FrostleteFrostlete
Rugby 101

Injury and recovery

Pes Anserine Bursitis

Medial knee pain just below the joint line, often confused with MCL injury

2 min readIntermediate

Pes anserine bursitis is irritation of the small bursa that sits under three tendons (sartorius, gracilis, semitendinosus) on the inside of the shin, just below the knee. It produces medial knee pain that is easily mistaken for an MCL sprain or medial meniscus problem, but the pain sits ~5 cm below the joint line, not on it. It typically responds well to conservative management.

What it is

On the inside of your shin, just below the knee, three hamstring/inner-thigh tendons fan out together onto the tibia. They are called the pes anserinus — literally 'goose's foot' — because of the shape. Beneath them sits a small fluid-filled cushion (a bursa) that reduces friction. When that cushion is irritated, you get pes anserine bursitis.

How it feels

  • Aching pain on the inside of the upper shin, a couple of finger-widths below the knee joint.
  • Sharper pain going up and down stairs, getting up from a chair, or after long runs.
  • Tenderness when you press on a coin-sized spot on the inner shin.
  • Sometimes mild swelling or a 'fullness' in the same spot.
  • Pain at night when lying on your side with your knees touching (a pillow between the knees often helps).

Common drivers

  • Sudden spikes in running volume — pre-season or returning from a break.
  • Hill running, uneven ground, or worn footwear.
  • Tight or weak hamstrings and hip adductors (the three tendons that share this attachment).
  • Poor frontal-plane control — knees collapsing inward in squats, landings, or running gait.
  • Co-existing knee osteoarthritis in older players.

What helps

  • Relative rest from the most provocative activity — usually running volume — not complete immobilisation.
  • Modifying training: bike, pool, upper-body strength while the area settles.
  • Addressing the drivers: hip and hamstring strength, landing mechanics, footwear.
  • Gradual progression of medial-chain loading (adductor and hamstring) once pain has settled.

Keep going