Pes Anserine Bursitis
Pes anserine bursitis is irritation of the small fluid-filled sac (bursa) on the inner side of the knee, just below the joint, where three tendons converge. A medical evaluation confirms the diagnosis; we want to be direct upfront that the shockwave therapy evidence here is mixed, with one trial finding it performed worse than corticosteroid injection.
Common Symptoms
- Aching or tender pain on the inner side of the knee, a few inches below the joint line
- Pain that worsens with stairs, especially going up, or with prolonged sitting
- Mild swelling over the inner knee in some cases
- Tenderness directly over the bursa on exam
Why It Happens
Repetitive friction or direct pressure at the pes anserine bursa — from activities like running, cycling, or breaststroke swimming — can irritate the bursa, and it's also common in people with knee osteoarthritis or who are overweight, where altered knee mechanics increase load on this area.
Why It Can Become Persistent
Because this area is loaded with everyday activities like walking and stairs, ongoing use can keep re-irritating the bursa unless contributing factors are addressed.
Who Commonly Gets It
Pes anserine bursitis is especially common in runners, in people with knee osteoarthritis, and in people who are overweight, more often middle-aged and older adults.
How It Is Usually Diagnosed
Diagnosis is usually clinical, based on the classic location of tenderness a few inches below and to the inner side of the knee joint; ultrasound can confirm bursal swelling if the diagnosis is unclear.
Traditional Treatment Options
- Activity modification: Reducing aggravating activities like stair climbing or cycling during flare-ups.
- Ice and NSAIDs: Common first steps for symptom control.
- Physical therapy: Addressing knee mechanics and surrounding muscle strength.
- Corticosteroid injection: A well-established, often effective treatment for this specific condition.
Why Someone Might Start Looking for Another Option
Some people would rather avoid an injection, or don't get full relief from activity changes alone, which is when other non-invasive options like shockwave therapy come up.
Where Shockwave Therapy May Fit
We want to represent this evidence honestly rather than selectively. One randomized trial found shockwave therapy produced better quality-of-life scores than a single corticosteroid injection, though the injection reduced bursal swelling on imaging more. A separate, larger three-arm trial comparing corticosteroid injection, platelet-rich plasma, and shockwave therapy found corticosteroid injection more effective than either of the other two for pain and function at both 1 and 8 weeks — meaning shockwave therapy was the weakest-performing option in that particular trial. Corticosteroid injection currently has the strongest track record for this specific condition.
How Shockwave Treatment Works for This Area
If shockwave therapy is chosen, acoustic pressure waves are applied to the area of the bursa; your provider will discuss how this compares with corticosteroid injection for your situation, including the trial above showing injection outperforming shockwave therapy.
What the Treatment Feels Like
Most patients describe a firm tapping or pressure sensation over the inner knee; your provider will discuss what to expect.
What Happens During Your First Visit
Your visit begins with a provider evaluation focused on your history and a physical exam relevant to your complaint. If shockwave therapy is determined to be clinically appropriate, your first treatment can typically be provided the same visit. See our What to Expect page for the full walkthrough.
New Patient Offer
New Patient Exam + First Treatment — $99
First treatment provided when clinically appropriate following your examination.
Who May Not Be Appropriate
- Anyone who has not yet had a medical evaluation to confirm the diagnosis
- Active infection, open wounds, or certain bone conditions at the treatment site
- Certain circulatory, neurological, or bleeding-related conditions, per your provider's screening
This list is not exhaustive. Your provider will screen for contraindications during your evaluation.
Frequently Asked Questions
Based on the best trial we found, no — corticosteroid injection outperformed shockwave therapy for pain and function in a head-to-head comparison. We think it's important to say that plainly rather than only highlighting the more favorable trial.
Mainly if you'd prefer to avoid an injection specifically — some people do. But based on current evidence, corticosteroid injection is the better-supported first choice for this particular condition.
What Research Says
Selected sources relevant to pes anserine bursitis. See the full Research Center for our complete source registry and methodology.
Medical Journal of the Islamic Republic of Iran · 2023 · Majidi, Saeb, Alaei, Khateri, Ezzati Amini, Nikoo
This open-label trial randomized 60 patients with pes anserine bursitis to three weekly shockwave sessions or a single ultrasound-guided corticosteroid injection and found shockwave therapy produced greater pain reduction and much larger quality-of-life gains, while the corticosteroid injection produced a greater reduction in bursal thickness on imaging.
Limitations: Open-label with no blinding, and an unequal treatment "dose" (three shockwave visits versus one injection) that confounds a fair comparison; follow-up was short to moderate in length.
Advances in Orthopedics · 2023 · Gouda, Abbas, Abdel-Aziz, Shoaeir, Ahmed, Moshrif, Mosallam, Kamal
As its title states, this three-arm trial of 180 patients with pes anserine bursitis compared corticosteroid injection, platelet-rich plasma, and shockwave therapy, and found corticosteroid injection was more effective than either of the other two for pain reduction and function at both 1 and 8 weeks — shockwave therapy was the weakest-performing arm in this particular trial.
Limitations: We're citing this study for exactly what it found — corticosteroid injection outperformed shockwave therapy head-to-head in this trial, not the reverse. Follow-up was short (8 weeks) and outcome-assessor blinding wasn't clearly reported.
Related Treatment Options
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First treatment provided when clinically appropriate following your examination.