“Pes anserine tendonitis is the inflammation of the 3 tendons that run along the inner lower aspect of the knee joint. The condition is also called “goosefoot” tendonitis because the 3 tendons together give the appearance of a goosefoot at their point of attachment on the shinbone.
What causes Pes Anserine Tendonitis?
Pes Anserine Tendonitis may be caused by repetitive activities or sports that require involve a lot of cutting movements while running s
uch as basketball or soccer, abnormal biomechanics, muscle imbalances, improper footwear, or some kind of knee pathology such as osteoarthritis.
What are the Symptoms of Pes Anserine Tendonitis?
You may experience pain in the inner aspect of the knee when bending or straightening your leg, pain with climbing stairs, swelling around the knee, loss or range of motion, or a sensation of the knee giving way.
Treatment of Pes Anserine Tendonitis
Most people diagnosed with Pes Anserine Tendonitis are able to make a full recovery with physical therapy. Here are some exercises that can help alleviate symptoms and get you back to your active lifestyle.
VMO Straight Leg Raise
Turn your foot slightly outward. Tighten the muscles on the front of your thigh and lift the entire leg from the bed no higher than the opposite knee. Make sure to keep your knee completely straight and maintain outward foot position.
Hold 10 seconds | Repeat 10times | Perform 1-2 sessions per day
Prone Quad Stretch
Lay on your stomach with strap around your involved foot or ankle. Gently pull your foot towards your hip until a moderate stretch is felt in the front of your thigh. Make sure to keep your knees together.
Hold 30 Seconds | Repeat 2 times | Perform 1-2 sessions per day
Seated Hamstring Stretch
Place your leg straight on the bed with your opposite foot on the floor. Keeping your knee straight and your toes pointed up, slowly lean forward until you feel a stretch in the back of the knee/thigh. Keep your back straight and do not tuck your chin, no bouncing.
Hold 30 seconds | Repeat 2 times | Perform 1-2 sessions per day
Standing ITB Stretch
Stand with the involved side toward a counter and cross the opposite leg in front of the involved leg. Hold onto the counter and gently lean the involved hip into the counter until a stretch is felt on the side of the hip.
Hold 30 seconds | Repeat 2times | Perform 1-2 sessions per day
Butterfly Adductor Stretch
Sit with your feet together and knees apart, gently push your knees to the floor until a stretch is felt in the groin. Maintain a straight back, use support if needed.
Hold 30 seconds | Repeat 2 times | Perform 1-2 sessions per day”(1)
The Longest Muscle
The sartorius is the longest muscle in the human body. Latin for "tailor," it is sometimes called the tailor The Longest muscle. It is a long, thin muscle that tracks obliquely across the thigh. Its origin is at the anterior superior iliac spine of the hip and inserts at the medial side of the proximal tibia near the knee joint. It crosses from lateral to medial (from the outer thigh to the inner thigh) across the rectus femoris and vastus medialis of the quadriceps. It is innervated by the femoral nerve from the vertebrae at L2-L4.
Structure and Function
The sartorius muscle has several important functions at the hip and knee joint. Its long, thin structure makes it a relatively weakly acting muscle and it is classified as a synergist—a muscle that works in conjunction with the larger muscles of the quadriceps group. This muscle:
Works to flex the hip
Aids in hip abduction (away from the midline)
Laterally rotates the thigh
Helps with knee flexion
Laterally rotates the leg when the knee is flexed
The sartorius muscle works in conjunction with the tensor fasciae latae during hip rotation and abduction. The muscle also works as a synergist in hip abduction with the gluteus medius and maximus, psoas, piriformis, and quadratus lumborum of the lower back.
During lateral rotation of the hip, the sartorius is a synergist to the gluteus maximus, obturator internus and externus, gemelli, quadratus femoris and the piriformis.
During knee flexion (bending), it assists the hamstring complex (semitendinosus, semimembranosus, and biceps femoris).
Common Dysfunctions
The frequent use of the sartorius also makes it prone to overuse or injury. Irritation of the bursa that lie deep to the sartorius is common in runners, as is chronic knee pain or weakness. The pes anserine bursa sits under the tendinous insertion point of the sartorius, gracilis (an adductor of the thigh), and semitendinosus at the inferior medial knee joint. When these three muscles are tight (overactive), they place excessive pressure on this bursa that has a physiological function of reducing friction from muscle and tendon moving over bone. Irritation of this bursa, or pes anserine bursitis, is a chronic knee pain cause. It can also cause an asymmetrical gait.
