Knee Bursitis
What is knee bursitis?
Bursae are small fluid-filled sacs positioned throughout the body at points of friction between tendons, muscles and bony surfaces. Their job is to reduce friction and allow smooth movement between these structures. The knee has several bursae, and when one becomes inflamed — a condition called bursitis — it fills with excess fluid and produces localised pain, swelling and tenderness.
Knee bursitis is a common cause of knee pain and swelling, and it is important to distinguish it from other causes of knee swelling such as meniscal tears, ligament injuries and osteoarthritis — all of which can produce a similar-looking swollen knee but require very different management.
Types of knee bursitis
Several bursae around the knee can become inflamed, each with a characteristic location, cause and presentation.
Prepatellar bursitis — the most common type — involves the bursa sitting directly over the front of the kneecap. It produces a rounded, fluid-filled swelling directly on top of the patella that is visible and palpable, and is typically caused by repeated pressure on the front of the knee from kneeling — hence its common names "housemaid's knee" or "plumber's knee." It is an occupational hazard for tradespeople, gardeners and anyone who kneels for prolonged periods. Acute prepatellar bursitis can also occur from a direct blow to the kneecap.
Infrapatellar bursitis involves the bursa below the kneecap, either the superficial infrapatellar bursa (between the patellar tendon and the skin) or the deep infrapatellar bursa (between the patellar tendon and the tibia). It produces swelling and tenderness in the fat pad region below the kneecap and can be confused with patellar tendinopathy or fat pad impingement. It is associated with jumping activities and is sometimes called "clergyman's knee."
Pes anserine bursitis is inflammation of the bursa on the inner side of the knee, just below the joint, where the sartorius, gracilis and semitendinosus tendons insert — the "pes anserine" (goose foot) attachment. It produces pain and tenderness on the inner side of the knee below the joint line, and is particularly associated with osteoarthritis, obesity, diabetes and tight hamstrings. It is often misdiagnosed as medial compartment arthritis or an MCL injury.
Semimembranosus bursitis involves the bursa behind the knee between the semimembranosus tendon and the medial gastrocnemius, and can present similarly to or in conjunction with a Baker's cyst.
What causes knee bursitis?
The causes vary by type but broadly include direct trauma or pressure (prepatellar), repetitive movement friction (infrapatellar), inflammatory conditions such as rheumatoid arthritis or gout (any type), infection (septic bursitis — which requires urgent medical assessment and is not managed with physiotherapy), and biomechanical factors including muscle tightness, weakness and altered movement patterns (pes anserine particularly).
How is it diagnosed?
Clinical assessment by a physiotherapist will identify the location, characteristics and likely cause of the bursitis. The position of the swelling — directly over the kneecap, below it, or on the inner side below the joint — is the primary diagnostic indicator. Ultrasound is the most useful imaging tool, confirming the diagnosis, assessing the size of the inflamed bursa and ruling out other pathology. Aspiration of the bursa fluid — usually performed by a GP or specialist — may be done for diagnostic purposes (to rule out infection or gout crystals) or therapeutically to reduce swelling.
How can physiotherapy help?
The physiotherapy approach depends on the type and cause of bursitis.
For prepatellar and infrapatellar bursitis caused by direct pressure or repetitive trauma, the primary intervention is addressing the aggravating activity — knee pads for occupational kneeling, modification of training loads for sporting bursitis — combined with swelling management using ice, compression and elevation. In the acute phase, the bursa needs to be offloaded rather than exercised. Once the acute inflammation settles, physiotherapy addresses any underlying biomechanical contributors to prevent recurrence.
For pes anserine bursitis, the approach is more comprehensive — hamstring and calf flexibility, quadriceps and hip strengthening, and management of any underlying osteoarthritis or metabolic conditions that are contributing. This type often responds well to physiotherapy but recurs if the underlying contributors aren't addressed.
For bursitis associated with inflammatory arthritis or gout, coordination with the patient's rheumatologist or GP for medical management of the underlying condition is essential alongside physiotherapy.
Clinical Pilates is useful in the rehabilitation phase for patients who need to rebuild strength around the knee without aggravating the bursa — the controlled, low-impact environment and modifiable load allow meaningful strengthening when direct knee loading is still uncomfortable. Real time ultrasound assists in retraining deep muscle activation where inhibition from pain and swelling is affecting rehabilitation.
