Massage therapy · Kitchener–WaterlooFat Pad Impingement

The fat pad (also called Hoffa's fat pad) is a cushion of fatty tissue that sits below the kneecap (patella) and behind the patellar tendon. After a direct blow to the knee, or with repeated minor injury, the fat pad can become swollen and pinched (impinged) between the bones of the knee joint (Saxena et al., 2021). Because the fat pad is richly supplied with nerves, it can be quite painful when irritated, and it is a common source of pain at the front of the knee (Saxena et al., 2021). Pain is usually felt at the front of the knee, on either side below the kneecap, and tends to get worse when the knee is straightened. If the fat pad stays irritated, it can become inflamed.

Fat Pad Impingement Anatomy

Pain at the front of the knee can have a number of different causes, one of which is impingement of the fat pad. The fat pad is a mass of fatty tissue lying below the patella (kneecap) and behind the patellar tendon. It moves as the knee straightens, and helps reduce friction between the kneecap, the patellar tendon and the deeper structures of the knee (Saxena et al., 2021).

How to Treat Fat Pad Impingement

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

• Chronic irritation or a direct blow can cause the fat pad to become swollen and inflamed, so that it gets pinched inside the knee (Saxena et al., 2021).
• People whose kneecap sits higher than usual (patella alta), or who have certain differences in the shape and alignment of the knee, appear more likely to develop the condition (Abelleyra Lastoria et al., 2023).
• Pain tends to worsen with jumping, standing for a long time, or other positions where the knee is pushed fully straight.
• Fat pad impingement is not usually associated with locking, clicking or the knee giving way; if these happen, get your knee checked.
• Patellar tendon problems and fat pad impingement are often confused with one another, and can occur together (Saxena et al., 2021).

Fat pad pain comes from a sensitive cushion of tissue below the kneecap getting pinched, often when the knee is pushed fully straight. My aim is to calm it down, take pressure off the fat pad, and build strength around the knee and hip so your knee copes with standing, stairs and sport again.

I start by assessing how your knee moves, especially in the last part of straightening, how your kneecap sits and moves, the strength and flexibility of your hips, thighs and calves, and how you stand, walk and squat. Front-of-knee pain can also come from the patellar tendon, so this shapes the plan.

When It's Sore

• I keep pressure off the irritated fat pad and work the thigh, hamstrings, calf and the tissue around the kneecap to ease tension
• Gentle kneecap mobilisation
• Taping to take pressure off the fat pad, and I'll show you how to tape it yourself
• Warm or cool applications in the clinic, and I'll show you how to use ice safely at home
• Cutting back what flares it, such as long spells standing with your knees locked straight
• Hip and buttock work where it helps, only with your informed consent and a written consent form

As It Settles

1. Saxena, S., Patel, D.D., Shah, A. and Doctor, M. (2021) 'Fat chance for hidden lesions: pictorial review of Hoffa's fat pad lesions', Indian Journal of Radiology and Imaging, 31(4), pp. 961–974. doi: 10.1055/s-0041-1739383
2. Abelleyra Lastoria, D.A., Benny, C.K. and Hing, C.B. (2023) 'Predisposing factors for Hoffa's fat pad syndrome: a systematic review', Knee Surgery & Related Research, 35, 17. doi: 10.1186/s43019-023-00192-4
3. NHS (2023) Knee pain. Available at: https://www.nhs.uk/conditions/knee-pain/ (Accessed: 8 October 2026).