Housemaid's knee is a common term for prepatellar bursitis, a swelling of the bursa in front of the patella (kneecap) just beneath the skin, often caused by trauma brought about by excessive kneeling. It may be of sudden onset (acute) or can become chronic, but there are ways to treat and prevent the condition.
Common symptoms include pain and tenderness on the kneecap and just below it, with the knee swollen and warm to the touch. You may even see a fluid-filled lump over the knee. In chronic cases, the lump may feel like it's floating underneath the skin. In either case, it will be difficult to kneel.
Treating Acute Cases
With a flareup of housemaid's knee, use the RICE (rest, ice, compression, elevation) technique: rest the joint; place an ice pack or bag of frozen vegetables wrapped in a tea towel over the knee for 20 minutes at a time every 2-3 hours; use a elastic bandage or neoprene splint to wrap the knee, but not too tight (your knee, leg and angle shouldn't be numb or change colour); elevate the knee on a bed, pillow or chair, keeping it above heart level.
After the first 3-5 days, you can alternate cold and heat treatments by applying cold for 10 minutes, followed immediately by 10 minutes of a heating pad or wrap. Alternating hot and cold water from a shower head is another idea. You can also use painkillers and anti-inflammatory medications like aspirin and ibuprofen. If you modify activities and stay off of the affected joint, the symptoms should resolve within two weeks.
Treating Chronic Cases
Patients with a chronic condition of housemaid's knee should avoid kneeling, or if this is impossible, wear padded knee supports. If the bursa has become infected, your doctor may need to prescribe antibiotics. If swelling persists, then the doctor may drain some of the fluid from the bursa, although this can risk further infection. Hydrocortisone can be injected into the knee, but it doesn't help in all cases. In the most serious cases, the bursa may have to be surgically removed. While there have been few studies on using herbs for cases of bursitis, anti-inflammatory herbs that may be helpful include boswellia, turmeric, willow and topical cayenne ointment.
The best way to avoid housemaid's knee is to avoid kneeling for any period of time or any other activities that cause repeated friction between the skin and kneecap. With some occupations this may be difficult, and people have been known to change professions because of recurrent knee problems. If this is not possible, at the very least wear padded knee supports or develop an alternate way of doing the work, such as using a small stool instead of kneeling.