Our physiotherapists Eliane Machado, Bethany Kippen and Emma Cameron and exercise physiologist Ash O'Regan all have experience in knee pain management.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
Bursae are small fluid-filled sacs positioned throughout the body at points of friction between tendons, muscles and bony surfaces. Their job is to reduce friction and allow smooth movement between these structures. The knee has several bursae, and when one becomes inflamed — a condition called bursitis — it fills with excess fluid and produces localised pain, swelling and tenderness.
Knee bursitis is a common cause of knee pain and swelling, and it is important to distinguish it from other causes of knee swelling such as meniscal tears, ligament injuries and osteoarthritis — all of which can produce a similar-looking swollen knee but require very different management.
Types of knee bursitis
Several bursae around the knee can become inflamed, each with a characteristic location, cause and presentation.
Prepatellar bursitis — the most common type — involves the bursa sitting directly over the front of the kneecap. It produces a rounded, fluid-filled swelling directly on top of the patella that is visible and palpable, and is typically caused by repeated pressure on the front of the knee from kneeling — hence its common names "housemaid's knee" or "plumber's knee." It is an occupational hazard for tradespeople, gardeners and anyone who kneels for prolonged periods. Acute prepatellar bursitis can also occur from a direct blow to the kneecap.
Infrapatellar bursitis involves the bursa below the kneecap, either the superficial infrapatellar bursa (between the patellar tendon and the skin) or the deep infrapatellar bursa (between the patellar tendon and the tibia). It produces swelling and tenderness in the fat pad region below the kneecap and can be confused with patellar tendinopathy or fat pad impingement. It is associated with jumping activities and is sometimes called "clergyman's knee."
Pes anserine bursitis is inflammation of the bursa on the inner side of the knee, just below the joint, where the sartorius, gracilis and semitendinosus tendons insert — the "pes anserine" (goose foot) attachment. It produces pain and tenderness on the inner side of the knee below the joint line, and is particularly associated with osteoarthritis, obesity, diabetes and tight hamstrings. It is often misdiagnosed as medial compartment arthritis or an MCL injury.
Semimembranosus bursitis involves the bursa behind the knee between the semimembranosus tendon and the medial gastrocnemius, and can present similarly to or in conjunction with a Baker's cyst.
What causes knee bursitis?
The causes vary by type but broadly include direct trauma or pressure (prepatellar), repetitive movement friction (infrapatellar), inflammatory conditions such as rheumatoid arthritis or gout (any type), infection (septic bursitis — which requires urgent medical assessment and is not managed with physiotherapy), and biomechanical factors including muscle tightness, weakness and altered movement patterns (pes anserine particularly).
How is it diagnosed?
Clinical assessment by a physiotherapist will identify the location, characteristics and likely cause of the bursitis. The position of the swelling — directly over the kneecap, below it, or on the inner side below the joint — is the primary diagnostic indicator. Ultrasound is the most useful imaging tool, confirming the diagnosis, assessing the size of the inflamed bursa and ruling out other pathology. Aspiration of the bursa fluid — usually performed by a GP or specialist — may be done for diagnostic purposes (to rule out infection or gout crystals) or therapeutically to reduce swelling.
How can physiotherapy help?
The physiotherapy approach depends on the type and cause of bursitis.
For prepatellar and infrapatellar bursitis caused by direct pressure or repetitive trauma, the primary intervention is addressing the aggravating activity — knee pads for occupational kneeling, modification of training loads for sporting bursitis — combined with swelling management using ice, compression and elevation. In the acute phase, the bursa needs to be offloaded rather than exercised. Once the acute inflammation settles, physiotherapy addresses any underlying biomechanical contributors to prevent recurrence.
For pes anserine bursitis, the approach is more comprehensive — hamstring and calf flexibility, quadriceps and hip strengthening, and management of any underlying osteoarthritis or metabolic conditions that are contributing. This type often responds well to physiotherapy but recurs if the underlying contributors aren't addressed.
For bursitis associated with inflammatory arthritis or gout, coordination with the patient's rheumatologist or GP for medical management of the underlying condition is essential alongside physiotherapy.
Clinical Pilates is useful in the rehabilitation phase for patients who need to rebuild strength around the knee without aggravating the bursa — the controlled, low-impact environment and modifiable load allow meaningful strengthening when direct knee loading is still uncomfortable. Real time ultrasound assists in retraining deep muscle activation where inhibition from pain and swelling is affecting rehabilitation.
Our physiotherapists Eliane Machado, Bethany Kippen and Emma Cameron and exercise physiologist Ash O'Regan all have experience in knee pain management.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
