Pes anserinus tendonitis
Pes anserinus tendonitis
Description, Causes and Risk Factors:
Pes anserine tendonitis (PAT) is a painful, inflammatory condition affecting the tendons between your shinbone and the hamstring tendons at the inside of your knee; typically caused by stress to the area. Specifically, the pes anserinus is the area where the tendons of 3 muscles (sartorius, gracilis, and semitendinous) come together. The three tendons merge together in the skin of the bone on the inside surface of the shinbone. The term, pes anserinus means "goose's foot" in Latin - owing to the webbed-foot pattern the three tendons make when they meet.
The causes of PAT in runners are well documented; they tend to have moderate-to-severe pronation of their feet, weak hamstrings, tight quadriceps and they would also have either suddenly increased their running intensity or change the terrain that they run on.
PAT is normally a gradual onset rather than a traumatic one and it's commonly a result of overuse.
In patients with moderate-to-severe pronation of their feet, the tibia will be internally rotated, putting strain onto the pes anserinus tendon. As most runners do not really do strength training, especially for the hamstring, the hamstring is unable to cope with the increase in intensity of running.
Furthermore, with most patients holding a Deskbound job, prolonged sitting would lead to tightness in the quadriceps and further weakness of the hamstring muscle. Running at a faster pace, a sudden increase in the frequency in training or adding more hills to one's training regime increases the strain on the hamstring as the hamstring needs to contract stronger and with an increase in frequency of training, it doesn't allow the muscles adequate time to recover.
To prevent PAT, it is important to first eliminate any of the underlying factors contributing to the condition. Ask your doctor or Physical therapist to take a look at your gait and your posture to see if there any biomechanical issues that need to be addressed. Secondly, get advice from your physical therapist or Trainer on setting a training schedule that fits your ability. Thirdly, but most importantly, warm up your hamstring and then stretch prior to activity!
Symptoms may include:
Swelling in front of the kneecap (pre-patellar) or underneath the kneecap (infra-patellar).
Pain increasing with exercise or climbing stairs.
Pain and often warmth and tenderness when touched.
Pain when bending or straightening the knee.
Pain that radiates to the back and inside of the thigh.
Visible swelling and/or redness of the tendon sheaths (tendonitis).
Pain located 2 to 3 inches below the kneecap.
Patients presenting with PAT normally would come in complaining of pain on climbing stairs, squatting, running and in severe cases, even standingfrom a seated position. Taking a good subjective history would be very essential in a proper diagnosis of the problem. Commonly, there would not be any incidence of an acute trauma but patients would normally tell of an increase in their intensity of training or a change of terrain of training, i.e., running more hills or running at a faster pace.
There is normally severe tenderness on palpation over the anteriomedial aspect of the knee, approximately 2-5cm below the anteriomedial joint line. It has been described as a "jump-off-your-chair" kind of a pain. It is rather intensive and sharp. The valgus stress test would be positive, thus making differentiation between pes anserinus and medial collateral ligament (MCL) strain difficult. Pain reproduced with resisted muscle activation of the hamstrings with a medial bias will indicate an involvement of the pes anserinus.
Muscle length test for the hamstring, gracilis and sartorius may prove to be tight. X-rays or even MRI may be required to rule out other causes of the knee pain like patellofemoral pain, MCL strain or medial menisci.
Prescription of nonsteroidal anti-inflammatory would be the normal management of PAT together with Physiotherapy treatment. Rest should only be encouraged for only the acute stage, which is about the first 24-48 hrs. Following that, light physical activity should be encouraged.
Blood Flow Stimulation TherapySM is an excellent tool for reduction of swelling and pain when treating PAT. When inflammation occurs, rest the area, apply cold compression for 10-20 minutes at a time for at least 3 times a day. Do this to the injured area for the first day up to 3 days. BFSTSM may be used after the acute swelling is improved. Cold compression therapy will reduce initial inflammation and swelling and BFSTSM increases blood flow through the area to speed the healing process. The Inferno Wrap® will stimulate blood flow and minimize the build up of scar tissue around the tendon during the healing process, helping the tendon heal more quickly.
If stitching of the tendon is required, do not use the Inferno Wrap® or Freezie Wrap® on the area until the wounds on the skin surface are no longer open (or "wet"). As well, allow 30 to 45 minutes between the Freezie Wrap® and the Inferno Wrap® treatments so the area can return to normal body temperature before beginning a different treatment.
The trick to any tendon injury is getting it to heal with minimal scar tissue formation and with as much realignment of tendon fibres as possible - something BFSTSM is great at! Even with optimum healing there is always less elasticity in a previously injured tendon. The trick is to make sure you heal this the best you can, that way your chance of re-injury down the road is much lower than average.
Physiotherapy treatment would include:
Therapeutic ultrasound and/or TENS would be administered to aid in decreasing the pain.
Running gait analysis would be done by the sports physiotherapist to pick up any biomechanical cause that led to the development of the tendonitis. The Sports physiotherapist would also work closely with the patient to work out a proper training program to get them back on track for their training.
Orthotics can also be done to correct the over-pronation of the feet to reduce the strain on the tendon.
Stretching of the hamstring and quadriceps and strengthening of the gluteus medius and hamstring are essential in managing and preventing recurrence.
NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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