Knee Bursitis: who to see and what helps

Knee Bursitis · Kitchener, Waterloo & Cambridge

Knee bursitis is a painful swelling of one of the small fluid-filled sacs that cushion the knee, most often the one in front of the kneecap. Most cases come from kneeling or a knock and should go away in a few weeks with rest from pressure, ice and padding. A knee that is hot or red, or a fever, can mean an infected bursa and needs a physician the same day. Otherwise, start with a physiotherapist or a chiropractor: both assess and treat at the first visit.

What knee bursitis is

A bursa is a small sac of fluid that cushions the places where skin, tendon and bone would otherwise rub. Bursitis is when one becomes painful and swollen. Two bursae account for most of it at the knee:

• Prepatellar bursitis. The bursa sits between the skin and the front of the kneecap. The swelling stays within the outline of the kneecap, outside the joint itself.
• Pes anserine bursitis. The bursa sits on the inner side of the knee, about 2 to 3 inches (5 to 8 cm) below the joint, between the shinbone and three tendons of the hamstring muscles.

A Baker’s cyst is different again: it affects the back of the knee.

Symptoms of knee bursitis

• A dull, achy pain
• Swelling on the front of the kneecap, which can come up quickly
• Tenderness
• More pain when you kneel, bend the knee or press on the swelling
• Pain with activity, but not usually at night
• Skin over the swelling that is warm or red (redness can be harder to see on brown or black skin). Ordinary bursitis can do this and so can an infection, which is why it is on the same-day list below
• With pes anserine bursitis: pain on the inner side of the knee, below the joint, that builds slowly and is worse with exercise or on stairs

What causes knee bursitis

• Kneeling. Repeated pressure on the bursa, kneeling above all, is the most common cause. The examples in the medical literature are carpet layers, roofers, plumbers and gardeners. In Waterloo Region that covers a lot of trades work, and plenty of spring gardeners.
• A knock. A direct blow to the front of the knee, or a fall onto it: a tackle, an icy driveway in January.
• Infection. Bacteria can reach the bursa through a cut or scrape over the kneecap, or from infected skin nearby.
• Gout and, rarely, rheumatoid arthritis. These are uncommon causes at this bursa. See Gout.
• For the pes anserine bursa: running, swimming or cycling, especially with a lot of hills or a sudden jump in mileage; tight hamstrings; obesity; and knee osteoarthritis.

How knee bursitis is diagnosed

By where the swelling is and what set it off. The question that matters most is whether it is infected. Warmth over the bursa is a good predictor of infection, and a fever with bursitis is treated as infection until shown otherwise, though not every infected bursa causes one. When infection or gout is possible, a physician draws fluid from the bursa with a needle and sends it for testing. An X-ray is indicated after a recent injury when a fracture is a concern, and other tests may follow if symptoms are severe or get worse despite treatment.

When a swollen knee needs urgent care

Call 911 or go to an emergency department, and do not drive yourself, if after a knee injury:

• the knee or kneecap has moved out of place, has changed shape or points at an odd angle
• you heard a crack when it happened
• you can see bone, or the knee is bleeding heavily
• the leg is numb, tingling or has pins and needles, or you cannot move it below the injury
• the skin has turned pale, blue or grey, or the leg feels cold
• you think your kneecap dislocated, even if it has gone back, and the knee became very swollen very quickly or you felt a pop or snap

Call 911 if the pain is so bad that you cannot move the leg. While you wait, keep the knee still and supported, do not raise the leg, and do not try to stand on it or push a kneecap back into place.

The emergency departments in Waterloo Region are:

• WRHN @ Midtown (formerly Grand River Hospital), 835 King St. W., Kitchener
• WRHN @ Queen’s Blvd. (formerly St. Mary’s General Hospital), 911 Queen’s Blvd., Kitchener
• Cambridge Memorial Hospital, 700 Coronation Blvd., Cambridge

If you cannot get there safely, call 911.

