Hoffa's syndrome: causes, symptoms, treatments

Knee pain can make it tough to move comfortably, especially if you notice soreness or swelling just below your kneecap. One possible cause is Hoffa’s fat pad syndrome (also called infrapatellar fat pad impingement).  This refers to irritation of the soft tissue beneath the kneecap.

“Hoffa’s syndrome may sound scary, but it’s just a term for a certain type of knee pain,” says Scott Loving, PT, DPT, a physical therapist at Hinge Health. “It often develops after changes in your activity levels. Certain people, like those with flat feet, may be more prone to it as well.” 

In most cases, knee pain related to Hoffa’s fat pad can improve with at-home treatments like targeted exercises and simple tweaks to your exercise routine. Here’s a closer look at Hoffa’s syndrome, including its causes and symptoms as well as how to treat and prevent it — especially with exercises recommended by Hinge Health physical therapists.

What is Hoffa’s syndrome?

Hoffa’s syndrome is named after Dr. Albert Hoffa, the physician who first described this type of knee pain. It refers to pain in the front of your knee, just below your kneecap. This area is home to a soft tissue called the infrapatellar fat pad, which can sometimes become sensitive or irritated, says Dr. Loving. 

Symptoms often overlap with other types of front knee discomfort, such as jumper’s or runner’s knee. Anyone can develop this kind of knee pain, but some people may be at more risk than others, including those who: 

• Participate in sports with kneeling, jumping, or quick changes in direction (such as basketball or volleyball)

• Have a history of knee injury, which can make the area more sensitive

• Have flatter feet, which might affect how your knee moves

• Are female athletes, due to natural differences in body shape and movement patterns 

Symptoms of Hoffa's syndrome

The classic symptom of Hoffa’s syndrome is pain directly below your kneecap that radiates to the outside of your knee, says Dr. Loving. You may also notice these symptoms:

• Kneecap swelling and tenderness

• A burning, aching sensation in your knee

• Trouble straightening or bending your knee

• Pain that worsens when you jump or walk up or down stairs

• A clicking or popping sound in your knee

• Your knee feels warm to the touch

Causes of Hoffa’s syndrome

You might notice Hoffa’s syndrome symptoms after you bump or twist your knee, or with changes in your activity — like starting a new exercise routine, increasing how far you walk or run, or spending more time on your feet. Common reasons you may develop Hoffa’s syndrome include: 

• Changes in activity. Your knees are resilient and capable of all types of movement. Sometimes, when you suddenly increase your activity or try something new, the soft tissues in your knee (including the Hoffa’s fat pad) become more sensitive for a while. “We often see symptoms in people who do more jumping or high-impact activities like running than they’re used to,” says Dr. Loving. Gradually building up your fitness routine helps your knees adapt.

• Trauma or direct impact. Getting hit in the front of your knee, twisting suddenly, or landing directly on this area can sometimes make your knee feel sore or swollen for a while. The tissues beneath your kneecap, including the fat pad, can become sensitive.

• Flat feet. Your natural foot structure can sometimes affect how your knees feel. For example, when you have flatfoot, your ankles might roll inward a bit more with each step. Over time, these natural variations in movement patterns can strain the tissues around your knees, says Dr. Loving.

• Previous knee injury. For some people, a previous knee injury (or even their natural kneecap shape) can make the knee feel a little less stable at times. When the kneecap shifts a bit more than usual, the tissues underneath — like the fat pad — may become sensitive or sore, says Dr. Loving. 

• Tight muscles and ligaments. If the ligaments in your knee or the muscles around it are too tight, the area below your kneecap may feel more sensitive or uncomfortable. Stretching and gentle movement can often help ease this sensation by promoting flexibility and easing pressure.

How movement can help hoffa’s syndrome 

Hoffa’s syndrome can make certain activities feel challenging. While it may seem counterintuitive to exercise when your knee hurts, staying active can help ease pain. “Motion is lotion when it comes to your kneecap — the more you move, the more you support your body’s natural healing process,” says Dr. Loving.

Focus on low-impact movements that gently promote blood flow to the tender area. Activities like swimming, cycling, or using an elliptical machine are often comfortable options, Dr. Loving says. It’s a good idea to temporarily pause high-impact activities — such as running, jumping, or deep squats — if they increase your discomfort.

You may notice improvements as you shift to lower-impact activities and incorporate targeted exercises that strengthen the areas around your knee into your daily routine.

The exercises above help you begin strengthening the muscles around your knee without putting extra pressure on the fat pad at the front of your knee. It’s best to start with these movements and hold off on deep knee bends or exercises like squats until your knee feels less sensitive. “As your knee becomes stronger and pain sensitivity decreases, you can gradually work back up to higher-level activities, such as jumping and running, at a pace that feels right for you,” Dr. Loving says. 

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Treatments for Hoffa’s syndrome

Most of the time, knee pain from Hoffa’s syndrome can heal with simple treatments like targeted exercises, applying heat or ice to the area, and using supports like kinesiology tape. Here’s what Hinge Health physical therapists recommend for Hoffa’s syndrome treatment.

• Try physical therapy and targeted exercises. Targeted exercises, like the ones above, can help strengthen the muscles around your knee, taking pressure off your Hoffa’s fat pad as it heals. You can do exercise therapy at home or work with a physical therapist who can guide you through movements tailored to your needs. You can see a physical therapist in person or use a program like Hinge Health, where you may access a PT via telehealth/video visit.

