I am back cycling medium distances but I am wary of putting my knee under too much stress on the hills. Prior to this bursa, I was regularly cycling 50 to 70 miles, and in 2011 managed a tour across the Pyrenees. Is the bursa likely to rupture under the stress of riding up hills or mountains?

Name and address supplied

A bursa is a fluid-filled sac that usually occurs over joints, or between tendons and bones, in order to reduce friction between surfaces. When a bursa becomes inflamed, it is usually painful and swollen. This is bursitis.

Although there are very many bursae in the human body, two (ischiogluteal and pes anserine) most often cause problems in the hamstring area. The hamstring muscles are at the back of the upper leg and serve to bend the knee and straighten the hip.

Ischiogluteal bursitis causes pain in the lower buttock and is made worse by sitting. Pes anserine bursitis causes pain on the inside of the leg just below the knee. They can result from repetitive motion such as cycling or running, and may be exacerbated by tight hamstrings, over-training and excessive force.

Initial treatment should be to rest the affected area and apply an ice pack. Pain and swelling may be eased with anti-inflammatory medication such as ibuprofen. Stretching exercises before and after a ride, along with strengthening exercises, can help. Some types of bursitis respond to a steroid (cortisone) injection.

Many cases resolve within a few weeks or months. In your case, the bursitis sounds more prolonged. You won’t ‘eliminate the bursa’ as it is meant to be there. What you are trying to do is suppress the inflammation. Increase your activity level gradually, as long as the pain does not recur. Your GP’s advice to ‘listen to your body’ is sensible. If you find the problem recurs, consult a physiotherapist.

I haven’t come across a bursa rupturing while cycling, but it may provoke the bursitis to flare up.

Dr Matt Brooks

This was first published in the April / May 2013 edition of Cycle magazine.