Do you have pain in the inner part of your knee?
Have you been experiencing inner knee pain when climbing stairs or standing up? It could be either your meniscus or your pes ancerinus. Let’s delve into the intricacies of these conditions and understand why the healing process might take time.
The meniscus, a C-shaped cartilage within the knee, functions as a shock absorber, situated on both sides of the knee. Conversely, the pes ancerinus is a conjoined tendon involving three muscles—the Semi-Tendinosis (part of the medial hamstring), Gracillis, and Sartorius. This tendon inserts just below the knee, resembling a “Goose Foot.” Pain associated with pes ancerinus is often due to inflammation of the bursa, a fluid sac between the tendon and bone, designed to minimize friction.
Distinguishing between these two conditions poses challenges as their symptoms overlap. Both exhibit pain in the inner knee, exacerbated by weight-bearing activities and relieved temporarily after walking, only to return during prolonged activity or stair climbing. While meniscus injuries often result from twisting, especially in younger individuals, in the older population, they can be degenerative. On the other hand, pes ancerinus bursitis generally develops gradually due to overuse.
A unique factor in differentiation lies in the walking phases. Pes ancerinus bursitis causes pain more during the swing phase, while meniscus pain is prominent during the weight-bearing phase. Physical examination, including tenderness on palpation over the anterio-medial or medial aspect of the knee and the joint line, may not provide a clear distinction. The McMurray test, compressing and extending the knee, may lack sensitivity.
Despite the significance of pinpointing pain location for differentiation, patients often present with diffuse pain, complicating diagnosis. The challenge lies in the clinical evaluation, where improvement in diagnostic precision is crucial for effective management.
How can Physiotherapy help?
Treating pes ancerinus bursitis necessitates a comprehensive examination of lower limb mechanics. Emphasis should be placed on stretching the hamstring and gracilis muscles, addressing their likely tightness. Additionally, incorporating soft tissue release is crucial to alleviate adhesions resulting from inflammation between the bursa and the conjoined tendon. To mitigate inflammation, the application of ultrasound and/or cryotherapy is essential. In severe cases, referral to an orthopedic or sports physician may be necessary for an anti-inflammatory injection directly into the tendon to provide relief. These therapeutic interventions collectively aim to enhance the recovery process and restore optimal functionality.
How can you prevent Pes Ancerinus Bursitis?
Preventing the recurrence of pes ancerinus bursitis and effectively managing associated pain requires diligence in maintaining a structured exercise routine, incorporating stretches, and strength training. Addressing biomechanical issues is pivotal, with the most common culprits being weakness in the gluteus medius, hamstring tightness, or over-pronation of the foot arch due to inappropriate footwear.
To tackle these issues, a thorough assessment is conducted, and tailored treatments are administered. Patients are encouraged to engage in hamstring stretches, fortify the gluteus medius through targeted exercises, and enhance knee control to prevent internal rotation during bending. Developing good body awareness is imperative in averting a recurrence of the problem.
In certain cases, recommendations may include a change of footwear, dependent on foot type, or the insertion of insoles to provide arch support. Supporting the arch can also act as a preventive measure against internal knee rotation, consequently alleviating strain on the pes ancerinus. These proactive measures collectively contribute to a comprehensive strategy for long-term management and prevention.