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Hoffa’s fat pad syndrome

What is it?

The infrapatellar (Hoffa’s) fat pad is a structure found within the front of the knee. It can be a common source of anterior knee pain if it becomes irritated or overloaded.

What are the common symptoms?

It is situated deep to the patella tendon below your knee cap area and will often swell with a “horseshoe swelling” under your knee cap area if irritated. This is nothing to worry about and is a normal presentation for this to occur.

You will often feel pain over the site of this swelling, sometimes more to one side of the swelling than the other but it can be both sides equally. The irritation of this structure is often caused by a subtle change in the way we are loading our knee (altered biomechanics). Sometimes this is caused when people over-straighten their knee naturally (hyper-extend).

How to manage it?

Modify your activity

  • If you have significantly increased your activity levels before the onset of the pain try to reduce the activity
  • Limit as much as possible, activities or postures that you know cause your symptoms to worse. In particular, try to avoid hyper-extending your knees or doing activities which would encourage this position.
  • Some taping techniques can be used to offload the Fat Pad.
  • To improve the swelling and pain try simple topical NSAID gels (anti-inflammatory gels) or using ice over the affected area

Pain relief

Painkillers like paracetamol will ease the pain, but need to be taken regularly in order to control the pain. Always follow the instructions on the packet.

Anti-inflammatories like ibuprofen can help with swelling, and therefore help you move more freely. Follow the instructions on the packet and discuss using them safely with a pharmacist, especially if you have any underlying health conditions

However, you should not take ibuprofen for 48 hours after an initial injury as it may slow down healing.

Up to date guidelines can be found on the NHS website:

Ibuprofen

Paracetamol

Other medicines can help to reduce inflammation, swelling and pain. You should discuss this with your GP if the simple pain relief advice does not help or if you are needing to take ibuprofen for more than 10 days.

Ice

Some people find using ice helpful on the painful area.

For ice therapy use a damp cloth containing an icepack (or bag of frozen peas) over the top of the painful area to help numb the pain. Leave it on for up to 20 minutes and use up to three times a day.

You should be cautious using these treatments if you have altered skin sensation or circulatory problems.

Check the skin regularly during and after the ice pack application

Stop if there is excessive pain, numbness or tingling

Do not put ice directly on to the skin as this may cause a burn.

Exercise

Regular exercise will be helpful but try not to overload the structures at the front of the knee with specific overloading activities such as deep squats or hyper-extending exercises.

Strengthening Exercises

  • Specific strengthening exercises for the quadriceps muscle complex are very helpful for this condition
  • Quadriceps control exercises are very helpful in learning to re-educate the muscle so that it does not over-extend
  • Proprioceptive exercises (positional sense of the joint) in particular re-educating the knee joint to not over-extend are very helpful too
  • Gluteal strengthening and core stabilising exercises will help also reduce the load on the knee and improve the biomechanics
  • As the pain improves, gradually re-introduce any normal day-to-day activities that you have been avoiding, returning to full activity as soon as your pain allows

Squat

Stand tall with feet slightly wider than hip-width apart. Toes pointing forward or turned a few degrees outwards. Keep your chest up and your spine and neck in a neutral position.

Squat down by sitting back and bring your arms forward. Push back up through the heels, chest up, and straighten your hips.

Note
– Keep your hips, knees and toes aligned
– Keep your weight evenly on your whole foot.

Repeat 10 times rest 1 minute. Repeat 3 times.

Deep Squat

Squat down by sitting back and bring your arms upwards. Push back up through the heels, chest up, and straighten your hips.

– keep hips, knees, toes aligned.

– Go only as low as you feel comfortable with

– Keep weight evenly on whole foot.

Repeat 10  times rest 1 minute. Repeat 3 times.

Single-leg Mini Squat

Stand tall on one leg with the other leg raised behind.

Squat down keeping your knee in line with the toes and your pelvis level. Push back up to the starting position.

As your technique improves and pain reduces, you can progress the exercises to a deeper squat

Repeat times 10 times rest 1 minute. Repeat 3 times.

Controlled knee extension

Stand tall with one knee slightly bent. A loop of an exercise band is placed around your knee and secured low in front of you. Take the slack off the band.

Tighten your front thigh muscles and straighten your knee against the resistance. In a controlled manner, let the band pull your knee back to the starting position

An exercise band can be bought online.

Physiotherapy 

If you find that you are not improving, some advice or treatment from a physiotherapist can be helpful in managing knee pain. Click here to self-refer to a physiotherapist.

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