Knee Bursitis Information

What is Knee Bursitis? What Causes it?

There are a Lot of Bursae in your Knee!

Knee Bursitis is a term that is used to describe a build up of fluid in a small sac of the knee called a bursa. Typically, people notice pain and a lump in their knee. For some people, the lump isn't noticeable, just the pain. Others notice more lump and little pain. Both situations are Knee Bursitis.

Sometimes you will hear the word "popliteal" when talking about knee bursitis. "Popliteal" is just a medical term that generally refers to that empty space at the back of your knee - it's not an important term. The popliteal has a bursa called the 'Semimembranous'. When the semimebranous bursa swells we typically call it a Baker's Cyst.

Medically, your knee cap is referred to as the 'patella'. The patella has 3 bursae associated with it, the Suprapatellar, the Prepatellar, and the Infrapatellar bursa. They are at the top, middle and bottom of your knee cap respectively.

There are more of them. The is also the Pes Anserine, the pretibial, the deep infrapatellar, two different gastrocnemius ones, fibular ones, and the list goes on. Some people even have bursae that other people don't! The thing to know is that there are a lot of bursae in the knee.

We haven't labeled them all in the pictures shown, because the exact name and location isn't that important. What is important is that you realize that the knee is very complex. From person to person, the size and location of a bursa can vary, so everyone's situation is always unique.

What is a Bursa, and What Does the Bursa Do?

A Bursa is a very important element of your knee health. The surface is both incredibly tough and incredibly slippery. Your body grows them between the parts of your knee that would rub on each other when you move. Your bones are tied in place to connecting bones in your body with ropes in your body called ligaments. Your muscles are tied to your bones with ropes called tendons. Where two bones might rub on each other during motion, your body pads the ends of the ones with padding called cartilage.

As your knee bends, the skin and fat and muscle and bones and tendons move too. In areas where they would rub against each other and wear each other down, your body often grows a bursa that acts like a water balloon between the parts. As you move, the parts slide easily over the slippery surface of the bursa. As your parts push and squeeze against each other the bursa squishes and pads the parts so they don't get injured.

The fluid inside every bursa is called 'synovial fluid'. Synovial fluid has many roles too. First, it is the cushion in the water balloon. Second it is a lubricant, like oil, that helps your body tissues be more slippery against each other. Third, Synovial Fluid also takes the place of blood in a lot of your joints.

A lot of the spots in your joints are too harsh of an environment for the delicate tissue that makes up your blood flow system. But where things are harsh, those cells still need nutrition and cleaning and oxygen and the things that blood supplies to the rest of your body. So, in the toughest environments, the blood exchanges all this stuff with the synovial fluid in the bursa for transport to rest of your knee. The synovial fluid is the lifeblood of your inner knee.

What is Bursitis and What Causes it?

When you have bursitis, it is because one of your bursae is getting over filled with synovial fluid. Your body is producing it for a good reason. Your body has detected that some of the tissue near the bursa is injured. It is typically some of the other tissue in your knee, as it is seldom the bursa itself that is damaged. Your body produces synovial fluid to keep your knee healthy. It is trying to heal an injury and you produce synovial fluid to help it heal and keep the injury protected.

Bursitis - your swollen bursa - is really a secondary reaction to another underlying injury. Typically, this happens when you've had an injury for a long time and it hasn't been able to heal properly. Perhaps you've damaged a ligament or tendon, or some cartilage, and as fast as it heals, your level of activity keeps reinjuring it. The injury may be small enough that you haven't noticed it as pain in regular life - or maybe you have a bit from time to time. When this cycle of reinjury continues for a long time, your knee produces more and more synovial fluid until finally the bursa starts to swell. As your bursa swells, you feel more pain. And at this point your body has achieved its goal of telling you that it is injured and needs a break!

What is the Underlying Injury Causing the Problem?

What is the underlying injury that is causing you to have Knee Bursitis? Most people with a knee bursitis don't realize their knee is actually injured. That's why they are looking for information on a knee bursitis, instead of the real problem in their knee. This is very common.

