Hoffa’s Fat Pad Impingement

By Sydney CBD Physiotherapist Dr Domenic Simeoni

Knee pain beginning or continuing to trouble you? This blog discusses one cause of knee pain known as “Hoffa’s fat pad impingement.” What is fat pad impingement? Why does fat pad impingement develop?  What are the symptoms of fat pad impingement at the knee? How to treat fat pad impingement? What can a physio do to help alleviate this knee pain? Keep reading to find out!

What is your fat pad?

The knee fat pad, also known as the “infrapatellar fat pad,” or Hoffa’s pad, is a soft structure that lies just below your knee cap and extends underneath the patellar tendon. It is primarily located between the femur (thigh bone) and tibia (shin bone), and acts to provide a cushion between the bones at the bottom portion of your knee. There is a high level of nerve innervation supplied to this fat pad, which means that if it becomes irritated or impinged, it can be one of the most sensitive structures in your knee causing a large amount of discomfort when compressed. 

Why does fat pad impingement develop?

Irritation to the fat pad at the bottom of your knee can develop over time for a variety of reasons. There are several underlying reasons why this region will become irritated, some of the more common causes of fat pad irritation include:

  • A direct blow or fall onto the front of your knee or knee cap
  • Tight quadriceps muscle causing direct compression and impingement of the fat pad
  • Hyperextended knee posture when standing or walking
  • A history of arthritis and swelling along the front of your knee
  • Poor mechanics of the knee joint with walking, running, jumping, or other weight bearing activities

If you are concerned that you may be suffering from a fat pad impingement book an assessment with your physio, osteo or chiro for diagnosis, treatment and self management advice.

Anterior knee anatomy

Posterior knee anatomy

What are the symptoms of fat pad impingement?

Fat pad impingement is typically associated with pain along the front of the knee just below and to the sides of the knee cap, also known as the patella. Depending on the severity of the injury the pain felt can be described as dull and achy, or in worse cases as sharp or stabbing.  The pain will be consistently felt in a similar location each time, and not typically radiate away from the spot of origin. There may also be swelling present around the injured area that is painful to touch or massage which is a clear sign that there is a structure in the knee that is being irritated during activity.

Pain in the front of the knee can also usually be felt when your knee is in a fully straightened  or hyperextended position as this puts extra compression and pressure through the fat pad.

When you develop pain associated with fat pad irritation, it can be felt with activities such as:

  • Walking
  • Squatting
  • Running
  • Going up or down stairs
  • Kneeling
  • Standing up from or sitting down into a chair

If you think you may be suffering from fat pad impingement; book and assessment with a physio, osteo, or chiro today. This will mean a tailored diagnosis, a treatment plan, knee mechanics correction advice delivered to you.

How is fat pad impingement treated?

Firstly, as with many injuries it is always a good idea to stop or reduce the activity that is causing you the pain. This means that first and foremost, a reduction or full stop to exercise may be necessary to initially promote healing of your knee.

During the initial stages of treatment, following the RICE protocol is also important to promote healing and stop your injury from getting worse. RICE stance for Rest, Ice, Compression, Elevation:

Rest – Avoid the activities that cause you pain

Ice – At the painful site

Compress – Through the use of a soft wrap or brace, always best to consult a health professional to learn how to correctly apply a wrap or brace.

Elevate – Place your knee above the level of your heart to allow gravity to drain swelling or oedema away from your knee and back into your bloodstream

wall squat exercise prescription to help with knee pad impingement

Treatment and management of fat pad impingement will often require you to undergo an assessment from a sports medicine doctor, physiotherapist, podiatrist, or osteopath. A thorough assessment of your body’s strength, joint mobility, flexibility, and running mechanics will be performed to identify movement patterns that are causing the development of an injury.

Once the acute pain of fat pad impingement has begun to dissipate, you will work closely with your physiotherapist to address areas of weakness in your core, hips, knee, and ankles that may be contributing to poor knee mechanics. You will also address poor flexibility or mobility at the knee, as well as the hip and ankle. With this combination of strengthening exercise and flexibility or mobility stretching the underlying cause for developing impingement of the fat pad can be alleviated over time.

Physiotherapy treatment for fat pad impingement?

If you are getting pain or discomfort along the front or inside of the knee, it is likely time to consider scheduling a physiotherapy assessment in order to help diagnose exactly what is happening at your knee that is causing the pain, and to begin the healing process. Fat pad impingement is only one possibility for the source of pain along the front and inside portion of the knee, so obtaining a proper and thorough diagnosis is very important to allow for proper healing of an injury.

Following the physiotherapy assessment, your Physiotherapist will be able to educate you on your specific areas of strength and weakness as well as any poor movement mechanics that may be contributing into the problem, giving you insight into why you are having discomfort. This information will also help your Physio to develop a treatment plan aimed at addressing your individual areas of weakness, or helping guide you to improve your movement mechanics.

Altering movement mechanics and  gaining strength or flexibility can take time and effort, but with the correct guidance you will find that pain along the front of the knee will dissipate and movement becomes easier and less taxing on your body, allowing you to exercise with less wear and tear on your body!

Physio or osteo can assess and treat your knee fat pad impingement
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