Reason for recurring knee bursa? Could squat technique be off?

[ilovethe80s]

I've been battling a bursa on my knee for a couple of years now. Normally it is directly on my kneecap and looks like a goose egg. When it gets really bad, I go in and they drain it, sometimes have to go back again as it fills back up.

This time, not only the kneecap but the whole area above the knee is the size of grapefruit and I could not bend my leg to walk. I thought it looked remarkably bad so I measured around the kneecap - 13.5" on one side - the affected side is 17". yikes.

I know the deal now (ice, compression, etc) so I am skipping the ortho at this point as the bills were adding up. The swelling has already subsided to 15" after a few days of icing and compressing.

But I am wondering the underlying cause of this. Surely I could not be so sh*t out of luck in the knee department that every time I bend to tie my shoe or a gnat lands on my leg it swells to a bursa. Could there be something off in my squat technique that is causing it? Sometimes I get a burning under the knee cap and I just feel like something isn't lining up right in there. I stop, check my squat stance, go into a squat stretch and can't even do that... I'd consider myself a pretty good squatter, but some days its just not happening with that knee, and if i push it - it's bursa time.

Also, I notice I get these more when I have lunges in my program - maybe it is because I tend to tap my back knee on the floor as I lunge?

What possible causes should I look into?

[summertown74]

Hi there! I don't think it's necessarily your squat or lunge "technique" as much as it is simply the force mechanism & tight muscles/tendons. So the bursa lie right under the tendon; when the muscle gets adhesions and gets "sticky", the tendon for that muscle gets pulled tight against the joint, thus lessening the space the bursa is accustomed to. That tightness leads to excess friction on the joint capsule, and the bursa. Friction leads to inflammation.

If that's the case, you can help this by decreasing inflammation in the joint, increasing blood flow to the tendon, and lengething/releasing the adhesions in the muscle belly. Ice, anti-inflammatories, self massage (like a rolling pin or a foam roller), arnica, advil, stretching. I would be super, super diligent about these things for a few weeks, see if that helps. If not then I would get an MRI. My definition of diligent is: self massage 3x/day, arnica 4x/day, ice 2x/day.

And yeah, don't tap your knee on lunges. Unless you're tapping onto a super padded surface, it's bound to create problems because of two things, the impact & the angle.

Hope that helps!!

[ilovethe80s]

Thanks summertown! Great, informative reply I don't think I can take anti-inflammatories regularly as I am nursing, but will definitely start massaging my kneecap, trying to get the blood flowing there. And stretching I am pretty bad with - I never do it for lack of time... but looks like I'm going to need to make it a priority. Thanks so much!

[Luvdogs]

I am having a similar issue right now. I had an MRI last year and have a meniscus tear and it is also discoid (flat, not concave). It flares up from time to time just by doing the silliest thing (took a spin class after it was feeling great for about a month, WRONG idea). Do you have a tear perhaps? Have you ever had an MRI on it? It was nice to know the cause so I can be very careful and avoid surgery. I am icing and getting ultrasound from my chiropractor right now...

[ilovethe80s]

Hi Julia,

My mom asked the same thing (about the meniscus). She does not do any exercise, but one day just walking up the street and had searing pain and swelling - had to have it drained and the dr said torn meniscus. I'm not in a position for surgery right now either (I have 3 little boys who would have a field day if I were slowed up on one leg) so going to baby my leg for now. I can usually feel something off in the leg a day or two before, and if I go ahead and squat, or it seems even bang my leg on something during those times, the bursa comes along. Please update on how it goes with yours. I did have an MRI the first time I had a bursa (I think an MRI is what I had anyway - the ortho was actually surprised it was just a bursa because the thing was so treacherous looking). Maybe it wouldn't be a bad idea to get another now that the problem is recurring though.

[mc-]

Dear ilovethe80s
yes technique could be off, but not perhaps where you think


Just to look at a few of the suggestions you've received.

Hi there! I don't think it's necessarily your squat or lunge "technique" as much as it is simply the force mechanism & tight muscles/tendons.

not so "simply" - what's going on to cause this - if this is the case?