The most common underlying injury is a small meniscus tear. The meniscus is a piece of very tough tissue called cartilage between your two knee bones. It is a rubbing pad, a protector, between your knee bones so the bones don't actually rub on each other. You may have heard the term 'bone on bone'. Bone on bone is not a good thing which is why there is always cartilage between bones.

Bones are separated where they would 'touch' by cartilage, and in your knee that sheet of cartilage is called your meniscus. Sometimes that meniscus get's a bit of a tear in it. Sometimes it just gets a bit frayed on the outsides. When the tear is significant you feel it in your knee long before knee bursitis develops. When the meniscus damage is minor though, you may not feel it. Your body produces more synovial fluid to help do all those good things for your meniscus that we discuss above. If your meniscus heals you never know there was a problem. But if your meniscus doesn't heal (typically because of small repetitive reinjury), your synovial fluid can build up to a point where a swollen bursa develops.

Another common cause is Osteoarthritis. People often don't realize there are two kinds of Arthritis: Osteoarthritis and rheumatoid arthritis. Rheumatoid arthritis is the bad one because it's a disease-like condition and it is a problem that doesn't go away. But most arthritis is actually osteoarthritis which is a problem coming from overuse - overactivity in a joint. Osteoarthritis can go away if you let up on the activity and let the joint heal. Often, active people develop osteoarthritis in their joints that they don't even realize is there. And the body's response to osteoarthritis is, again, to start producing synovial fluid to help the joint heal. When it is mild enough that you don't notice it, but it persists for a long time, then that can cause knee bursitis to develop.

We want to be clear here: Overactivity that causes osteoarthritis is when you do something excessively strenuous over and over. If the activity is light, you can do it endlessly and never have to worry about developing arthritis. If the activity is light, the bursa and synovial fluid are always in place, and the joint moves freely, without damage. Walking, running, lifting medium to light weights repeatedly, constant bending of the knee - these are all considered light activity. Even a whole lot of light repetitive activity is not a concern for a healthy knee. Your knee is designed to do that type of activity repeatedly.

If the activity is heavy though, if you are putting a lot of pressure on the joint during the motion, tissue can rub that shouldn't. Bones can push together or ligaments and tendons can get squeezed to the point the synovial fluid gets squeezed out of the way and the cartilage touch each other. If it happens occasionally, that's not a problem. The bursae and cartilage are there for that purpose, to be a bumper and wear pad during times of heavy strain. But there's a limit when it comes to heavy activity.

If you do a heavy load activity over and over and over again so that the parts of your knee constantly bumping and grinding on each other, then it is possible they get worn down over time faster than they can regenerate. When that is the case, a doctor will tell you the joint has developed osteoarthritis.

Osteoarthritis can go away if you let up on the activity and let the joint heal. Often, active people develop osteoarthritis in their joints that they don't even realize is there. And the body's response to osteoarthritis is, again, to start producing synovial fluid to help the joint heal. When it is mild enough that you don't notice it, but if it persists for a long time, then that can cause Knee Bursitis to develop.

Again, it's worth noting that if you are doing mild repetitive activity, you are not likely to sustain any injury no matter how much you do it. If the cartilage on the bones is not being pushed hard enough to bump and rub a lot, then your joint can do that activity forever. If the tendons and ligaments are not being squeezed excessively during repetitive motion then you will be fine. So don't get confused by the terms 'overuse injury' and 'repetitive strain injury'. That sort of injury only occurs if the excessive activity is also excessively strenuous on the joint.

Never wear compression bandages or straps or tight elastic products around your joints during times of repeated activity. That is a recipe for strain on your knee that results in tissue damage and eventually arthritis and/or bursitis. Yes, companies make them and sell them to make money, but they are only likely to injure the person wearing them. Bands and straps may look cool, but they are definitely compromising your knee health if you wear them during activity.

