Knee Bursitis Exercises: Relieve Prepatellar and Pes Anserine Bursitis

Knee bursitis is inflammation of one of the small fluid-filled sacs (bursae) that cushion the knee joint. The most common types are prepatellar bursitis (in front of the kneecap) and pes anserine bursitis (on the inner knee below the joint). While rest and anti-inflammatory measures help initially, specific exercises speed recovery and prevent recurrence.

Understanding Knee Bursitis

Types of Knee Bursitis

Prepatellar Bursitis (Housemaid's Knee):

• Swelling directly over kneecap
• Caused by kneeling or direct trauma
• Common in carpet layers, roofers, gardeners

Pes Anserine Bursitis:

• Pain on inner knee, 2-3 inches below joint
• Associated with tight hamstrings, obesity, osteoarthritis
• Common in runners and overweight individuals

Infrapatellar Bursitis (Clergyman's Knee):

• Below the kneecap
• From kneeling on hard surfaces

Causes

• Prolonged or repetitive kneeling
• Direct impact to knee
• Overuse from running or jumping
• Muscle tightness (especially hamstrings)
• Obesity
• Underlying arthritis

Symptoms

• Localized swelling
• Tenderness to touch
• Pain with movement or pressure
• Warmth over affected area
• Difficulty kneeling (prepatellar)
• Pain going up/down stairs

Phase 1: Acute Phase

Goals

• Reduce inflammation
• Protect the bursa
• Maintain range of motion
• Avoid aggravating activities

RICE Protocol

Rest: Avoid kneeling or aggravating activities Ice: 15-20 minutes, 3-4 times daily Compression: Elastic bandage if swelling significant Elevation: Above heart level when possible

Heel Slides

Maintain range of motion:

1. Lie on back
2. Slide heel toward buttocks
3. Bend knee as far as comfortable
4. Slide back to straight

Perform: 15-20 reps, 3 times daily

Quad Sets

Keep quad muscle active:

1. Sit with leg extended
2. Tighten quad, pressing knee down
3. Hold 5-10 seconds
4. Relax and repeat

Perform: 20-30 reps, 3-4 times daily

Ankle Pumps

Maintain circulation:

1. Pump ankle up and down
2. Circle ankle both directions
3. Continue throughout day

Perform: 20-30 reps, multiple times daily

Hamstring Stretch (Pes Anserine)

Critical for pes anserine bursitis:

1. Sit on floor, one leg extended
2. Reach toward toes
3. Keep back straight
4. Feel stretch behind thigh
5. Hold 30 seconds

Perform: 3-4 reps each leg, 2-3 times daily

Phase 2: Recovery Phase

Goals

• Progress strengthening
• Address muscle imbalances
• Improve flexibility
• Gradually return to activities

Straight Leg Raises

Build quad strength without bending knee:

1. Lie on back, uninjured knee bent
2. Tighten quad on affected leg
3. Lift leg 8-12 inches
4. Hold 3 seconds, lower slowly

Perform: 15-20 reps, 3 sets

Side-Lying Leg Raises

Strengthen outer hip:

1. Lie on unaffected side
2. Keep top leg straight
3. Lift toward ceiling
4. Lower with control

Perform: 15-20 reps, 3 sets

Clamshells

Target hip stabilizers:

1. Lie on side, knees bent
2. Keep feet together
3. Open top knee toward ceiling
4. Don't let pelvis roll back
5. Lower slowly

Perform: 15-20 reps each side, 3 sets

Standing Hamstring Curl

1. Stand holding support
2. Bend knee, bringing heel toward buttocks
3. Lower slowly
4. Progress to resistance band

Perform: 15-20 reps, 3 sets

Iliotibial Band Stretch

For prepatellar and lateral knee issues:

1. Stand with affected leg behind
2. Cross affected leg behind other
3. Lean away from affected side
4. Feel stretch on outer thigh
5. Hold 30 seconds

Perform: 3-4 reps, 2-3 times daily

Quad Stretch

1. Stand holding support
2. Bend knee, grab ankle
3. Pull heel toward buttock
4. Keep knees together
5. Hold 30 seconds

Perform: 3-4 reps each leg, 2-3 times daily

Calf Stretch

1. Stand facing wall
2. Step back with leg to stretch
3. Keep heel down, lean forward
4. Feel stretch in calf
5. Hold 30 seconds

Perform: 3-4 reps each leg, 2-3 times daily

Phase 3: Strengthening

Goals

• Build strength around knee
• Improve stability
• Return to normal activities
• Prevent recurrence

Wall Sits

1. Stand with back against wall
2. Slide down to comfortable position
3. Don't go deeper than 60-70 degrees
4. Hold position

