The knee is a hinge joint that is responsible for weight-bearing and movement. It consists of bones, meniscus, ligaments, and tendons. The knee is fully designed to fulfill various amounts of functions, including the following below:
- Provide enough stability.
- Helps lower and raise your body.
- Allows twisting of the leg.
- Makes walking much more efficient.
- Supports the body in an upright position without the need for muscles to function.
Additionally, the knee is also one of the most complex joints in the human body. It connects the thigh (femur), to the shin bone (tibia), and also includes a smaller bone, the fibula, which is located next to the tibia, and finally, the kneecap (patella).
Our bodies are filled with small fluid-filled sacs called bursae that are located at certain friction points, such as joints or bony prominences. These bursa help cushion and protect the bone from friction as tendons and muscles cross over bone during movement, especially in places like elbows, knees, and hips.
There are a number of different bursae around the knee. The Infrapatellar bursa is found just below the kneecap and sits around the patellar tendon, the large tendon that connects the quadriceps muscles to the lower leg. The Infrapatellar bursa is actually made up of two sacs:
- Superficial Infrapatellar bursa – sits in front of the patellar tendon, between the tendon and the overlying skin.
- Deep Infrapatellar bursa – sits underneath the patellar tendon, between the tendon and shin bone (tibia).
Infrapatellar bursitis occurs when one or both bursa sacs inside the knee become irritated and inflamed resulting in swelling and knee pain. Generally, bursitis is quite painful; this is due to the bursa sac becoming irritated and inflamed, affecting the bursa and the soft tissue around it. When pressure or friction is too high, excess fluid can build up in the bursa sac, and / or the lining of the sac can thicken, causing inflammation. When a bursa becomes inflamed, moving your knee becomes painful and difficult (this is known as bursitis). Any actions that put pressure on the inflamed bursa can increase irritation and cause further inflammation and pain.
Causes & Symptoms
Inflammation of the Infrapatellar bursae or the surrounding tendons (quadriceps tendon and patellar tendon) usually develops due to overuse, trauma, or degeneration of the protective tissue in the knee. A few specific causes of Infrapatellar bursitis include:
Without exercise or activity, muscles can weaken and your knee no longer has the muscle support it needs to move correctly. This can cause excess load on the knees and hips, or your weight may be distributed unevenly within your knee joint. Uneven distribution of weight will put extra stress on some areas compared to others leading to abnormal wear and tear on the stressed areas.
A direct blow to the knee, at the top of the tibia, can cause injury to the Infrapatellar bursa during athletics or when falling on the knee. In some cases, blood may also leak into the bursa causing irritation, inflammation, swelling, and pain.
Excessive friction or rubbing on the Infrapatellar bursa can aggravate it over time. If your work or exercise routine requires frequent climbing, running, jumping, or hiking you may be at a higher risk of Infrapatellar bursitis due to the frequent knee bending. This type of risk increases if there is anything that may cause abnormal wear and tear within the joint.
Pressure on the Infrapatellar Bursa
Work and frequent activities that place repetitive pressure on the Infrapatellar bursa can cause Infrapatellar bursitis. Although, the bursae in your knee function as cushions to protect the tendons and other soft tissue, frequent kneeling during your work or activities often creates more stress than they can handle. The excess pressure causes the bursa to become irritated and inflamed, leading to swelling and thickening of the bursa lining. When kneeling on hard surfaces, knee pads are recommended to treat or prevent Infrapatellar bursitis.
Infrapatellar bursitis often develops secondary to other knee problems, most commonly jumper’s knee (patellar tendonitis) and Osgood Schlatter’s disease.
Additionally, you might be suffering from Infrapatellar bursitis if you are experiencing one or more of the following symptoms:
You may experience pain and tenderness just below the kneecap on the inside part of the knee.
Pain worsens during exercise or when you’re climbing stairs but can also increase by simply bending and straightening your knee. Knee pain caused by bursitis typically starts gradually and develops over a few days or even months.
Swelling, tenderness, warmth, and redness
Swelling is typically evident with Infrapatellar bursitis and often appears as an abscess over or below the kneecap. This swelling may appear immediately following trauma, over a couple of hours, or up to 7 to 10 days after the event that caused the irritation.
Limited range of motion and weakness
Pain often limits your knee movements as you stop performing motions that make the pain worse. If Infrapatellar bursitis is left untreated the inflammation can increase, causing more pain, limiting movement even more. Eventually, weakness in the leg muscles and the tendons around the knee can set in. As you lose strength in your quadriceps, your legs may begin to give out during daily activities.
Who gets Infrapatellar Bursitis?
Infrapatellar bursitis is a common complaint, however, your risk of developing this condition can increase with the following risk factors:
- Sleeping awkwardly – Patients suffering from Infrapatellar bursitis may have interrupted sleep patterns; simply bending your knee or rolling over during sleep can cause pressure on the inflamed bursa, increasing your pain. The pain can range from mild to very sharp depending on the amount of swelling and inflammation in the bursa.