Isometric Strain Injury

Your knee is designed to be in constant motion. That motion contributes to synovial circulation and prevents the parts of your joints from getting squeezed for too long. Your blood has your heart to pump it through your body, but synovial fluid only moves through your joints as a result of motion. You don't need to be excessive though, and the motion does not need to be under heavy weight. If you have any pain at all when you are moving, then you are doing something you should not be doing. Heed the pain. Move, but heed the pain.

People don't realize, you can actually hurt your knee by 'doing nothing'. Constant pressure on a body part when it is not moving can lead to injuries called Isometric Strain Injury. If you are inactive for an extended period of time, and your knee is being held in a position where part of it is being squeezed to much and too long, you may be hurting yourself.

You have a synovial fluid and bursa buffer between the parts in your knee to protect them most of the time. When you move, the synovial fluid is squeezed from between the parts into areas between the bones called synovial cavities. The synovial fluid moves back when the squeeze is released, over and over again. It's designed to work that way. That gentle flow in and out of the bursa to other parts of your knee acts as circulation for the synovial fluid to do the work of the blood that isn't there.

Isometric Strain may be hurting your knee when you aren't moving at all. This kind of injury happens when you keep your knee locked in a certain position for a long period of time. It may be locked straight, or bent, or maybe with a twist. But, if you keep your knee pressed into any one position for an extended period of time, that tissue being squeezed can get damaged. Remember the synovial fluid shock absorber? Well, if you keep enough pressure in one place for long enough, the synovial fluid gets pushed out of place until there's nothing between the different tissues. Then, if you move suddenly, maybe not even with a lot of effort, a tear is much more likely.

Isometric Strain happens more often than you realize. It's what happens to people who stand in one place for a long time with one or both knees 'locked'. Or think about crossing your legs for a long time when sitting - that torque on your knee is severe. Some people cross their ankles when they sleep. Doing so causes the knee of the top leg to hyper-extend for hours possibly, constantly pressing on one part of the knee joint.

There are things that we do, that maybe you haven't thought about that cause isometric strain in different parts of your body. If you are unsure what caused your injury, think about this possibility as well. If this is the culprit then you may need to correct that habit, or you risk causing the injury over and over again. You will need to stop it for some time to at least let your knee heal.

This goes for your tendons and ligaments, bones, cartilage and nerves and the other tissue in your knees. If they get squeezed under even modest pressure for a very long time, they can get damaged.

With Isometric Strain, you usually don't notice it when you're actually doing the damage. This makes it hard to figure out, because you end up feeling the pain during other times of activity.

It is quite possible that the activity you are doing when you feel the pain isn't the root cause of the problem. But, the pain is an indication that your situation is bad enough. By this point, all sorts of activity may start to make your situation worse. The good news is, that if you correct the underlying cause and treat the condition so it heals, you may be able to resume your favorite activity and never have to worry about developing knee bursitis again.

There are other much less common inner knee injuries that can result in a knee bursitis. Suffice it to say that if some part of that knee has an injury that you don't know about and your body is trying to resolve it for a long time, a knee bursitis can result.

Diagnosing Knee Bursitis - It's Valuable to get Tests

So often people go to their GP complaining about pain and swelling in the knee and the doctor says, "it's knee bursitis". They may call it by bursitis of that particular part, but it's all the same issue to you. In the vast majority of cases, that is likely to be an incomplete diagnosis. Bursitis is what happens when an underlying injury goes for an extended time without healing - it's a symptom of an underlying injury. Yes, the bursitis is the cause of your pain, so that's often all the doctor addresses. When they call it bursitis it's because they haven't determined what the underlying issue is.

As discussed, there are many knee issues that can show up as pain and swelling. There could be ligament damage or a torn tendon, or perhaps tendonitis. There could be bone spurs. You might have rheumatoid arthritis or be feeling osteoarthritis without bursitis being part of it. There could be infection or gout. It may be something more serious. Whatever the case, declaring it 'Knee Bursitis' is just the doctor saying you have a symptom.

