Quick Summary
Pain beside the patellar tendon, especially when straightening the knee, may involve the fat pad. Assessment helps distinguish it from other front-of-knee problems. Our physiotherapists in New Malden can assess your symptoms and help you choose appropriate next steps for your goals. We agree practical goals and review your progress.
Understanding Hoffa’s Fat Pad Impingement
Hoffa’s fat pad is sensitive fatty tissue behind the patellar tendon at the front of the knee. It may become irritated or compressed with certain movements. Fat-pad changes on a scan do not by themselves prove the cause of pain; symptoms and examination need to fit together.
Assessment at J&J Therapy
We check the painful positions, knee movement, swelling and control when standing or stepping. We discuss whether your history fits fat-pad irritation and explain what would prompt medical investigation rather than continuing treatment without improvement.
Image: erico / DBCLS, Togo picture gallery · CC BY 4.0. Adapted and annotated.
Do You Experience These Symptoms?
- Tenderness below the kneecap, often beside the tendon.
- Pain when standing with the knee pushed back or fully straightened.
- Discomfort with kneeling, walking or repeated knee movement.
An assessment helps guide your next step, based on your symptoms, health and goals.
Why symptoms may develop
A direct knock, repeated hyperextension or changes in training can contribute. Symptoms may also occur alongside other knee conditions. We avoid labelling all anterior knee pain as impingement because patellar tendon and kneecap-joint problems can feel similar.
Treatment and rehabilitation options
Hands-On Manual Therapy
Careful treatment around the knee may help comfortable movement when indicated. We avoid deep pressure on the sensitive fat pad and forceful end-range extension. A short taping trial may be considered if it reduces symptoms during a relevant task. We explain the purpose and check your comfort and response throughout treatment.
Is Shockwave Suitable?
Shockwave is not a routine treatment for Hoffa’s fat pad irritation. The first steps are assessment and reducing the movements that repeatedly provoke the area. Your physiotherapist can explain the more suitable options and how their effect will be reviewed during your ongoing rehabilitation.
Targeted Exercise Programme
Exercise starts in a comfortable range, with attention to knee and hip strength and standing habits. We gradually reintroduce more demanding movement as symptoms allow, rather than forcing the knee into a painful locked-back position. Your home plan is adapted as your function and confidence improve.
When to Seek Urgent Medical Help
While most symptoms are not serious, urgent medical attention is required if you experience any of the following:
- Seek urgent GP or NHS 111 advice if you cannot move the knee, bear weight, or straighten a knee that is locked.
- A hot swollen knee with fever or feeling unwell needs urgent medical assessment.
- Go to A&E for a deformed leg after injury or a foot that becomes cold, pale or numb.
Your questions answered
Must I keep my knee bent all the time?
No. The goal is comfortable normal movement. Temporarily avoiding repeated painful hyperextension is different from keeping the knee stiff or immobile.
Does an MRI diagnosis explain all my pain?
Not necessarily. Fat-pad findings can appear without matching symptoms. Your examination and response to activity help guide a sensible plan.
Which appointment should I book?
Start with a Physiotherapy Initial Assessment for new, persistent or recurring symptoms. We can assess the problem and agree a plan linked to your daily activities. If you have already had medical care or surgery, bring the relevant instructions.
Book a Physiotherapy Assessment or call our reception team on 07935 869938. Find J&J Therapy at CI Tower, Ground Floor, New Malden.
Related conditions
Patellofemoral Pain Syndrome (Runner’s Knee) · Patellar Tendinopathy (Jumper’s Knee)
Sources and further reading
This page is for general information only and does not replace professional medical advice.
Information updated 15 October 2026. General information only; this page cannot diagnose your symptoms. Treatment is agreed after assessment. For urgent or severe symptoms, use the medical services described above.