Anatomy Nerd

I noticed that I was feeling pain near my left knee whenever I bent forward at the hip. It didn’t make any difference if the knee was straight or bent, bearing weight or not. It’s been over twenty years since I studied anatomy formally, but I have lots of friends who are massage therapists, so I figured somebody would be happy to school me on this condition. I posed an anatomy challenge on social media that went something like this: Hey anatomy nerds, what do you think of this: I flex the hip and feel pain below the patella, medial/anterior surface of the leg. 

I thought I’d used appropriate anatomical language, but I made one mistake: I should have said the location of the pain was “distal to the patella,” which means closer to the foot than, say, to the belly button. “Below the patella” can also be interpreted as “deep to the patella,” which would mean more interior rather than toward the skin. The most anatomical responses to my question were based on an understanding of the pain as deep to the patella: a trigger point massage therapist suggested trigger points associated with deep knee pain; a nurse suggested ligament injury. These are both good suggestions for pain in that location. Neither of these people offered any other ideas after I clarified.

A bodyworker/Psych-K practitioner associated the pain with an emotional issue that we had talked about in my last Psych-K session with her, and I think she was right.

A massage therapist/yoga instructor/dancer told me some stretches and strengthening exercises that give her relief when she feels the same pain.

A sound engineer who is holistically minded told us all that looking for anatomical answers to problems isn’t holistic, and we should see a TCM (Doctor of Traditional Chinese Medicine) for dietary advice. (I’ll save for another time my thoughts about that.)

No one attempted to explain the anatomy of the condition, even after I gave them a hint: pes anserine.

The pes anserine, which means “goose’s foot” is the site of attachment of three muscles to the tibia, which is the bigger bone of the lower leg. A slight depression occurs at this spot, and its shape is said to resemble the footprint made by a goose. There’s a mnemonic to remember the three muscles: Silly Goose’s Toes, SGT, for Sartorius, Gracilis, and semiTendinosis.

All of these three muscles attach to pelvic bones at the top, and cross the knee joint at the other end. Sartorius is the muscle that raises your leg to sit criss-cross applesauce. Gracilis is an adductor of the upper leg, which means it pulls the leg toward the midline from a spread-eagle position. It’s the only adductor that crosses the knee joint. Semitendinosus is a hamstring, which pulls the upper leg back, and bends the knee.

Right after I left the hint, I searched “pes anserine,” and found the description of my condition right away. It turns out there is a pes anserine bursa, which can get irritated. This was news to me; I’d thought bursae, fluid-filled sacs that lubricate movement between tissues, were all associated with joints. But when you think about the actions of all the muscles involved, you can see why I couldn’t bend the hip in any comfortable way: every direction I moved pulled at least one of those muscles, irritating the inflamed bursa at their shared point of attachment.

Apparently pes anserine bursitis is one of those odd conditions that are generally caused by either an injury, or being a middle-aged woman. I guess living through middle age as a woman is akin to being overworked and injured.

The pain was mostly gone by the time I figured out what it was, and it wasn’t ever really an urgent problem, I just thought it would be fun to talk anatomy. I was surprised to discover that, after all these years, I’m the biggest anatomy nerd I know.