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Physical Therapy Guide to Knee Bursitis

What Is Knee Bursitis?

Knee bursitis occurs when one or more of the knee bursae become damaged, irritated, or inflamed. Normally, a bursa acts as a cushion to reduce friction between two body parts. Bursae on the front of the knee provide a cushion between:

  • The kneecap and skin.
  • The patellar tendon (attaches the kneecap to the shinbone) and tibia (larger bone of the lower leg).

Prolonged pressure or traumatic blows can injure a bursa. Repeated motions can cause irritating friction on the bursa, and lead to developing bursitis. “Itis” means “inflammation.” When a bursa is injured, it can swell and become painful.

Knee bursitis can be caused by:

  • Repeated motions, including certain sports, such as running.
  • Prolonged kneeling, as when scrubbing floors, or praying in a kneeling position.
  • Prolonged crawling, such as when laying carpet or tile.
  • Direct trauma, such as being hit or falling on the knee.
  • Knee surgery or knee joint replacement.
  • Infection.
  • Autoimmune conditions.

Bursitis also can develop on the outside of the knee that is commonly referred to as Pes Anserine Bursitis. This type of bursitis often occurs in distance runners, breaststroke swimmers, older adults, and people with knee osteoarthritis.

How Does It Feel?

People with knee bursitis may feel pain when moving the knee, kneeling, or even at rest. The condition also can be painless, with only visible swelling present. With knee bursitis, you may experience:

  • Swelling on the front of the knee.
  • Redness on the front of the knee.
  • Pain when you press on the front of the knee.
  • Pain when moving the knee or kneeling.
  • Pain that continues when at rest, in some cases.
  • Stiffness in the knee joint.
  • Problems with straightening or bending the knee.

How Is It Diagnosed?

Your physical therapist will conduct a thorough evaluation that includes taking your health history. They also will ask you detailed questions about your injury, such as:

  • How and when did you notice the swelling and/or pain?
  • Have you been doing any repetitive activity?
  • Did you receive a direct hit to the knee, fall on it, or kneel for a long time?

Your physical therapist also will perform special tests to help determine if you have knee bursitis. They will gently press on the front of your knee to see if it is painful to the touch. They also may use additional tests to determine if other parts of your knee are injured. Your physical therapist will observe how you can move your knee and test your strength and flexibility.

Your physical therapist also may screen for other, more serious conditions that could cause knee pain or swelling. They may team with an orthopedic doctor or other health care provider. Your doctor may order further tests to confirm the diagnosis and rule out other damage, such as a fracture or infection.

How Can a Physical Therapist Help?

Your physical therapist will work with you to design a specific treatment program that will speed your recovery. Your program will include exercises and treatments that you can do at home. Physical therapy will help you return to your normal lifestyle and activities. The time it takes to heal from knee bursitis varies, but results can be achieved more quickly if you follow a proper swelling management, stretching, and strengthening program.

During the first 24 to 48 hours after your diagnosis, your physical therapist may advise you to:

  • Apply light compression to the area by wrapping the knee a specific way using a wrap.
  • Rest the area by avoiding any activity that causes pressure or pain in the knee.
  • Apply ice packs at a certain frequency and for a specific length of time.
  • Consult with a physician for further services, such as medication or diagnostic tests.

The goals of physical therapy are to:

  • Reduce pain.
  • Improve your movement, strength, flexibility, and endurance.
  • Help you get back to doing the things you want to do.

After the initial treatment outlined above, your physical therapist will work with you to:

Reduce pain and swelling. If repeated activities led to your knee bursitis, your physical therapist will teach you how to avoid or modify them to allow healing to begin. They may use various treatments in the clinic (such as machines that use heat, light, or sound) to control and reduce your pain and swelling.

Improve motion. Your physical therapist will choose specific activities and treatments to help restore normal movement. These might begin with “passive” motions that they perform for you to gently move your knee joint. You will progress to doing active exercises and stretches for yourself.

Improve flexibility. Your physical therapist will determine if any of your leg muscles are tight. They will begin by helping you to stretch them and teach you how to stretch them on your own.

Improve strength. If your physical therapist finds any weak or injured leg muscles, they will teach you the correct exercises to steadily restore your strength and agility.

Improve endurance. Restoring your leg’s muscular endurance is important after any injury. Your physical therapist will work with you to help you regain the endurance you had before the injury.

Improve balance. Regaining your sense of balance is important after any injury. Your physical therapist will teach you exercises to improve your balance skills.

Restore agility. Speed and accuracy of leg movement is important in sports. Your physical therapist can help you regain these skills to prepare for any return to sports activities.

Learn a home program. Your physical therapist will teach you strengthening and stretching exercises to do at home. These exercises will be specific for your needs. If you do them as prescribed by your physical therapist, you can speed your recovery.

Return to activities. Your physical therapist will discuss your activity goals with you. They will use them to set your work, sport, and home-life recovery goals. Your treatment program will help you reach your goals in the safest, fastest, and most effective way possible. Your physical therapist also will teach you exercises, work retraining activities, and sport-specific techniques and drills to help you achieve your goals.

Speed recovery time. Your physical therapist is trained and experienced in choosing the best treatments and exercises to help you:

  • Heal safely.
  • Return to your normal lifestyle.
  • Reach your goals faster than you are likely to do on your own.

If Surgery Is Necessary

Surgery is not often needed for knee bursitis. If you do require surgery, you will need to follow a recovery program over several weeks, guided by your physical therapist. After surgery, your physical therapist will design your treatment program as described above, to help you:

  • Minimize swelling and pain.
  • Regain motion and strength.
  • Return to normal activities in the safest and speediest manner possible.

I don't like to exercise.

Competitive sports and hour-long fitness classes are not for everyone. Physical activity doesn’t have to involve things you don’t like doing to be effective. Discover the types of activities that you enjoy and make them part of your daily physical activity routine.

Can This Injury or Condition Be Prevented?

Your physical therapist can recommend a home program to help prevent knee bursitis. This may be especially valuable for people with jobs that require lots of kneeling. It may include strength and flexibility exercises for the leg muscles, and tips for protecting the knee from repeated stress.

To help prevent a return of bursitis, your physical therapist may advise you to:

  • Avoid kneeling for prolonged periods.
  • Use knee pads or a cushion to protect your knees when you kneel, including during sports or other physically challenging activities.
  • Avoid hard hits or prolonged pressure to the front of the knee.
  • Follow a consistent flexibility and strengthening exercise program, especially for the knee and leg muscles. This will help you maintain good physical conditioning, even in a sport’s offseason.
  • Always warm up before starting a sport or any heavy physical activity.
  • Gradually increase any athletic performance, rather than doing too much too soon in terms of the amount or intensity of activity.

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat various conditions, such as knee bursitis. However, when seeking a provider, you may want to consider:

  • A physical therapist who is experienced in working with people with orthopedic conditions. Some physical therapists have a practice with an orthopedic or sports medicine focus.
  • A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in orthopedic physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to your condition.

You can search for physical therapists in your area who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association.

General tips when you’re looking for a physical therapist (or any other health care provider):

  • Get recommendations from family, friends, or other health care providers.
  • When you contact a physical therapy clinic for an appointment, ask about the physical therapists’ experience in helping people with knee bursitis.
  • Be prepared to describe your symptoms in as much detail as possible.