Why is my Medial Collateral Ligament Strain Not Getting Better? Because It Is Pes Anserinus Tendinitis

When long-distance runners complain about knee pains, it is often complaints about pain in the front of their inner knee, and below the knee cap. Pain comes about especially when climbing uphill or upstairs. This pain sometimes misdiagnosed as a medial collateral ligament (MCL) strain given the location. However, it is actually Pes Anserinus Tendinitis.

What is Pes Anserinus Tendinitis?

It is an inflammation of the tendons between your shinbone as well as muscles that form parts of your hamstring and thigh. Three tendons (Semitendinosus, Sartorius¹ and Gracilis) join up to form the pes anserinus tendon. Pes anserinus in latin means ‘goose feet’; roughly describing the webbed look of the three tendons coming together. The pain felt at the area where the pes anserinus tendon joins to the shin bone.

It oftens misdiagnosed as MCL or medial-meniscus strain. This is because of the close location of the pes anserinus tendon to the MCL and medial meniscus.

What Strains The Tendon?

Things that strain the pes anserinus tendon are

1. Severe pronation of the feet – this causes the tibia (one of the lower leg bones) to rotate inwards which strains the tendons
2. Weak hamstring muscles – when combined with an intense running programme, the hamstrings may not be able to cope with the high workload. This is often an overlooked area in a runner’s strength training regime.
3. Tight thigh muscles (quadriceps) – weakens the opposing hamstring muscle. Muscles tightness here, further encouraged. This is especially if you have a deskbound job that requires you to sit at your desk all day long.
4. A sudden change in the volume and intensity of training

Diagnosing Pes Anserinus Tendinitis

Patients typically complain about pain climbing stairs, squatting, running and in severe cases, standing from a seated position.The pain would also appear gradually and for runners, following an increase in their training volume and intensity (uphill, or running faster).

However, even if your symptoms match those listed above, it is advisable to ensure that it is not other possible condition such as Patellar-Femoral Pain (PFP), MCL strain and medial-menicus strain

Treating Pes Anserinus

During the initial inflamed painful stage, your doctor may prescribe NSAIDs to help reduce the swelling and inflammation and recommend rest for the first 24-48 hours. Ice or cyrotherapy can help speed up the recovery by reducing the inflammation.

Once less painful, your therapist may suggest the following treatment depending on your cause of the tendinitis as list above.

1. For severe foot pronation – orthotics can help correct over pronation of your foot
2. To strengthen the weak hamstrings – see Hamstring Exercises for Long Distance Runners
3. Release tight thigh muscles with sports massage and a stretching programme.
4. A training programme that appropriately increases your training volume and intensity.

Experiencing knee pain? Find out more about physiotherapy for knee pain relief and how our physiotherapist at Core Concepts can help resolve your pain.

¹ Ed note. The Sartorius is the longest muscle in the human body