For individuals who sit for long periods, tight hips and tight hip flexors including the sartorius are common. As a result, hip pain or an uneven gait may occur. However, the anterior hip pain caused by a tight sartorius is often mistaken for issues with the psoas and iliacus. While they may contribute to the discomfort, the sartorius should not be ignored! Learning to identify and correct tight hip flexors is key to finding relief!
Athletes in sports that require sharp turns with a planted foot and quick direction changes may also experience a stinging sensation at the hips. This may be caused by an acute injury or strain to the sartorius muscle.
Once pain at the medial knee or hip has been identified, how can you work to alleviate it?
Yoga for Relief
The benefits of yoga are many. Relaxation, stress relief, flexibility, and circulatory health are only a few! Yoga asana (or poses) have the ability to relax the mind and body. The flow of yoga and several asanas are excellent ways to target the sartorius muscle specifically. The following YOGA poses allow the relaxation and stretching of the Sartorius
We know that the sartorius acts to flex and laterally rotate the hip as well as flex the knee. Many postures that require a cross-legged position activate the sartorius. Like the lotus pose (Padmasana), butterfly pose (Baddha Konasana), and cow face pose (Gomukhasana).
However, to relax and stretch an overactive sartorius, one may also try the following YOGA poses:
Reclining Hero Pose (Supta Virasana),Half Reclining Hero Pose (Ardha Supta Virasana), Warrior I (with a straight back leg), Bow Pose (Dhanurasana), Camel Pose (Ustrasana), Firefly Pose (Tittibhasana), High Lunge, Low Lunge (Anjaneyasana), One-Legged King Pigeon Pose (Eka Pada Rajakapotasana). Many of these poses stretch the whole of the hip flexors and the muscles surrounding the knee. General static and dynamic stretches can also assist with an overactive sartorius and the discomfort associated with it. However, yoga generally moves at a slower pace and the asanas force the practitioner to sink deeper into the postures. The result is a better, more effective stretch.(2)
Other Alternative Therapy that has been known to give excellent results is described in the TCM literature which is in the article: To observe the clinical effect of bloodletting-cupping for pes anserinus myotenositis.
Methods
A total of 169 patients of pes anserinus myotenositis were collected. The tapping or bloodletting with plum-blossom needle or the syringe needle was adopted at the local Ashi points to induce bleeding and the cupping was followed. The cup was retained for 10–15 min. The treatment was given once a week and continued till the clinical symptoms disappeared or the patients were unwilling to continue the treatment. The maximal treatment was 10 times. Before and after treatment, the score of visual analogue scale (VAS) and Lysholm knee score, as well as the clinical effects were observed of the patients.
Results
Of 169 cases, 137 cases were cured, 20 cases improved and 12 cases failed. The effective rate was 92.89%. Of the 137 cured cases, 10 cases were cured after 1 time of treatment, 5 cases were cured after 10 times of treatment and the rest 122 cases were cured between 2 and 9 times of treatment. VAS score was reduced to be (1.10 ± 0.32) after treatment from (4.35 ± 0.60) before treatment and Lysholm score was increased to be (92.74 ± 5.04) from (65.42 ± 6.38).
Conclusion
The bloodletting-cupping alleviates knee pain, or even cure it completely and improves the motor function of knee joints in the 169 patients of pes anserinus myotenositis. The clinical effect is satisfactory.(3)
BIBLIOGRAPHY
1) https://www.frischortho.com/blog/what-is-pes-anserine-tendonitis-20797.html
2) https://www.issaonline.com/blog/post/hip-and-knee-pain-use-yoga-for-your-sartorius-muscle.
3) Shaoren CAI, Yong JIN, Wanyu ZHANG, Zhongtang LIAO, Bloodletting-cupping for 169 cases of pes anserinus myotenositis, World Journal of Acupuncture – Moxibustion, Volume 29, Issue 3, 2019,,Pages 231-234, ISSN 1003-5257,https://doi.org/10.1016/j.wjam.2019.08.001.
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