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Physical Therapy Exercises 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 have demonstrated effectiveness in reducing pain and improving function. 1

Understanding Pes Anserine Tendonitis

Pes anserine tendonitis is an inflammatory condition affecting the conjoined tendons of the sartorius, gracilis, and semitendinosus muscles at their insertion on the medial aspect of the proximal tibia 2. This condition often presents with:

• Pain and tenderness over the proximal medial tibia at the insertion of the conjoined tendons 1, 3
• Pain that worsens with activities, particularly those involving knee flexion 4
• Reduced range of motion and strength in the affected knee 3

Recommended Physical Therapy Exercises

Initial Phase (1-2 weeks)

• Relative Rest: Reduce activities that aggravate symptoms while continuing activities that don't worsen pain 1, 4
• Ice Application: Apply ice through a wet towel for 10-minute periods to provide short-term pain relief by reducing tissue metabolism and blunting inflammatory response 1, 4
• Gentle Stretching Exercises:
  • Hamstring stretch: Sit with affected leg extended, reach toward toes while keeping back straight 1
  • Adductor stretch: Seated butterfly position with soles of feet together, gently press knees toward floor 1

Intermediate Phase (2-6 weeks)

• Eccentric Strengthening Exercises:
  • Eccentric hamstring curls: Standing, slowly bend knee against resistance, then slowly lower 1
  • Eccentric adductor exercises: Side-lying leg raises with slow lowering phase 1
  • Wall slides: Back against wall, slowly slide down to 45° knee bend, hold, then return to standing 1
• Progressive Stretching:
  • Continue and increase duration of initial stretches 1
  • Add dynamic stretching as tolerated 1
• Deep Transverse Friction Massage: Apply to the tendon insertion area to promote healing 1

Advanced Phase (6+ weeks)

• Sport-Specific Exercises:
  • Functional movements that mimic daily activities or sports 1
  • Progressive resistance training for the involved muscle groups 1
• Return to Activity Program:
  • Gradual reintroduction of previous activities with modified intensity 1
  • Maintenance exercises to prevent recurrence 1

Adjunctive Therapies

• Biomechanical Correction: Address foot pronation or flat feet with appropriate orthotics if these are contributing factors 1
• NSAIDs: May be used for short-term pain control if appropriate 4, 1
• Ultrasound Guidance: Can be helpful for diagnostic purposes and for guiding interventions when needed 4, 5

Important Considerations and Pitfalls

• Avoid Complete Immobilization: This can lead to muscle atrophy and deconditioning 4, 1
• Caution with Corticosteroid Injections: While they may provide faster short-term relief, they don't improve long-term outcomes and could potentially weaken tendon structure 1
• Differential Diagnosis: Consider other conditions that may mimic pes anserine tendonitis, such as knee osteoarthritis (which commonly coexists), medial meniscus injury, or pes anserine bursitis 5, 6
• Imaging Considerations: Ultrasound can demonstrate tendon thickening and heterogeneous echogenicity in tendinopathy 4, but clinical correlation is essential as imaging findings may be present in asymptomatic individuals 5

By following this progressive exercise program with appropriate adjunctive therapies, most patients with pes anserine tendonitis can achieve significant improvement in symptoms and return to normal activities 1.