If it has been nagging you, you want to know the underlying cause so you can address the issue most effectively. An X-Ray or an MRI, or perhaps an Ultrasound will provide further insight, so the real issue can be properly diagnosed. If you know what part of your body is injured and in what way, it will give you valuable insight into what you can do to recover properly and completely.

How Long Does Knee Bursitis Last?

Some people get to this point and realize what may be the root cause. Perhaps it was an increase in activity level or a new activity. Perhaps it was that you have always maintained a fairly high activity level, but as you age or gain weight (we almost all do a bit with age), maybe your body can't keep up as well. In many, many cases, you did something once that caused you to have an injury in the moment, and it didn't have a chance to heal, and the injury has persisted ever since. That's the best scenario, because if that's the case, if you can allow your body to heal and get past that injury, you are likely to be able to return to the same activity level as before and never have the problem again. No matter what the cause, though, you have an underlying injury and you need to let it heal. If you heal your injury, regardless of the reason it started in the first place, your bursitis will go away and you will likely be able to resume normal life. That is, if this whole ordeal is dealt with properly...

What Can You Do About Bursitis?

When you get a diagnosis of 'bursitis', almost always, the bursitis is the second thing that is wrong with you. In very rare circumstances your bursitis might just be an infected bursa and, if your doctor suspects that, they will do bloodwork. Then, if it's infection, they will prescribe antibiotics. Most of the time though the bursitis only occurs because of the underlying injury that hasn't been able to heal.

A lot of the time your doctor won't do any more tests and will just tell you to go home and rest. That's because if you rest your knee enough, the underlying issue will go away and then so will the bursitis. There's no medicine to cure bursitis, so there's nothing more the doctor can do. If your bursitis persists for a long time, your doctor may send you for an MRI or X-Ray to get a better look. Regardless of whether the underlying issue is tendon or ligament or cartilage (maybe your meniscus), rest is what is really required. As long as that inner injury doesn't heal, the problem will persist.

What Not to do when you have a Knee Bursitis

The internet is full of bad advice about treating your knee. Here's a short list though: It's not your shoes. Draining it doesn't solve the underlying problem. Anti-inflammatories don't help - it's not that kind of swelling. Pain killers probably make it worse. Driving through the pain will just make it worse.

What You Should do when you have a Knee Bursitis

For a little while - not forever - it is really helpful to give your knee a rest. In many cases, resting your knee for a few weeks will give it time to heal to a point that your body gets ahead of the healing / reinjury cycle. It's important to realize that once the pain and swelling go away, your underlying injury may not be healed completely, so take it easy and go back to regular life gradually once the pain and swelling are gone. If you want to be more proactive about healing the problem, you can click here to visit the Recommended Treatments page.

Rest & Use Conservative Treatments

If you want your Knee Bursitis to go away as quickly as possible, you need to rest the affected knee. Avoid any physical activities that could cause further injury to your knee. If your Knee Bursitis developed from a knee injury or condition, do your best to avoid the activity that caused this knee injury or condition. Consider using crutches to keep the weight off your injured knee and avoid re-injury.

Do regular ColdCure^® treatments to control the pain and swelling. The compression during each treatment helps gently move the synovial fluid back into your knee.

You can also focus on healing your underlying knee injury with regular BFST^® treatments. This combination will work to finally get rid of your Knee Bursitis.

Around the 4-6 week mark you can start doing some light stretching and strengthening exercises. Slowly work your way back to your regular level of activity. Continue doing BFST^® treatments long after the pain and lump disappear to maintain the healing you've done. Do a ColdCure^® treatment if you experience any flare-ups of pain and swelling and after any significant activity.

Surgery Should Be a Last Resort

You don't have to undergo surgery in order to get rid of your issue. You can get rid of your knee bursitis and the underlying injury with conservative treatments. However, it's possible that your underlying knee condition or injury requires surgery. These are very rare cases.

