Bursitis of the knee, often referred to as “housemaids’s knee,” involves inflammation of one or more bursae at the front of the knee. It can be extremely painful with movement, with kneeling, or even when at rest. Conversely, it can also be painless with only visible swelling present. There are many different causes of knee bursitis, the most common being trauma, either from a direct blow to the knee or the result of repetitive activities such as kneeling or crawling on hard surfaces for long periods of time. This is often seen in tile setters or carpet installers, or in individuals who scrub floors. More commonly though are athletes who experience the discomfort of knee bursitis–up to 10% of runners develop the condition. However, there is no direct correlation to knee bursitis and any particular age or ethnic group. This condition can also be caused by infection or autoimmune conditions. Physical Therapists should be contacted as the first line of defense to treat individuals with knee bursitis by decreasing pain, reducing inflammation and stiffness, and addressing any any associated weakness in the knee or leg.
WHAT EXACTLY IS KNEE BURSITIS?
Knee bursitis, also called infrapatellar or prepatellar bursitis, occurs due to damage, irritation, or inflammation of 1 or more bursae. A bursa is a fluid-filled sac that acts as a cushion (or friction reducer) between two body parts. This could be between bone and tendon, bone and ligament, or bone and skin. The bursae that are found on the front of the knee serve as cushions between the patellar tendon and tibia (shin bone) and between the kneecap and the skin. A traumatic blow or prolonged pressure can damage a bursa, and repetitive movements can lead to irritating friction on it, causing the bursitis. Since “itis” means “inflammation,” an injured bursa can swell and become painful. Some causes of knee bursitis can be:
- Direct trauma, such as being hit or falling directly on the knee
- Prolonged kneeling, as when installing flooring or praying in a kneeling position
- Prolonged crawling, as when laying carpet or scrubbing floors
- Repetitive motions, including certain sports, such as running
- Autoimmune conditions
WHAT DOES KNEE BURSITIS FEEL LIKE?
Symptoms of knee bursitis may include:
- Pain in the front of the knee with touching it
- Swelling in the front of the knee
- Redness in the front of the knee
- Stiffness in the knee joint, or difficulty bending or straightening the knee
- Pain with kneeling
HOW DO I KNOW IF I HAVE BURSITIS?
Your first source of resolution should be your Physical Therapist, who should conduct a thorough and comprehensive evaluation that starts with your medical history. Detailed questions will also be asked in terms of your injury, such as:
- Did you receive a direct blow to the knee, fall on it, or kneel on it for an extended period of time?
- How/when did you first notice the pain and/or swelling?
- Have you been performing any repetitive activity?
Your Physical Therapist should then conduct a hands-on assessment that includes specific tests
to determine the likelihood that you have knee bursitis. They should also check knee mobility, strength, swelling, and observe motions and activities that are symptomatic.
HOW DOES PHYSICAL THERAPY HELP?
Your Physical Therapist should design and individualized treatment program specific to your needs and goals. This will help speed recovery and should include exercises and treatments that you can do at home. The goal of Physical Therapy is to return you to your normal activities and lifestyle. While healing time varies between individuals, most results are generally achieved between 2 and 8 weeks or less–this is based upon the implementation of a a proper swelling management, stretching, and strengthening program.
During the first 24-48 hours following your diagnosis, your Physical Therapist may advise you to:
- Apply ice to the area for 10-15 minutes every 2 hours
- Apply light compression to the area by wrapping the knee in a specific way using a compression wrap
- Rest the area by avoiding any activity that causes pain or pressure in the knee
Your Physical Therapist should also work with you to:
- Decrease Pain and Swelling– Your Physical Therapist may use pain-relieving modalities to control and reduce your pain and swelling. They will also help you to understand and modify any repetitive activities that may have contributed to the knee bursitis to allow the healing process to begin.
- Increase Range of Motion– Your Physical Therapist should choose specific treatments and activities to help restore normal motion in the knee and leg. These often start with passive motions (the Physical Therapist will gently move your knee and leg for you) and progress to active exercises and stretches that you do on your own.
- Increase Flexibility– Your Physical Therapist should see if any of your leg muscles are tight, then start helping you stretch them, progressing to teaching you how to stretch them yourself.
- Increase Strength– If your Physical Therapist determines that you have weakness after their evaluation, they should choose and instruct you in the correct exercises and equipment to gradually restore your strength and agility.
- Restore Agility– Speed and accuracy of leg movement is extremely critical in athletics. Your Physical Therapist should help you to regain these skills in preparation for a return to sports activity.
- Improve Balance– Regaining your sense of balance is very important after an injury. Your Physical Therapist should teach you exercises to improve your balance skills.
- Increase Endurance– It is extremely critical to restore muscular endurance in your legs after an injury. Your Physical Therapist should develop a program addressing increase endurance to help you return to your prior level of function before the injury.
- Instruction in a Home Exercise Program–Your Physical Therapist should teach you stretching and strengthening exercises that you can perform at home. These exercises should be specific to your goals and needs to help speed your recovery.
- Return to Activities– Your Physical Therapist should discuss your activity goals with you so you can both work together in setting your work, sport, and home life recovery goals. This will allow you to reach your goals in the fastest, safest, and most efficient way possible. This should include specific exercises, sport specific activities and drills, and work retraining activities to assist you in achieving your goals.
- Speed Recovery Time– Your Physical Therapist should be highly trained and experienced in choosing the best exercises and treatments to help you to heal safely, reach your goals, and return to your normal lifestyle faster than you are likely to do it on your own.
CAN KNEE BURSITIS BE PREVENTED?
Your Physical Therapist should be able to construct a home exercise program to help prevent knee bursitis that may include flexibility and strengthening exercises for the leg muscles. In helping to prevent a recurrence of the injury, your Physical Therapist may advise you to:
- Avoid hard hits (if possible) or prolonged pressure to the front of the knee.
- Avoid kneeling for prolonged periods of time.
- If you do have to kneel, wear knee pads or use a padded cushion to protect your knee.
- Maintain good physical conditioning, even in a sport’s off-season, by following a consistent flexibility and strengthening exercise program (especially for the knee and leg muscles).
- Always warm up properly before engaging in any sport or heavy physical activity.
- Increase athletic activity gradually (rather than suddenly).
If you or someone you know is experiencing knee pain and think that it may be bursitis, don’t wait to take action. Call my office at once at (302)691-9055 or visit my website at www.wildermanpt.com and schedule your FREE 30 minute consultation to see how Physical Therapy can help you. Don’t delay–schedule now!