So the bursa lie right under the tendon; when the muscle gets adhesions and gets "sticky", the tendon for that muscle gets pulled tight against the joint, thus lessening the space the bursa is accustomed to. That tightness leads to excess friction on the joint capsule, and the bursa. Friction leads to inflammation.

sure this may be one reason for inflammation - if inflammation is the whole story. not clear here.

If that's the case, you can help this by decreasing inflammation in the joint, increasing blood flow to the tendon, and lengething/releasing the adhesions in the muscle belly.

again, this is a really specific diagnosis without evidence that this is what's going on.

Ice, anti-inflammatories, self massage (like a rolling pin or a foam roller), arnica, advil, stretching. I would be super, super diligent about these things for a few weeks, see if that helps. If not then I would get an MRI. My definition of diligent is: self massage 3x/day, arnica 4x/day, ice 2x/day.

arnica will pull blood towards an area, that's fine; advil will retain water and try to bring down inflammation if any is present - you would know if this works if you take in one day and the next day you feel much better. if there's no effect, there's no effect.

Ice, self-massage are each
1) passive approaches
2) assume the site of pain is the source of pain.

not necessarily so, joe.

ice rarely does harm, but all it does is act as a kind of anaesthetic: it doesn't really bring down swelling much tho many folks think it does. compression does that. the anaesthetic effect can induce a kind of calming of the nerves and sometimes that's great - but the effect is often temporary. sometimes temporary is enough.

stretching,
well lots of folks stretch or foam role because they think something is "tight" and they want it to let go.
Few folks ask "why is it tight" in the first place?

Generally speaking, tight muscles or movement / performance restriction is about the nervous system: that body governor does not trust us. When we have pain that's a signal to change something that we're doing - unfortunately it's not a prescription of what to change.

But pain may feel like it's in our knee, or wherever, but it's happening in our brains. The site is not the source.
Especially in chronic pain: we start to get wired to feel anything through a familiar path.

So what does this mean for this seeming bursa related issue?

Asking the question: what's happening?

With the folks i coach, 99% of the time it's movement related. The movement issue itself may have something to do with the kinds of shoes they wear, that their eyes haven't been checked - ever - or in decades - that their balance is off or that for whatever reason something is happening in their movement patterns that the compensations going on are causing a chain reaction and some limb starts signaling.

So especially since you've been having this issue for awhile, i'd connect with a movement specialist who can look at how you move, assess that, and help you develop an active approach to help your nervous system let you perform better.

Often one session is enough to eleviate the pain and get the athlete on a path they can own to feel better.

If you want to PM me with where you live, if i know someone in the area i'll be happy to recommend them.

Here's an overview of
active vs passive approaches (you do it vs being done to - even if by yourself)
http://www.begin2dig.com/2010/04/ben...y-passive.html
movement assessments
http://www.begin2dig.com/2010/11/wha...for-petes.html

And yeah, don't tap your knee on lunges. Unless you're tapping onto a super padded surface, it's bound to create problems because of two things, the impact & the angle.

Hope that helps!!

I'm not sure what's meant by angle here: the pounding of the knee - never a good idea - but the angle - our knees have a pretty good range of motion, and if we don't practice the full range of motion - if we only go to the end or weird positions in an accident - our brain has no practice with that range of the motion and will freak out and induce often greater injury.

The problem comes if the person moving the knee into a particular lunge position can't control it and that's why it's hitting the ground.

Sorry that's a lot of information but i'm having an empathy attack: i see a lot of clients who have joint pains and think they're buggered and for the most part all that has to happen is rather than focus in on the site pull back and look a little bit more at the system to get to a solution. One of my colleagues says pain's informative but it's a liar. What he means is that it's giving us important information that something has to change, but tends to mislead our attention.

All the best

mc

[summertown74]

Sorry, 80's, I should've been more specific re: which areas to ice & massage....I think you should be massaging, stretching, and in general, treating the quadriceps muscles, the hamstring muscles, the gluteal & hip flexor/extensor muscles, and the illiotibial band, not your knee. Yes a very specific "diagnosis" was given, without specific advice...my apologies . Mc gave some excellent thorough advice, I should not give advice post wine . I agree that your brain is saying some movement you're doing is dangerous and thus is telling your muscles to tighten & guard....That's the way our muscular system works. Whenever the brain perceives a threat it will tell the muscles to guard against it, so...if you are squatting too much, or lunging too much, or doing either incorrectly, or doing either with a previously existing imbalance in your body, then your brain will say, "hey, this isn't working, we need the ...whatever...muscles to tighten up to stabilize ...whichever...joint". So, barring a structural injury (such as a tear or dislocation, etc.), in order to treat it you really have to be thorough & start at the beginning of the problem. So truly the first thing you need to do is rule out an injury.
Good luck m'dear.

