Hoffa’s (Knee) Fat Pad Impingement Syndrome - Causes & Treatment

Fat pad impingement (also called Hoffa's fat pad impingement syndrome) affects the fat pad in the front of you knee. Sports physio Maryke explains what causes this painful condition and discusses the pros and cons of 12 treatment options, ranging from exercises, taping, and orthotics to surgery.
👉 Examples (on Amazon) of some of the treatment solutions she mentions in the video:
✅ Heel raising shoe inserts: geni.us/2tvfBEu
✅ Orthotics for overpronation: geni.us/dEHA2x2
✅ Zinc oxide tape: geni.us/CxTj1P
✅ Hypafix tape: geni.us/WsYg1y
🌟Need more help with an injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan: www.sports-injury-physio.com/
📽️ Other videos mentioned in this one:
▶️ Taping technique: • Taping Technique for A...
▶️ Icing: • How Long to Ice an Inj...
▶️ Glute bridge progressions: • Glute Bridge Exercise:...
▶️ Exercises for overpronation: • Foot Pronation Exercises
📚Chapters in this video:
00:00:00 Introduction
00:00:49 Anatomy & function
00:02:07 Causes of fat pad impingement
00:04:06 Fat pad impingement diagnosis and symptoms
00:09:04 Treatment options for fat pad impingement
00:21:38 How we can help
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👌If you want to show your appreciation for the advice you found here, you can support my channel by making a donation via PayPal: bit.ly/SIP-channel
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References:
Abelleyra Lastoria, D. A., et al. (2023). "Predisposing factors for Hoffa’s fat pad syndrome: a systematic review." Knee Surgery & Related Research 35(1): 1-14.
Kitagawa, T., et al. (2022). "Effect of physical therapy on the flexibility of the infrapatellar fat pad: A single-blind randomised controlled trial." PLoS One 17(3): e0265333.
Mace, J., et al. (2016). "Infrapatellar fat pad syndrome: a review of anatomy, function, treatment and dynamics." Acta Orthopædica Belgica 82: 1-2016.
Hannon, J., et al. (2016). "Evaluation, treatment, and rehabilitation implications of the infrapatellar fat pad." Sports Health 8(2): 167-171.
Dragoo, J. L., et al. (2012). "Evaluation and treatment of disorders of the infrapatellar fat pad." Sports Medicine 42: 51-67.
👉Some links here are affiliate links that go to places where you can buy something relevant. If you buy something on those websites we may get a small commission at no extra cost to you.

[@SportsInjuryPhysio]

👉 Examples (on Amazon) of some of the treatment solutions I mention in the video: ✅ Heel raising shoe inserts: geni.us/2tvfBEu ✅ Orthotics for overpronation: geni.us/dEHA2x2 ✅ Zinc oxide tape: geni.us/CxTj1P ✅ Hypafix tape: geni.us/WsYg1y If you buy anything via these links, we may get a small commission at no extra cost to you.

[@lesleybarnor]

The absolute best video online about fat pad injury and I’ve searched for hours. Over weeks. Many suggest the causes but then the treatments they offer immediately causes swelling. This is the first video to offer advice that starts right from serious injury of Hoffas - very early stages. Thank you!!! So in depth. So detailed. So perfectly broken down . There’s nothing she left out. What incredible asset to this industry. Thank you 🙏🏾 so much. For even helping my diagnosis.

[@SportsInjuryPhysio]

You're very welcome!

[@vickilittel8630]

I wish she were located near me. She seems so knowledgeable and compassionate. The doctors I have seen just fat shame me and tell me to lose weight. They automatically assume I am lazy, which I'm not. How am I supposed to increase my exercise if it causes increased pain?

[@lesleybarnor]

Precisely! Well done for not giving up and doing your own research! Now there’s a way out!

[@samuelgray8214]

This was really helpful

[@vvkishore]

Brilliant! Extremely detailed and well informed!!! 👍

[@SportsInjuryPhysio]

Thank you kindly!

