Monday, March 17, 2008

Case of the Week - Pes Anserine Pain

Even those with some anatomy background might be wondering, Did I miss something? Where is the pes anserine? The name pes anserine means goose foot. We use it to describe three tendons that splay out like the toes of a goose. These tendons, the gracilis, sartorius and semitendonosis, all belong to muscles with different functions. As a unit, however, they often cause pain in the medial knee. Patient with pes anserine pain often complain of ITB syndrome, and vice versa. See last week’s blog for information on ITB syndrome.

Patients with pes anserine pain often complain of pain in their knee, specifically the inner side toward the back. It should be noted that patients with pain within the knee joint itself are usually describing a different condition.

As with ITB Syndrome, pes anserine pain’s root cause is often muscle imbalance. The muscles that control the knee muscle contract with equal force, quality and endurance on all sides of the joint. When one group is weaker, it becomes overworked leading to tendonitis, pain with exercise and eventual pain at rest. Last week we discussed the importance of VMO strength in alleviating ITB syndrome in runners. With pes anserine pain, the strength of the ITB is key. The pes anserine tendons support the knee from the inner side and the ITB supports the joint from the outer side. As the quads and hamstrings flex and extend the knee, the supportive structures on the sides help guide the movement. If the ITB is weak at the knee, the pes anserine tendons must work harder to stabilize the joint. Eventually, this will cause pain and inflammation in the area.

The short-term solution is to alleviate the excess tension. Massage of the pes anserine tendons, including use of the foam roller, will decrease local tension. Patients should also stretch their thigh adductors and hamstrings on a regular basis. Massage of the ITB may also be indicated.

The long-term treatment plan should involve identifying and correcting muscle imbalances in the knee, hip and ankle. In the most common presentation, this involves strengthening the tensor fascia lata and gluteus medius (hip abductors) at the hip and stretching the hip adductors.

For a great article on knee anatomy, visit

Exercise: Adductor and hamstring stretch

Stretching your adductors and hamstrings is something most people have done at some point. The key here is quality. Always lean into a stretch slowly. For these stretches, keeping your spine straight and hinging your movement from the hip will give a better stretch, faster. Breathe into each stretch for 10 seconds and slowly return to center before moving on.

Suggestion of the week: Increase new exercise slowly

Especially with running, but with any sport, increase the intensity slowly to build up muscle and avoid injury. If starting a new running routine, increase by small increments depending on your fitness level. A beginner should start with increases of minutes, instead of distance. An experienced runner can increase at 2-3 mile intervals so long as they provide adequate recuperation time in between runs.


  1. Add. Longus orginates on the pubis and inserts on the mid third of the femur/linea aspera, not the proximal medial tibia. The three muscles I've known to form the insertion of pes anserine are sartorius, gracilis, and your picture shows...

  2. Wow finaly! an answer to the pain! Thank you.

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