Q: What's the best way to treat housemaid's knee? I'm afraid I have a bad case of it from playing with my grandchildren on the floor.

A: Housemaid's knee is a term sometimes still used to describe bursitis. Bursitis is the inflammation of a bursa. A bursa is a sac made of thin, slippery tissue. Bursae (plural) occur in the body wherever skin, muscles, or tendons need to slide over bone.

Bursae are lubricated with a small amount of fluid inside that helps reduce friction from the sliding parts. They can also be found between muscle and fibrous bands of connective tissue. Four of the most common areas where bursitis develop are the knee, elbow, hip, and heel. Causes of bursitis include trauma, inflammation, and infection.

Treatment depends on the underlying etiology (cause) of the problem. The diagnosis is made based on patient history, symptoms, and special tests. The problem must always be sorted out carefully as the same symptoms can occur with tumors, arthritis, fractures, tendinitis, and nerve damage. Sometimes bursitis is a secondary problem caused by some other disease process such as gout or sarcoidosis.

Treatment is usually conservative (nonoperative) care. Rest, activity modification, and medications such as antiinflammatories (for pain and swelling) or antibiotics (for infection) are the main management tools. Stretching the soft tissues around the bursa may help. Applying a compressive wrap or garment around the knee may give some relief from the painful symptoms but may not eliminate the problem.

Surgery to remove the bursa (called bursectomy) is usually reserved for patients who do not respond to nonsurgical care. There is always a risk of additional problems or complications with any surgery, so this is not the first step in treatment. But it has its place when all else fails.

In your case (kneeling and/or crawling on the floor), a knee pad may be helpful as well. Something as simple as the type of protective pads carpet layers wear may be all you need. Try it out and see how it feels. Something with memory foam or compressed foam will offer the best support. Limiting your floor activities may be required until you get the symptoms under control.

Reference: Daniel L. Aaron, MD, et al. Four Common Types of Bursitis: Diagnosis and Management. In Journal of the American Academy of Orthopaedic Surgeons. June 2011. Vol. 19. No. 6. Pp. 359-367.