Hoffa’s fat pad syndrome

Hoffa’s fat pad syndrome involves inflammation of a pad of fatty tissue behind the knee cap at the front of the knee. It is a normal part of human anatomy, acting as a shock absorber for the knee cap. It has an excellent nerve supply, therefore injury or damage can cause significant pain.


Inflammation and irritation of this fat pad can happen when it becomes squashed between the knee cap and thigh bone from direct injury or repeated aggravation. Once the fat pad swells, it is more likely to become irritated.

Common symptoms

  • Pain, tenderness and swelling around the knee cap or sides of the patellar tendon (tendon attaching your thigh muscle to shin bone)
  • Movements that often aggravate pain include straightening the knee, squatting, going up and down stairs or standing for a long time.
  • People who have existing knee injuries are more likely to experience Hoffa’s fat pad syndrome. Other groups more at risk of this condition include patients with hypermobility, occupations involving repeated kneeling, and people that play sports that put excess strain on knee joints such as skiing.

Activity modification

Resting your knee and avoiding painful movements or activities is often very useful in settling pain down. If you had increased your activity levels before the onset of the pain try to reduce back to your baseline level of activity to help settle your symptoms.



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.

Pain relief

Over the counter painkillers like paracetamol will ease the pain, but need to be taken regularly in order to control the pain. A short course of 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 or GP, especially if you have any underlying health conditions.



Strengthening your thigh and hip muscles is helpful in controlling your whole lower limb movement and may help to prevent irritating the fat pad in day to day activities.

A rough guide would be to perform 8-12 repetitions of each exercise and 2-4 sets of these repetitions. Allowing a break of 30 seconds to 1 minute between sets is advisable. Pain can help guide numbers of repetitions and sets. Exercises should be carried out every other day.

Inner range quadriceps

Stand with leg slightly bent and exercise band above knee, attaching band to table leg or similar.
Tense muscles in the front of your thigh, straightening your knee and pulling back against the band.
Slowly release the band so your knee bends again.

hoffas fat pad syndrome inner range quadriceps

Wall Squat

Stand with your knees bent at 45 degrees, leaning your back against the wall. Your feet should be at least 30cm away from the wall and hip width apart; make sure you can see your toes.

Keep your thigh muscles tightened the whole time. Aim to hold this position for 10 seconds. Feel in the front of your thigh. If this increases your pain, try with your feet further apart.

hoffas fat pad syndrome wall squat

Standing leg lifts

Stand facing a worktop with your feet slightly wider than your hips. Lean forwards and rest on your forearms. Bend your knee. Lift your foot to the ceiling using your bottom muscles.

hoffas fat pad syndrome standing leg lift

When to seek help?

If your symptoms continue after trying the advice above, you should seek further advice from a healthcare practitioner.

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