Author Topic: pes anserine bursitis  (Read 14734 times)

Le Barbu

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pes anserine bursitis
« on: February 23, 2016, 08:57:04 AM »
I got a chronic pes anserine bursitis (left knee) since 18 months now. It appeared over 2-3 days while biking short distances (10 miles) in cold temperature (5C is not that cold but still).

I'm otherwise in good health and really wish to get rid of it. I'm 43 years old, 5'11" - 184lb

I used to bike +/-1,000 miles a year (50% cross country MTB, 50% comuting) but now it's nearly impossible (pain and swelling after 10 minutes)

I tried about everything to get it healed: rest, ice, elevation, physiotherapy, avoid repetitive movement, heat, strengthtening of surounding, stretching, NSAIDs (ibuprofen, naproxen, voltarin) etc, etc, etc.

I even got corticosteroid injections (1 last november and a second 4 weeks ago). On the last injection session, they tried to remove some of the content with a 18GA needle but only got 0.5ml (probably 20-25% of the total) since it was very thick (but otherwise normal for synovial liquid)

Over this 18 months period, I had 4 ultrasounds and the results showed that the structure is regular, clean and clear. The mesurements are 30mmx20mmx10mm (almond shape ans size) and remains consitent.

Last fall, I took a 3 months COMPLETE rest. I was just doing the bare minimum to get my things done. No walks for fun, no training of any kind. No differences!

On the positive side, I can actually squat 300lb with proper form (below parallel etc) no problemo (no pain, no swelling). It doesn't seem to make thing better or worse.

What does increase pain/swelling: bike, ice skating, walk on irregular ground, cold temperature, kneeling. I therefore try to avoid this as much as I can.

Is anyone here know how I could get this shit healed forever? I am tired no one think it's an real issue and decide to handle it seriously!


GuitarStv

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Re: pes anserine bursitis
« Reply #1 on: February 23, 2016, 09:34:42 AM »
How often are you stretching each week?
Do you mash the pedals hard, or are you spinning in an easy gear all the time?
Are you using clipless pedals/cleats, or does the pain come from cycling with platforms?
Do you naturally overpronate?
Have you had your saddle height properly set?

TXScout2

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Re: pes anserine bursitis
« Reply #2 on: February 23, 2016, 09:46:30 AM »
Can you describe the exercise/stretching routine that you have tried in the past to address the issue? 

GuitarStv

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Re: pes anserine bursitis
« Reply #3 on: February 23, 2016, 09:55:01 AM »
I'm also wondering if the cold weather could be contributing to it.  What were you wearing over your knees while cycling in the cold ?

Le Barbu

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Re: pes anserine bursitis
« Reply #4 on: February 23, 2016, 09:59:35 AM »
How often are you stretching each week? when I began physio, I was recomanded to stretch 2x/day (10x 45 seconds stretch-15 seconds off) but saw zero benefit  and quit after 2 months
Do you mash the pedals hard, or are you spinning in an easy gear all the time? I use to spin a bit faster than average but I wouldn't say "easy"
Are you using clipless pedals/cleats, or does the pain come from cycling with platforms? both, I use clips when MTB and clipless otherwise
Do you naturally overpronate? I am more a natural supinator
Have you had your saddle height properly set? no. but I tested about every height after the problem appeared and nothing help

Le Barbu

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Re: pes anserine bursitis
« Reply #5 on: February 23, 2016, 10:04:45 AM »
Can you describe the exercise/stretching routine that you have tried in the past to address the issue?

When I began physio, I was recomanded to stretch 2x/day (10x 45 seconds stretch-15 seconds off)

Position was laying on my back, near a door frame, left leg 90 degres from my body  left foot pointing a bit toward center and rigth leg straight on the floor.

I was also doing eccentric excercises with an elastic band for 5 minutes 1x/day and hip thrusts


Le Barbu

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Re: pes anserine bursitis
« Reply #6 on: February 23, 2016, 10:08:35 AM »
I'm also wondering if the cold weather could be contributing to it.  What were you wearing over your knees while cycling in the cold ?

When it did happen, I had nothing over my knees as I usually do in late september mornings. I only use to wear longer pants when temperature drops below freezing point or when winds are terrible.

TXScout2

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Re: pes anserine bursitis
« Reply #7 on: February 23, 2016, 10:32:52 AM »
Which eccentric exercises?

