Fat Pad Syndrome

Fat Pad Syndrome

Article by John Miller

Fat Pad Syndrome

Fat Pad Impingement, Hoffa’s Syndrome

What is Your Hoffa’s Fat Pad?

Hoffa’s fat pad is your knee fat pad, or infrapatellar fat pad is a soft tissue structure that lies just below and under the patella tendon. The fat pad has abundant nerve innervation, making it one of the most pain-sensitive knee structures.

If irritated, your fat pad can be a great source of knee pain and discomfort. Since the fat sits just below the knee cap, it can cause pinching or “impingement” on the fat pad if there are problems with the kneecap alignment. Fat pad syndrome is also known as Hoffa’s Syndrome.

What Causes Fat Pad Syndrome?

  • A forceful blow to the front of the knee (i.e. fall, motor vehicle accident, football tackle)
  • Tight quadriceps
  • Genu recurvatum (excessive extension of the knee)
  • Forward tipping pelvis
  • History of osteoarthritis in the knee
  • Scarring and subsequent fibrosis (hardening) of the fat pad

What are the Symptoms of Fat Pad Syndrome?

Fat Pad Impingement, also called Hoffa’s Syndrome, can include some or all of the following symptoms:

  • Pain in the front of the knee
  • Swelling below and around the knee
  • Pain with fully straightening the knee
  • Pain with prolonged walking, squatting and kicking activities.
  • Pain with wearing high heels

These symptoms can also be characteristic of several other knee conditions. e.g. patellar tendinopathy or patellofemoral joint pain syndrome. Hence, it is best to contact your knee physiotherapist for a thorough assessment and proper diagnosis.

How is Fat Pad Syndrome Diagnosed?

On examination, your physiotherapist or sports doctor will look for signs of the symptoms mentioned above. Also, they will perform a clinical test called Hoffa’s test, which involves moving the kneecap after you contract your quadriceps muscles.

fat-pad-syndrome

An MRI may also diagnose fat pad inflammation, but it is not very accurate for diagnosing fat pad impingement. A thorough assessment by your physiotherapist or sports doctor is usually able to provide you with a more definitive movement associated diagnosis.

Please seek the advice of your physiotherapist.

What is the Treatment for Fat Pad Syndrome?

Physiotherapy treatment will hasten your recovery. Your physiotherapist will aim to:

  1. Reduce your pain and inflammation. Modalities may include electrotherapy, cryotherapy, therapeutic taping, acupuncture and gait education.
  2. Normalise your joint and muscle range of motion.
  3. Strengthen your knee and leg muscles.
  4. Optimise your patellofemoral (kneecap) alignment.
  5. Improve your proprioception, agility, dynamic balance, landing technique and function, e.g. walking, running, squatting, hopping and landing.

We suggest that you discuss your knee injury after a thorough examination and accurate diagnosis from your knee injuries clinicians such as your sports physiotherapist, sports doctor or knee surgeon.

If knee pain and symptoms continue to persist, fat pad surgery may be an option. Surgical treatment of fat pad impingement may involve arthroscopic debridement or partial removal of the fat pad.

How to Prevent Fat Pad Syndrome?

The best way to prevent the occurrence or recurrence of fat pad impingement is to optimise the muscles’ strength and flexibility around the knee, hip, and ankle. Your physiotherapist is an expert at guiding you towards the best exercises to correct any deficits in these areas.

If you have previously battled fat pad impingement, it is best to avoid potentially aggravating activities such as kneeling, squatting and kicking for prolonged periods. For females, it is best to limit walking in high heels.

Please seek the advice of your physiotherapist.

Article by John Miller

Experience the PhysioWorks Difference?

You'll be impressed with the experienced physiotherapists, massage therapists, allied health team and reception staff representing PhysioWorks.

If you've been searching for health practitioners with a serious interest in your rehabilitation or injury prevention program, our staff have either participated or are still participating in competitive sports at a representative level.

To ensure that we remain highly qualified, PhysioWorks is committed to continuing education to provide optimal care. We also currently offer physiotherapy and massage services for numerous sports clubs, state and national representative teams and athletes. Our experience helps us understand what you need to do to safely and quickly return to your sporting field, home duties, or employment.

How You'll Benefit from the PhysioWorks Difference?

At PhysioWorks physiotherapy and massage clinics, we strive to offer our clients quick, effective and long-lasting results by providing high-quality treatment. With many years of clinical experience, our friendly service and quality treatment is a benchmark not only in Brisbane but Australia-wide.

What are Some of the BIG Differences?

We aim to get you better quicker in a friendly and caring environment conducive to successful healing. Our therapists pride themselves on keeping up to date with the latest research and treatment skills to ensure that they provide you with the most advantageous treatment methods. They are continually updating their knowledge via seminars, conferences, workshops, scientific journals etc. Not only will you receive a detailed consultation, but we offer long-term solutions, not just quick fixes that, in reality, only last for a short time. We attempt to treat the cause, not just the symptoms.

PhysioWorks clinics are modern thinking. Not only in their appearance but in the equipment we use and in our therapists' knowledge. Our staff care about you!  We are always willing to go that 'extra mile' to guarantee that we cater to our client's unique needs. All in all, we feel that your chances of the correct diagnosis, the most effective treatment and the best outcomes are all the better at PhysioWorks.

Article by John Miller

Common Youth Leg Injuries

youth sports injuries

Why are Children's Injuries Different to Adults?

Adolescent injuries differ from adult injuries, mainly because the bones are still growing. The growth plates (physis) are cartilaginous (strong connective tissue) areas of the bones from which the bones elongate or enlarge. Repetitive stress or sudden large forces can cause injury to these areas.

