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10 Bursitis of the Knee questions
Written by: James Gill BOst GOsC 6039. Registered Osteopath, Founder & Clinic Director
Medically Reviewed by: Mr Andrew O’Neill M.Ost GOsC 11018. Registered Osteopath & Shockwave Therapy Specialist
What is a Bursa?
A bursa is a small fluid-filled sac that acts as a cushion between the bone and muscles, tendons and skin. They allow your joints to move freely and ease rubbing. Occasionally this sac can become inflamed or irritated and this is called ‘Bursitis’. This is commonly seen in the major joints of your body: shoulders, elbows, hips, knees or the ankle. It is often mistaken as arthritis due to the location of the pain experienced.
There are a few locations of bursa in the knee. The most commonly implicated is the ‘prepatellar bursa’ (aka housemaids or carpenters knee), this is in front of the knee cap and reduces friction in flexion and extension of the knee but due to its location it is prone to trauma from kneeling and blunt force impact.
Just above the kneecap, is the ‘suprapatellar bursa’, this bursa allows the quadriceps to glide over the lower part of the thigh bone when flexing and extending and is generally implicated in the same way as the prepatellar bursa.
“In our London clinics, we often see patients who have ‘pushed through’ knee swelling, only for it to become a chronic issue. Early intervention with the right diagnostic assessment is the difference between a two-week recovery and a two-month struggle.” – James Gill, Registered Osteopath & Clinic Director.
As well as this, there is the ‘infrapatellar bursa’ below the kneecap. This can develop due to kneeling, chronic overuse and irritation and is commonly associated with ‘jumper’s knee’ and patellar tendonitis. Lastly is the ‘pes anserine bursa’; with this patients report medial knee pain around the knee joint line.
What are the signs & symptoms of knee bursitis?
The most common signs and symptoms of knee bursitis are:
- A dull, ache around your knee. This can build up slowly or can be acute and severe.
- Redness and increased warmth around the area.
- Tender to touch.
- Swelling around the knee.
- Stiffness and difficulty/pain when moving the knee.
Chronic bursitis occurs when there are repeated attacks of bursitis. This can lead to surrounding musculature deterioration due to lack of use at the joint due to pain experienced.
What are the common causes of Bursitis?
Bursitis is most common in adults over the age of 40. It is usually caused by repetitive pressure over an area or due to overuse. You can also get bursitis as a result of a sudden injury, but it isn’t uncommon to be caused by sitting or standing in the wrong way for long, extended periods at work or home or not stretching adequately prior to exercising.
This is due to age related change in your body. Your tendons are less elastic and aren’t able to handle stress as effectively, this can put more stress on a bursa leading to bursitis. At our Stratford and Canada Water clinics, we frequently see a rise in prepatellar bursitis (Housemaid’s Knee) among patients starting high-intensity gym programs or those in trades involving frequent kneeling. Early intervention is key to preventing the bursa from becoming chronic or thickened.
Other conditions such as gout, tendonitis, arthritis (osteoarthritis, rheumatoid arthritis and psoriatic arthritis), diabetes and thyroid problems can also raise your risk of developing bursitis. More rarely, bursitis can be caused by an infection (even a superficial cut getting infected).
How is Knee Bursitis diagnosed?
Diagnosis of knee bursitis is based on a full case history – reviewing your symptoms and medical history followed by a physical assessment. Our Osteopaths, Physiotherapists, and Chiropractors perform detailed physical examinations to identify the specific bursa involved and rule out “Red Flag” issues. Occasionally you may need to be referred for further diagnostic tests. These may include:
- Aspiration – this involves a needle being used to take some fluid from the bursa to test it for signs of infection or gout.
- Imaging – X-Rays are used to rule out any other underlying problems that can be causing your pain. MRIs and Ultrasounds allow the whole joint to be examined and can examine the bursas themselves.
- Blood tests – these can be done to rule out or confirm any other conditions.
What are the treatment options for Knee Bursitis?
At Bodytonic Clinic, we provide evidence-based management plans aligned with current NICE (UK) guidelines to restore mobility and reduce pain. The treatment depends on whether or not it involves infection.
Aseptic bursitis (without infection)
This bursitis may go away with self-care such as the R.I.C.E. protocol (Rest, Ice, Compression, Elevation). If it persists, you may be referred for specialised treatment which can include:
- Injection of a steroid into the area to reduce swelling and pain.
- Specialised splints or braces to limit movement of the affected joint.
- Soft tissue manual therapy to allow the muscles surrounding the bursa to reduce in tension.
- An exercise program personalised to you to treat underlying muscular weakness.
- Postural and gait analysis and education to avoid further overuse injuries.
If Chronic Knee Bursitis symptoms persist despite rest and medication, advanced non-invasive options may provide the therapeutic support needed. We utilise the versatility of Radial Shockwave (ESWT) for treating widespread inflammation and compensatory muscle tension, and the precision of Focused Shockwave (FSWT) to target deep, chronic bursae that are highly sensitive, aiding in the resolution of pain and swelling.