Le Barbu

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Re: pes anserine bursitis
« Reply #8 on: February 23, 2016, 11:22:11 AM »
Which eccentric exercises?

standing up, used an elastic band, stretched with my "good leg" and released slowly with "injured" one, knee straight (not bent) ROM of about 12 inches forward. do it for 5 minutes (about 40 reps) and over weeks, increased the elastic band tension (double it or use a stronger one).

the purpose was to work the semitendinous muscle/tendon eccentrically ONLY (no concentric) to help recovery of the tendinonis I was develloping because of the pes anserine inflamation. physiotherapist says concentric exercises can maintain tendinosis

TXScout2

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Re: pes anserine bursitis
« Reply #9 on: February 23, 2016, 01:36:39 PM »
Did you experience semitendinosus tendinosis symptoms separate from the pes anserine bursitis?  Or did it all just feel like pain in the same place to you?

I think you could probably design a more effective exercise and stretching routine than the one you described.  It's a pain to do rehab right because it can take 30+ minutes a day, everyday  It sounds like you were passively stretching sartorius, concentrically working glutes, and eccentrically working semitendinosus and gracilis.  It sort of hits a few parts of the hip/knee, but I don't think it would address all the issues.  Overall I would want to add exercises that strengthen while increasing the active range of motion in all of flexion, extension, adduction, and abduction. 

You could keep doing what you were doing, although I am not that big of a fan of the passive sartorius stretch.  I would rather work lunge variations keeping the glute activated (this is active work for hip flexors) I would work romanian deadlifts from the straddle position, just with bodyweight, start with sets of 20 pulses near the bottom of the ROM (this is active work for hip extensors and adductors)  If the concentric irritates it then you can use a chair or something to help you in that part of the range.  I would also add clamshell exercises (active hip abduction) to supplement the hip thrusters (active extension), to work glute medius.   Also add seated 90:90 stretch transitioning from one side to the other while keeping the feet down (active adduction and abduction).   Maybe start with 2 minutes RDL, 2 minutes lunge (each leg), 2 minutes hip thrusters, 2 minutes clamshells, 2 minutes 90:90.   

Le Barbu

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Re: pes anserine bursitis
« Reply #10 on: February 23, 2016, 04:08:31 PM »
@TXScout2

I do not feel any tendinosis symptom myself but the physiotherapist told me both conditions are associated and he found signs of a mild one near the tibia attachement.

I neither feel any tightness in the area. My overall strength is danm good, especialy in the mid-lower body.

I will take time to figure out the exercises you listed and give you a follow up

Thank you for stopping by!

TXScout2

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Re: pes anserine bursitis
« Reply #11 on: February 24, 2016, 12:39:20 PM »
Just keep in mind that 3 tendons attach to the pes anserine area, from muscles that perform abduction, adduction, hip flexion, and knee flexion.  If just one of those is either a little tight from having a short active range of motion, or even if an antagonist muscle is too weak, it could be throwing something off.  So you may have to throw the kitchen sink at it, really work the hip from every angle, increasing strength.  But when I say strength I am referring to nervous system's ability and willingness to actively move a muscle into a particular range of motion.  So you may be strong like squat 300 lbs strong, but are you strong like can sit flat on your butt with straight legs and actively lift your feet off the ground and push them into a straddle? 

Le Barbu

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Re: pes anserine bursitis
« Reply #12 on: March 03, 2016, 03:41:12 PM »
Latelly, I had periformis tightness and when it was released, I saw a bit of improvement in my pes anserine bursitis. I hope it's gonna help and continue to perform stretching and strength training.

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Re: pes anserine bursitis
« Reply #13 on: March 03, 2016, 11:03:15 PM »
If your piriformis was tight you may have either back or hip weakness. How is your ability to stand on one leg? Compare side to side and see if you notice a difference. Try again with your eyes closed. Id be curious to have a look at your squat because if you are doing a lot of biking you may also have weaker gluts and are quite quad dominant. Im just making some guesses as I can't really formally assess. Consider looking into medial plica syndrome as well. Usually people with any kind of bursitis find any movement quite irritating including things like squats. People with medial plica irritation are fine with short bursts of activity but get killed with running or cycling.

Just some thoughts from another friendly physiotherapist :)
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2684145/

TXScout2

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Re: pes anserine bursitis
« Reply #14 on: March 07, 2016, 10:37:24 AM »
Just remember if the piriformis is tight, and gets released, but your activities/movement/stretching stay the same, the piriformis will just get tight again.

