‘Fat Pad’ Impingement (Hoffa’s Syndrome)

‘Fat Pad’ Impingement (Hoffa’s Syndrome).

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Running Training and the Importance of Body Maintenance

Looks like it may well turn out to be a busy year for me after all. I still have concerns over the ‘fat pad’ impingement that is effecting me, although this has subdued sufficiently to allow me to train in earnest. I’m still scheduled to have an ultrasound scan in a few weeks time and possible guided cortisone shot if this is still deemed the best way to aid a quicker recovery and reduce the swollen ‘pad’ in question.

However, I am successfully logging the miles again and speedwork has been thrown down over the last few weeks. Fortunately the Zurich marathon is 3 months away and as long as there is no further breakdown from my body and the commitment to train in the cold, rain and ice where I live, then hopefully, I’ll be able to shoot with some confidence at my elusive sub 2 hr 40 marathon time.

So now it looks as if I may have finally been accepted into another of the ‘glamour’ races in New York and now the trick becomes careful planning of my schedules to not over race this year in between the two marathons (roughly six months apart), train smart and allow sufficient recovery, both during training and after each race.

Every good runners manual will recommend slowly increasing your mileage each week by no more than @ 10 percent. This is to ensure that we’re not suddenly placing increased stress on our bodies that it’s not ready to handle and breaks down, maybe a hamstring is pulled or your IT Band becomes aggravated or achilles tendon becomes inflamed amongst other complaints. All of which will slow you down, probably enforce a period of prolonged rest in the middle of your important training and leave you feeling very frustrated. Sure, you maybe feel good enough on your weekly long run to chuck in a couple of miles and may decide to keep running until you finally feel tired or sore. Yes, you may still feel great after this new long distance you’ve achieved. Trouble is, the potential damage of too great a training increase may not show itself until several days down the line when little ‘niggles’ begin to show themselves – often a cumulative effect.

It is also painfully important to get sufficient rest. The body improves physically by becoming more powerful and stronger and efficient not just from the actual training, but from the adaptions it takes from the training sessions. This means your body improves during the rest. Now, obviously, this is not the ‘green light’ to take days and days off from training to keep resting, but rest should be considered as part of your training.

You may be able to physically cope with a long run one day, perhaps a couple of other tempo run sessions and some speed and hill work each week. However, these are all considered hard sessions and depending on your running background (how many years you’ve been running, how many miles you’ve logged over time to build that endurance base – Consider many of the East Africans who often run several miles a day to and from school from a very young age!), your age and how fit you – these considerations are factors in how well you recover from these sessions and there will typically always be the need for two or three easier sessions per week or perhaps a 10 day training cycle. For most, a hard days training session such as a 20 miler or a long tempo run, which both take a toll on the body, will be sandwiched by easy running days before and after to allow recovery and be ready to train hard again.

There are of course some other great ways to assist the body and not ‘overtraining’, which can lead to injuries, becoming run down and ill, constantly tired and lethargic, etc. If you can, consider having a regular massage to relax the muscles and tissue and help flush out the toxins by speeding up the blood flow. Sleep is also very important. Once the mileage you log each week begins to increase, your body will demand that extra rest and you should aim to get a good eight hours shut eye whenever possible.

Other training methods can help just as much to maintain fitness, cardio-vascular capacity and lessen the tax on already tight and worked muscles. Consider cross training by biking or swimming, perhaps using an elliptical machine in the gym or even cross country ski if you’re in a wintry environment. These won’t substitute actually running, but for anyone with little niggling injuries or perhaps just need to take a few days off from training but still feel the need to keep up some body maintenance training, cross training should be considered.

We can also all benefit from some strength training. There will be great benefits to be had from working on your ‘core’ muscles to maintain good running form and posture. Consider one or two days a week of some light weight work and don’t merely focus on those legs.  If you’re aware of any body mechanical imbalances where you’ve been susceptible to injury, look for some advice on how to strengthen those area, focus on training those glutes and hips, etc.

Finally look to your diet. Just as important to any rest and training. A long or very hard session can lead to great body adaptions and therefore improvement. However, recovery can be greatly aided be replenishing lost nutrients within an all important window that lasts only around 30 minutes or so after you’ve finished your session. You should aim to take on a mix of both carbs and proteins (typically a suggested ratio of 4:1) during this window immediately after you finish training. Often a drink containing these ingredients will be easier to digest and will be absorbed into the body much quicker than solids, but both are important. This should then be followed by a more substantial meal, nothing excessive  in size, within the next 1-2 hours. You should also ensure that you are well hydrated at all times. Often after a long run of over an hour or more, you will become dehydrated to some degree and it is important to replenish as soon as possible and keep drinking throughout the day until your urine  becomes clear or at least only a pale yellow discolouration.

Overall it is important to eat healthily, get a good balance of foods, avoid too much bad fats (especially saturated fats) and if you are logging big miles each week, keep your carb diet to around 60% or so of your diet – try and keep to the ‘good’ carbs, those which are slow release such as nuts, pulses, beans, wholemeal grains, etc.