Perform: 30-45 second holds, 3-5 sets

Step-Ups

1. Stand facing 4-6 inch step
2. Step up with affected leg
3. Bring other foot up
4. Step down with control

Perform: 12-15 reps each leg, 3 sets

Mini Squats

1. Feet shoulder-width apart
2. Squat to 45-60 degrees (not deep)
3. Keep weight in heels
4. Return to standing

Perform: 15-20 reps, 3 sets

Terminal Knee Extensions

1. Loop band around sturdy object at knee height
2. Face anchor, band behind knee
3. Start with knee slightly bent
4. Straighten fully against resistance
5. Return slowly

Perform: 15-20 reps, 3 sets

Single-Leg Balance

1. Stand on affected leg
2. Maintain slight knee bend
3. Hold 30-60 seconds
4. Progress: eyes closed, unstable surface

Perform: 3-4 reps, 30-60 seconds

Glute Bridges

1. Lie on back, knees bent
2. Squeeze glutes, lift hips
3. Create straight line from shoulders to knees
4. Hold 3-5 seconds, lower

Perform: 15-20 reps, 3 sets

Leg Press (Light)

When cleared for gym work:

1. Use leg press machine
2. Moderate range (avoid deep flexion)
3. Light to moderate weight
4. Control throughout movement

Perform: 12-15 reps, 3 sets

Special Considerations by Type

Prepatellar Bursitis

Key Focus:

• Avoid kneeling until healed
• Use knee pads when returning to kneeling
• Strengthen quads to support kneecap
• Address any direct trauma causes

Additional Exercises:

• Emphasis on quad strengthening
• VMO-focused exercises
• Patellar mobility exercises

Pes Anserine Bursitis

Key Focus:

• Hamstring flexibility is critical
• Address obesity if applicable
• Check for flat feet (may need orthotics)
• Common with medial knee osteoarthritis

Additional Exercises:

• Daily hamstring stretching (multiple times)
• Hip adductor strengthening
• Avoid exercises that stress inner knee

Prevention Strategies

For Prepatellar Bursitis:

• Use kneeling pads
• Take breaks from kneeling
• Vary positions frequently
• Strengthen supporting muscles

For Pes Anserine Bursitis:

• Maintain hamstring flexibility
• Strengthen hip stabilizers
• Address weight if needed
• Proper footwear and orthotics if flat-footed

Activity Modifications

During Recovery

Avoid:

• Kneeling on affected knee
• Deep squats
• High-impact activities
• Activities that reproduce pain

Continue:

• Swimming (avoid breaststroke kick)
• Cycling (seat high enough)
• Upper body exercises
• Walking (if pain-free)

Returning to Activities

Progress gradually:

1. Start with low-impact activities
2. Add duration before intensity
3. Use protective gear (knee pads) if kneeling
4. Stop if pain returns

Sample Weekly Program

Monday/Thursday - Strength

• Straight leg raises: 3x15
• Wall sits: 3x30 sec
• Step-ups: 3x12
• Glute bridges: 3x15
• Terminal knee extensions: 3x15

Tuesday/Friday - Flexibility & Balance

• Hamstring stretch: 3x30 sec
• Quad stretch: 3x30 sec
• IT band stretch: 3x30 sec
• Calf stretch: 3x30 sec
• Single-leg balance: 3x45 sec

Wednesday - Light Activity

• Walking or cycling: 20-30 minutes
• Side-lying leg raises: 2x15
• Clamshells: 2x15

Daily

• Ice after activity if needed
• Hamstring stretches (especially pes anserine)
• Avoid aggravating activities

When to Seek Medical Care

Red Flags

See a provider if:

• Severe swelling that doesn't improve
• Signs of infection (fever, redness, warmth spreading)
• Inability to bend or straighten knee
• Pain that doesn't improve with rest
• Symptoms lasting more than 2-3 weeks

Treatment Options

If conservative measures fail:

• Aspiration (draining fluid)
• Corticosteroid injection
• Physical therapy
• Rarely, surgery (for chronic cases)

Common Mistakes

1. Continuing to kneel - Must avoid pressure on bursa
2. Ignoring hamstring tightness - Critical for pes anserine
3. Deep squatting too soon - Compresses the bursae
4. Skipping ice - Important for inflammation control
5. Returning too fast - Bursitis can become chronic

Key Takeaways

Knee bursitis responds well to conservative treatment:

1. Rest from aggravating activities - No kneeling on prepatellar
2. Ice regularly - Controls inflammation
3. Stretch hamstrings - Essential for pes anserine type
4. Strengthen gradually - Build supporting muscles
5. Prevent recurrence - Use knee pads, maintain flexibility

Most cases resolve within 2-4 weeks with proper management. The key is avoiding what caused it while building strength to support the knee long-term.