Overview

Constant friction on the front of the knee irritates a small lubricating sac (bursa) located just in front of the kneecap (patella). The bursa enables the kneecap to move smoothly under the skin. If the bursa becomes inflamed, it fills with fluid and causes swelling at the top of the knee. This condition is called prepatellar bursitis.

Who is at risk:

• people who constantly kneel to work, such as plumbers, roofers, carpet layers, coal miners, or gardeners
• athletes who participate in sports where direct blows or falls on the knee are common, such as football, rugby, wrestling, or basketball
• someone who has been in a motor vehicle collision
• people with rheumatoid arthritis or gout

Diagnosis

Symptoms of kneecap bursitis include:

• pain with activity, but not usually at night
• rapid swelling on the front of kneecap
• tender and warm to the touch

Your doctor may first recommend an x-ray to rule out the possibility of a fracture. Conservative treatment is usually effective as long as the bursa is simply inflamed and not infected.

Treatment Options

• Rest and discontinue the activity or substitute another activity until the bursitis clears up.
• Apply ice at regular intervals three or four times a day for 20 minutes at a time. Each session should reduce swelling considerably if the knee is also being rested.
• Elevate the affected leg when you're not walking.
• Take an anti-inflammatory medication such as aspirin or ibuprofen. (Check with your doctor before taking any medication.)

If the swelling is significant, your doctor may decide to drain (aspirate) the bursa with a needle. Chronic swelling may also be treated by draining the bursa. If the swelling continues, your doctor may recommend surgical removal of the bursa. This operation is an outpatient procedure. It takes a few days for the knee to regain its flexibility and some weeks before normal activities can be resumed.

Prevention

You can help prevent bursitis by following these simple recommendations:

• Wear kneepads if you work on your knees or participate in high-risk sports such as football, basketball, rugby, or wrestling.
• Rest your knees regularly by stopping to stretch your legs. You also may wish to consider switching activities on a regular basis to avoid prolonged stress on your knees.
• Apply ice and elevate your knees after a workout.

How can I prevent bursitis of the kneecap?

The simplest way to avoid another episode of bursitis is to avoid the activity that caused it. Of course, this may be impossible for the serious athlete. For these people, quality kneepads should be used during activity, and frequent breaks from the causative activity should become routine. It's also wise to reduce or stop the activity at first sign of pain and to ice the knee following each training session or game.

Improving sports performance

The key to improving sports performance after a diagnosis of bursitis of the kneecap is proper a rehabilitation program, and adhering to some of those same principles after the injury is gone.

Continue to perform the exercises in the rehabilitation section to strengthen the leg muscles around the knee, and also refer to the prevention section for important information on how to keep you in the game and perform to your fullest potential.

Remember that the single most important aspect of improving performance is stretching before and after you step onto the field, court, ice, or golf course.

Benefits derived from stretching include:

• increased physical efficiency and performance
• decreased risk of injury
• increased blood supply and nutrients to joint structures
• increased coordination
• improved muscular balance and postural awareness
• decreased risk of lower-back pain
• reduced stress
• enhanced enjoyment

Rehabilitation exercises

Although rest, nonsteroidal anti-inflammatory drugs, and avoiding the activity that caused the injury are the main steps for rehabilitating your bursitis, the following exercises, which place no extreme mechanical or weight-bearing stress on the knee, patellar tendon, or kneecap and use full range of knee motion, can be very effective during rehabilitation:

• Knee extension
  Use a leg extension resistance training machine. Begin the exercise seated with the knees at as nearly full flexion as the machine being used will permit. Start with that amount of resistance which can be overcome with no pain. Fully extend the knees and hold this position for 3 to 5 seconds. Slowly return to the beginning position, rest for 5 seconds, then repeat this cycle for a total of 10 times. Increase resistance from one training session to the next as pain permits.
• Knee flexion
  Use a leg flexion resistance training machine. Begin the exercise laying face downward with the knee as extended as the machine will allow. Start with an amount of resistance that can be overcome with no pain. Fully flex the knees and hold for 3 to 5 seconds. Slowly return to the beginning position and rest for 5 seconds. Repeat this cycle for a total of 10 times. Increase resistance from one training session to the next as pain permits.

During rehabilitation from prepatellar bursitis, you'll need to maintain strength of the thigh muscles. Here's an exercise that does not put undue stress upon the knee:

• Half knee bends
  Stand with back flat against a wall, arms at sides, feet at shoulder width, and heels about a foot from the wall. Allow the knees to bend slowly, lowering the body weight until the knees are flexed at a 45-degree angle, or until pain intervenes. Immediately return slowly to the upright position and rest for 5 seconds. Repeat this cycle for a total of 10 to 15 times.

When can I return to my sport or activity?

The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your activity is determined by how soon your bursitis recovers, not by how many days or weeks it has been since your injury occurred.

Generally, full use of the affected knee should be delayed until all symptoms subside. In the interim, activities that place no pressure on the knees, such as swimming or cycling, can maintain cardiovascular fitness. Unfortunately, prepatellar bursitis caused by infection may result in prolonged absence from activity, although sometimes, when the most effective antibiotic is applied against bacterial infection, exactly the opposite could occur.,/

You may safely return to your sport or activity when, starting from the top of the list and progressing to the end, each of the following is true:

• You have full range of motion in the injured knee compared to the uninjured knee.
• You have full strength of the injured knee compared to the uninjured knee.
• You can jog straight ahead without pain or limping.
• You can sprint straight ahead without pain or limping.
• You can do 45-degree cuts, first at half-speed, then at full-speed.
• You can do 20-yard figures-of-eight, first at half-speed, then at full-speed.
• You can do 90-degree cuts, first at half-speed, then at full-speed.
• You can do 10-yard figures-of-eight, first at half-speed, then at full-speed.
• You can jump on both legs without pain and you can jump on the injured leg without pain.

Alternative exercises

During the period when normal training should be avoided, alternative exercises may be used. These activities should not require any actions that create or intensify pain at the site of injury. They include:

• swimming
• water running
• stationary bicycle (add resistance gradually from one session to the next, as pain allows)

How long will the effects of the injury last?

Symptoms may disappear within 10 days or persist for more than two weeks and recur from time to time. The most rapid recovery is expected when the condition is due to a single blow to the area that is localized to the front of the knee.

Prepatellar bursitis caused by overuse often resolves after two weeks if you refrain from the activity that caused the problem. If the bursitis is caused by an infection, recovery may take several weeks, depending on the effectiveness of the drug treatment.