If pain is present at the front of the knee, around the bottom of the kneecap and is exacerbated when the knee is fully extended the infrapatellar fat pad might be the source of discomfort.
The infrapatellar fat pad, also known as the Hoffa’s fat pad sits behind and just below the kneecap. The anatomical location (seen in blue in the picture) is thought to expose this fat pad it to mechanical load, especially during end of range knee extension (straightening), according to Larbi et al. (2014).
The mechanical load during knee extension – in symptomatic cases – causes the fat pad to become impinged, hence the reason why some clinicians will refer to this condition as infrapatellar fat pad impingement syndrome. The fat pad also has a rich supply of nerves which contribute to level of discomfort often experienced with this condition.
With this condition, pain tends to be in anterior (front) region of the knee and is usually described as being felt behind or just below the knee cap. Placing high load through the knee may cause exacerbation of symptoms such as ascending and descending stairs, jumping and running. In more severe and irritable cases, patients can also present with a degree of localised swelling and range of motion can be hindered.
Most commonly this condition is thought to develop gradually over time following repetitive overextension of the knee. Some individuals may be more susceptible to developing this injury if they have a perpetuity towards knee hyperextension, Larbi et al. (2014) give the example of jumping sports and those with ligamentous laxity as potential contributing factors. In other instances, this condition can start following a direct blow to the knee.
Seeking advice from a musculoskeletal specialist is recommended. At Pure Physiotherapy, our clinicians complete a thorough assessment which facilitates in making an accurate working diagnosis and the subsequent development of an individualised condition specific rehabilitation protocol.
Your Physio will educate you on the condition so that you are able to help support your recovery. Initial treatment should focus on reducing pain and inflammation. Your Physiotherapist will discuss a simple pharmacotherapy such as Ibuprofen which is a non-steroidal anti-inflammatory. We recommend that you always read the patient information that comes with your medicine, and if you have any questions ask your pharmacist for advice. It may also be suggested that you use ice to help settle the inflammation and reduce pain levels further.
Your clinician will also recommend that you limit or avoid aggravating tasks, dependent upon severity and the individual. Some examples include not standing for too long, remaining vigilant in not over-extending the knee, and avoiding sports that exacerbate symptoms. If your symptoms do not improve to the point where you feel you are able to self-manage then our clinicians are ideally positioned to treat this condition.
Your clinician may use certain taping techniques on the symptomatic knee which may ease the irritation on the fat pad. Your Physiotherapist at Pure will design a condition-specific strengthening programme. Your prescribed exercise plan will be individualised to your needs and will be progressed as you recover. Regular re-assessment will allow modifications to be made and will ensure you are making progress towards your goals. Please find the patient resources section of our website where we have created a series of recommended exercise programmes to increase knee strength and stability. We advise consulting with your Physiotherapist prior to trying any of these exercises.
Larbi, A., Cyteval, C., Hamoui, M., Dallaudiere, B., Zarqane, H., Viala, P. & Ruyer, A. (2014). Hoffa’s disease: A report on 5 cases. Diagnostic and Interventional Imaging. 95(11), 1079-1084.