Diagnosis Explanation:

Pes anserine bursitis is inflammation of the pes anserine bursa, a fluid-filled sac located on the inner side of the knee, just below the joint. This condition is common in runners, athletes, and people with osteoarthritis. It results from overuse, repetitive knee stress, muscle tightness, or improper biomechanics. Symptoms include pain, tenderness, and swelling on the inner knee, especially when climbing stairs, squatting, or after prolonged activity.

Specific Work Modifications:

• If your job requires standing or walking: Take frequent seated breaks and wear shock-absorbing footwear.
• If your job involves lifting: Avoid deep knee bending or twisting motions; use proper body mechanics.
• If your job is desk-based: Keep your knee elevated when sitting and perform gentle mobility exercises throughout the day.
• Avoid: Prolonged standing, kneeling, deep squats, and repetitive stair climbing.

Specific Activity Modifications:

• If you run or play sports: Reduce high-impact activities and switch to swimming or cycling.
• If you hike: Use trekking poles and avoid steep inclines or rocky terrain.
• If you do weightlifting: Avoid deep squats, lunges, and leg presses; focus on controlled quad and hip strengthening.
• Avoid: Jumping, pivoting, running on hard surfaces, and any movement that worsens pain.

Recommended Supplements:

• Collagen Peptides – 10g daily for soft tissue repair.
• Glucosamine & Chondroitin – 1500mg/1200mg daily for joint and cartilage support.
• Omega-3 Fatty Acids – 1000mg daily to reduce inflammation.
• Vitamin C – 500mg daily to promote collagen synthesis.
• Turmeric (Curcumin) – 500-1000mg daily for pain relief.

Recommended Nutrition and Hydration:

• Increase Lean Protein (chicken, fish, tofu, eggs) to support tissue healing.
• Eat Anti-Inflammatory Foods (berries, leafy greens, turmeric, nuts) to reduce swelling.
• Consume Hydrating Foods (cucumber, watermelon, citrus) to maintain joint lubrication.
• Limit Processed Foods & Sugars to minimize inflammation.
• Hydration: Drink 8-10 cups of water daily to support tissue hydration and recovery.

Home Exercise Prescription (Rehabilitation for Pes Anserine Bursitis)

Early Phase (0-2 Weeks, Reducing Pain & Swelling):

• RICE Protocol – Rest, Ice (15-20 min, 3x/day), Compression (brace or knee sleeve), Elevation.
• Quadriceps Sets – Tighten thigh muscle, hold for 5 seconds, repeat 10 reps, 3x/day.
• Hamstring Stretch – Sit with one leg extended, reach for toes, hold 20 seconds, 3x/day.
• Inner Thigh Stretch – Sit with soles of feet together, gently press knees downward, hold 20 seconds, 3x/day.

Strengthening Phase (2-6 Weeks, Regaining Strength & Control):

• Straight Leg Raises – Keep knee straight, lift leg, hold for 5 seconds, repeat 10 reps, 2x/day.
• Clamshells (Hip Strengthening) – Lie on your side, open and close knees, 10 reps, 2x/day.
• Mini Squats (No Deep Bending) – Slight knee bends while keeping weight on heels, 10 reps, 2x/day.
• Glute Bridges – Lie on back, lift hips while keeping knees bent, 10 reps, 2x/day.

Advanced Phase (6+ Weeks, Improving Stability & Return to Activity):

• Step-Ups – Step onto a low platform, push through the heel, repeat 10 reps, 2x/day.
• Stationary Cycling – Low resistance for 10-15 minutes/day to maintain knee mobility.
• Balance Exercises – Stand on injured leg for 10-20 seconds, increase as tolerated.

Helpful Books:

1. The Knee Injury Bible: Everything You Need to Know About Knee Pain, Prevention, and Treatment – Kevin R. Stone, MD.
2. Heal Your Knees: How to Prevent Knee Surgery and What to Do If You Need It – Robert Klapper, MD, and Lynda Huey.

Contact the Key West orthopedic clinic or reach out to Dr. Jason Pirozzolo.