The simple answer is yes. The knee joint is very complex and stress is continually placed upon it during our daily activities. It has been reported to be one of the most common sites for inflamed bursa in the body. The purpose of bursa around joints is to lubricate the muscles and tendons when they are gliding. This lubrication prevents friction injury to the soft tissues and allows us to function normally while walking or running.
What Causes Bursitis?
Bursa are small sacs filled with fluid that is secreted by the lining of the bursa. When there is too much secretion of fluid, the bursa swell and become inflamed resulting in pain and limitation of movement. Inflammation may be brought on by the following:
- Overuse – Repetition of an activity such as frequently going up and down stairs or working on your knees.
- Misuse – Using the lower leg to push an object over a short distance.
- Trauma – Sports injuries or falls.
- Arthritis – Joint degeneration alters knee mechanics during walking.
Bursitis of the knee may co-exist with other knee pathologies, and failure to recognize the bursa as a contributing factor to the pain and disability may reduce the rate of recovery. This may also contribute to chronic knee pain.
Location of the Bursa
There are many bursas in the knee; some are less significant than others. The major bursas include the following:
- Pes Anserine – The pes anserine (an-sir-een) bursa is located on the medial or inside aspect of the knee. The symptoms include pain on the inside of the knee. Movement during flexion and rotation such as turning the foot out can increase the pain. A key in considering the possibility of pes anserine involvement would be the inability to kneel or walk down steps. Overuse in sport activities is a common cause.
- Suprapatellar – This bursa is located underneath the upper knee cap and beneath large tendons of the lower thigh that connect to the knee cap. Injury can occur from acute trauma or even micro trauma (very small and unnoticed injuries contributed to by repetition or overuse)to the bursa. Running continually on rough or uneven surfaces or working and crawling on the knees for long periods of time are common causes. The pain is felt above the knee cap and into the upper thigh. Walking up and down steps and getting up from the seated position will be painful. The knee can feel like “it’s catching” during range of motion activity. Arthritis is common with suprapatellar bursitis.
- Prepatellar – This bursitis has been referred to as “Housemaid’s Knee”. Like all the other bursa, it can become symptomatic by trauma or repetitive strain. Crawling on your knees or receiving a direct blunt trauma from sports are common causes. The pain and swelling from this bursa is noted on the knee cap with pain going above or below the knee cap. Kneeling or going up and down stairs can be very painful. This condition often coexists with arthritis of the knee.
- Infrapatellar – The bursa is located under and below the knee cap and the large tendon that extends from the knee cap to the tibia or shin bone. This bursa is a common problem for distance runners. Direct trauma or over-use can trigger the symptoms. Working on the knees is a common cause of pain in this bursa. The pain radiates around the knee and swelling is noted just below the knee cap.
The location of the pain aids the doctor in determining which bursa(s) are contributing to the pain and limitations. More serious knee injury may occur and bursa injury can coexist with cartilage or ligament tears.
Treatment of Knee Bursitis
Conservative management is the first step in the care and treatment of knee bursitis. The knee must be rested during the acute treatment phase. If not treated, it is very possible that a chronic problem may develop which can adversely affect activities of daily living. Some recommendations for the care and treatment of knee bursitis include:
- Ice – Apply ice to the area of swelling. Pain can radiate from the area of swelling to distant areas and ice applications to these distant areas are not necessary. Only apply over the area of swelling.
- Compression – Some authorities suggest a compression bandage or elastic knee sleeve be worn if you must be up and working. This should not be worn to bed but only during the day.
- Ultrasound – Ultra high frequency sound waves are used to help reduce localized swelling.
- Electrical Muscle Stimulation – This promotes muscle relaxation and reduces the strain on the tendons around the knee.
- Knee Pillow – Placing a small pillow between the knees when sleeping reduces the pressure from one knee resting on the other.
- Knee Pads – When returning to work, the use of knee pads can cushion the knee cap and reduce the trauma and stress of being on your knees.
- Exercises – Exercises to strengthen and balance the muscles that move the knee will assist in recovery and help maintain the condition of the knee.
- Weight Control – Obesity can contribute to bursitis and reduce the rate of recovery.
- Medication – This is beyond the scope of this article. Over- the-counter (OTC) pain medications should be used following the manufacturer’s recommendations. These should be discussed with your primary care physician for contraindication to any other medications you may be taking.
If conservative management of the knee bursitis is not successful, steroid injections or possible aspiration by using a needle to draw the fluid out of the area may be necessary. A main factor in preventing reoccurrence is altering or changing the cause of the problem. Running on smooth and flat surfaces, using a kneeler when working on your knees and maintaining a regular exercise program for the knee can all aid in preventing a reoccurrence.
The doctors at Coon Rapids Chiropractic Office have experience in the care and treatment of knee bursitis.