such as the patient’s hobbies, work-related activities, and any recent falls. These details are needed to understand if prolonged kneeling is involved in their activities.
It is also important to know your medical history, as underlying conditions could cause the knee bursitis. In such cases, the bursitis treatment should also include a treatment for the underlying cause.
Imaging techniques such as an X-Ray and MRI can help diagnosing a knee bursitis. MRI is helpful to rule out anatomical derangements and other conditions that have similar symptoms.
As the knee joint has several bursae, it is extremely important to have knowledge of knee anatomy before reaching a diagnosis.
Surgical removal of the bursa is usually considered as a last resort and recommended to individuals undertaking strenuous activity in their day-to-day lives.
A surgical procedure to remove the bursa is followed by a rehabilatory program before the patient can resume their activities.