Fat Pad Impingement (Hoffa's Syndrome)

(also known as Hoffa's Disease, Fat Pad Syndrome, Patellar Tendon Lateral Condyle Friction Syndrome)

Hoffa's Syndrome (fat pad impingement) causes pinch pain in the front of the knee with swelling and inflammation under the knee cap (patella) and along the patellar tendon.

Hoffa's pad (also known as the infrapatellar fat pad) is a fatty pad that sits below the knee cap (patella) directly behind the patellar tendon. It functions to cushion the patella from hitting against the condyle of the femur (or end of the thigh bone) in the case of a direct blow to the front of the knee.

Hoffa's Syndrome is a condition in which the infrapatellar fat pad either suffers a contusion or an injury, resulting in damage and swelling. This can lead to the Hoffa's pad becoming trapped between the femur and the patella every time the leg is extended.

Fat pad impingement can also occur if the fat pad is pinched when the leg turns inward abnormally while running. The risk of this happening increases if you have instability in your knees or hips which can be a result of other conditions such as Achilles injuries. When favouring a sore Achilles tendon in one foot, you begin to use improper mechanics to walk or run and this can lead to unbalanced loads and over straining one of your knees and/or hips.

The fat pad in the knee has a lot of nerves, so any injury to it is extremely painful. Because straightening the leg will cause the fat pad to become trapped it is being re-injured constantly and can lead to a significant recovery time if not treated quickly and correctly.

Symptoms of Fat Pad Impingement

  • Pain, inflammation, and swelling at the front of the knee cap and along the sides of the patellar tendon.
  • Increased pain when the knee is extended.
  • Standing for long periods on hyperextended knees will increase the pain.
  • Squatting or using stairs will often make the pain worse.

Fat Pad Impingement Risk Factors

As in the case with most conditions featuring soft tissue inflammation and pain, Hoffa's Syndrome can occur from either an acute injury event (kick to the knee) or through a chronic injury (long term problem, gradually worsening over time). There are a variety of causes for Fat Pad Impingement, but the most common is said to be from knee hyperextension, occuring most often in kicking and jumping sports. A list of typical causes are as follows:

Hoffa's Syndrome (fat pad impingement) can be caused by the fat pad pinching between the patella (knee cap) and the femur following a blow during contact sports.
  • Participating in activities or sports where a blow to the knee is possible such as football, rugby, soccer, and hockey.
  • Participating in activities or sports where hyperextension of the knee is possible such as football, rugby, soccer, and volleyball.
  • If you have suffered an anterior cruciate ligament (ACL) injury the stability of your knee decreases, leaving the infrapatellar fat pad more prone to being pinched.
  • Runners with excessive pronation (also known as flat feet) or weak hips may experience quick leg turns inward while the knee cap (patella) remains behind, causing the fat pad to be pinched.
  • Hyperextension of the knee, via anterior pelvic tilt. Body biomechanics are altered when wearing high heeled shoes, and a common result is knee hyperextension and a shortening of the quadriceps muscle group.
    (reference: http://boneandspine.com/hoffa-syndrome/)
  • People who have tight quadriceps. Tight quadriceps
  • People who has Iliotibial (IT) Band Syndrome.
  • Anyone who has a history of hyperextension in the knee

Hoffa's Syndrome Diagnosis

Your doctor or health care professional will examine your knee to determine if you have Hoffa's Syndrome (fat pad impingement). Typically, he/she will ask you to lie down with a bent knee. You then slowly straighten your leg while the doctor presses his or her fingers below the knee cap (patella), on either side of the patellar tendon. Any pain or hesitation when straightening the leg is considered a positive test for Hoffa's Syndrome.

Conservative Treatment Options for Hoffas Syndrome

Allowing your knee to rest is always recommended when you are suffering from fat pad impingement. Avoid activities that may have caused the injury or irritation. This means stop the sports or if you wear heels, you should stop this as well. It is difficult to rest your knee completely as you have to get on with your daily activities but it is important to do so to stop what is or may become a vicious cycle, as swelling and inflammation will worsen the impingement.

Conservative Treatment Step 1: Reduce The Initial Inflammation

Inflammation is the body's natural response to an immediate achilles injury and is a normal part of the healing process - helping to reduce tissue infection in the early stages of injury. Swelling, pain, heat sensation, redness, and loss of function are the main symptoms experienced.

The combination of rest, topical pain relief cream and minor amounts of cold is the gold standard in medicine for minimizing tissue damage and reducing inflammation after injury or activity. It serves as a critical bridge into the next phase of the healing process.

