You've spent the week on your knees: laying tiles, working under a sink, weeding a garden bed. Now there's a soft, puffy swelling sitting right on top of your kneecap. It's tender, a little warm, and awkward to kneel on. There was never a moment you could point to as the injury. It just appeared.
That's prepatellar bursitis. Its old name is housemaid's knee 4, and that name tells you most of what you need to know about how people end up with it.
A bursa is a small, fluid-filled sac that acts as a cushion between bone and soft tissue 2. The prepatellar bursa sits between your kneecap and the skin over it. It's so close to the surface that you can see and feel it when it fills with fluid. That's why it looks alarming, and also why it's fairly easy to recognise.
The two common causes are injury and overuse 2. For this bursa, overuse nearly always means kneeling, repeatedly and for long stretches 1. Laying carpet and production-line packing are named work triggers 2, and tilers, plumbers, roofers and gardeners fall into the same pattern. Doing the same movements every day, or putting sustained stress on a joint, raises the risk 2. The other route in is a direct blow to the front of the kneecap.
Some things make it more likely. Carrying extra weight increases the risk of knee bursitis, and gout, rheumatoid arthritis and diabetes can all contribute 2.
The mechanism is simple. This isn't a fault inside the knee joint. It's a cushion at the front of the knee that's been pressed on more than it can tolerate, so what settles it is changing what presses on it.
This is the distinction that matters most, because the two can look alike and are treated very differently.
Bursitis here comes in two forms: septic (infected) and non-septic. Across prepatellar and olecranon bursitis together, roughly one in three cases is septic 5. That's not a rare complication.
The signs that point towards infection are specific: a fever above 37.8°C, skin over the bursa noticeably warmer than the skin around it, and cuts or breaks in that skin 5. In everyday terms, watch for a high temperature, or feeling hot, cold or shivery 3.
Confirming it is a medical job, not a physiotherapy one. A GP may draw off fluid from the bursa to test for infection and gout 1,3. Blood tests, an x-ray or an ultrasound can help rule out other causes 1,2. Septic bursitis is treated with antibiotics 5.
Swelling over the kneecap with a fever, or skin that's hot and angry, needs a GP visit the same day. Once infection is ruled out, the rest is straightforward.
If your pain sits below the kneecap rather than on top of it, with no puffy swelling, that's a different pattern. Patellar tendinopathy is the page to read next.
This one is mostly diagnosed by looking and feeling. Bursitis is usually picked up on physical examination 6: a tender, warm swelling sitting right over the bursa 2. Your doctor will ask how long it's been there, how sore it is, and what puts you at risk of it. They'll also ask about fever or chills, because an infected bursa needs a different plan 6.
Then they'll compare the sore knee with your other one, press around it for tenderness, and see how far it bends before pain stops you 6. If an X-ray is ordered, it's to check that a fracture or another bone problem isn't behind your symptoms 6.
Once infection is ruled out, the evidence points one way: conservative treatment 5. Here's what that looks like with us.
Government health guidance also lists occupational therapists alongside physiotherapists for bursitis. They can help you find ways to change the activity that caused it 1,2. If your knee problem is really a work-setup problem, that's a useful referral, and we'll tell you so.
Protection, rest, ice, compression and elevation is the standard first response 1. Use an ice pack wrapped in a tea towel for about 10 minutes at a time, repeated every few hours 3. Avoid knocking or banging the knee while it settles 3.
Braces or splints can reduce stress on the area and support good alignment 2. That's a mechanical reason, not a proven outcome. But if you have to keep kneeling for work, good padding is often the most practical change you can make.
Paracetamol or anti-inflammatories such as ibuprofen are commonly used for bursitis 3,5. Physiotherapists don't prescribe medication, so ask your GP or pharmacist.
This is a medical procedure that we don't perform. It's a standard part of managing both forms of bursitis, and it's also the test that tells them apart 5. There is a trade-off: a procedure on the joint is one of the things that raises the risk of infection afterwards 1.
The evidence puts this well down the list for this bursa. A treatment pathway built from the published literature reserves it for people with confirmed non-septic bursitis and high athletic or occupational demands 5. That's a narrow group. Corticosteroid injection into a joint also raises the risk of joint infection and can, rarely, cause tendon rupture 1. And an infected bursa should never be injected with steroids 3. This is a decision for your GP or specialist, not us.
