💧 Pre-Patellar Bursitis: Causes, Treatment and Recovery Strategies

What Is Pre-Patellar Bursitis?

Pre-patellar bursitis — often called “housemaid’s knee” — occurs when the small fluid-filled sac (bursa) that lies between the kneecap and the skin becomes irritated or inflamed.

The bursa acts as a cushion to reduce friction during kneeling, crawling, or direct pressure on the front of the knee.

When irritated, it can fill with fluid and swell, producing visible puffiness and tenderness just in front of the patella.

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Common Causes

• Repeated kneeling — gardening, tiling, plumbing, or certain gym exercises

• Direct trauma — a fall or hard knock to the front of the knee

• Prolonged pressure from kneeling on hard surfaces

• Infection (septic bursitis – less common, but important to rule out)

• Secondary irritation from friction, poor mechanics, or post-surgical changes

Athletes and tradespeople are especially prone, but it can occur in anyone who frequently loads the front of the knee.

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Typical Symptoms

• Localised swelling directly over the kneecap

• Warmth or redness around the area

• Pain when kneeling or bending the knee deeply

• Occasionally fluid you can move with your fingers under the skin

• In septic cases: fever, heat, significant redness (needs medical review)

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Modern Management Approach (2025 Guidelines)

The key in managing pre-patellar bursitis is to identify the underlying cause and control the inflammatory process without completely de-conditioning the knee.

Most cases resolve within 2–6 weeks with targeted physiotherapy and sensible activity modification.

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1. Load and Activity Modification

Reduce positions that aggravate pressure on the bursa:

• Avoid kneeling on hard floors or performing deep kneeling exercises.

• Use knee pads or foam supports if kneeling is unavoidable.

• For athletes, substitute high-impact drills with lower-load variations until swelling subsides.

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2. Acute Symptom Control

• Ice or cold compression for 10–15 minutes several times daily.

• Relative rest, not total inactivity — gentle range-of-motion and isometric quad exercises prevent stiffness.

• Anti-inflammatory medication if prescribed by your GP.

If swelling is severe, aspiration (draining) can relieve pressure — but this should be done by a clinician under sterile conditions.

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3. Rule Out Infection

Always differentiate septic vs non-septic bursitis.

Redness, warmth, systemic symptoms, or rapid swelling warrant prompt medical review.

If infection is confirmed, antibiotics or drainage may be required before rehabilitation resumes.

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4. Progressive Rehabilitation

Once infection and acute swelling are controlled, the focus shifts to restoring strength, mobility, and tissue capacity.

Key elements:

• Quadriceps and gluteal activation to support knee control

• Gradual load progression via squats, step-ups, and lunges once pain-free

• Soft-tissue work for surrounding tightness (quads, ITB)

• Movement retraining to avoid repeated compressive postures

At The Knee Physio in Bury St Edmunds, we use VALD ForceDeck and Dynamo systems to monitor lower-limb strength symmetry and power output — ensuring a safe and objective return to full activity.

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5. Return-to-Sport Criteria

Before full sport or occupational return, aim for:

• No visible swelling or tenderness

• Full pain-free range of motion

• Equal squat and lunge symmetry (verified by force testing)

• Confidence kneeling or performing sport-specific drills

A short-term compression sleeve or knee pad can offer reassurance during early return phases.

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When to Seek Expert Help

If swelling persists beyond two weeks, keeps recurring, or limits function, book a specialist physiotherapy assessment.

Early management prevents chronic bursitis, where the bursa thickens and remains irritated.

At The Knee Physio, we combine clinical assessment, ultrasound referral (if required), and data-driven rehab to restore normal function and reduce recurrence risk.

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Preventing Recurrence

• Avoid prolonged kneeling without padding

• Strengthen quads, glutes, and calves for better weight distribution

• Maintain healthy soft-tissue flexibility

• Address movement mechanics to prevent compensatory load through the front of the knee

Regular conditioning and smart training progressions keep the bursa unprovoked and your knees resilient.

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The Takeaway

Pre-patellar bursitis is rarely serious, but ignoring it or repeatedly aggravating the area can lead to chronic swelling and restricted activity.

Early identification, pressure modification, and progressive loading are the cornerstones of management.

With the right physiotherapy guidance and objective assessment, most people return to full activity quickly — without lingering stiffness or recurrence.

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