You've been clocking more trails on the North Shore, local mountains, or logging longer runs along the Seawall, and somewhere around kilometre five — or on the way back down from a steep descent — you start to feel it. A nagging ache on the inner side of your knee, just below the joint. Not sharp enough to stop you, but persistent enough to make you worry.
That specific spot has a name: the pes anserine. And it tends to flare up right around the time Vancouverites get back into full summer activity mode.
What Is Pes Anserine Tendonitis?
The pes anserine (Latin for "goose foot") is where three tendons converge on the inner, lower portion of your knee — the sartorius, gracilis, and semitendinosus. These muscles run along the inner thigh and hamstring, and they all anchor together just below the knee joint on the shin bone.
When this area is overloaded — from repetitive bending, uphill climbing, or a sudden jump in mileage — the tendons and the small bursa beneath them can become irritated and inflamed. The result: pain and tenderness on the medial (inner) side of your knee, typically 2–5 cm below the joint line.
It's commonly mistaken for a meniscus issue or MCL strain, which is why getting an accurate assessment with a physiotherapist matters.
Why Does It Happen to Runners and Hikers in Summer?
This one comes down to a few familiar patterns.
Too much, too soon. After a quieter winter, it's tempting to go straight into long weekend hikes up Grouse or back-to-back running days. The pes anserine tendons adapt slowly — much slower than your cardiovascular fitness. Pushing the distance or elevation before the tissue is ready is the most common trigger.
Downhill mechanics. Descending puts significantly more load through the medial knee than flat running. Hikers in particular notice symptoms after long downhill sections where the knee flexes repeatedly under load.
Hip and glute weakness. When your hip abductors and external rotators aren't doing their job, your knee tends to collapse inward (valgus) with each step. This shifts stress onto the inner knee structures — including the pes anserine — with every single stride or step.
Tight hamstrings and adductors. Limited flexibility in these muscles increases tension through the tendons at their insertion point, making them more susceptible to irritation.
How We Help: Physiotherapy and Massage Therapy for Pes Anserine Tendinitis
What a Physiotherapist Will Look For
At our clinic on West Broadway in South Granville, a physiotherapy assessment will go beyond the knee itself. Your physio will examine how your hip, knee, and ankle work together — because pes anserine tendinitis is almost always a mechanics problem, not just a local tissue problem.
Treatment typically includes manual therapy to reduce local irritation, progressive loading exercises to rebuild tendon tolerance, and targeted strength work for the hips and glutes to correct the biomechanical drivers.
Running or hiking gait analysis may also be part of the picture — especially if you're preparing for a summer race or a backcountry trip and can't afford to take weeks off.
How Massage Therapy Helps
Tight hamstrings, adductors, and medial quad muscles contribute directly to pes anserine loading. An RMT can work through these tissues to reduce tension and improve mobility around the knee and hip.
Massage therapy works best in combination with physiotherapy for this condition — the soft tissue work supports the rehab by giving your muscles more length and responsiveness to work with.
We offer direct billing to most major extended health insurers, so you can focus on getting better rather than managing paperwork.
5 Things You Can Do Right Now
1. Back off the hills temporarily. You don't need to stop moving entirely — flat running or cycling is usually better tolerated. Give the tendon a break from high-load flexion before gradually reintroducing hills.
2. Ice after activity. Apply ice for 10–15 minutes to the tender spot after exercise. It won't fix the underlying issue, but it helps manage irritation in the short term.
3. Strengthen your glutes and hips. Clamshells, side-lying hip abduction, monster walks with a resisted band, and single-leg eccentric squats off a step are your friends. Weak hip abductors are one of the most common drivers of medial knee overload.
4. Stretch your hamstrings and adductors daily. Hold each stretch for at least 30–45 seconds, twice per day. Don't rush this — tendon-related conditions respond better to consistency than intensity.
5. Check your footwear and running surface. Worn-out shoes or always running on the same cambered road surface can contribute to valgus loading. Rotate your routes and replace footwear regularly.
Frequently Asked Questions
How do I know if my inner knee pain is pes anserine tendinitis and not a meniscus tear?
The location is the key differentiator. Pes anserine pain sits 2–5 cm below the joint line, while meniscus pain tends to sit right at the joint line. That said, both conditions can coexist, and the only way to know for certain is a proper clinical assessment. A physiotherapist can usually differentiate these without imaging during a hands-on exam.
Can I keep running or hiking with pes anserine tendinitis?
Often yes — but with modification. Complete rest is rarely the right answer for tendon issues, since tendons need load to heal. The goal is finding the right amount of load: enough to stimulate adaptation without provoking symptoms. Your physio will help you map out what that looks like for your specific activity level and goals.
How long does it take to recover from pes anserine tendinitis?
Mild cases with early treatment can resolve in 4–6 weeks. More chronic or significant presentations may take 8–12 weeks of consistent rehab. The biggest predictor of recovery time is how long the issue has been going on before treatment starts — which is a good reason not to wait it out.
Ready to Get Back on the Trail?
If that inner knee ache has been following you around on your summer runs or hikes through Kitsilano, South Granville, or beyond, it's worth getting it looked at before it sidelines you for longer than you'd like.
Our team at Therapy X Clinic — on West Broadway in South Granville — includes physiotherapists, RMTs, and other healthcare professionals who work regularly with active Vancouverites navigating exactly this kind of overuse injury. We offer direct billing to most major extended health plans, including ICBC and WorkSafe BC so booking is easy.
Book an appointment online or call us at 604-742-3688 to learn more about how Therapy X can help you get back to the activities that make Vancouver summers worth it.