Meniscus surgery usually involves the removal of part of the meniscus and that is not what you want. That's a path to an eventual full knee replacement, it's just a temporary fix. If the doctor says it's meniscus related, avoid surgery at all costs. You want to do everything you can to let your meniscus heal on its own.

Only in rare cases is it required for the knee bursa to be drained or removed. If it's an option, you want to keep the synovial fluid and just move it back into your knee joint where it belongs, where it can help. In order to remove a knee bursa, arthroscopic surgery must be performed. This is typically only done in cases where the bursitis is disease related and keeps coming back. Your knee will miss that bursa when it's gone.

If surgery is your only option, make sure your post-surgery recovery goes as smoothly as possible by using BFST and ColdCure. Use a ColdCure^® Leg Wrap to reduce the inflammation and relieve the pain for the first few days following surgery. Once the inflammation has gone down, promote blood flow to the injured area using a BFST^® Knee Wrap. This will improve your circulation and help you heal faster.

There is also a possibility that the bursa could rupture, causing fluid to move into the calf and result in further swelling and pain in the calf. A ruptured cyst isn't great, but it's not the worst situation either. Until the underlying injury is dealt with, in some circumstances, it becomes difficult for the ruptured bursa to heal. You almost certainly want to take up crutches for a period of time after a ruptured bursa so it can reseal itself. You want a functional bursa to keep capturing the synovial fluid and return it back into your knee. Symptoms of a ruptured Knee Bursitis are similar to those of a blood clot, so if you're not certain that your knee bursa has ruptured, please see your doctor.

Dealing With Pain

Painkillers are BAD, Not Good

Painkillers mask the pain, causing you to continue to stress and injure your knee. This will only make your condition worse. It is understandable that people need relief from the pain, so if you have to take painkillers, restrict them to times when you are off your feet. You can use painkillers to help you sleep. If you think Isometric Strain may be happening when you sleep, then painkillers are not a good idea then either. Using them when you are active is a recipe for permanent damage. Your choice of pain killers is important. You can give us a call to discuss which ones are best.

The ColdCure^® Knee Wrap is designed to relieve the pain associated with a swollen bursa. This safe and effective pain reliever is also great at bringing down swelling and inflammation. The ColdCure^® Knee Wrap is incredibly soothing and provides support and protection for your knee. The painkilling element is incredibly powerful and it works instantly - there's no 20 minute wait like with pills.

Knee Bursitis can be extremely painful and debilitating. Painkillers such as ASA or acetaminophen are often used to treat the pain but these drugs do nothing to treat the actual condition. In fact, painkillers are known blood thinners and make the bleeding worse for fresh tissue injuries. Cortisone injections are used in extreme cases but these too are intended to only address the pain. They do not promote healing of the injury itself and they put you at a very high risk of further injury.

Blood Flow is Essential for Healing

You don't have to wait for endless months in pain. You can heal much more quickly with the right treatment. For a knee injury, blood flow is the most critical element in rapid recovery. Blood flow feeds the synovial fluid through the synovial walls and is key to keeping the injury clean and nourished. Blood Flow Stimulation Therapy^™ (BFST^®) gives your knee the blood flow it needs to heal quickly and completely.

BFST^® brings extra oxygen and nutrient-rich blood to the injured area - a requirement for the body to heal itself. Unfortunately, an injured knee at rest often has restricted blood flow, which extends your healing time and greatly increases the amount of scar tissue that develops. With a King Brand^® BFST^® Knee Wrap, blood flow can be stimulated in the area of injury while you are at rest. With improved blood flow and without strenuous physical activity and the risk of re-injury, you can recover from your knee injury at a surprisingly rapid rate.

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King Brand^® BFST^® and ColdCure^® Wraps are FDA Registered medical devices. They are intended to prevent, treat and cure soft tissue injuries and chronic conditions. Part of being an FDA Registered company means that our products are made from high quality, biocompatible materials. These devices are manufactured and tested to the highest safety standards in the industry.

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