Conservative Treatment Step 2: Attend a Physio Clinic

Your PT may prescribe ultrasound and/or tens sessions. Further to this, taping the knee is a common, easy protocol that is used for treatment of Hoffa's Syndrome. The aim of taping is to offload stress on the fad pat and prevent impingement, while also helping constrain knee extension. More importantly, the PT will most likely assess your specific biomechanics and attempt to correct them if they are determined to be causal factors to your condition. Stretching and strengthening exercises, centered on the quadriceps and hamstrings will probably be provided to you as well.

Conservative Treatment Step 3: Increase Flexibility & Stability in the Knee

MendMeShop Knee Tshellz Wrap speeds the healing of the soft tissue surrounding the patella to strengthen your entire knee following Hoffa's Syndrome.

After the inflammation and swelling below your kneecap and around your patellar tendon is gone, you can begin to treat your entire knee with the TShellz Wrap®. A T•Shellz treatment boosts local blood circulation, and increases heat in tissue around the treatment area. The intent of this heat is to increase elasticity as well as elongate tissue in the knee joint - longer and more flexible tissue mean the knee is less likely to strain during activity. Soft tissue in a knee that is not used over a couple days, (which is not unusual for Hoffas Syndrome) will both weaken and shorten very quickly - so when you eventually DO move, you may find that you are running into knee strain issues due to atrophy. This is why we recommend TShellz Wrap® treatments before activity where the weak knee will be under stress - the intent is to reduce your risk of secondary injuries in the knee, while the increased blood flow is there to help your body strengthen these same tissues.

Hoffa's Syndrome can be extremely painful and there is no real quick fix home treatment to make it just go away although getting rid of the swelling might be enough to do it. However, don't lose sight of the importance of maintaining or even increasing strength and stability in the knee as overcompensation (ie. pain in right knee eventually stresses the left knee and hip due to limping) and atrophy (weakening, shortening and wasting away of soft tissue due to lack of use) can and do take hold very quickly (within days if the pain is really bad). The Knee TShellz Wrap® will help combat atrophy, and can also be used on the opposite knee to try and keep it flexible and healthy as it takes on substantially more stress due to your bad knee.

During your recovery, you will probably have to modify and/or eliminate any activities that cause pain or discomfort in your knee until your pain and inflammation settle. Taking the time to care for your knee properly will have your knee back to normal faster and allow you to get back to the activities you enjoy.

On-going Circulatory Boost treatments at home (via the TShellz Wrap®, every day, will soothe, relax and relieve pain in the area. TShellz Wrap® treatments on the knee will allow treated tissue to extend further when you do some stretching after the treatment. In a nutshell, consistent TShellz Wrap® treatments combined with light stretching will elongate tissues & increase their elasticity - this in turn helps reduce the risk of further injury and might aid in reducing impingement on the fat pad. Basically, it will reduce the risk of your knee inactivity turning into a chronic problem where you continue to lose strength, stability and Range of Motion. Our Knee TShellz Wrap provides effective, non-invasive, non-addictive pain relief and blood circulation stimulation.

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Conservative Treatment Step 4: Recognize That Healing is a Process

With dedication, the right tools, and the right information - our hope is you will achieve your goal of a sustainable recovery. We propose a combination approach of cold, heat treatments (via the TShellz Wrap®, and functional movements to help keep your knee as strong and healthy as possible during your period of inactivity (when the impingement is flaring). Why? Impingements can be very painful and there is not always a quick solution to get rid of it - but what we do know is that a stronger, more stable knee joint is more likely to experience a complete recovery once Hoffa's Syndrome is gone. Don't let inactivity due to Hoffa's Syndrome permanently reduce your range of motion - keep your knee healthy, flexible and strong even when its not active - this means using a Knee TShellz Wrap® at least twice a day.

If you have questions, we welcome you to call our office toll-free at 1-866-237-9608 (Continental US), or Internationally at +1-705-532-1671.

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During your recovery, you will probably have to modify and/or eliminate any activities that cause pain or discomfort at the location of your soft tissue injury until the pain and inflammation settle. Always consult your doctor and/or Physical Therapist before using any of our outstanding products, to make sure they are right for you and your condition.


Please be aware that this information is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider before using any of our outstanding products to make sure they're right for you and your condition or if you have any questions regarding a medical condition. Always see your doctor for a proper diagnosis as there are often many injuries and conditions (some very serious) that could be the cause of your pain.

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