[@SarahOnAir3]

WOW! This video was absolutely eye opening. I fell and injured my fat pads in January of 2021, it was a workers comp case so part of my issue is definitely how slow the state was in approving things. But, over 2021 and 2022 I had PT on both knees and it helped, but didn't fix it. I was told I have bi-lateral Patellofemoral syndrome, a touch of patella tendonitis, and IFP impingement / Hoffas I both. In Jan of 2023, I did three rounds of hypersonic injections, that was SO much more painful and really, really hurt. In the fall of 2023 we finally did surgery with a subtotal removal of inflamed hoffas. But now I'm 9 months post op on my right, and 6 months post op on my left, and my pain is so much worse than before surgery, I don't know what to do. I am thinking maybe it's scar tissue..? I also scored high on the Brighton test so maybe it's hEDS? The state is denying more PT, and I am in tons of pain. I don't know what to do!! :(

[@jopont6823]

super informative video, well done Maleke

[@SportsInjuryPhysio]

Thank you kindly

[@ricardos.4456]

Best video about Hoffa syndrome I’ve seen! Thank you! Figuring out how to solve mine… trying electrolisis with the PT now as well as correcting muscles, loads and postures (acl injury a year ago). I wish I discovered this video earlier, because not all PTs know about this!

[@SportsInjuryPhysio]

Thanks for watching!

[@gskylexkk7280]

Very useful and helpful. Thanks

[@SportsInjuryPhysio]

Glad it was helpful!

[@rubaalbarghouthi]

Very informative video 👍 thanks you so much for your time and effort 👌

[@SportsInjuryPhysio]

So nice of you

[@theresathompson2270]

Suffering with this at the moment, your video was so helpful, thank you

[@SportsInjuryPhysio]

Glad you found it helpful!

[@birgittaskavollberrahou294]

You are a great fysio! This comes from a medical doctor and fysioherapist with a Hoffa´s knee at the moment :)

[@SportsInjuryPhysio]

Thank you! And good luck with your recovery.

[@maxw5900]

Wonderful information. I've had this issue for years and I couldn't figure out what it was, thanks!

[@lmaarcl]

Did the treatment she described help you to solve it?

[@jayhutt1]

I spent a couple of weeks up on a ladder painting my home, with my knees locked! Towards the end of the project the pain began in my right knee. After much research and having a background in musculoskeletal anatomy I believe that this is my problem. Thank You so much for the information and guidance presented here!

[@SportsInjuryPhysio]

You're welcome!

[@marionym5969]

Thanks for the video. I think I have have exactly this. Since a scar tissue removal surgery I have patellar maltracking and I can’t figure out why. I didn’t have this impingement before surgery and now I have it and something always gets stuck under the inside of my patella. My patella is hanging inside knee. What can I do for this?

[@laurakoch7734]

Which physiotherapist would you recommend for an online consultation (I think they are all good). But I was in long rehab for quadriceps attachment tendinosis from running and just before I could start running again, I got an unclear diagnosis on the other knee. I think it's patella tendinitis or hoffitis. Unfortunately, the first measures didn't work and I can't do anything anymore. So it would be great to come across someone who specializes in running and injuries like this. Thank you!!!

[@SportsInjuryPhysio]

You're right, they're all good :-) Barry and Kevin would be especially good with treating the issues you describe.

[@yuanzhengkim1957]

Can I have ultrasound therapy for hoffa fat pad? It's been like this for over four years,thanks very much!

[@SportsInjuryPhysio]

Ultrasound won't do any harm but it also doesn't really help for this.

[@user-il8jv5gh1u]

Thank you for this. I feel this is what I'm suffering with at the moment, although my physio is going more down the lines of the IT band. 95% of the day my knee is fine, but I find if I sit at my desk I tend to straighten out my leg - and then when I stand up I get the pain. I also get it when walking down/up hill on occasions if it's irritable. It has stopped me running though, and after about 1.5k gets to the point I can only jut about walk on it.

[@SportsInjuryPhysio]

If you want help figuring it out, this is something that our team of physios can assess and help with via video call. You can read more about the video call service here: www.sports-injury-physio.com/

[@fayyazakhtar720]

Great

[@0Nikotyna0]

My physio diagnosed my with this syndrome, asked to ice it and gave me some exercises. It’s been two months now and the only time the knee is hurting is if i start running, usually after 2-3km it gets me again. Any other exercise, cycling, rowing, stairs climbing are fine. I can’t feel it anymore as well when hyperextending my leg. Do you think it’s a matter of resting it even longer? I really would like to come back to running again and this is the only activity I feel the knee - it’s not painful, but discomfort is there so I don’t want to push it and just stop.

[@SportsInjuryPhysio]

You likely need to focus a bit more on other rehab and exercise more but you also perhaps need to ease into running a bit more slowly and think about what you are doing while you run. E.g. instead of doing continuous runs, do few minutes jog and then walk. But while you run and walk make sure you don't overstride (not placing foot down far in front of you) because that can cause impingement - when you run, try and make contact closer underneath your body. For me it helps if I think about pulling my feet up to my butt rather than driving into big stips with my quads.

