Understanding Fat Pad Impingement: A Hidden Cause of Knee Pain
- Emma Glynn
- Jul 21, 2025
- 6 min read
Updated: Aug 15, 2025
By Emma Glynn - The Hip & Knee Physio
If you're dealing with persistent pain at the front of your knee, especially when standing still, walking downhill, or after leg day, it might not be your tendon. It could be your fat pad.
Often overlooked, fat pad impingement is one of the most misdiagnosed causes of anterior knee pain. Many patients are told it’s “just your patellar tendon” or “early arthritis,” when in fact, the culprit is a sensitive, inflamed piece of tissue tucked behind the kneecap. The longer it’s missed, the harder it is to settle. Here’s what you need to know and how to treat the condition.
What Is Fat Pad Impingement?
The infrapatellar fat pad (also known as Hoffa’s fat pad) is a small, soft pad of tissue that sits just behind your kneecap and patellar tendon. It cushions the joint and helps absorb shock during movement. However, it’s also packed with nerve endings. When it gets irritated or pinched, it hurts, a lot!
Fat pad impingement occurs when this tissue becomes trapped or compressed, typically during full knee extension or hyperextension. It becomes swollen, angry, and exquisitely sensitive. Unlike tendon pain, it often gets worse the more still you are (1).
Typical Symptoms: How Do You Know It’s Not Your Tendon?
Fat pad pain has a distinct pattern:
Aching or sharp pain at the front of the knee, just below or around the kneecap
Worse when standing still, especially with knees locked
Pain walking downhill or downstairs
Tenderness around the patellar borders (not directly over the tendon)
Discomfort with deep squats, lunges, leg press, or other quad-dominant exercises
May feel like your knee is “catching” or irritated in full extension (2)
Unlike patellar tendinopathy, which typically flares during loading (e.g., jumping, landing, running), fat pad impingement often nags after the activity or hangs around during day-to-day movements like walking, driving, or standing at a desk (3).
Why It’s So Commonly Missed
Fat pad impingement doesn’t always scream in the clinic. It’s a quiet, low-grade, nagging pain until it blows up. Here’s why it’s often misdiagnosed:
It mimics tendon pain or general “knee pain”
It’s not well understood by all practitioners - especially if biomechanical assessment is rushed or incomplete
Scans (like MRIs) may show “patellar tendinopathy” or mild inflammation, but fat pad issues are often a clinical diagnosis (4)
Patients may adapt by avoiding full extension or bending, masking the symptoms until they’re flared
If you’ve been stretching, rolling, or “pushing through it” without relief, it’s time to look deeper.
Who’s at Risk?
Fat pad irritation can affect anyone, but certain patterns increase your risk:
Runners, gym-goers, Pilates devotees, and active adults
History of knee surgery, especially arthroscopy or ACL recon
Hypermobility or a tendency to lock knees in standing
Poor quad/glute coordination, particularly in terminal extension
Overuse of exercises like deep squats, leg press, or walking lunges with poor form or insufficient rest (5)
Treatment: What Helps?
Treating fat pad impingement requires more than just rest or a few stretches. It’s about reducing irritation and fixing the mechanics that caused it.
Initial Treatment Principles
Reduce aggravation:
- Limit time spent standing still with knees locked
- Avoid deep knee flexion (squats, lunges, leg press) in early stages (6)
Use offloading strategies:
- Fat pad taping to reduce pressure
- Heel lifts to avoid full extension
- Swap high-load exercises for controlled, neutral-range movements (6)
Re-train mechanics:
- Improve hip and glute activation
- Rebuild VMO control near terminal extension
- Focus on smooth load transfer through the knee (6)
Avoid unnecessary injections:
- Cortisone directly into the fat pad can cause tissue damage and is generally contraindicated (7)
Most cases respond well with early intervention and progressive loading. Chronic cases may need a carefully structured rehab plan tailored to your biomechanics.