Common Adolescent Leg Injuries

In the adolescent leg, common injuries include:

Osgood-Schlatter's Disease

Pain at the bump just below the knee cap (tibia tubercle). Overuse injuries commonly occur here. The tibia tubercle is the anchor point of your mighty quadriceps (thigh) muscles. Because of excessive participation in running and jumping sports, the tendon pulls bone off and forms a painful lump that will remain forever. This type of injury responds to reduced activity and physiotherapy.

More info: Osgood Schlatter's Disease

Sinding-Larsen-Johansson Disease

Pain at the lower pole of the knee cap (patella). Overstraining causes Sinding-Larsen-Johansson disease. Because of excessive participation in running and jumping sports, the tendon pulls bone off the knee cap. This type of injury responds to reduced activity and physiotherapy.

More info: Sinding Larsen Johansson Syndrome

Anterior Knee Pain

Anterior knee pain or patellofemoral syndrome frequently gets passed off as growing pains. Cause of this pain includes overuse, muscle imbalance, poor flexibility, poor alignment, or more commonly, a combination of these. Anterior knee pain is one of the most challenging adolescent knee injuries to sort out and treat. Accurate diagnosis and treatment with the assistance of a physiotherapist with a particular interest in this problem usually resolves the condition quickly.

More info: Patellofemoral Pain Syndrome

Knee Ligaments

The cartilage between the leg bones have a better blood supply and are more elastic in adolescents than in adults. As adolescents near the end of bone growth, their injuries become more adult-like. Hence more meniscal and ACL (anterior cruciate ligament) injuries are likely. MCL (medial collateral ligament) injuries result from a lateral blow to the knee. Pain felt on the inner side (medially) of the knee. MCL injuries respond well to protective bracing and conservative treatment.

More info: Knee Ligament Injuries

ACL (anterior cruciate ligament) injuries

This traumatic knee injury is significant. Non-contact injuries of the ACL are becoming more common than contact injuries of the ACL. Adolescent females are at high risk. Combination injuries with MCL or menisci are common. Surgical reconstruction is needed if the adolescent wishes to continue participating in "stop-and-start" sports.

More info: ACL Injury

Meniscal injuries

Your meniscus is crescent-shaped cartilage between the thigh bone (femur) and lower leg bone (tibia). Meniscal injuries usually result from twisting. Swelling, catching, and locking of the knee are common. If physiotherapy treatment does not resolve these damages within six weeks, they may require arthroscopic surgery.

More info: Meniscus Tear, Discoid Meniscus

Sever's Disease

Heel pain is commonplace in young adolescents due to the stresses of their Achilles tendon pulling upon its bony insertion point on the heel (calcaneum). It is a common overuse injury due to excessive volume of training and competition, particularly when loads are increased dramatically in a short period. Diminished flexibility and muscle-tendon strength mismatching may predispose you. Physiotherapy, reduced activity, taping and orthotics are the best ways to manage this debilitating condition for the active young athlete.

More info: Sever's Disease

Ankle Sprain

An ankle sprain is probably the most common injury seen in sports. Ankles sprains involve stretching of the ligaments and usually occur when the foot twists inward. Treatment includes active rest, ice, compression and physiotherapy rehabilitation. An ankle sprain usually improves in 2-6 weeks with the correct treatment. Your ankle physiotherapist should check even simple ankle sprains. A residually stiff ankle post-sprain can predispose you to several other lower limb issues.

More info: Sprained Ankle

Patellar Instability

Patellar (kneecap) instability can range from partial dislocation (subluxation) to dislocation with a fracture. Partial dislocation treatment is conservative. Dislocation with or without fracture is a much more severe injury and usually will require surgery.

More info: Patella Dislocation

Osteochondritis Dissecans

The separation of a piece of bone from its bed in the knee joint is Osteochondritis Dissecans (OCD). This injury is usually due to one major macro event with repetitive macro trauma that prevents complete healing. This injury is potentially severe. Treatment varies from rest to surgery. An Orthopaedic Surgeon's opinion is vital.

More info: Juvenile Osteochondritis Dissecans (JOCD)

Growth Plate Fractures

A fracture through the growth plate can be a severe injury that can stop the bone from growing correctly. These fractures should be treated by an Orthopaedic Surgeon, as some will require surgery.

Avulsion Fractures

youth pelvis hip avulsion

Image source: https://radiologyassistant.nl/pediatrics/hip/hip-pathology-in-children

An avulsion fracture occurs when a small segment of bone attached to a tendon or ligament gets pulled away from the main bone. The hip, elbow and ankle are the most common locations for lower limb avulsion fractures in the young sportsperson.

Treatment of an avulsion fracture typically includes active rest, ice and protecting the affected area. This active rest period is followed by controlled exercises that help restore range of motion, improve muscle strength and promote bone healing. Your physiotherapist should supervise your post-avulsion exercises. Most avulsion fractures heal very well.  You may need to spend a few weeks on crutches if you have an avulsion fracture around your hip. An avulsion fracture to your foot or ankle may require a cast or walking boot.

An excessive gap between the avulsed bone fragment and main bone may not rejoin naturally in rare cases. Surgery may be necessary to reunite them. In children, avulsion fractures that involve the growth plates also might require surgery. All avulsion fractures should be reviewed and managed by your trusted physiotherapist or an Orthopaedic Surgeon.

For more information regarding your youth sports injury, please consult your physiotherapist or doctor.

Youth Leg Injuries

Pelvis & Hip

Knee

Heel & Ankle

Common Youth & Teenager Sports Injuries

Common Youth Neck & Back Pain

Common Youth Arm Injuries