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Inner Knee Pain

Pain On Inside of Knee No Swelling: If there is no swelling with your medial knee pain, it is likely only a minor injury such as a small cartilage tear or a grade 1 sprain of the MCL.

Inner Knee Pain When Running: Knee pain medial side during or after running is most typically caused by a cartilage tear or Runners Knee.

Inner Knee Pain When Straightening Leg: Pes Anserine Bursitis is the main culprit here as the bursa can easily get squashed when straightening the knee.

Medial Knee Pain with Flexion: Most medial knee pain gets worse with knee flexion, especially when weight bearing through the leg. If it’s worse when standing, it may indicate an MCL tear or meniscus tear. If it happens when you are sitting or bending the knee, it may be pes anserine bursitis or plica syndrome.

Anterior Medial Knee Pain: If your inner knee pain is coming round to the front of the knee, it may be a problem with the kneecap or Runners Knee rather than one of the structures on the inner knee.

Causes of Inner Knee Pain

Medial knee injuries are common because of muscle weakness and/or tightness around the knee that can subtly change the way the knee moves. This causes more force to go through the inner side of the joint, rather than distributing weight evenly through the whole joint, which results in damage to the inner side of the knee and therefore results in medial knee pain. For example, it is much more common to get osteoarthritis on the inner side of the knee than the outer side.

Pes Anserine Bursitis

Inflammation of the pes anserine bursa, causing medial knee pain. The pes anserinus is an area on the medial (inner) side of the knee where three muscle tendons attach to the tibia (shin bone). Pes anserinus means “goose’s foot” and it gets its name from the webbed-foot shape made by these three tendons where they join forming one tendon and attach to the shin bone.  Repetitive stress or friction over the area results in inflammation of the pes anserine bursa. The bursa produces excessive fluid and thus swells, placing pressure on the surrounding structures. Pain from pes anserine bursitis usually develops gradually rather than suddenly and tends to get worse with activities such as stair climbing and running. 

The most common causes of pes anserine bursitis are:

Repetitive Stress: Activities where the three muscles are being used repetitively, such as in running (particularly uphill), cycling, swimming (particularly breaststroke), and side-to-side movements can cause friction and pressure on the bursa.

Muscle Weakness/Tightness: Weakness and/or tightness in the hip and knee muscles can place increased tension on the pes anserine tendons which damages the tendon itself and increases pressure on the bursa.  Tight hamstrings are a common cause of pes anserine bursitis.

Poor Training Techniques: Training errors such as sudden increases in distance or intensity, not warming up and inadequate stretching can over stress the area.

Other Medical Conditions: Joint inflammation associated with arthritis can cause swelling of the bursa. Studies have shown that approximately 20% of people with knee osteoarthritis suffer from pes anserine bursitis. People with Type 2 Diabetes or Osgood Schlatters are also more likely to develop bursitis.

Gender: Pes anserine bursitis is more common in women, due to a wider pelvis and the angle of the knee joint.

Altered Biomechanics: changes to the position of the leg bones and soft tissues, such as flat feet or a turned out foot can place extra pressure on the Pes Anserine region.

Obesity: More weight goes through the area increasing the pressure on the knee bursa.

Trauma: direct injury such as a blow to the pes anserinus area can lead to swelling of the bursa.

Plica syndrome

A condition caused by inflammation in the lining of the knee joint. It results in achy knee pain which gets worse with activity, particularly up and down stairs, a feeling of instability in the knee and sometimes a catching or locking sensation. Plica syndrome develops when the synovial folds are irritated and become inflamed. This may be due to direct knee trauma, overuse or repetitive activities, or an underlying knee problem that affects the pliability of the synovial membrane. The knee plica may get trapped or pinched between the knee bones, or caught on the femur. When this happens, the knee plica in question becomes inflamed, gradually thickens and eventually, if left untreated, becomes hard.

Plica syndrome is typically caused by:

Direct Trauma: A blow to the knee e.g. a fall on to the knee or a RTA where the knee hits the dashboard

Repetitive Knee Movements: Activities where you repeatedly bend and straighten the knee are often to blame for knee plica syndrome e.g. running, cycling, going up and down stairs

Sudden Increase In Activities: If you rapidly increase your exercise levels it can lead to overloading of the synovial plica and thus they become inflamed

Knee Injuries: particularly twisting injuries, meniscus tears or anything that causes bleeding in the knee joint

Prolonged Flexion: sitting for long periods or sleeping with your knee bent often result in pain with plica synovialis

Underlying Knee Conditions: such as osteochondritis dissecans, fat pad irritation or synovitis

Muscle Weakness: As the plica are indirectly attached to the quadriceps, weakness in the quads muscles increases the force through the plica leading to irritation and inflammation

Treatments for Inner Knee Pain

Rest: temporarily avoid activities that cause pain. This may mean modifying your activities or indeed stopping some altogether to allow the swelling to settle down.

Regular Ice: Applying an ice pack for 10-15 minutes, every couple of hours, to the inner side of the knee can help to reduce pain and swelling associated with pes anserine bursitis. 

Herbal Remedies: peppermint, chamomile and lavender are anti-inflammatory, calming and pain relieving; turmeric and ginger assist in healing and pain relief; arnica assists in healing and strengthening tissues; magnesium assists in healing and reducing inflammation.

Medication: Anti-inflammatories such as ibuprofen can help to reduce pain and inflammation with knee bursitis. Always check with your doctor before taking any medication.

Stretches: performing simple stretching exercises is an important part of the treatment process to take the pressure off the bursa. 

Strengthening Exercises: weakness in the hip and knee muscles makes subtle changes to the way the forces go through the knee, so by strengthening the glutes, quads and hamstrings, you can ease the pressure on the pes anserinus bursa.

Physical Therapy: A physical therapist can assess any areas of weakness and tightness that may be contributing to the problem and work on a rehab program with you.  They may also use treatments such as ultrasound and acupuncture to help reduce pain and inflammation with knee bursitis.

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