• Keep moving. Hoffa’s syndrome can make your knee feel sore, which may make you want to stay off it. But gentle movement actually supports your recovery. Activities like walking, swimming, yoga, or tai chi are all low-impact ways to promote healing, oxygen-rich blood to your knee. 

• Apply ice or heat. Ice can help tame inflammation and swelling in your Hoffa’s fat pad. You may also find it soothing to apply a heat pad to your knee, says Dr. Loving. Try both methods or stick to the one that works best for you.

• Take over-the-counter (OTC) medication. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can help ease pain so you can do your targeted exercises and stay active when you have knee pain. Other options are topical NSAIDs or pain relief creams. If you have a medical condition or take other medications, check in with your provider to make sure these OTC options are ‌safe to take.

• Try taping.Your physical therapist may suggest using elastic or kinesiology tape over your kneecap while exercising with Hoffa’s syndrome. Taping can provide gentle support and compression to the area, which may help you feel more comfortable as you move, says Dr. Loving. As your knee begins to feel better, you can stop taping. Your physical therapist can guide you on the best way to apply it.

• Consider complementary treatments. Talk to your provider or your physical therapist to see if you’re interested in trying alternative treatments for knee pain relief, such as massage, acupuncture, or dry needling.

• Ask about TENS therapy. TENS, or transcutaneous electrical nerve stimulation, uses gentle pulses to quiet your pain response and help reduce pain associated with conditions like Hoffa’s syndrome. One option is the wearable device Enso, available through Hinge Health. It’s small, wireless, and portable.

How to prevent Hoffa's syndrome 

While it’s not always possible to prevent Hoffa’s syndrome completely, there are steps you can take to protect your knees, like changing out old footwear and adding supportive orthotics to your shoes if needed. Try these strategies recommended by Hinge Health physical therapists.

• Warm up and cool down. “It’s tempting to jump right into activities,” says Dr. Loving. But taking a few minutes to warm up the muscles that support your kneecap before you start, and cooling down after you finish, can help your knees feel their best. Try doing dynamic warmups like squats, calf raises, and lunges. After your workout, consider doing some static stretches, like a quad stretch, which require you to hold that stretch for a little longer.  

• Keep the muscles strong and flexible. Protect your knees by doing exercises that target a variety of muscles around your knee, such as your quads and hamstrings, says Dr. Loving. The above targeted exercises are a great starting point. Consider working with a physical therapist who can also suggest movements to improve your lower body flexibility.

• Replace worn out shoes. Supportive footwear can play a role in how your knees feel during physical activity. If your workout shoes are showing signs of wear — such as a loss of cushioning or tread — it may be time to consider a new pair. Experts suggest replacing your athletic shoes after a few months of regular use.

• Consider an over-the-counter orthotic. If you have flatter feet, adding an over-the-counter orthotic to your shoes may help support your comfort during activity, says Dr. Loving. Some research suggests that orthotics can improve knee function and may help prevent discomfort for certain people. (Your physical therapist can help you decide if this option is right for you.)

When to see a doctor

Knee pain from Hoffa’s syndrome often improves on its own with at-home treatments. But if your front of knee pain is severe, getting worse, or causing difficulty with daily activities, see a healthcare provider. It’s also a good idea to get care if you have:

• Swelling that’s getting worse or encompassing your whole knee

• Issues bearing weight on your knee

• Knee instability, or it feels like your knee will give out when you stand or walk

If you have any of these symptoms, something else might be going on. “A doctor may want to run tests to rule out issues with the meniscus (cartilage) or knee ligaments,” Dr. Loving says. 

PT tip: Listen to your body

Sometimes, it’s okay to push through mild pain and discomfort, but that’s usually not the case with Hoffa syndrome. “If an activity increases your pain, take a break or try a gentler movement to allow your knee to recover,” says Dr. Loving. “Paying attention to how your knee feels during exercise can help you heal more quickly and get back to the activities you love.”

How Hinge Health can help you

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

References

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2. DuBose, M., & Taqi, M. (2023). Hoffa Pad Impingement Syndrome. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK589637/

3. Chen, Z., Wu, J., Wang, X., & Ren, Z. (2022). The effect of foot orthoses for patients with patellofemoral pain syndrome: A systematic review and meta-analysis. Heliyon, 8(6), e09656. doi:10.1016/j.heliyon.2022.e09656

4. Furman, A. (n.d.). How Do I Know When It Is Time To Replace My Athletic Shoes. Www.aapsm.org. https://www.aapsm.org/replace_shoes.html

5. Li, X., Williams, P., Curry, E. J., & Hannafin, J. A. (2016). Unusual presentation of anterior knee pain in elite female athletes: report of two cases. Orthopedic Reviews, 8(1). doi:10.4081/or.2016.6291

6. Larbi, A., Cyteval, C., Hamoui, M., Dallaudiere, B., Zarqane, H., Viala, P., & Ruyer, A. (2014). Hoffa’s disease: A report on 5 cases. Diagnostic and Interventional Imaging, 95(11), 1079–1084. doi:10.1016/j.diii.2014.06.009

7. Lee, J.-H., Lee, S.-K., Park, E.-Y., Kang, S.-W., Won, Y.-J., Ha, J.-J., & Yang, M. (2022). Effect of Korean Medicine Treatments for Fat Pad Syndrome of Knee Joint: A Case Report. Journal of Acupuncture Research, 39(1), 53–58. doi:10.13045/jar.2021.00220