Wondering if Your Knee Pain Is Actually Fat Pad Impingement?
Don’t guess. Download The Fat Pad Self-Check Toolkit - a free, 2-minute screen to help you identify fat pad impingement and learn what to do next.
If your pain has been lingering for more than 2–4 weeks, or it’s interfering with training or daily life, book an experienced assessment. Fat pad issues don’t always settle with rest, and early rehab matters.
The Bottom Line
Fat pad impingement is real, common, and treatable, but only if it’s recognised. If you’ve been managing “front of knee pain” with ice, rest, or band-aid advice and nothing’s changing, this is your sign to take it seriously. Smart rehab starts with a smart diagnosis.
Additional Considerations for Knee Health
Importance of Early Diagnosis
Recognising fat pad impingement early can prevent further complications. Many patients delay seeking help, thinking their pain will resolve on its own. This can lead to chronic issues that are harder to treat. If you suspect fat pad impingement, don’t wait. Early intervention is key.
Lifestyle Modifications
Incorporating lifestyle changes can significantly aid recovery. Consider adjusting your workout routine to include low-impact exercises. Activities like swimming or cycling can reduce stress on the knee while maintaining fitness.
Strengthening Exercises
Strengthening the muscles around the knee is crucial. Focus on exercises that target the quadriceps, hamstrings, and glutes. This can provide better support to the knee joint and reduce the risk of future injuries.
Stretching and Flexibility
Incorporate stretching into your routine. Flexibility can improve joint function and reduce tension in the muscles surrounding the knee. Pay special attention to the quadriceps and hamstrings.
Seeking Professional Help
If you're unsure about your symptoms, seeking professional help is essential. A qualified physiotherapist can provide a thorough assessment and tailored treatment plan. They can also guide you through rehabilitation exercises and monitor your progress.
Not sure what’s behind your hip or knee pain? Take this free, 60-second quiz created by APA Titled Musculoskeletal Physiotherapist Emma Glynn. It’s designed to help you identify the most likely cause of your pain — from fat pad irritation to osteoarthritis — and guide your next step.
👉 Take the quiz now and get tailored insights to move forward with confidence.
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The content provided on this website is for general information and educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. While The Hip and Knee Physio strives to present accurate and up-to-date information, we do not guarantee results or outcomes based on the information provided. Any exercises, strategies, or recommendations featured on this site should not be considered a personalised treatment plan. Always seek the advice of a qualified healthcare provider before starting any exercise program, particularly if you are experiencing pain, injury, or a pre-existing medical condition. Use of this website does not create a physiotherapist–patient relationship. The Hip and Knee Physio accepts no responsibility for any injury or loss arising from reliance on or use of this information. By using this website, you agree to these terms.
References
Dragoo JL, Johnson C, McConnell J. Evaluation and treatment of disorders of the infrapatellar fat pad. Sports Med. 2012;42(1):51–67.
Eberbach H, Zwingmann J, Hanke MS, et al. Clinical diagnosis of Hoffa’s fat pad impingement: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2020;28(4):1206–1215.
Duri ZAA, Aichroth PM, Wilkins P. The fat pad. Clinical observations. J Bone Joint Surg Br. 1996;78-B(5):685–688.
Melloni P, Valls R, Yuguero M, et al. Infrapatellar fat pad involvement in knee pathology: MR imaging findings. Eur Radiol. 1998;8(3):437–443.
Fulkerson JP, Edgar C. Fat pad syndrome: diagnosis and treatment. Phys Sportsmed. 2003;31(1):22–27.
Cowan SM, Crossley KM, Bennell KL. Musculoskeletal physiotherapy for patellofemoral pain syndrome. Physiotherapy. 2002;88(9):626–636.
Jacobson JA, Kim SM, Brigido MK, et al. Corticosteroid injections: what’s the risk to soft tissues? AJR Am J Roentgenol. 2016;206(3):495–501.
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