[@mindymay3]

This fits my issue to a T! Thank you. I also have several of the other knee problems you mentioned. My question is, I've had this for a few days now, and today, I started getting shooting pain from my knee up my thigh without any movement. Can this be part of it?

[@SportsInjuryPhysio]

I would perhaps also speak to your doctor and just check if perhaps you have an inflammatory condition - because excessive inflammation can sometimes cause that type of pain at rest. But it may also happen when you keep your knee too still. So, it is a bit difficult to give a very clear answer as to what is normal in your case. If you wanted help figuring this out and rehab plan, this is something that our team of physios can assess and help you with via video call. You can read more about how the online consultations work here: www.sports-injury-physio.com

[@mindymay3]

@@SportsInjuryPhysio Thank you so much for your detailed reply! My knees do swell a lot; I have a Baker's cyst, probably a torn meniscus, minimal articulate cartilage, etc. 'Former' runner. 😕I have had bloodwork to check for inflammatory issues, and those were negative. I'll keep your rehab plan in mind, thank you!

[@SportsInjuryPhysio]

You're welcome!

[@Memozmania]

Hi . I have patella alta and hoffa fat pad syndrome in both knees from last 10 months.. I have done physio throughout the period but irregularly. The pain is still there and my left knee locks when i try to sit with crossed legs. Your suggestive advice will be appreciated 🙌..

[@SportsInjuryPhysio]

I can't really provide any extra advice that in the video because I don't know all the details of your case. For physio to be effective, you must work closely with your therapist so they can adjust your plan and provide treatment advice depending on how your condition changes. So, I would suggest that you get a review from your physio. Or if you wanted a second opinion, this is something that our team of physios can assess and help you with via video call. You can read more about how the online consultations work here: www.sports-injury-physio.com/services

[@mikaelacather6462]

what exercises would be best for someone who has this condition and low hamstring tendonitis?

[@SportsInjuryPhysio]

It's best to get a bespoke rehab plan since your exercises has to be adjusted depending on how sensitive your knee is into all directions, but I discuss low hamstring tendonitis exercises in this video: kzbin.info/www/bejne/borGkIqrps53qLc If you wanted help with your rehab and an exercise plan, this is something that our team of physios can assess and help you with via video call. You can read more about how the online consultations work here: www.sports-injury-physio.com/

[@mikaelacather6462]

@@SportsInjuryPhysio Thank you!

[@ancientdiscoverys]

Does this sometimes cause a tapping noise at the site if the fat pad when the knee is fully extended?

[@SportsInjuryPhysio]

That's not something I've come across before.

[@itsmrBaka]

has anyone purchased a knee brace that has helped avoid further injury/aggravation? i’m in a soccer league and have identified my knee pain as hoffa’s since hyperextension is the only time i ever feel pain. i do plan on getting checked, but for now will do some rehab at home and use a brace outside of games(unless the one suggested is able to be used without constricting movements)

[@SportsInjuryPhysio]

The problem with braces is that they all tend to apply pressure over that area, so you will have to look for one that only has a thin strap support - something like this geni.us/74f6 but perhaps you can find a more compact one - but these types of braces are usually on the pricier side and in my opinion overkill for this type of condition.

[@davidquevedop]

Hello, I am from Mexico and I practiced athletics, 3 months ago I suffered a grade 1 tear in the long head of my femoral bicep, it was a 6 cm tear with a length of 0.79 cm, I never stopped walking normally but to date I have not been able to run 3 weeks ago I went to get checked and I still have a 3cm tear. But I ask you, why is it that in these 3 months the pain has not gone away? And if you consider it a good idea to strengthen even if you are torn I really liked your content and your knowledge on these topics since the information I have found in Spanish is quite old and mediocre. si ve este mensaje gracias por su atención, de verdad lo aprecio mucho:)

[@davidquevedop]

The story of my injury is very strange in my opinion. One day while I was running I heard my muscle thronge and I went to the physiotherapist at my university and he told me that it wasn't a tear, which I believed him, the fact is that I couldn't run and I didn't stop lifting weights 2 weeks after my injury. I trusted myself because it never hurt me, it only hurt when I did that exercise, I tried to run and when I had gone 30 meters I heard how it sounded like a strong, dry tear, they told me IT WAS NOT A TEAR, which I trusted. I wasn't going to know that since that day the pain has never gone away again, compression doesn't help me and before in physiotherapy they gave me ultrasound and laser. but a month ago they said they didn't want me to go anymore and my leg is all blistered from so much heat that I apply I really have learned a lot from your videos and I'm sorry if my words are not understood, I'm using Google Translate xd

