Pes Anserinus Tendinitis / Bursitis

The pes anserinus (or pes anserine tendon) is a combined tendon of three muscles (Gracilis, Sartorius & Semitendinosus). It is found on the inside of the knee joint and passes slightly anteriorly to attach to the inner, front (anteromedial) Tibia (shin bone).

Runners can experience pain in this area as a result of inflammation to either the tendon itself, or a bursa which sits between the tendon and the bone. A bursa is a small sack of fluid which is designed to reduce friction between soft tissues and the underlying bone. There arew numerous bursae around the knee, as well as the hip, shoulder and elbow joint for example.


The symptoms of pes anserinus tendonitis start with a gradually worsening pain on the inner knee, below the knee cap level. Initially the pain may ease as you warm up into your run, As the condition progresses, the pain will persist and often worsen.

It will be tender to touch the tendon and its insertion and some mild swelling or ‘puffiness’ may be visible. In worse cases the area may be warm to the touch. Away from running, pain is often aggravated by walking up stairs.

The symptoms don’t vary much between tendinitis and bursitis. The main difference is pain is often present at night with cases of bursitis.

 What Causes Pes Anserinus Injuries?

Pes anserinus bursitis and tendinitis are overuse injuries which develop over time – rarely from one particular moment. If your pain occurred very suddenly, consider an MCL sprain. It may develop over the course of one long run, or maybe a few weeks. But the cause is overuse to the tendons – in whatever form. This results in small microtears within the tendon fibres which can become inflamed and painful. At this point, the body trys to heel itself and lays down scar tissue to repair the tears – but this is quite inflexible tissue which doesn’t function like normal tendon fibres. This causes stiffness in the tendon.

The tendon may become overused due to a change in your training – for example running more uphill or just increasing the intensity of your training program. Or a change in your footwear for example. New runners or those who haven’t had a professional gait analysis may be wearing unsuitable running shoes.

There are many other problems which could also contribute. For example, the hip muscles may be either too weak or too tight – or a combination! The hip muscles have a lot to answer for when it comes to running injuries! Problems in this area translate down into the knee joint as a rotation effect is placed on the Femur (thigh bone).

Treatment of Pes Anserinus Tendinitis / Bursitis

As with all running injuries the first step is to stop running and rest the knee. Ice should be applied for the first few days at regular intervals for 15 minutes at a time to ease pain and inflammation. Anti-inflammatory medications may also be advised by your Doctor.

If you choose to see a professional sports injury therapist they may use other treatments to help reduce the pain and inflammation, such as electrotherapies like ultrasound / laser.

They should assess you and your movement patterns / strength and flexibility from head to toe, This will help identify areas of weakness or tightness which may be contributing. They should also look at your running style, running shoes and training program.

Hip exercises which may be recommended include stretches for the hip flexors, groin muscles and rotators, as well as hip abductor strengthening such as clams and hip hitching exercises:

Return to Running

A return to running is not recommended until the tendon / bursa are free from pain on a daily basis and during other, non-weight bearing exercises such as cycling. Improvements in the hip strength should also be noted and any footwear and training errors corrected.

At this point, a graded return to running program can begin which should start with short duration jogging, possibly combined with walking intervals, for 10 minutes or so initially. Have a minimum of 2 days rest between runs to allow the muscles to recover and any recurrence of the pain to develop. If you experience no problems either during or after your first run, try the same again and gradually build in this way. If you feel the pain return at any point, rest and resume treatment.

11 thoughts on “Pes Anserinus Tendinitis / Bursitis

  1. What happens if it occurs after a total knee replacement. What is the treatment?


    1. The treatment doesn’t really change – depending on how soon after the knee operation it developed and how much movement you have at the knee. But basically – rest and ice, then massage after it’s calmed down a bit. Then focus on the same strengthening and flexibility work.


    2. I fell about 2mths ago and hit both my knees a cpl times on my way down (I blacked out 2ce in about 30 min and fell in my house) along with landing on them, my knees are both still causing me severe pain & swelling, I can’t afford to see a doctor, what do I do?


  2. What can happen if you push through the pain? I have a 24 hour endurance event coming up which involves wearing a 40lb pack the entire time. Can this result in additional damage or is it just a pain issue?


    1. Steve – from my experience it might result in both. I pushed through the pain with endurance running, but not under the same circumstances you are planning. The result was additional damage, most likely in the form of scar tissue which caused ongoing pain. Tendons and ligaments have slow cellular replacement cycles so they are slow to heal. I have been battling my pain for three years. This is not to say that you will face the same. Hopefully not. Do what you can before your race, and your best judgement call. If it works out for you then that’s great. If not, then you made the wrong choice. The endurance race sounds fantastic, and I can see where it would be a difficult call. Good luck with whatever you decide. Remember, there will always be another race. But you only get one set of knees.


  3. Thank you so much. Before I found article I thought it was a confusing case of mcl strain now I know to try only. 10 minuets and give 2 days rest. And work back gradually to more running at a time.


  4. Just want to know if a knee brace would help.


    1. Unlikely. The cause of the problem is more than likely from your hips and movement patterns. So wearing something on the knee is unlikely to help


  5. Lorie Johnson 6th Mar 2016 — 4:50 pm

    Hi, I’m so glad I found this article as I finally have a name fur the tendon problems I’ve been having for months now. 8 months ago I had pain around my knee cap due to overuse. When visiting the doc he pushed on this tendon attachment area and he determined that may have been the cause. I had already tried prednisone so I had a shot of cortisone and started PT. The PT did very aggressive astym right on the attachment site but no where else. Since then my knee has hurt there when it didn’t before. My new PT is having me stretch and strengthen my hips so I’ve gotten stronger but I still have pain even though I have not run in 3 months. Is there anyway the first PT did damage to the area? I found out he is not certified to even do astym. Any insight or advice you have would be greatly appreciated!!


  6. inspection pes anserinus tendinitis. help me search answer inspection ?


  7. can it be caused by wearing high heels? I went to a wedding and did a lot of walking around in high heels which I am unaccustomed to and developed this pain in both knees?


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