Pes anserine bursitis: symptoms, causes, and gentle knee exercises

Pes anserine bursitis is a term for a type of discomfort or tenderness on the inner side of your knee. Bursae are small, fluid-filled sacs found throughout your body, especially around joints. Their job is to help your tendons glide smoothly over bones as you move. This makes everyday movement more comfortable. When these sacs become inflamed, it’s known as bursitis. It can lead to soreness, tenderness, or stiffness around your knee — especially when going up or down stairs, squatting, or after spending more time on your feet than usual.

“Most knee bursitis improves with simple approaches like modifying activity levels, doing targeted exercises, and physical therapy,” says Mark Schroeckenstein, PT, DPT, a physical therapist. 

Read on to learn more about pes anserine bursitis, what causes it, and how to treat and prevent it, including exercises recommended by Hinge Health physical therapists.

What is pes anserine bursitis?

Pes anserine bursitis means extra sensitivity or irritation  of the pes anserine bursa on the inner side of your knee, just below the joint line. This bursa sits underneath the point where three tendons from different muscles meet and attach to your shinbone (tibia). These muscles include:

• Sartorius (front of the thigh)

• Gracilis (inner thigh)

• Semitendinosus (part of the hamstrings at the back of the thigh)

The tendons that connect with the above muscles glide over the bursa with every step you take, says Dr. Schroeckenstein. “If the area becomes irritated — for instance, after more activity than usual or because of changes in the  muscles around the knee — you might notice pain or swelling. This can make everyday movements feel less comfortable for a while.”

Causes of pes anserine bursitis

Pes anserine bursitis can occur in anyone, but may be more likely to affect people who are more active or with certain health conditions (such as diabetes). Many factors can play a role, such as  doing more activity than your body is used to, changes in muscle strength or flexibility, and changes in your joints over time.These include:

• Muscle strength. If the muscles around your knee (like your quads and hamstrings) aren’t as active as usual, other areas like the bursae may take on a bit more of the load. This can sometimes make your knee feel more sensitive or irritated during movement. Building strength in these muscles can help support your knee and can promote greater comfort with activity.

• Muscle tightness. Sometimes, tight hamstrings or inner thigh (groin) muscles can create extra tension or rubbing near the bursa. Gently improving flexibility in these areas may help reduce pain sensitivity and support comfortable movement.

• Ramping up activity too quickly. Movement is great for your knees, but big increases in how much or how often you exercise can make the area around the bursa more sensitive. “Suddenly running five days a week when you’re used to two, or starting a walking routine after being inactive all winter, are examples of activity changes that can stir up symptoms,” says Dr. Schroeckenstein. Gradually building up your activity levels gives your body time to adjust and helps prevent discomfort.

• Knee osteoarthritis. As you age, it’s common for the protective tissue (cartilage) in your knee to change. These changes don’t always cause symptoms. For some people they can create extra sensitivity or irritation near the bursa and contribute to pes anserine bursitis.

• Trauma. A fall or direct bump to the inside of your knee can make the bursa more sensitive and lead to swelling, Dr. Schroeckenstein says. Sometimes, injuries like a strained or sprained knee ligament (such as the MCL (medial collateral ligament) are connected with bursitis, as these injuries can increase irritation in the area. 

• Excessive weight. Carrying more body weight can mean your  knees do more work, especially during activities that involve a lot of bending, like running or squatting, and this can sometimes put more stress on the bursa. 

• Health conditions. People with certain health conditions, like diabetes, may also be more likely to experience pes anserine bursitis. Diabetes can affect how your body manages inflammation and how well tissues heal, which can make some areas — like structures in and around your knee — more sensitive or prone to discomfort. Taking care of your overall health and building strength around your knees can help support comfort with movement.

• Anatomy. Everyone’s knees and feet are a little different. The way yours work together can change how pressure is felt around the knee joint. For instance, if your knees tend to turn inward or you have flatter feet, you might notice more irritation or strain on the pes anserine bursa. These variations are common. Adjusting movement patterns or footwear can help if you notice discomfort.

Symptoms of pes anserine bursitis

Pain from pes anserine bursitis often shows up during or after activities that put extra pressure on the inside of your knee, such as running and climbing stairs. “People tend to notice symptoms the most when they’re getting out of a chair or moving after being still for a long period of time,” says Dr. Schroeckenstein. You may notice:

• Achy pain on the inner side of the knee, just below the kneecap

• Swelling or warmth around the knee

• Pain worsens with activity and eases with rest

• Pain when bending the knee or standing up from a chair 

• Increased discomfort after periods of inactivity or prolonged activity 

• Stiffness or limited range of motion in the knee

How movement can help pes anserine bursitis

While you may feel more discomfort from pes anserine bursitis symptoms during activity, resting too much usually isn’t helpful for long-term recovery. Gentle movement and targeted exercises can increase blood flow to your knee, bringing oxygen and nutrients that support healing. Stretching helps ease tightness that may contribute to irritation, while building strength in the muscles around your knee reduces the load on the bursa so you can move more comfortably.