Le Barbu

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Re: pes anserine bursitis
« Reply #15 on: March 07, 2016, 11:30:33 AM »
Thank you for the insight. The periformis tightness come from a to intense squat session mid-january. At this moment, my pes anserine bursitis was improving big time. Then, overnight it came back again. Now, I am improving my squat form* with ligth weights and everything is under control.

*at the bottom of the squat, my hip was shifting forward a bit

southern granny

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Re: pes anserine bursitis
« Reply #16 on: March 09, 2016, 03:58:36 PM »
I went through a period of joint inflammation that was very painful.  Eventually, i found out that tart cherry juice (100%), not cherry flavored apple juice, helped a great deal.  I had a small juice glass each morning and then another before bed.  It was like a miracle.  If you try it and don't see improvement within one week, then it probably won't work for you.  I woke up on day 4 and found relief.  Good luck to you

Le Barbu

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Re: pes anserine bursitis
« Reply #17 on: March 15, 2016, 08:04:30 AM »
Got the pes anserine bursea completely drained and injected with a corticosteroid yesterday. Very confident about the result, I'll keep you updated!

Le Barbu

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Re: pes anserine bursitis
« Reply #18 on: April 21, 2016, 08:27:40 AM »
Update,

I did not get much relief from the cortisone injection, even if the bursae was completly drained (about 3ml) for the first time.

What I discovered lately is that I was always feeling better the day after I did my squats. Even more when I squat a lot (volume day mean 5 sets x 5 reps @ 75% 1RM)

So, I began to squat for 3 sets x 15 reps @ 40% 1RM twice a day with the best form I can, deep and slow. The only place were I feel tightness/soreness is located in my left inner thigh (same left side than my pes anserine bursitis is located) near the ischial tuberosity. Wich lead me to think the semitendinosus muscle is strained, tight on the upper end wich cause bursitis on the other end (knee)! On top of that, I do my best to release the thightness with trigger points using my hands and a tennis ball few times a day.

All this make me think I had this soreness when I did jobs like flooring (tiles or hardwood) wich need many repetitive movements (kneeling, stand up, kneeling, stand up) over the same day. If it's the same bitch, then I'll make this my bitch!

Today, the inflamation of the bursae is reduced by more than 50% (my palpation estimate) and I will have a echography tomorrow that will tell me more accurate informations.


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Re: pes anserine bursitis
« Reply #19 on: April 21, 2016, 03:49:37 PM »
...twice a day with the best form I can, deep and slow. The only place were I feel tightness/soreness is located in my left inner thigh...

This doesn't sound a lot like stretching exercises to me :/

Le Barbu

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Re: pes anserine bursitis
« Reply #20 on: April 21, 2016, 05:47:44 PM »
...twice a day with the best form I can, deep and slow. The only place were I feel tightness/soreness is located in my left inner thigh...

This doesn't sound a lot like stretching exercises to me :/

I tried every kind of hamstrings stretching exercises you can think about and nothing gave me results I can feel. What should I do then?

bassman2003

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Re: pes anserine bursitis
« Reply #21 on: April 21, 2016, 06:36:41 PM »
Sounds likely to be more of a neuro-muscular imbalance issue than anything else to me.  Your best bet is to find a great physical therapist to fix the problem.  And if you go to PT, and they have you do static hamstring stretches, just leave.  Seriously, leave.  If you are in the US, your best bet is to start with someone with their OCS.  This is someone that specializes in ortho injuries.  Less than 10% of PTs are board certified, and less than 5% have their OCS.  From there call the clinic and ask the clinician if they are FMS/SFMA (Selective Functional Movement Assessment) trained.  If an OCS/SFMA clinician can't pinpoint your problem, I'd be highly surprised.  Sounds your first PT wasn't that great.  Make sure you tell your therapist what you tried in the past that didn't work.

If you're outside the US, not sure what to tell you :). Graston or dry needling trained would be a plus but not as crucial as the OCS/SFMA.

Here's the link to the APTA directory of OCS clinicians
http://aptaapps.apta.org/DirectoryofCertifiedSpecialists/default.aspx

Just to let you know I'm hopefully no schmuck (and to put my bias out there), I'm an OCS physical therapist who is SFMA trained.  I treat ortho full time, and am adjunct faculty at a university for both the PT and residency programs.

