‘Fat Pad’ Impingement (Hoffa’s Syndrome)

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

‘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