If, like me, you may well be attempting more than one long race per year ( a couple of marathons, possibly some half marathons and maybe even an ultramarathon), it’s also important to not jump straight back into training in the first few days straight after your last long race. Your muscles may actually feel good, but after having just ran a marathon, your tendons and even bones will be very susceptible to more damage as the muscles have just taken a beating and are grossly taxed, meaning something else has to take the strain. Gradually ease yourself back into some easy, slow, short running over the following week or so. The desire may be too much to handle in not running for a while, but consider some of the great names and athletes, such as Paula Radcliffe and Karen Goucher for example, who may take as much as a whole month off before resuming training again, depending on their schedules of course.

All in all, recovery is a very personal thing and is dependant on a multitude of factors, such as how well trained you are, how much you taxed yourself during the race ( a marathon will take much longer to recover from properly than say a 10k race), did you give it everything you had, did you ‘bonk (where your body has depleted its energy levels from it’s nutrient stores) and how quickly you get nutrients back into your body.

So, train hard, train smart and work for your goals.

‘Fat Pad’ Impingement (Hoffa’s Syndrome)

I write this piece from a personal viewpoint as unfortunately around where  live, it has come to my attention that there is simply not enough knowledge of this recognized problem.

My problems started a few months ago after completing the Berlin marathon. My IT Band went around the 19 mile mark and I only truly realised the full impact of this on my body some weeks later. Don’t get me wrong, as the pain and discomfort was obvious during the final miles of the race as I missed my goals, but it was only as I tried to step back into my training once again a couple of weeks later that I felt the need to see a physio for knee discomfort that was more than just delayed muscle onset.

I was diagnosed with IT Band syndrome and although my problems had stemmed from mechanical issues (typically weak glute not firing properly, pronating too much, weak hip, etc), the pain was very much in the knee. The IT Band had, over time, become inflamed, thickened, laid down scar tissue and continued to rub over the many bony points and bursars around my knee. This problem was perpetual as every time I tried to run, the scar tissue and tight IT Band around the knee would become thicker, laying down more scarring each time.

The physio and I threw everything at it, some serious downtime, regular ART to breakdown the scarring, dry needling to loosen the IT Band, regular massages, specific exercises to strengthen my root causes around glutes and hip. Everything, but still a nagging discomfort remained, which, in fact worsened around the ‘fat pad’ area just under and to the outside of the patella. We worked it to death with all the treatment and carefully considered everything for the inflammation (Ice, Ibruprofen, needles, rest, taping to lift the patella – usually received with good success, etc, etc), but still no real success.

Basically this ‘fat pad’ area becomes inflamed and thickened it can get ‘pinched’ between the end of the thighbone and the kneecap and is often a longstanding condition. http://bit.ly/gWYUq. Having thrown everything at it for weeks, it was decided by a few physio’s who had been heavily involved in studies in Australia that the best accepted and recognized step now would be to have a cortisone shot. It had been shown to work on many, many occasions with virtually no real risk at all (all injections / needles come with the inherent risk of infection being introduced to a site). In fact, had i been a professional athlete, this would probably have been given to me weeks and weeks ago!

Finally I went to see a doctor to try and obtain a cortisone shot to the ‘fat pad’. I was scorned away and told all about my mechanical imbalances and what was causing the knee discomfort and told to address these – I had been vigorously of course over the last several weeks and still am! I was, however sent for an X-ray which eventually showed up some small signs of the onset of arthritis, which is very normal in a gentleman of my age who has been very active over the last 10-15 years with my running, biking, soccer and skiing, etc. Still the Dr refused to give me this shot and advised me to consider another sport!

Time to look for a second opinion from a recognized sports medic in town. A little more sympathetic, but still wanted me to have an ultrasound first to better guage what was going on – although she did go on to say that she thought it may well be ‘fat pad’ impingement and when pressed, suggested that the treatment may well be a cortisone shot!!! Aaargh! Will no-one give me this shot! No, I have to wait several weeks for ultrasound before even getting there!! – Missing the Zurich marathon in April is becoming an increasing concern.

To be fair, medics are rightly concerned with cortisone shots that there is also a minimal risk that it could weaken any surrounding tendon, possibly leading to a tear or rupture, if injected into the wrong spot. However, the ‘fat pad’ area is directly under the skin and is fairly large, next to a thick tendon that is also fairly obvious – In other words ‘X’ really does mark the spot and it would be difficult for anyone to miss, with a needle or even a mallet!

It is so hard to have this malfunction diagnosed and of course, everyone has their own school of thoughts on how best to treat or tackle physical problems. However, from my experience, too many ‘experts’ are simply not skilled enough in specific knee disorders amongst athletes – bear in mind that general practitioners will have to cover an extremely wide range of medical complaints and problems and it is perhaps a little unfair to expect them to know everything, right?!

I guess time will tell if my problem has been accurately diagnosed by myself and my physio and if indeed, I can actually manage to get anyone to give me this shot. Perhaps it won’t prove to be the miracle cure I’m after, but in my case, it seems like it should at least be considered as the worst case scenario appears to be that nothing will improve.

As for our understanding and treatment of this ‘fat pad or Hoffa’s syndrome, well, it appears that some parts of the world are more dialled in and aggressive in their treatments than others.

Any feedback on this condition would be most welcome