What is knee bursitis?
Knee bursitis refers to the inflammation (-itis) of one or more of the bursae in the knee. A bursa is a fluid-filled sac in place to ease friction between other structures, such as tendons, ligaments and bone, and is a very necessary structure in the body. There are many throughout the knee (and all other joints), and these can sometimes become painful and problematic when irritated.
What are the symptoms of knee bursitis?
Bursitis is typically an overuse injury, so you’ll notice it will worsen over time and be difficult to pin down to one specific incident. It will typically worsen with activity, settle with rest, and swell and be hot to touch when particularly aggravated. Depending on which bursa is irritated (there are more than 10 around the knee!), that will dictate where you feel your pain.
The most common ones are the bursae found above, below and over the top of the patella (kneecap), and the point at which the hamstrings attach on to the inside of your knee. These are the sites with highest amounts of friction, particularly in cyclists and runners.
What causes knee bursitis?
Being an overuse injury, this is typically seen at times when training volume has increased or towards the end of a season when the accumulative load is higher. The bursa becoming irritated is a sign that your knee joint didn’t quite have the capacity to handle the training loads.
Occasionally there can be other causes of bursitis, which are less mechanical, such as certain inflammatory conditions. It's therefore beneficial to get yourself over to a physiotherapist if your knee pain is being particularly persistent, where they can assess and refer you onwards to other services if necessary.
How can you treat knee bursitis?
Although it may provide some benefit to know exactly which bursae are irritated, the treatment can often look similar. Your first move should be to highlight the activities that aggravate the pain and reduce them where possible. If it’s only when running, for example, take a step back from running, but continue your cycling and swimming, and let the pain settle. At this point, tell your coach and/or a physio to best advise on your next steps.
The plan is to increase your knee’s capacity to handle training load and slowly reintroduce the aggravating activity over time. A movement screen would tell you which muscle groups or joints are moving too much or too little and dictate what you need to do in your rehabilitation.
A good exercise programme that improves single-leg stability and control, alongside activity modification and a slow increase back into ‘normal training, will often work nicely. Everyone’s different, though, and of course your programme would be tailored to you.
How can you prevent knee bursitis?
Having a tailored programme from your coaching team and physio should ensure you avoid those spikes in training load, and reduce the chances of experiencing an overload injury in the first place. Different athletes will have different levels of input, but having a strength and conditioning programme in your regular regime is vital.
Knee pain may be stubborn to treat, so seeking a professional opinion early on could keep you on the start line for those key races!
If you have any concerns at all, like with any health issue, seek medical advice from a qualified medical practitioner, whether that's a doctor or physiotherapist.
James Davis is a chartered physiotherapist at Six Physio Moorgate