Sharp pain felt at the front of the knee just below the knee cap during the power phase or downstroke when pedaling.
What causes Fat pad impingement?
It can occur following direct trauma or impact to the front of the knee or from repetitive pinching of the fat pad between the knee cap and the thigh bone.
The infrapatellar fat pad, or Hoffa’s fat pad, is a small wedge of fatty tissue that sits beneath and to either side of the patella tendon at the front of the knee. It has quite a dense concentration of blood vessels, nerves and inflammatory mediating chemicals within it. This enables it to become a potent source of pain once irritated
Previous trauma to the front of the knee
Previous knee surgery
Low cadence / over-gearing
Sudden increase in cycling up hills / mountains
What are the symptoms?
Pain can be felt by pressing on the soft tissue to either side of the patellar tendon at the front of the knee
There is often some swelling or a puffy appearance of the fat pad when compared to the other knee.
An inability to fully straighten the knee with sharp pain felt at the front of the knee is present in more severe or acute cases.
How can I manage Fat pad impingement?
If your current cycling is aggravating the symptoms then it is essential to consider either reducing the duration or intensity of your rides, or stopping altogether for a short period of time.
Avoiding prolonged or forced extension (straight) position of the knee will provide some relief. Sleeping with a pillow under the knee (if you sleep on your back) can also be particularly helpful.
Wearing shoes with a slight heel or wedge reduce how much the knee goes into extension when standing / walking thereby reducing irritation in acute cases.
Icing regularly is extremely helping in calming acute symptoms.
Simple over the counter anti-inflammatories such as ibuprofen are also helpful in settling symptoms in the acute phase. You must always consult your GP / Physician prior to commencing any course of medication.
One of the purported factors in developing fat pad impingement is due to having some degree of patellofemoral joint (PFJ) dysfunction. As such, exercises interventions will often follow similar guidelines.
Strengthening exercises for the glute med muscles, quadriceps alongside mobility exercises to address any limitations in flexibility around the hip and knee. Care needs to be taken with forcing into full knee extension (straightening) as this can often compress and irritate the fat pad.
There are a number of different techniques that have demonstrated good capacity to reduce short term pain in cases of fat pad impingement. These can either be applied with rigid tape (pictured) or more stretchy kinesio tape in the video below.
It’s important to keep a close eye on skin reactions to taping as you will likely aim to try and keep the tape on for a couple of days. If you notice any reddening of the skin or itching you should remove the tape immediately.
Sports Massage Various soft tissue techniques can be applied to the quadriceps in a bid to ease tension or spasm felt within the muscles which may also contribute to the pain in the knee.
If the cause of the fat pad impingement was not due to a fall or other direct trauma to the knee then it is quite likely that bike fit will prove pivotal in assisting full recovery and minimising future risk of redeveloping the problem. Similar to other knee complaints, saddle height is likely the key factor associated with aggravation. Following this, a very aggressive forward or low position can bring the weight forward on the bike and increase pressure through the front of the knees
In cases where the diagnosis has been established via both clinical exam and imaging (such as MRI) and has been resistant to conservative measures a corticosteroid injection can be extremely effective.
Failing all of the above strategies leaves few other options. Arthroscopic resection of the fat pad has generally been found to improve symptoms and allow return to activity.
What else could it be?
Pre patellar bursitis
If you are having issues with your knee and want to get in touch about booking a consultation or a bike fit then please email us: firstname.lastname@example.org.