Le Barbu

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Re: pes anserine bursitis
« Reply #22 on: April 21, 2016, 07:34:55 PM »
Sounds likely to be more of a neuro-muscular imbalance issue than anything else to me.  Your best bet is to find a great physical therapist to fix the problem.  And if you go to PT, and they have you do static hamstring stretches, just leave.  Seriously, leave.  If you are in the US, your best bet is to start with someone with their OCS.  This is someone that specializes in ortho injuries.  Less than 10% of PTs are board certified, and less than 5% have their OCS.  From there call the clinic and ask the clinician if they are FMS/SFMA (Selective Functional Movement Assessment) trained.  If an OCS/SFMA clinician can't pinpoint your problem, I'd be highly surprised.  Sounds your first PT wasn't that great.  Make sure you tell your therapist what you tried in the past that didn't work.

If you're outside the US, not sure what to tell you :). Graston or dry needling trained would be a plus but not as crucial as the OCS/SFMA.

Here's the link to the APTA directory of OCS clinicians
http://aptaapps.apta.org/DirectoryofCertifiedSpecialists/default.aspx

Just to let you know I'm hopefully no schmuck (and to put my bias out there), I'm an OCS physical therapist who is SFMA trained.  I treat ortho full time, and am adjunct faculty at a university for both the PT and residency programs.

Thank you bassman2003, I am in Canada and will try to find a good physical therapist. Now, what do you mean by neuro-muscular imbalance? Is there something I can do to help myself meanwhile?

bassman2003

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Re: pes anserine bursitis
« Reply #23 on: April 21, 2016, 08:38:38 PM »
Neuromuscular imbalance is a situation in the body in which certain muscles become inhibited and don't perform well during functional movements.  The muscle in question may become weak (in relation to other muscles) or simply not be activated well by your nervous system (more common).  When certain muscles do not function well, other muscles may try to compensate. 

In both cases of muscles being either inhibited or firing in compensatory patterns, these muscles may carry a high amount of 'tone' in them for a lack of a better word.  This 'tone' is sometimes interpreted by novice clinicians as tightness, and these patients are given static stretches, which doesn't do a damn thing and sometimes makes the patient worse.  Static stretches (holds of 15 seconds or greater) have been shown to actually decrease the muscles ability to fire.  Professional athletes never static stretch before an activity, they always perform dynamic "stretching' movements.  I rarely tell an athletic individual in mild to medium amounts of pain to perform static stretches as a part of their rehabilitation program.

I sometimes use a 'party trick' (not really a trick) with my 2nd year grad students to teach them how much the neural system plays a role in the facilitation and inhibition of muscles.  I take a student who believes they have 'tight' hamstrings, and perform neural glides to facilitate good neural input to the muscle and help with any sciatic nerve mobility issues.  Usually they gain about 15-20 degrees of movement during a straight leg raise test with about 30 seconds of treatment.

When you say you have good strength in your legs, pain can still commonly occur because the force couples applied to the joints during functional movements are not symmetrical or appropriately proportional.  So your legs are strong but the muscles aren't firing in the right patterns, which merely exacerbates and feeds into your sx.  IMO, the most commonly inhibited muscle in the lower extremity is typically the gluteus medius.  I would start with some good, closed chain, gluteus medius strengthening in order to facilitate that muscle, and see if you feel if that helps.  But ultimately you need a good clinician to diagnose your problem and figure out exactly which muscles are inhibited during your activities, if that is the problem.

Sorry for the long reply, get pretty geeked about this sort of stuff ;)

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Re: pes anserine bursitis
« Reply #24 on: April 22, 2016, 09:22:09 AM »
Sounds likely to be more of a neuro-muscular imbalance issue than anything else to me.  Your best bet is to find a great physical therapist to fix the problem.  And if you go to PT, and they have you do static hamstring stretches, just leave.  Seriously, leave.
[ . . . ]

I laughed at this one.  I had some knee issues that the PT diagnosed as being caused by imbalances and tight hamstrings.  The basis of my treatment plan was was to lay on my back with my legs going up a wall for 30-60 seconds at a time.

I am going to check out your link.  Thanks.

Le Barbu

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Re: pes anserine bursitis
« Reply #25 on: April 22, 2016, 10:33:36 AM »
Neuromuscular imbalance is a situation in the body in which certain muscles become inhibited and don't perform well during functional movements.  The muscle in question may become weak (in relation to other muscles) or simply not be activated well by your nervous system (more common).  When certain muscles do not function well, other muscles may try to compensate. 