Get medical care the same day, from a physician, a nurse practitioner, an urgent care clinic or an emergency department, if:

• the pain is severe or getting worse
• the knee swells severely right after an injury or starts to swell within two hours, or there is a large amount of bruising
• the knee is badly swollen, or has changed shape without an injury
• you cannot put weight on the leg or walk more than a few steps
• you cannot bend the knee or straighten it completely, or it is very stiff or difficult to move
• the knee locks in one position, buckles or gives out, or clicks painfully (painless clicking is normal)
• you heard or felt a pop when it happened
• you think your kneecap went out of place and moved back by itself
• the knee is hot or red, or the skin around it has changed colour
• you have a high temperature, or feel hot, cold, shivery or generally unwell, with a painful or swollen knee
• you have severe pain in the knee that started suddenly

The last three can be signs of an infection. These lists combine NHS advice with British Columbia’s advice on knee injuries, using Ontario’s routes to care. None of these signs should wait for an appointment with us.

Nobody can tell an inflamed bursa from an infected one by looking, which is why a hot or red knee is on the same-day list even if you feel well.

What the evidence says about treating knee bursitis

• Where this comes from. Two reviews of bursitis at the kneecap and elbow, under Sources; one could be read in full and one only as a summary. The evidence behind them is limited, and they do not agree on everything.
• Start simple. For bursitis from kneeling or pressure, most people respond to ice, raising the leg, changing the activity, padding and a simple pain reliever.
• Infection is a different condition. It needs antibiotics, and people who are unwell with it or whose immune system is weakened should always be treated in hospital. One review, of 52 papers, puts infected cases at about a third of the total; the other describes infection as uncommon.
• Draining with a needle: the reviews differ. One lists it among the general measures. The other recommends against it when the bursa is clearly not infected, because the needle can introduce an infection; after a blow, though, it may shorten symptoms when the swelling interferes with daily activities.
• Steroid injections are not routine. One review says they should not be routinely used for bursitis from repeated pressure: the evidence is weak, and the harms include skin thinning, loss of skin colour and infection. The other allows that one may be performed for confirmed non-infected bursitis in people with high athletic or occupational demands. An infected bursa is not injected.
• Pes anserine bursitis is treated almost entirely without surgery: rest or a substitute activity, ice, anti-inflammatory medication and stretching. American orthopaedic surgeons’ public information says a steroid injection often provides prompt relief.
• Physiotherapy and hands-on treatment. Nothing we read assesses them for bursitis. British Columbia’s health advice includes physiotherapy to strengthen the muscles around the joint.

What a doctor may offer

CARESPACE does not provide these: drawing off fluid with a needle, antibiotics for an infected bursa, a steroid injection in selected cases and, rarely, surgery to drain or remove a bursa that is severe, persistent or keeps coming back.

How each CARESPACE service treats knee bursitis

Physiotherapy

A physiotherapist can examine where the swelling sits and how the knee moves. Anything that suggests infection or gout goes to a physician. For bursitis from pressure the work is practical: finding what is loading the bursa (kneeling at work, a hard floor, a change in training), how to pad or change it, and when to go back to kneeling. For pes anserine bursitis it can include hamstring stretching and a look at hills and mileage. CARESPACE supplies braces and supports.

See our physiotherapy team →

Chiropractic

A chiropractor can assess the knee in the same way and give the same advice on pressure, padding and activity. Nothing we read assessed joint manipulation for bursitis, so an adjustment is not the treatment here. Chiropractors can order X-rays, which are indicated after a recent injury when a fracture is a concern.

See our chiropractic team →

Other services people ask about

Massage therapy and acupuncture: nothing we read assessed either for knee bursitis, and pressing on an inflamed bursa makes it more painful.

Where most people start

With a physiotherapist or a chiropractor. A knee that is hot or red, or a fever, goes to a physician first, the same day.

How your team works together

Knee bursitis is mostly looked after by one practitioner, with a physician for infection, gout or a bursa that keeps refilling.