“Think of a bursa as a hydraulic cushion. When it’s healthy, you don’t feel it. When it’s inflamed, every movement of the joint creates friction-that is why rest alone often isn’t enough to break the inflammatory cycle.”
Septic bursitis
Requires medical intervention such as Aspiration of the fluid, Antibiotics, or potentially surgical drainage (bursectomy).
Advanced Non-Invasive Treatment: Shockwave Therapy
If Chronic Knee Bursitis symptoms persist despite rest and medication, advanced non-invasive options may provide the therapeutic support needed. At Bodytonic Clinic, we utilise a dual-technology approach to address both the inflammation and the surrounding tissue tension:
- Radial Shockwave (RSWT): We use the versatility of Radial Shockwave for treating widespread inflammation and compensatory muscle tension in the quadriceps or hamstrings that often occurs when the body tries to protect an injured knee.
- Focused Shockwave (FSWT): For deeper or highly sensitive bursae (such as the infrapatellar or pes anserine bursa), we utilise the precision of Focused Shockwave. This targets the deep, chronic inflammation at its source, helping to accelerate the resolution of pain and swelling where traditional therapies may have stalled.
“The precision of Focused Shockwave allows us to reach deep-seated chronic inflammation that traditional manual therapy sometimes can’t touch. It’s often the ‘missing link’ for patients who feel they’ve reached a plateau in their recovery.” – Andrew O’Neill, Shockwave Therapy Specialist and Registered Osteopath.
How long does Knee Bursitis last?
Especially with aseptic bursitis, it can usually be treated at home and should go away within a few weeks. It can limit motion in the interim but if treated adequately, it doesn’t cause any long-lasting effects or deformities.
Can Knee Bursitis be prevented?
Yes! It may not always be possible to stop it from happening but there is a lot you can do to prevent it from occurring by:
- Maintaining a healthy weight – this takes excess load and pressure off your knee joint.
- Taking regular breaks when putting pressure on the joint, such as kneeling.
- If kneeling cushion underneath with a pillow or knee pads.
- Stretching regularly to reduce stiffness and improve flexibility.
- Warming up and cooling down after exercise so your muscles are more likely to work effectively.
- Cleaning any cuts on or around your knees to prevent an infection.
What are the best exercises for Knee Bursitis?
IMPORTANT SAFETY NOTICE: Always consult a qualified clinician before attempting new exercises. If your knee is hot to the touch, you have a fever, or the redness is spreading, seek immediate medical attention (NHS 111) as this may indicate a septic infection.
- Hamstring stretch: Lie on your back with the unaffected leg flat on the floor. Raise the affected leg straight up. Use a resistance band around the arch of the foot. Lower the leg against resistance with 20% force for 10 seconds. Repeat 8-10 times.
- Quadriceps stretch: Lie on your side with the affected leg on top. Bend your upper knee to grasp your ankle and gently pull towards your buttocks. Hold for 30-60 seconds.
- Adductor stretch (for pes anserine bursitis): Sitting on the floor with feet together, let knees fall out to the side. Lightly push down with elbows. Hold for 30-60 seconds.
*It is recommended to get the go-ahead from your NHS GP or physical therapist before carrying out these exercises.
Book Your Assessment in London
Bodytonic Clinic offers dedicated knee assessments at both of our London locations. With 13 combined treatment rooms, we offer high availability for both new patients and follow-up care.
- Canada Water Clinic (SE16): 8 Treatment Rooms | Serving Docklands and Rotherhithe.
- Stratford Clinic (E15 / E20): 5 Treatment Rooms | Serving Stratford and East Village.
When to seek urgent medical advice
Call your GP or 111 if your symptoms haven’t improved in 2 weeks, you have a high temperature/fever, trouble moving your knee, or severe/sharp pain. These can be signs of an infection indicating the need for immediate medical investigation.
Seek immediate help if:
- Your pain doesn’t get better/gets worse with treatment.
- You have night sweats.
- Swelling, redness, and warmth increase around the knee.
Deeper Insights into Lower Limb Health
Deeper Insights into Lower Limb Health
- Differentiating Knee Pain: Hoffa’s Fat Pad Syndrome vs. Bursitis – Learn why anterior knee pain is often misdiagnosed.
- Gait Analysis: How Your Walk Impacts Your Knees – Discover if your biomechanics are the root cause of your inflammation.
- Why Your Ankle Keeps Clicking – Understanding the link between ankle instability and knee stress.
- Recovery & Relaxation: The Benefits of Cupping for Muscle Pain – How complementary therapies aid clinical recovery.
External Clinical Resources
For further information on the clinical guidelines and management of bursitis, we recommend the following professional resources:
- NHS UK: Bursitis Overview – General patient guide to symptoms and home care.
- NICE CKS: Knee Bursitis Management – Detailed clinical knowledge for healthcare professionals in the UK.
- Versus Arthritis: Knee Pain – Specialist support and information for joint-related conditions.
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