What are the recommended physical therapy approaches for pes anserine tendonitis?

Physical Therapy Approach for Pes Anserine Tendonitis

Eccentric strengthening exercises combined with stretching should be the primary physical therapy approach for managing pes anserine tendonitis, as these interventions effectively reduce pain and improve function. 1

First-Line Physical Therapy Interventions

• Active exercise therapy should be prioritized over passive modalities for pes anserine tendonitis treatment, as active interventions promote self-management and demonstrate greater effectiveness 1
• Implement a progressive eccentric strengthening program specifically targeting the pes anserine tendons (sartorius, gracilis, and semitendinosus) to reduce symptoms and promote tendon healing 1
• Include stretching exercises for hamstrings and adductor muscles to improve flexibility and reduce tension on the tendon insertion point at the medial tibia 1
• Modify activities to avoid aggravating movements while maintaining appropriate activity levels to prevent deconditioning 1

Treatment Protocol Timeline

Initial Phase (1-2 weeks)

• Implement relative rest from aggravating activities while maintaining general fitness 1
• Apply ice through a wet towel for 10-minute periods to provide short-term pain relief 1
• Begin gentle stretching of hamstrings and adductors 1
• Consider NSAIDs for temporary pain control if appropriate 1

Intermediate Phase (2-6 weeks)

• Progress to eccentric strengthening exercises with gradually increasing resistance 1
• Continue and advance stretching program 1
• Incorporate deep transverse friction massage to promote healing in the tendon 1
• Address biomechanical issues with appropriate orthotics, particularly if excessive foot pronation or pes planus is contributing to the condition 1

Advanced Phase (6+ weeks)

• Implement sport or activity-specific exercises 1
• Guide return to normal activities as tolerated 1
• Develop a maintenance program to prevent recurrence 1

Adjunctive Therapies

• Deep transverse friction massage can be used to reduce pain and promote healing in the tendon 1
• Correction of biomechanical issues with appropriate orthotics may be beneficial, particularly if valgus knee deformity is present, as this has been identified as a risk factor for pes anserine tendonitis 2
• Consider corticosteroid injection as an alternative treatment option if physical therapy is ineffective, as research shows comparable outcomes between physical therapy and corticosteroid injections 3

Important Considerations and Pitfalls

• Avoid complete immobilization as it leads to muscle atrophy and deconditioning 1
• Be cautious with corticosteroid injections around tendons; particularly avoid direct injections into the tendon substance due to risk of rupture 1
• Patients with pes anserine tendonitis often have more severe pain and greater functional limitations compared to those with knee osteoarthritis alone, requiring comprehensive management 3
• Valgus knee deformity, especially when combined with collateral instability, significantly increases the risk of developing pes anserine tendonitis and should be addressed as part of the treatment plan 2