In both cases of muscles being either inhibited or firing in compensatory patterns, these muscles may carry a high amount of 'tone' in them for a lack of a better word.  This 'tone' is sometimes interpreted by novice clinicians as tightness, and these patients are given static stretches, which doesn't do a damn thing and sometimes makes the patient worse.  Static stretches (holds of 15 seconds or greater) have been shown to actually decrease the muscles ability to fire.  Professional athletes never static stretch before an activity, they always perform dynamic "stretching' movements.  I rarely tell an athletic individual in mild to medium amounts of pain to perform static stretches as a part of their rehabilitation program.

I sometimes use a 'party trick' (not really a trick) with my 2nd year grad students to teach them how much the neural system plays a role in the facilitation and inhibition of muscles.  I take a student who believes they have 'tight' hamstrings, and perform neural glides to facilitate good neural input to the muscle and help with any sciatic nerve mobility issues.  Usually they gain about 15-20 degrees of movement during a straight leg raise test with about 30 seconds of treatment.

When you say you have good strength in your legs, pain can still commonly occur because the force couples applied to the joints during functional movements are not symmetrical or appropriately proportional.  So your legs are strong but the muscles aren't firing in the right patterns, which merely exacerbates and feeds into your sx.  IMO, the most commonly inhibited muscle in the lower extremity is typically the gluteus medius.  I would start with some good, closed chain, gluteus medius strengthening in order to facilitate that muscle, and see if you feel if that helps.  But ultimately you need a good clinician to diagnose your problem and figure out exactly which muscles are inhibited during your activities, if that is the problem.

Sorry for the long reply, get pretty geeked about this sort of stuff ;)

Thank you bassman2003 for the imputs. I really think you are pointing out the weakest link of my kynetic chain!!

1-Is it possible to perform neural glide by myself for this area? (sitting on a table, hands behind my mack, head bent forward, eyes closed, lift my foot and move ankle, repeat)

2-Do you consider single leg squat (on unstable surface like floor mat) a good closed chain excercise for gluteus medius?

I got an apointment this afternoon for another echography, I'll let you know about the results

bassman2003

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Re: pes anserine bursitis
« Reply #26 on: April 23, 2016, 08:29:25 PM »


Thank you bassman2003 for the imputs. I really think you are pointing out the weakest link of my kynetic chain!!

1-Is it possible to perform neural glide by myself for this area? (sitting on a table, hands behind my mack, head bent forward, eyes closed, lift my foot and move ankle, repeat)

2-Do you consider single leg squat (on unstable surface like floor mat) a good closed chain excercise for gluteus medius?

I got an apointment this afternoon for another echography, I'll let you know about the results

I don't want to get specific for your case, because it wouldn't be appropriate for me to give medical advice out over the internet ;).  Just to comment on your two questions though, the technique you mentioned in #1 is more a neural tensioning activity.  IMO, the evidence states that a true glide/flossing technique is usually more effective than a tensioning technique.  But without an examination, it would be impossible to determine if neural mobility was one of your deficiencies.  And single leg squats are great for glut med strengthening, but most people can't start performing those without compensation (even without an unstable surface).  A typical progression I would take many clients through would be bridges/clamshells, then monster walks, then single leg squats.  They would have to be able to perform the lower level exercises without compensation or pain, before progressing.

Disclaimer: Please don't take any of this as medical advice that could be specifically geared towards you.  I can only speak in generalities.

Best of luck.


bassman2003

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Re: pes anserine bursitis
« Reply #27 on: April 24, 2016, 12:15:18 PM »
Canadian RMT checking in, what's a monster walk? Just in case it is the one thing that will revolutionize my clients' homecare.

Le barbu, what province are you in?

Lateral sidestepping (or forward/diagonal stepping) with resistance band around the ankles, being careful to avoid mild valgus collapse. 

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Re: pes anserine bursitis
« Reply #28 on: April 25, 2016, 07:39:55 AM »
Thank you!

TXScout2

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Re: pes anserine bursitis
« Reply #29 on: April 25, 2016, 02:01:02 PM »
Just seeing this.  I am trying to follow what happened...it seems like you are saying your symptoms did NOT subside after having the bursa drained, but after that you have begun doing high rep low weight squats and have felt better?  If the low intensity work is helping then I would keep it up, but are you also still squatting heavy?  Or did you replace the heavy squats with light squats?  It would be useful to see what your squats look like. 