- Obesity and osteoarthritis – Infrapatellar bursitis can affect some patients who are overweight, especially if you are experiencing osteoarthritis.
- Sports – Sports that result in direct blows or frequent falls on the knee (such as wrestling and football) can increase your risk of Infrapatellar bursitis. Runners can develop pain and inflammation in the Infrapatellar bursa, situated on the inner side of your knee below the joint.
- Prolonged kneeling – People who work on their knees for long periods (plumbers, gardeners, and carpenters) are at increased risk of Infrapatellar bursitis.
How Does it Affect You? How Serious is it?
In most cases, Infrapatellar bursitis can last for anything from a couple of weeks to a few months. Fortunately, if you follow the right set of treatments, particularly resting from aggravating activities, then symptoms linked to this condition should settle within a few weeks. However, if Infrapatellar bursitis has developed secondary to other knee problems, such as patellar tendon inflammation (jumper’s knee) or Osgood Schlatter’s disease, then it may take 3 to 6 months for you to fully recover. Osgood Schlatter’s disease is a condition that occurs when a tendon in the knee pulls against the top of the shinbone. This causes pain in the knee and upper shin.
Recommended Treatment & Rehabilitation
To begin a diagnosis for Infrapatellar bursitis, your doctor will first gather a medical history about your current condition and symptoms. He or she will then ask about:
- The amount of pain you are having with your affected knee.
- How long you have had your symptoms and if you are experiencing a range of motion loss with the leg and knee.
- Details about what caused the pain in the knee, when it started, and whether or not you have ever had treatments for this or a similar condition in the past.
In addition, range-of-motion movements and tests will be done to see how much movement has been lost in your knee. Your knee may hurt from your doctor poking and prodding at it, but by doing this the doctor will better understand the source of your pain, the level of tenderness in and around your knee, and how well your knee can move with this condition. Your doctor may also consider any previous knee injuries or joint stiffness that you may have had in the past. This will help your doctor to determine if you have an even more complex injury in your knee and rule out any other foot injuries that may be present.
If soft tissue is suspected, an MRI scan may be undertaken to view where and how extensive the damage is. An X-ray may also be recommended to rule out other possible causes of your symptoms.
Your doctor may also prescribe rehabilitation. Therefore, a physiotherapist may suggest the use of heat, ice, and ultrasound to help calm the pain and swelling. Your physiotherapist may also recommend specialized stretching and strengthening exercises used in combination with a knee brace, taping of the patella, or shoe inserts. These exercises and aids are used to improve muscle balance and joint alignment of the hip and lower limbs easing pressure and problems in the bursa. Regarding exercises that can help reduce any further development of Infrapatellar bursitis, here are some exercise methods for you to try:
Lie on your back with your affected knee straight. Your good knee should be bent. Afterward, bend your affected knee by sliding your heel across the floor and toward your buttock until you feel a gentler stretch in your knee. Finally, hold this position for about 6 seconds, and then slowly straighten your knee. After finishing the first set, repeat 8-12 times a day.
Firstly, sit with your affected leg straight and supported on the floor or a firm bed. Secondly, place a small, rolled-up towel under your affected knee. Your other leg should be bent, with that foot flat on the floor. Tighten the thigh muscles of your affected leg by pressing the back of your knee down into the towel. Lastly, hold for about 6 seconds, then rest for up to 10 seconds before repeating the exercise 8-12 times a day.
Lie on your back with your good knee bent so that your foot rests flat on the floor. Your affected leg should be straight, and make sure that your low back has a normal curve. You should be able to slip your hand in between the floor and the small of your back, with your palm touching the floor and your back touching the back of your hand. Tighten the thigh muscles in your affected leg by pressing the back of your knee flat down to the floor. Hold your knee straight, then while keeping the thigh muscles tight and your leg straight, lift your affected leg up so that your heel is about 30 centimeters off the floor. Finally, hold for about 6 seconds, then lower slowly. Rest for up to 10 seconds between repetitions before repeating 8-12 times a day.
Alternative & Homeopathic Treatment
It is possible to successfully treat mild to moderate cases of Infrapatellar bursitis at home – homeopathic treatments for this condition include:
- Rest – Activities that may aggravate the affected Infrapatellar bursitis, such as kneeling, crawling, or participating in high-impact sports, should be avoided. Rest can help reduce the symptoms at a higher rate as you’re avoiding most activities simply by resting.
- Cold compression – Applying a cold compress to the knee may help decrease swelling and alleviate other symptoms. A cold compress can be purchased or made at home and applied to the knee for about 20 minutes 2-3 times a day.
- Non-steroidal anti-inflammatory drugs (NSAIDs) – Over-the-counter non-steroidal anti-inflammatory medications, such as ibuprofen, may reduce knee pain, swelling, and inflammation.