Knee Bursitis Pain: Anatomy, Causes, Symptoms, Healing Cycle, Treatment & Research Studies

Knee Joint

The knee joint is the largest and one of the most complex weight-bearing joints in the human body. The knee joint is the junction between the tibia, femur, and patella. The integrity of the knee joint determines the ease and range of movement as well as the quality of life of an individual. Different structures including bursae ensure friction-free movement at the knee joint. Inflammation of bursae at the knee gives rise to pain and compromises the range of movement. [1]

What is Bursa?

Bursa can be referred to as a fluid-filled entity that can be found between the skin and tendon, or in relation to tendon and bone. Bursae are proximal to large joints of the body, such as the knee, hip, and shoulder joint, which experience greater movement and friction. The primary function of bursae is to minimize friction between structures at the joint during movement. This protects from damage to the involved structures and maintains the integrity of the joint. Following bursae are associated with the knee joint. [2]

  1. Prepatellar bursa – present between knee cap or patella and the skin
  2. Infrapatellar bursae – superficial and deep infrapatellar bursae are present underneath patella 
  3. Suprapatellar bursa – located superior to the patella, between femur and tendon of quadriceps femoris 
  4. Pes Anserine bursa – present between the tendons of hamstring muscle and tibia, towards the inner aspect of knee joint
  5. Semimembranosus bursa –  located at the back of the knee joint, prevents friction between gastrocnemius and semimembranosus muscles 

What is Knee Bursitis?

Knee bursitis is characterized by inflammation of bursae around the knee joint. This produces pain as the adjacent structures irritate the inflamed bursa and also hinder the complete range of movement. Different types of knee bursitis are named according to their occupational associations. For instance, semimembranosus bursitis is also called baker’s cyst whereas clergyman’s knee is referred to as superficial infrapatellar bursitis. [2]

Symptoms of Knee Bursitis 

Individuals suffering from knee bursitis present with the following signs and symptoms. [3]

  1. Aching or burning pain around the knee joint
  2. The knee joint appears swollen
  3. Differential warmth and tenderness around the joint
  4. Limited range of motion at the knee joint
  5. The onset of pain during movement
  6. Stiffness of the knee joint
  7. Fever and chills in case the bursitis is associated with an infection

Causes and Risk Factors of Knee Bursitis 

Following are the causes and risk factors associated with knee bursitis. [4

  1. Direct trauma to the knee joint 
  2. Infection of the bursa 
  3. Occupational associations that involve repetitive movement at the knee joint. Constant friction compromises blood flow and causes knee bursitis.
  4. Pre-existing inflammatory conditions that include rheumatoid arthritis, osteoarthritis, and gout are predisposing factors for knee bursitis. 
  5. Muscles tightness or spasm
  6. Obesity imposes greater stress on the knee joint and leads to knee bursitis. 

Normal Healing Cycle 

Prior to the discussion about knee bursitis treatment, it is imperative to discuss the normal healing mechanisms. The normal healing cycle comprises the following stages. [5]

  1. Inflammation

During this stage, inflammatory cells are recruited to the site of injury. The cells release inflammatory mediators that are responsible for eliciting redness, swelling, pain, and warmth at the inflammation site. The cascade of reactions aims at eliminating the agent responsible for the inflammatory response of the body. 

  1. Proliferation 

This stage is characterized by the formation of scar tissue. During the proliferation stage, new blood vessels are formed, fibroblasts deposit collagen fibers, and reepithelization occurs. Excessive scar tissue is responsible for causing fascia restrictions and muscle trigger points. 

  1. Maturation 

The maturation stage signifies the recovery of the injured tissue. The inflammatory reactions are ceased and the involved site is cleared of inflammatory mediators. The maturation stage is the ideal outcome concerning wound healing. 

While acute inflammation subsides within a few days, chronic inflammation may last from months to years. The healing cycle oscillates between the inflammation and proliferation stages, thus, unable to achieve recovery of the injured or inflamed tissue. 

Knee Bursitis Treatments That Do Not Work

People may opt for several home remedies and clinical treatments to relieve knee bursitis pain. However, these techniques do not target inflammatory and proliferative processes of the healing cycle, hence, do not play a significant role in managing knee bursitis pain. 

  • Thermal treatment such as heat and/or ice therapy
  • Electrical stimulation 
  • Massage and foam roller 
  • Physiotherapeutic techniques such as knee joint mobilization and muscle stretching 
  • Strength exercises while the healing cycle is at the inflammation stage 

Treatment For Knee Bursitis Pain

The treatment regimen for knee bursitis involves simultaneous manipulation at the inflammatory and proliferative stages of the wound healing cycle. Following steps shall be followed to achieve maximum treatment outcomes. 

  1. One shall limit movement at the affected knee joint.
  2. Knee pads are used for reducing friction between the knee joint and external surfaces. This prevents further exacerbation of knee bursitis symptoms. 
  3. Resolution of inflammation stage requires following tools.
    • Sufficient rest
    • MagnaHeal is a healing device that works on the principles of magnetic therapy to reduce inflammation. MagnaHeal 1 treats mild inflammation whereas MagnaHeal 2 is used for treating severe inflammation. [6]  
    • An anti-inflammatory diet plays a significant role in managing inflammation. 
    • Investigation and treatment of nutrient deficiency also help modulate knee bursitis. AskASTR is software designed to identify nutrient deficiencies and help determine supplements essential for the resolution of the inflammatory stage. 
  1. The resolution of the proliferation stage is characterized by three features.
    • Releasing the scar tissue – A3 tool releases superficial whereas the A5 tool releases deep scar tissue.
    • Releasing fascia restriction. Fascia is composed of superficial and deep layers. The deep layer is further divided into aponeurotic, epimysium, perimysium, and endomysium layers. [7] Adherence of these layers during the proliferative stage gives rise to fascia restriction and limits the range of movement at the knee joint. A1 tool targets superficial and aponeurotic, while A5 tool targets the other three fascia layers. 
    • Trigger points or muscle knots are released by using A3 and A5 tools. 

Conclusion 

Knee bursitis may have different clinical presentations depending on the location of the bursa and the nature of the injury. Traditional therapeutic techniques do not target inflammation and proliferation stages of the healing cycle, hence, ineffective for the treatment of knee bursitis. Magnetic therapy, an anti-inflammatory diet, and nutrient supplementation facilitate the healing process. A1, A3, and A5 tools are used for releasing scar tissue, fascia restrictions, and trigger points. These therapeutic techniques are beneficial for relieving knee bursitis pain. 

References 

  1. https://pubmed.ncbi.nlm.nih.gov/21540705/ 
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3354353/ 
  3. https://pubmed.ncbi.nlm.nih.gov/15940489/
  4. https://pubmed.ncbi.nlm.nih.gov/20521045/
  5. https://www.ncbi.nlm.nih.gov/books/NBK518964/ 
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3617815/    
  7. https://pubmed.ncbi.nlm.nih.gov/30252294/ 

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