The knee joint is constantly working to provide balance between the foot, leg and the thigh and to some degree the rest of the body. The muscles of the knee are consistently contracting to move or stabilise the joint as it is put through its motion are often susceptible to acute repetitive and chronic strain (tendinitis, tendinosis and/or bursitis)

Terminology
A tendon is a structure that attaches muscle to bone. Tendinitis is acute inflammation as a result of a larger scale damage of the tendon. Tendinosis refers to chronic degeneration of a tendon over a period of time (the tendon fails to heal properly during a normal healing period).Bursa are small fluid filled sacs (little water-balloon like structures) that rest in between tendons (or between tendon and bone) and act as buffers to friction. Bursitis occurs when the bursa (balloon) gets irritated and becomes inflamed. Tendonitis, Tendinosis or Bursitis can occur independently or may occur together in an area. There are 11 Bursa around thee knee.

Causes

• Tendon and bursa injuries are most commonly caused by repetitive strain and/or by excessive load due to poor posture during movement (altered biomechanics).
• Damage can also be cause by direct trauma.
• Some arthritic conditions (e.g. Rheumatoid Arthritis) can also be implicated
  

Signs & Symptoms

• Knee pain (often be felt below or above the knee cap cap).
• Bursitis can also occur at the back of the knee and cause pain in that area). This is commonly known as a "bakers cyst".
  
• Pain can be constant or with certain knee movements.
• There may be knee weakness with certain movements.
• Pain can be more prominent at night and can wake you at night.
• Pain when getting up from a chair (especially after sitting for long periods)
• Pain with going up and/or down stairs
• Pain may increase with walking, cycling or standing for long periods.
  

Treatment

• Your osteopath will conduct a full past medical history and physical examination to determine the cause of your knee pain.
  
• Your osteopath will examine the positioning of foot, ankle, knee, hips and pelvis to ensure that it is moving with correct biomechanics in relation to the rest of the body.
• Treatment will be aimed at:
• Reducing pain and inflammation through direct and indirect techniques to the tendon and bursa.
  
• Correcting any hip movement/biomechanical abnormalities through treatment and education.

Management

• A short course pain relieving and/or anti-inflammatory medication may be of benefit with consultation of your doctor or pharmacist.
• Ice is beneficial in the first 24-48 hours (3 sets of 10 minutes on 10 minutes off - 2 or 3 times per day). Stop using ice with any discomfort or if there is no relief.
• Once pain has settled you will be prescribed stretching and strengthening exercises with an aim to restoring your knee to its pre-injury state and make it stronger with an aim to prevent recurrence.
• You will also be educated on lifestyle and ergonomical factors that maybe contributing to the tendon/bursa damage.
  
• You may also be referred to a specialist for imaging (Ultrasound, MRI, X-Ray) if required (e.g. to rule out other causes of the pain).
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