Cutting and draining the bursa, or removing it, is reserved for severe cases, cases that don't respond to treatment, and bursitis that is long-standing or keeps coming back 5. Even for infected bursae, the reviewed evidence did not support removing the bursa straight away 5.
Once infection has been ruled out, a swollen kneecap bursa follows The Well Motion Recovery Path™. You move up a phase when the knee tolerates more pressure, not when a week ends.
How long it usually takes. Bursitis in general should settle in a few weeks 3. No source we found gives a figure for this bursa alone. If it keeps coming back and a surgeon removes the bursa, the timeline is theirs: a systematic review of 10 studies reported 80% of people treated endoscopically were pain free after 1 year 9.
No trial has tested kneepads, or anything else, for preventing prepatellar bursitis. So these go after its known causes:
Most bursitis can be treated at home and should settle in a few weeks 3. Get it assessed rather than carrying on alone if 3:
Act quickly on the fever and heat signs, because that could be infection and it means a GP today. The rest usually just means whatever is driving it hasn't been found yet. That's a solvable problem.
We start by listening: how it began, what makes it worse, and what it's stopping you from doing. Then we examine the area, explain what we find in plain English, and agree a plan with you. Your first visit is 40 minutes at Engadine and 30 minutes at our other clinics.
We see patients at Engadine, Mount Annan, Narellan and Appin, and at home through our mobile physiotherapy service. If you have private health cover, here's how health fund rebates work for physiotherapy.
Bursitis can usually be treated at home and should go away in a few weeks 3. That figure is for bursitis in general, not this bursa specifically. None of the sources we used gives a separate timeline for the knee. The earlier checkpoint matters more: if one to two weeks of self-care hasn't helped, or it's getting worse, get it looked at 3. What usually makes it drag on is going back to the same kneeling load before the bursa has settled.
None of the sources we used looks at walking specifically, so we won't claim it's been shown to help or harm. The guidance says to avoid activities that cause or worsen your pain 1, and that gentle mobilising exercise is part of treatment 2. With prepatellar bursitis the problem is usually kneeling and direct pressure, not walking on flat ground, so most people can keep walking. If yours clearly gets worse with it, mention that at your assessment.
Don't knock or bang the joint 3. Don't go straight back to the activity that triggered it without changing how you do it 2. Don't stop moving the knee altogether: gentle mobilising exercise is part of treatment 2. And don't treat a hot, swollen knee with a fever as ordinary bursitis to ice at home. See a GP 3,5.
Usually, yes. Most cases settle within a few weeks 3. The catch is that it can come back. If the kneeling carries on unchanged, the bursa has no reason to stay settled. You can't always prevent bursitis, but you can reduce flare-ups by changing how you normally move 1. That means taking breaks during repetitive tasks, avoiding or modifying the movement that caused it, keeping to a healthy weight 1, and using padding when you kneel 3.
A twist or sudden change of direction, often with a pop at the time, and a knee that hasn't felt trustworthy since.
Read morePain on the outside of the knee that builds through a run, settles with rest, then comes straight back on the next one.
Read moreAn ache at the front, around or behind the kneecap. Worse on stairs, on hills, and after long sitting.
Read moreCatching, locking or swelling after a twist, sometimes with a knee that won't fully straighten.
Read moreA tender, bony lump just below the kneecap in a growing, sporty teenager.
Read moreMorning stiffness and an ache after activity, building over years rather than days.
Read moreThe MCL runs down the inside of your knee. Most injuries happen when something hits the outside of the knee and forces it inwards; it's the ligament most commonly injured in knee trauma.
Read moreA patellar dislocation is the kneecap being forced out of its groove at the end of the thigh bone. It almost always goes outwards, towards the outside of the knee.
Read morePatellar tendinopathy, often called jumper's knee or patellar tendonitis, is pain in the tendon just below your kneecap that builds when the tendon is overloaded.
Read moreA Baker's cyst is a build-up of fluid behind the knee, usually excess fluid from the knee joint itself.
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