Massage therapy · Kitchener–WaterlooPrepatellar Bursitis

Carpet layers, plumbers and other people who spend a great deal of time on their knees may end up with swelling at the front of the kneecap (AAOS, n.d.). Bursae are small, jelly-like sacs that act as cushions to reduce friction. The prepatellar bursa sits between the kneecap and the skin, and it allows the kneecap to move smoothly underneath the skin. If the bursa becomes irritated and inflamed, it produces too much fluid and swells at the front of the kneecap (AAOS, n.d.).

Prepatellar bursitis is commonly known as housemaid's knee due to the high prevalence in people who kneel a lot. Pressure from the ground pushes the kneecap into the bursa, and if this is repeated often enough, it can cause inflammation in the bursa (known as bursitis) (AAOS, n.d.). A direct blow to the front of the knee, for example in football, wrestling or basketball, can also cause it (AAOS, n.d.).

Less commonly, bacteria can get into the bursa through a cut, scrape, insect bite or puncture wound and cause an infection. This is called infectious bursitis. It is less common but more serious, and it needs to be treated more urgently (AAOS, n.d.).

Prepatellar Bursitis Anatomy

How to Treat Prepatellar Bursitis

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

• If you are going to work on your knees, wear kneepads or other padding, and take regular breaks (AAOS, n.d.; NHS, 2023).
• If you play contact sports like basketball, football or wrestling, wear kneepads to protect your knees (AAOS, n.d.).
• After working out, apply ice to the knees and elevate them to allow them time to rest (AAOS, n.d.).
• Try switching activities regularly to avoid placing continual stress on the knees (AAOS, n.d.).
• Rest the knees regularly by stopping to stretch the legs (AAOS, n.d.).
• Clean any cuts on your knees to help prevent infection (NHS, 2023).

A swollen bursa at the front of the knee doesn't like being pressed, rubbed or knelt on. My aim is to let it settle, ease the muscles around the knee, and keep the knee moving and strong so you can get back to work, kneeling and sport with less chance of it flaring again.

I start by asking about your work, your sport and how much time you spend kneeling. Then I assess how your knee moves, the strength of your thigh and hip muscles, and how you kneel, squat and walk. I also check for signs that need a doctor first, such as redness, heat or fever.

While It's Swollen

• No pressure on the bursa itself, and no dragging of the skin over it
• Positioning so nothing presses on the front of the knee
• Hands-on work for the thigh, hamstrings and calf, working around the knee rather than on it
• Gentle lymphatic drainage above the knee to help with swelling
• Cool applications in the clinic, and I'll show you how to use ice and raise the leg at home
• Gentle, pain-free knee movement

As It Settles

1. American Academy of Orthopaedic Surgeons (AAOS) (n.d.) Prepatellar (kneecap) bursitis. OrthoInfo. Available at: https://www.orthoinfo.org/en/diseases--conditions/prepatellar-kneecap-bursitis/ (Accessed: 7 October 2026).
2. NHS (2023) Bursitis. Available at: https://www.nhs.uk/conditions/bursitis/ (Accessed: 7 October 2026).