Goosing around that niggle knee

Experiencing medial pain below the knee joint - Pes Anserine Bursa written by Carla Mullins and edited by Olivia Taylor

There is a group of muscle attachments known as the goosefoot that are delightfully whimsical. Sadly, the pain one feels when something is amiss with this area is not so delightful. Straightening and bending the knee becomes a rather painful ordeal.

The goose’s foot, also known as the Pes Anserine, is a common tendon point where muscles of the Gracillis, Semitenditous and the Sartorius conjoin over the bursa. The bursa, or the Pes anserine bursa (PAB), is found on the medial aspect of the knee about one to two fingers below the knee joint. You can find this point by bending your knee and tracking your fingers down the patella tendon to its attachment point at the tibial tuberosity. Once here, slide your fingers medially and obliquely. This is around the point that you will find the PAB. Hopefully, it won’t feel painful unless like me you have twisted an ankle and taken a fall on the cement.

Who experiences it – apart from me?

I had stubbornly been working in an old pair of running shoes which led to a trauma and a bio mechanics issue, and ultimately, irritation around the knee. Pain below the knee joint is a common overuse and biomechanical problem seen particularly in runners. Swimmers sometimes call it “the breast stroke knee”. Being overweight may contribute to the problem, but this has not been proven (Alverez, 2007). Older women also tend to experience this issue at higher rates; you have to love that old Q angle.

Pain in this area is evident by applying light pressure. You will also likely feel pain when bending and straightening your knee while loading the area e.g. when walking and running. This area is so intrinsic to our everyday movements, that the pain can quickly become tiresome. If you are experiencing pain, you should consult an appropriate professional.

I started by visiting my lovely Physiotherapist. When asked why I was there, I explained, “I think I have pes anserinus bursitis in my left leg exacerbated by a stuck fibular and restricted dorsiflexion in my left ankle.” She smiled. Following her examination, she proceeded to agree with my diagnosis (she knows me and is familiar with my diagnostic skills). After being advised to focus on muscle release and ankle range of motion, I was sent home taped up and equipped with an arsenal of exercises to aid my rehabilitation. Some of the program and pilates ideas I implemented are detailed later in this article.

It is important to seek a diagnosis from your Physiotherapist to rule out similar conditions like Medial Collateral Ligament problems and Medial Meniscus (pain is generally located higher up and in the joint). As with most things, consulting a professional sooner rather than later is advisable to ensure the inflammation doesn’t become chronic. You can then begin working on unloading the bursa, and increasing the strength and flexibility of the muscles.

In my case, I acted early and could resume exercising almost immediately, albeit modified exercise and with some targeted foci. Others may find that the inflammation is so great that they need to take NSAID and implement anti-inflammatory practices like icing and unloading.

Some helpful exercises and suggestions when working with PAB…

1. Remember that while the bursa is irritated there can also be some tendon issues. You will need to work on appropriately loading the affected muscles and tendons.

2. Address the kinetic chain, not just the knee. There will be many reasons why the knee is irritated and simply addressing the inflammation will not result in lasting relief. My flat foot, twisted ankle and old runners all contributed to the problem. In other cases, you will see issues stemming from poor hip function. This hip pattern will need to be addressed to unload the knee.

3. Stretch and massage the surrounding muscles, particularly those forming the Pes ancerenus grouping. Consider hamstring stretches, hip abduction stretches for the sartorius muscle and adductor stretches for the gracillis.

4. Implement closed kinetic chain work to strengthen and condition the muscles. This can be supported by mat exercises at home or as part of the warm-up. For this, I love the reformer and spine corrector work.

I have outlined some specific ideas and exercises that I found most effective for addressing this area below. Most of this content is limited to paid subscribers only.

I like to use the Makarlu Lower Limb stretch series to support this

In the classes section of MoveMent, you will find a lovely class using the spine corrector. The class has some lovely flow ideas and stretch ideas that elongate and strengthen the lower limb. The class is available for paid subscribers, but can be purchased separately as an on-demand class.

Other ideas and videos are below available to our paid subscribers.