[mc-]

Sorry, 80's, I should've been more specific re: which areas to ice & massage....I think you should be massaging, stretching, and in general, treating the quadriceps muscles, the hamstring muscles, the gluteal & hip flexor/extensor muscles, and the illiotibial band, not your knee. Yes a very specific "diagnosis" was given, without specific advice...my apologies .

first - i don't think one can give a specific diagnosis without going through someone's history and seeing them move so that was what i meant - sorry that wasn't clear.

second, a concern with each of these approaches in this advice, is that they do nothing to check how well a person moves the affected areas to begin with as PART of a complete movement. If the person has a movement issue, icing, stretching and massage will not address that more fundamental issue. they'll only keep treating the results. It's like repairing an oil leak by putting more oil into the engine rather than replacing a faulty gasket. one is treating symptoms; the other is getting at the problem. we get back to offering diagnosis without seeing the person or knowing their history and getting at the causes.

third, while these are generic prescriptions - ice, stretch massage -, for the reasons given in the above post, they're superficial and passive and rarely lead to a cure where the body is learning how to behave better, but become perpetual maintenance.

why?
ice, stretch, massage does nothing to help the brain learn the motor patterns. without that one will be stuck with this kind of pre- post- hoc passive care.

again - why does the person need these treatments in the first place? because something is happening somewhere to cause the issue. Perhaps addressing that will enable the inflammation or whatever other symptoms to finish their cycle and stop recurring. so getting closer to the source of the issue rather than treating symptoms will likely have a longer term benefit.

how get at that higher up approach to better movement/addressing the issues showing up?
we have to ge that the site of pain is not the source of pain.

then, dial in better controlled movement.
a way to do this is
by learning the skills to move each part that moves (i.e. our joints) in their range of motion under control at various speeds - one finds that the need for stretching/icing/massaging goes away because the body is moving optimally within it's design. And if we can't get that control going, it might be because some proprioceptive, visual or vestibular issue is in the way.

getting to whether the latter is the case, or tuning in which particular moves will give the most bang for the buck for where we are right now can be accelerated by seeing a movement specialist.

Starting and working with the musculo-skeletal system is way too far down the chain more times than not to address a problem such that it's actually fixed rather than requiring constant maintenance.

best
mc

[ilovethe80s]

wow - glad I asked on here, some seriously smart ladies on this forum.

Thanks mc - I didn't realize that re the ice/ compression - I was icing my knee for a few days and then I threw a wrap on it, once it was compressed, the swelling went down dramatically in a couple of days. But you are right, I am just treating the symptoms each time they arise as opposed to fixing the underlying problem. I was not even aware that movement specialists existed, but you are right, I think ideally that would be the way to go. Either that or avoid squats, and I don't think that one's going to happen

[summertown74]

Mc...I think i may be misunderstanding you here: are you saying that muscles don't affect movement patterns and therefore can't be at the root of a physiological problem? If so I respectfully disagree. From the time we start crawling we are developing compensation patterns. Muscles can tighten and develop scar tissue as a result. Throw in some injuries, and the tightness becomes a shortened muscle eventually affecting ROM. a compensation pattern be3comes a pathological tightness which becomes an injury or an inflammation or a bone spur or any other number of atructural problems. Of course what I described in two seconds takes years (usually) to develop. I've simplified and left out a lot of stuff as I'm typing on my phone!
just my perspective.

first - i don't think one can give a specific diagnosis without going through someone's history and seeing them move so that was what i meant - sorry that wasn't clear.

second, a concern with each of these approaches in this advice, is that they do nothing to check how well a person moves the affected areas to begin with as PART of a complete movement. If the person has a movement issue, icing, stretching and massage will not address that more fundamental issue. they'll only keep treating the results. It's like repairing an oil leak by putting more oil into the engine rather than replacing a faulty gasket. one is treating symptoms; the other is getting at the problem. we get back to offering diagnosis without seeing the person or knowing their history and getting at the causes.