[@davidquevedop]

I really have already spent more or less 600 dollars on ultrasounds and supplements for the tear and I still don't see much improvement :(

[@SportsInjuryPhysio]

This type of injury can take 9 to 12 months to fully recover so it is normal for the pain to not yet have gone. It is important that the rehab exercises you do must be set at the correct level - if they are too intense for your tendon's current tolerance or just simply in the wrong position then they will also make your pain worse. The rule with rehab and exercise is usually that it is OK to do as long as: 1. It only causes a slight discomfort while doing it, AND 2. It does not cause an increase in your pain and swelling that lasts for more than 24 hours So, your rehab has to be adapted to fall into those guidelines. This video explains more about distal hamstring tendonitis. If your doctor has said that you can start rehab for your tear, then the advice may also be right for your case: kzbin.info/www/bejne/borGkIqrps53qLc

[@amradel3048]

Hi there! I think this is the culprit for me. I've surmised that pain is felt when laying on my back and trying to hyperextend my knee or after being in a lotus yoga pose then standing and loading the knee. Also, when standing my knee gives way and overextends without much resistance. Would really appreciate your take on this.

[@amradel3048]

I forgot to mention that pain is more along the joint line of my outer knee, not under the patella

[@SportsInjuryPhysio]

It does sound as if you're pinching something in that position, but because your pain is more to the outer side it may not be the fat pad. Regardless of what it is, you should be able to get it to settle down and recover by following the same advice about avoiding those positions and getting into the habit of controlling your knee better rather than just passively letting it go into hyperextension.

[@DevelopingNL]

I like to run in minimalist shoes! Like Vibram Fivefingers - is that ok on all surfaces?

[@SportsInjuryPhysio]

I can't really answer that because I don't know your situation etc.

[@DevelopingNL]

@@SportsInjuryPhysio I just want to know if it is bad for the body to walk and train in minimalist shoes on hard artificial surfaces?

[@SportsInjuryPhysio]

It can give you injuries to your metatarsal bones and plantar fascia - some people manage to do it but others don't

[@happy_bulls7457]

Any chances of returning to sports with bulge Hoffa fat pad ?

[@SportsInjuryPhysio]

I'm not sure what you mean with bulge Hoffa fat pad

[@markjustinealinsugay1249]

Hello mine is not pain full but its swelling.

[@SportsInjuryPhysio]

Swelling in that area can be the fat pad but it might also be coming from inside the knee joint.

[@markjustinealinsugay1249]

@@SportsInjuryPhysio d swelling started to reduce ive been puting ice on it.

[@rain-wanders]

This is super informative, I was kind of hoping that maybe THIS was what my knee pain was, but I don't think it is. I don't have health insurance right now, so I can't get it diagnosed, but I have in basically that same exact spot a really nervy pain that sends electric bolts of pain when I try to kneel on my knee (can't do it at all now, it feels like I'm being shocked by a taser there when I try to,) and my skin even feels painful / tender sometimes. It feels slightly stiff when it's bent and okay when it's straight. I can't find anything online that talks about the electrical shock feeling I get when I kneel on it. I am going to search your other videos to see if maybe you've talked about this type of injury before. Also, the strange thing about this injury is it wasn't caused by anything, it just showed up randomly one day with no known cause.

[@SportsInjuryPhysio]

Maybe I can point you in the right direction but I have a few questions: 1. how often do you kneel on your knee? 2. The stiffness you feel, is it deep inside, or just over the front on the tendon or does it feel behind the kneecap?

[@vespertineSSB]

I also have similar pain to this! I also tend to feel it on my skin as well, and the pain tends to come in strange 5-minute flare ups then suddenly disappears. For me, though, it seems quite unpredictable when the pain will come on. I try to reproduce it by bending or extending it and nothing happens

[@mindymay3]

11:05

[@NAIDU162]

Mam,how can i contact you.. i am having this issue from last one year.. shown to many doctors but no improvement. Please share contact number

[@NAIDU162]

Mam, I got this issue due to over exercise.. initially felt pain after using indian toilet... there after I am not able to fold by knee. By wearing knee cap band I used play volleyball But from 2 months I stopped playing and under medication. While driving also feel pain(left leg-- clutch). How much time it will take.. which exercise I should do

[@SportsInjuryPhysio]

Hi there, You can contact us here: www.sports-injury-physio.com/contact