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The knee has 14 bursae. A bursa is a small sac that prevents friction from occurring between tendon, muscle, bone and skin. If the bursa becomes irritated it fills with fluid and becomes inflamed resulting in ‘bursitis’. The pre-patellar bursa is the most commonly affected bursa of the knee. This is referred to as ‘housemaid’s knee’.

Signs & Symptoms

  • Pain (overhead activities – throwing, swimming, weights)

  • Catching feeling

  • Impingement with combined abduction and internal rotation

  • Swelling

  • Weakness

  • Tenderness on palpation of the rotator cuff tendon

  • Painful arc on movement (between 70 and 120 degrees of abduction)

What Causes It?

  • Poor control of shoulder and scapula

  • Repetitive overhead activities

  • Overuse (increased volume of training)

  • Shoulder instability

  • Trigger points and tightness within rotator cuff muscles

  • Training technical faults

How to Self Manage

  • R.I.C.E. protocol

  • Avoid  aggravating activities such as those listed above


  • Assessment of the shoulder complex

  • Review and modification of sporting or work activities aggravating shoulder

  • Assess rotator cuff and other stabilising muscles for weakness and/or imbalance

  • Biomechanical review of shoulder and scapular function and stability

  • Prescribe an individualised program to improve stability and strength

  • Soft tissue massage and trigger point release

  • Acupuncture and dry needling

  • Liaising with coach RE sporting technique if required

How Physio Helps

  • Assess the patellar tendon to determine if it is the source of pain

  • Biomechanical review

  • Muscle imbalance correction

  • Eccentric loading program for the patellar tendon

  • Prescription of a brace to offload the patellar tendon

  • Deep transverse frictions

  • Stretching of hamstrings, calves, ITB, and calf muscles

  • Strengthening of quadriceps, glutes and gastrocs.

  • Neural mobilisation

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