This exercise targets the muscles on the outside of your hip, which helps support healthy knees and promotes better mobility during movement.

These exercises help increase flexibility in the muscles and tendons around the pes anserine bursa, while also building lower-body strength. This combination supports healthy movement, relieves tension, and reduces pressure on the bursa and knee joint, improving your comfort during daily activities.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Treatments for pes anserine bursitis

Most cases respond well to simple treatments, such as activity modification, targeted exercises, physical therapy, and pain relief strategies like ice and anti-inflammatory medications. Consider these expert-backed treatments for pes anserine bursitis.

• Try physical therapy and targeted exercises. Targeted exercises strengthen and stretch the soft tissues that support your knee so that you move more comfortably. You can do exercise therapy at home or work with a physical therapist who can guide you through movements tailored to your needs. You can see a physical therapist in person or use a program like Hinge Health, where you may access a PT via telehealth/video visit.

• Stay active and modify your activity levels. It can help to change up your activities or try different types of movement if your knee is sensitive. “That doesn’t mean you have to stop completely,” says Dr. Schroeckenstein. “Adjust your workout schedule by reducing certain activities and mixing in others, like biking or swimming, to give your knee some variety.” Doing more low-impact movements helps keep your muscles flexible and strong, which supports healing.

• Apply ice or heat. Icing your knee can help ease swelling and increase comfort. Heat can also help soothe tender areas and promote healing. Try both methods or stick to the one that works best for you. 

• Use compression. Wearing a knee sleeve or wrapping your knee with an elastic bandage or kinesiology tape during exercise can help reduce swelling and ease discomfort.

• Try over-the-counter (OTC) medication. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can help ease pain so you can do your targeted exercises and stay active when you have knee pain. Other options are topical NSAIDs or pain relief creams. If you have a medical condition or take other medications, check in with your provider to make sure these OTC options are ‌safe to take.

• Consider complementary treatments. Talk to your provider if you’re interested in trying alternative treatments for knee pain relief, such as massage, acupuncture, or dry needling.

• Try TENS therapy. TENS, or transcutaneous electrical nerve stimulation, uses gentle pulses to quiet your pain response and help reduce pain associated with pes anserine bursitis. One option is the wearable device Enso, available through Hinge Health. It’s small, wireless, and portable.

How to prevent pes anserine bursitis

There are simple ways to lower your risk for knee bursitis. Focusing on gradual training progress, keeping your muscles strong and flexible, warming up before activity, and choosing supportive footwear can all make a difference. Here are some steps you can take to help prevent pes anserine bursitis.

• Slowly increase activity. When starting a new exercise routine or taking on a bigger challenge, like training for a race, try easing in gradually so your body has time to adjust. Begin with shorter sessions and increase your time or distance little by little each week. The key is to find your movement sweet spot, or the point where you feel like you’re applying effort without straining yourself. This gentle approach helps your muscles and joints adapt, reducing the chance of discomfort or injury.

• Warm up first. Taking a few minutes to do a dynamic warm-up before activity can increase blood flow, loosen up your muscles, and help your body move more comfortably — especially around the knee. This can make your workout feel smoother and reduce pressure on the bursa.

• Stretch and strengthen regularly. Maintaining flexibility and strength in your glutes, hips, and thighs can help support your knee and reduce extra pressure on the bursa.

• Wear supportive shoes. Choosing footwear that fits well and matches your activity can help cushion your steps, support healthy joint alignment, and reduce extra pressure on your knees.

• Use orthotics. If you have flatter feet or your knees tend to angle inward, orthotics may make your knees feel more comfortable and supported. Talk to your healthcare provider to see if this could help you.

When to see a doctor

Pain from pes anserine bursitis often improves on its own with simple treatments. But if your pain is severe, getting worse, or causing difficulty with daily activities, see a healthcare provider. It’s also a good idea to get care if you have:

• Pain going down your leg or extending beyond the knee area

• Trouble moving or extending your knee

• Change in skin color around the knee (could be a sign of an infection)

PT tip: Add more variety to your workout routine

“Your body craves variety, and it can be therapeutic,” says Dr. Schroeckenstein. Mixing up your workouts — such as alternating between walking, swimming, cycling, or other activities — helps you build strength and flexibility throughout your body while keeping movement fun and comfortable for your knees.

How Hinge Health can help you

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

1. Pes Anserine (Knee Tendon) Bursitis - OrthoInfo - AAOS. (n.d.). Www.orthoinfo.org. https://orthoinfo.aaos.org/en/diseases--conditions/pes-anserine-knee-tendon-bursitis/

2. Mohseni, M., & Graham, C. (2024, January 29). Pes Anserine Bursitis. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK532941/

3. Curtis, B. R., Huang, B. K., Pathria, M. N., Resnick, D. L., & Smitaman, E. (2019). Pes Anserinus: Anatomy and Pathology of Native and Harvested Tendons. American Journal of Roentgenology, 213(5), 1107–1116. doi:10.2214/ajr.19.21315

4. Pes Anserinus Bursitis. (2011). Physiopedia. https://www.physio-pedia.com/Pes_Anserinus_Bursitis