Massage therapy · Kitchener–WaterlooKnee Bursitis

• Obesity
• Osteoarthritis of the knee
• Being duck-footed, flat-footed or having knock knees
• Incorrect training techniques, such as not stretching, a lot of hill running or suddenly increasing your mileage
• Tight hamstring muscles

Warning signs of infection: a bursa can become infected, especially after a cut, scrape or insect bite over the knee. Infected bursitis is more serious and needs urgent treatment (AAOS, n.d.b). Contact your family doctor or nurse practitioner straight away if the area is red and hot, or you have a high temperature or feel hot, cold or shivery (AAOS, n.d.b; NHS, 2023).

Bursae help to protect the moving parts of the knee. There are lots of them in the knee, but some of the more common problems are:

Popliteal cyst (known as a Baker's cyst) – a fluid-filled lump at the back of the knee. In adults it usually happens when another condition damages the knee, such as a knee injury, osteoarthritis, rheumatoid arthritis or gout. Sometimes there is no particular cause, especially in children (NHS, 2025). If you have pain and swelling in your leg together with breathlessness or chest pain, call 911 or go to the emergency room at your nearest hospital, as this could be a blood clot that has travelled to the lungs (NHS, 2025).

Prepatellar bursitis (known as housemaid's knee) – a swelling over the front of the kneecap, often caused by constant kneeling or a direct blow to the front of the knee (AAOS, n.d.b).

Suprapatellar bursitis – occurs just above the kneecap.

Infrapatellar bursitis – occurs just below the kneecap.

Pes anserine bursitis – pain and tenderness on the inner side of the knee, about 2 to 3 inches below the joint, where three hamstring tendons attach to the shin bone (AAOS, n.d.a).

1. Rest

Stop any activities that cause pain and discomfort. Try substituting a different activity, such as low-impact exercise like cycling, until the bursitis has had time to clear up (AAOS, n.d.a; AAOS, n.d.b).

2. Ice

Apply ice 3 or 4 times a day for 20 minutes at a time (AAOS, n.d.a). Make sure to wrap the ice in a thin towel, and never apply it directly to the skin, to prevent an ice burn.

3. Pain Relief

The NHS (2023) says painkillers such as paracetamol or ibuprofen can ease the pain of bursitis, and AAOS (n.d.a) notes that anti-inflammatory medicines such as ibuprofen may also reduce the inflammation. (This medicine information comes from the NHS and AAOS OrthoInfo, not from me. Always check with a pharmacist or your family doctor or nurse practitioner before taking any medicine.)

Options outside my scope

• Draining the bursa (aspiration): fluid can be taken out of the bursa with a needle, both to ease symptoms and to test for infection or gout (NHS, 2023).
• Steroid injection: an injection of local anaesthetic and a steroid into the bursa can give quick relief; it is not given if the bursa is infected (AAOS, n.d.a; NHS, 2023).
• Antibiotics: used if the bursitis is caused by an infection (NHS, 2023).
• Surgery: rarely, a bursa that is severe or keeps coming back may need to be drained surgically or removed (NHS, 2023).

How I can help (see the My Approach tab)

• Hands-on work for the muscles around your knee, with no pressure on the bursa
• Stretching for tight hamstrings and strengthening for your thighs and hips
• Advice on kneeling, padding, training and a gradual return to activity

Work high on the inner thigh is only with your informed consent and a signed consent form. If flat feet or how your knees line up keep it irritated, I'll help you work out whether an arch support would help and how to get one, and point you to a chiropodist or podiatrist for a custom orthotic.

If the knee becomes red and hot, or you feel feverish or shivery, the bursa may be infected: I won't treat over it, and you should contact your family doctor or nurse practitioner straight away.