Physical Therapy For Knee Bursitis | What To Expect From Your Physiotherapist

Physicial Therapist and a patient with knee bursitis

The truth is that most cases of knee bursitis resolve on their own. But, physical therapy for knee bursitis can help you heal faster. Not to mention, avoid recurring episodes.

We, physical therapists, combine passive and active treatments. This helps you recover from your knee bursitis as fast as possible.

We also teach you how to:

  • Treat your knee bursitis at home.
  • Adapt your current lifestyle to aid your recovery.
  • Reduce your risk of future episodes.

So, without further ado, here’s…

How physical therapists treat knee bursitis

When medical professionals talk about conservative treatment, they generally refer to physical therapy.

The treatment itself will depend on several factors, like:

  • Your goals
  • Your preferences, and
  • The specific training of the therapists themselves

For example, some therapists are best working with athletes. But, others also specialize in treating metabolic or autoimmune conditions. So, you have options.

That said, all physical therapists share the same goals despite our different backgrounds. These include:

Reduce pain and swelling from the bursitis

Bursae are fluid-filled sacs that reduce friction between bones, tendons, and soft tissues. Bursitis happens when there’s excessive friction, leading to swelling of the bursa.

That initial inflammation is a natural response from the body. It allows cells and nutrients to gather around the injury to start the healing process.

But, this response also causes pain. This is normal – expected, even. The pain is also your body’s way of telling you to rest.

Now, we understand that pain can get in the way of your recovery.

This is especially true if it persists longer than it should.

This is where a physical therapist will come in handy.

We can provide short-term pain relief and help reduce excess fluid on your knee joint. We have many ways to do this, but the most common ones we use include the following:

  • Cold or heat therapy.
  • Electrotherapy.
  • Manual techniques.
  • Therapeutic exercise.
  • Apply compression with a compressive wrap.

By now you might be asking: Why only short-term relief?

Our profession allows us to work with your body; not against it. This means we won’t be able to stop inflammation, nor should we.

So, expect pain and inflammation at a lesser level to come back after your sessions. Again, this is normal as your body needs this to heal.

In any case, your physical therapist will also give you at-home remedies. These will help you manage your symptoms on your own.

This is crucial because the less pain and swelling you have, the more likely you are to…

Improve knee strength and flexibility

The faster you get to this part of your rehab, the sooner you can also get back on track. This is also where long-term pain relief starts.

During your sessions, your physical therapist will evaluate you about the following:

  • Your medical history.
  • How you move your body.
  • Your lifestyle (e.g. occupation, hobbies, frequent activities, etc.)

Your PT uses the info to design a treatment program tailored to your needs.

Keep in mind that the initial focus will be on pain-free movement.

So, these programs generally start with gentle stretching exercises to improve your flexibility. This also promotes healing of the affected area.

Expect your PT to constantly check your pain levels and alter any exercise that causes you pain.

This, together with your at-home care, will…

Speed up your recovery time

The best way to speed up your recovery is to follow the instructions of your physical therapist. It sounds biased, I know, but that’s the truth.

The reason I say this is because treating acute knee bursitis can be tricky. Sometimes it feels like you’re getting faster than expected. But, you still run the risk of making your symptoms worse.

Following your PT’s recommendations helps keep you on a straight line to recovery – no matter how tedious.

The mundane start also lays the foundation for the more challenging parts of the program. Ultimately, the entire process will…

Help you return to the activities you want/need to do but stopped due to knee bursitis

This phase focuses on strategies that safely reintroduce you to your job or hobbies. Individualized exercises and strategies are keys here.

For example, housemaids and runners are both prone to bursitis. But, their programs will be different because they also use their bodies differently.

To be even more specific:

A housemaid has a high risk of developing prepatellar bursitis.

This is because the nature of their job includes frequent kneeling. This, in turn, causes prepatellar bursitis (otherwise known as “housemaid’s knee”).

Their program will likely include:

  • Wearing knee pads.
  • Strengthening the lower leg muscles, focusing on the ones around the knee joint.
  • Therapeutic exercises before and/or after the job. This prepares the knee joint for the effort. Or, reduce the load on the affected bursa at the end of the day.

On the other hand…

A runner is prone to knee bursitis because of overuse.

Frequent movement of the knee is inherent to the sport. Thus, leading to overuse injuries, including bursitis.

That said, a program for runners will likely include correcting their techniques and imbalances. This will help reduce friction on the knee. Thus, preventing and healing injuries.

But, as you might have guessed, this final phase involves a bit of experimentation.

This is also why it’s best to go through it with a physical therapist. We’re trained to take most, if not all the guesswork out of the process.

Part of our mission here is to connect qualified physical therapists to you. So, if you need our help, we’re all in.

In any case, the biggest issue with bursitis is recurring episodes. To avoid them, your physical therapist will help you…

Reduce your risk for a future episode of knee bursitis

The key here is patient education. First, your PT will tell you what likely triggered your bursitis. And, second, give you the right tools to reduce your risk of reinjury.

Of course, these will vary from person to person since there are many factors that can lead to bursitis. Common causes include:

  • Prolonged or frequent kneeling.
  • A direct impact on the bursa.
  • Excessive friction due to overuse.