Browse by service: physiotherapists and chiropractors.

What to expect at your first visit

1. What set it off. Kneeling, a knock, a cut or scrape over the knee, and whether you have felt feverish or unwell.
2. The knee. Where the swelling sits, warmth and redness, and how far the knee bends.
3. What it looks like, and whether a physician should see it first.
4. A first treatment and a plan to leave with: how to protect the bursa and what to change at work or in training.

What you can do at home

• Take the pressure off: avoid kneeling and whatever else sets it off.
• Hold an ice pack wrapped in a towel on the swelling for 10 to 20 minutes at a time, a few times a day.
• Raise the leg when you are resting.
• Ask a pharmacist about a pain reliever such as acetaminophen or ibuprofen.
• When you go back to kneeling, use knee pads or a cushion and take regular breaks.
• Clean any cut or scrape over the knee.

See a physician or nurse practitioner if it has not improved, or is getting worse, after one to two weeks of looking after it yourself.

How long knee bursitis lasts

The NHS says bursitis should go away in a few weeks. Nothing we read gives a recovery time for the kneecap bursa or says how often it returns.

Knee bursitis treatment in Kitchener, Waterloo and Cambridge

Kitchener. Physiotherapy in Kitchener and Chiropractor in Kitchener. Locations: Victoria North, Fischer-Hallman, Westmount East and Deer Ridge.

Waterloo. Physiotherapy in Waterloo and Chiropractor in Waterloo. Locations: Weber North, Uptown Waterloo and Waterloo GoodLife.

Cambridge. Physiotherapy in Cambridge. Locations: Hespeler Road.

The city pages linked above show the locations and practitioners for each service, with their next availability.

Common questions

How do I know if my knee bursitis is infected?

You cannot be sure by yourself: testing fluid from the bursa is how it is confirmed. If the knee is hot or red, or you have a fever, see a physician the same day.

Is ice or heat better for knee bursitis?

Ice. The sources we read recommend it, and none recommends heat.

Can I keep kneeling at work?

While it is settling, avoid the pressure that caused it as far as your job allows. After that, pad the knee and take regular breaks.

Should I have it drained or injected?

For ordinary bursitis from kneeling, usually neither, as the evidence section explains. Both are a physician’s decision.

Where can I have knee bursitis looked at in Cambridge?

Book with a physiotherapist in Cambridge, or call 519-208-2273 and our Central Reception Team will find the closest location with an opening. If the knee is hot or red, or you have a fever, see a physician the same day instead.

Do I need a referral?

No. Book online or call 519-208-2273. You pay at each visit and receive a receipt for your extended health plan. More on fees and insurance →

Sources

• Khodaee M. Common Superficial Bursitis. American Family Physician, 2017.
• Baumbach SF, Lobo CM, Badyine I, Mutschler W, Kanz KG. Prepatellar and olecranon bursitis: literature review and development of a treatment algorithm (abstract). Archives of Orthopaedic and Trauma Surgery, 2014.
• NHS. Bursitis. Reviewed October 2023; its next review was due in October 2026.
• HealthLink BC. Bursitis. Current as of November 2022.
• American Academy of Orthopaedic Surgeons, OrthoInfo. Prepatellar (Kneecap) Bursitis and Pes Anserine (Knee Tendon) Bursitis.
• Bunt CW, Jonas CE, Chang JG. Knee Pain in Adults and Adolescents: The Initial Evaluation. American Family Physician, 2018. This is the edition used; the journal published an update under the same title in 2026, which opens in full only with a login.
• NHS. Knee pain (reviewed December 2023), Dislocated kneecap (reviewed March 2026), Sprains and strains (reviewed April 2024) and Septic arthritis (reviewed September 2026).
• HealthLink BC. Anterior Cruciate Ligament (ACL) Injuries (when to call a doctor after a knee injury). Current as of November 2022.

Related conditions

Knee Pain

Baker’s Cyst

Gout

Knee Osteoarthritis

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