third, while these are generic prescriptions - ice, stretch massage -, for the reasons given in the above post, they're superficial and passive and rarely lead to a cure where the body is learning how to behave better, but become perpetual maintenance.

why?
ice, stretch, massage does nothing to help the brain learn the motor patterns. without that one will be stuck with this kind of pre- post- hoc passive care.

again - why does the person need these treatments in the first place? because something is happening somewhere to cause the issue. Perhaps addressing that will enable the inflammation or whatever other symptoms to finish their cycle and stop recurring. so getting closer to the source of the issue rather than treating symptoms will likely have a longer term benefit.

how get at that higher up approach to better movement/addressing the issues showing up?
we have to ge that the site of pain is not the source of pain.

then, dial in better controlled movement.
a way to do this is
by learning the skills to move each part that moves (i.e. our joints) in their range of motion under control at various speeds - one finds that the need for stretching/icing/massaging goes away because the body is moving optimally within it's design. And if we can't get that control going, it might be because some proprioceptive, visual or vestibular issue is in the way.

getting to whether the latter is the case, or tuning in which particular moves will give the most bang for the buck for where we are right now can be accelerated by seeing a movement specialist.

Starting and working with the musculo-skeletal system is way too far down the chain more times than not to address a problem such that it's actually fixed rather than requiring constant maintenance.

best
mc

[mc-]

Mc...I think i may be misunderstanding you here: are you saying that muscles don't affect movement patterns and therefore can't be at the root of a physiological problem?

No.

If so I respectfully disagree. From the time we start crawling we are developing compensation patterns. Muscles can tighten and develop scar tissue as a result. Throw in some injuries, and the tightness becomes a shortened muscle eventually affecting ROM. a compensation pattern be3comes a pathological tightness which becomes an injury or an inflammation or a bone spur or any other number of atructural problems. Of course what I described in two seconds takes years (usually) to develop. I've simplified and left out a lot of stuff as I'm typing on my phone!
just my perspective.

What enables muscles to fire?
What contributes to the patterns muscles develop?

**the site of pain is not the source of pain**
too many musculo-skeletal approaches - like the suggestions above - act like they are the same.

There is an entire chain with complex systems interactions that occurs in the nervous system both pre-cognitively (reflexively) and cognitively (learned) that fires before anything gets to a muscle. To focus on a system so far away from the source or the driver of a movement is bound to lead to less effective results than dealing with issues that drive a particular pattern.

As stated - the visual, vestibular and proprioceptive systems are as examples higher up the chain that musculo-skeletal. Working with these systems more directly, and actively, means that responses happen at the speed of the nervous system - and depending on what fibers that's over 300mph. Doing so actively, with an active self-oriented movement rather than passive manipulation will also fire up way more of that rapid system.

This approach means doing something as simple as changing ones footware to let the foot move all its joints to provide a clearer map to the brain of where one is in space can cause immediate performance benefits (pain reduction is a performance benefit). THis is why sometimes just asking someone not to crank their neck back in a deadlift but keep their head neutral while looking UP with their eyes will have an immediate performance improvement.

the site is not the source; the nervous system is the governor of all other systems in the body - being able to connect more directly with that system actively seems to yield both rapid and lasting performance benefits.

mc

[ilovethe80s]

I don't mean to bump an old thread but I just wanted to note the verdict on here just in case anyone has similar symptoms. It turns out I have a pretty bad meniscus tear that requires surgery - I should have heard a distinct pop when it happened, or had some sort of distinct painful injury. Oddly, I don't remember anything like that, but my knee does click quite a lot.

From having the untreated tear, a baker's cyst formed under my knee cap, which gives the pressure like the knee is bending backward.

And lastly, those two issues were causing inflammation and aggravating the bursa. So the bursa was just an indication of other things going on. The bursa issue and the cyst are expected to clear on their own following the meniscus procedure. A simple scope to clean up the knee and remove the torn portion should fix, crutches for only a few days and then good to go, no further rehab.

Thanks again to all who helped me on this!