Also, some conditions make people prone to develop knee bursitis. Rheumatoid arthritis, gout, diabetes, and osteoarthritis are the most common. (1)

If you have any of these conditions, know that managing them will also help you avoid knee bursitis.

Knee bursitis exercises you can do at home

Straight-leg raises

This is a light strengthening exercise to work your thigh muscles. It can help prepatellar bursitis as it works the patellar tendon without much effort. To perform straight-leg raises:

  1. Lie on your back, with the affected knee straight. The other leg can be straight or bent, whatever is most comfortable for you.
  2. Raise the affected leg, keeping it straight.
  3. Slowly, lower the leg back to the surface.

Seated hamstring stretch

This stretching exercise can reduce stress in the knee joint. To perform it:

  1. Sit at the edge of a chair.
  2. Put the affected leg straight in front of you. Bend the other, with the foot flat on the ground.
  3. Keep the affected leg straight while you bend forward.
  4. You’ll feel a gentle stretch on the backside of your thigh.
  5. Hold it for 20-30 seconds. Then, go back to the starting position.

Calf stretch

This exercise targets the calf muscles, which can affect knee flexibility. To perform a calf stretch:

  1. Sit at the edge of a chair, with the affected leg straight in front of you.
  2. Place a stretching strap or a belt on the ball of your foot, securing it with your hands.
  3. Pull your toes towards your shin until you feel a gentle stretch on the calf area.
  4. Hold it for 20-30 seconds. Then, go back to the starting position.

3 tips to exercise with knee bursitis

1. Don’t push through the pain

Remember that pain is a signal from your body that you could use some rest. Pushing through it can worsen your knee bursitis.

2. Rest before you feel like you need to

Causes of knee bursitis include repetitive motions and friction. You may not notice the swelling at the moment, so it’s best to pause and rest before it appears.

3. Avoid movements that worsen your knee pain

You’ll be able to do them again once you’re fully recovered!

What if physical therapy is not enough?

Infected and recurrent bursitis may need other treatments apart from physical therapy. Bursitis treatment may also include:

Antibiotic treatment

Infected bursitis requires antibiotics. Here, the inflammation comes from your immune system fighting off harmful bacteria.

You’ll need antibiotics to reduce swelling from septic bursitis.

Injecting a corticosteroid drug

This is an option for people that don’t feel relief after taking pain medications. Yet, it can increase the risk of having septic bursitis – the syringe can introduce bacteria.

Also, some research suggests it may provide the same results as physical therapy, but with more side effects. (2)

Surgery

Bursitis is rarely treated with surgery. But, people with an infected bursa that doesn’t respond to antibiotics may need a surgical procedure. (1)

People with severe cases of repetitive bursitis may need it as well. Orthopaedic surgeons usually remove the affected bursa altogether.

The post-surgical period also includes some physical therapy too.

How do I know if I have knee bursitis?

You’ll probably have a swollen, painful lump on the location of the bursa.

For prepatellar bursitis – the most common type of knee bursitis-, the lump is right on top of the kneecap. (1, 3)

The knee looks like it has a balloon on top of it. It may cause knee pain and swelling. If it’s infected, it can also be warm to the touch.

You can also know whether you have knee bursitis or not, depending on what happened before it got swollen.

If your job involves frequent kneeling on hard surfaces and/or for long periods, you may have bursitis. The prolonged pressure may cause inflammation on the bursa.

A direct blow on the bursa can also cause bursitis.

FAQs:

Is walking good for knee bursitis?

Yes, if walking doesn’t worsen your pain levels. Your physical therapist may recommend walking as part of your treatment.

However, if walking makes your pain worse, rest. Pain is your body’s way of telling you that your knee isn’t prepared for that effort yet. Once you feel better, try walking a shorter distance to check how you feel.

What is the best exercise for knee bursitis?

The one that can improve strength and flexibility without making your knee bursitis worse. Also, the one that gets you closer to the activities you need/want to do.

Your physical therapist will know which one is the best exercise for YOUR knee bursitis.

How can I heal bursitis in my knee fast?

By resting and following the recommendations of your physical therapist.

Avoid the activities that worsen your pain, take the prescribed medications, and respect the timelines. Don’t go back to movement activities unless you’re cleared by your therapist. It can cause a setback.

Conclusion: How can a physical therapist help my knee bursitis?

By giving you individualized strategies to get back to your life before the knee bursitis episode. We can help you recover as fast and safely as possible.

We can also save you the hassle of recurrent bursitis!

Resources

  1. Lohr, Kristine. “Bursitis: Practice essentials.” [Updated 2020 Dec 11]. Medscape. Available from: https://emedicine.medscape.com/article/2145588-overview
  2. Sarifakioglu Banu, Ikbali Sevgi et al. “Comparison of the efficacy of physical therapy and corticosteroid injection in the treatment of pes anserine tendino-bursitis.” Journal of physical therapy science vol. 28,7 (2016): 1993-7. doi:10.1589/jpts.28.1993
  3. Rishor-Olney Colton R, Pozun A. “Prepatellar Bursitis.” [Updated 2021 Feb 22]. StatPearls. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557508/