I agree with most of what Bassman said.  I'm sure a clinician could help.  I think if you embark on a lower body strength/mobility program your symptoms could subside without ever having a specific muscle diagnosed as being neurally deficient though.   I agree with the clamshells > banded monster walk > single leg squat progression.  You could also work in some frog pumps.  However I think its worthwhile to hit the other exercises too, like the 90/90 movements for hip rotation and the straddle work for the adductor mobility/strengthening.  It can be time consuming but if you commit to it you should see the benefits. 

Le Barbu

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Re: pes anserine bursitis
« Reply #30 on: April 25, 2016, 07:51:39 PM »
Just seeing this.  I am trying to follow what happened...it seems like you are saying your symptoms did NOT subside after having the bursa drained, but after that you have begun doing high rep low weight squats and have felt better?  If the low intensity work is helping then I would keep it up, but are you also still squatting heavy?  Or did you replace the heavy squats with light squats?  It would be useful to see what your squats look like. 

I agree with most of what Bassman said.  I'm sure a clinician could help.  I think if you embark on a lower body strength/mobility program your symptoms could subside without ever having a specific muscle diagnosed as being neurally deficient though.   I agree with the clamshells > banded monster walk > single leg squat progression.  You could also work in some frog pumps.  However I think its worthwhile to hit the other exercises too, like the 90/90 movements for hip rotation and the straddle work for the adductor mobility/strengthening.  It can be time consuming but if you commit to it you should see the benefits.

I just discovered, once I was reseting my squat weigth to get them quite below parallel, that I felt better, especially within 24 hours. The thing is I can't squat heavy every day but with low weigth high reps, its not a problem. I remembered once I sent through a bicep tendinosis with that kind of pattern.

Now, I tried clamshells, monster-walk and bridge. I'll keep you updated and maybe post my squat form.

Le Barbu

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Re: pes anserine bursitis
« Reply #31 on: April 28, 2016, 08:57:37 AM »
Update: I am on day #10 since I began to get better and better every day!

You (TXScout2 and bassman2003) convinced me it was probably a mobility/strength-imbalance case than anything else.

What I do NOW in the morning is: 10 clamshells, 2 minutes Monster-walk, 2 sets x 10 reps deep and slow squats @ 110lb (5RM 290lb)

During the day: few sets of "air squats", 1 leg stand (shifting the hips up & down)

At night:  10 clamshells, 2 minutes Monster-walk, 3 sets x 10 reps deep and slow squats @ 110lb or heavy squats (depends on my training schedual), rolling a tennis ball on my but (periformis area) and about any kind of mild stretching (nothing special, just moving mid-lower body randomly on a yoga mat while watching tv at nigth instead of sitting on the couch)

I still "feel something" in the left gluteus-medius area and in the upper part of left semitendinosus. This is feeling could be described as "weakness" or "fatigue"

Bursitis doesnt bother me anymore but I can still feel a little swelling (probably 30% of what it has been at the worst?)

I will keep doing this routine (maybe adjust?) until I succeed and keep you updated

Thanks!

Le Barbu

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Re: pes anserine bursitis
« Reply #32 on: June 23, 2016, 08:23:10 AM »
Update: I have been injected with cortisone exactly 2 months ago with no succes. I have drained my bursae by myself with Vacutainer tubes and 18GA needles for about 10 days in row (from may 12th to may 22nd) for a total of about 10ml of "normal" synovial fluid (1ml drained on average every day). Then, I used heat+cold therapy every nigth for a month. Today, I feel better than anytime in the last 20 months! If the progress keep the same pace, I should be totally ok in about 10 days. I got to remind myself to be very carefull when I begin to bike again! 

Le Barbu

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Re: pes anserine bursitis
« Reply #33 on: December 02, 2016, 08:14:22 AM »
TXScout and bassman2003,

Just to keep you updated, my pes anserine bursitis journey as ended. The origine of the problem was just a bit of tigthness of the semitendinosus. Not even a tendinosis or anything complicated. The belly of the muscle has to be stretched and massaged a bit AFTER intense workout or exercises (squat, deadlift, bike, etc). Now, it's over and I just stay aware about it to come back again.

Thank you for following and support through this issue!