Ask a PT: Is There an Actual Cure for Plantar Fasciitis?

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Question 1:

I’ve been diagnosed with Pes Anserine Bursitis. I am writing this after trying every stretch, exercise and rest that has been prescribed, and have even bought two new pair of shoes. Please, what can I do for my knee to feel normal again?! I have gone to see so many professionals (but no PT’s) and I have not seen improvement…please can you help me?!

— Tom, 34
San Diego

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Answer: Dr. Marc Robinson

Hi Tom,

Thanks for your question. I can understand how you must feel. The Pes Anserine is the insertion point of the gracilis, sartorius and semitendinosus. Pes Anserine Bursitis occurs from inflammation of the bursa under the insertion of these tendons on the inside of the knee below the knee joint. Because I’ve seen pes anserine bursitis misdiagnosed many times, I wanted to share a quick review of what it is and what its symptoms include.

One study showed that the prevalence of pes anserine bursitis was 2.5 percent as detected by an MRI. It is interesting to note that only 2.5 percent of people with symptomatic knees actually had pes anserine bursitis. There is a possibility that the pain may be coming from the knee joint or the lower back. The medial meniscus and MCL should be ruled out as sources of pain. In addition, the lower back should be ruled out as it can refer pain to the inside of the knee due to complex nerve pathways. A physical therapist can help differentiate these potential sources of pain.

I can provide general recommendations under the assumption that you have pes anserine bursitis as diagnosed by a licensed physician. Tightness in the hamstrings can lead to excessive pulling at the insertion of the semitendinosus. Hamstrings tightness may be related to a literal shortening of the muscles; however, many times the feeling of tightness is related to another factor such as weakness of the core or glutes. The tightness experienced may be a symptom of excessive tone and overuse of the hamstrings as a compensation.

Strengthening the core, glutes and hamstrings can be beneficial to alleviate the feeling of tightness. If the hamstrings are contributing to the symptoms, then progressive loading of the hamstrings with concentric and eccentric exercises can help. In addition, the hamstrings can be stretched statically and dynamically.

In most cases of knee pain, hip strengthening is recommended. Exercises such as bridges, clams, fire hydrants, squats, hip hikes, and single leg exercises can help reduce stress to the knee and improve running performance. The dosage and specific progression of these exercises will vary depending on strength level and symptom response.

Another recommendation is to improve running mechanics. Poor running mechanics can lead to repetitive stresses to the knee. The improvement of running mechanics will help to reduce excessive stress to the knee allowing the injured tissues to heal.

As you can see, you have different options to recover from this injury and subtle changes in your recovery program can make a big difference. If the symptoms persist, try a one-on-one consult with a physical therapist.

Stay active,

Dr. Marc

Dr. Marc Robinson is a Physical Therapist in San Diego, CA who provides online physical therapy and virtual consultations for those who need on-demand help with injuries. His company, Evercore offers online injury prevention courses and fitness products to promote a pain-free, active life. They specialize in low back pain and helping their clients achieve health goals beyond what the traditional medical system can offer.

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