Fat Pad Impingement

Keen soccer player Ms. K presented with sharp pain just under the kneecap. It was very sore when running and going up and down stairs. She had fat pad impingement of her knee.

 

The fat pad is “cushion” structure sitting below the big tendon that joins the kneecap to the shin bone. It can become swollen from the kneecap squashing into it through sport or impact. Although not a severe structural injury, it can be very restrictive due to the pain. “Fat pad impingement” is a common presentation for stop start sports participants. In the old days it was common with the staff in English castles who were scrubbing floors (housemaid’s knee!).

 

Simple taping is usually very effective, and I often enjoy the look on the sufferer’s face after they go up a step after being taped (and it doesn’t hurt!). Management of knee stiffness, strength, relative rest and return to normal activities then begins.

 

Untreated it can persist for a long time and will invariably lead to loss of strength in the knee and possible further problems from this.

 

Avoid power activities of the knee that hurt: stairs, ladders, hills, squatting and sprinting as well as kneeling (AND no scrubbing floors!).

SHOULDER BURSITIS

By Brendan Dax • October 27, 2025
Bursitis is one of the many causes of impingement pain of the shoulder, giving restriction and pain when lifting the arm. Bursae are small sacks of fluid and when inflamed in the shoulder, take up too much space, getting squashed when raising your arm causing painful pinching. Like all musculoskeletal problems, this is a problem of mechanics. Something doesn’t move properly. From a manual physiotherapy perspective, bursitis, like all shoulder impingement problems usually responds well to joint mobilisation. In all my years of treating shoulder impingement almost all presentations have associated neck/upper back spinal joint stiffness. Manual mobilisation (loosening up) of the neck/back and shoulder joints will always yield improvement, unless there is structural damage. Having seen 100s of acute onset (within the previous two days) shoulder problems in the industrial sector, I can assure you that most of them come in with chronic, stiff upper backs that they’ve had for ages. True bursitis usually responds as well to a guided Cortisone injection. Bear in mind if the neck and shoulder joints are still stiff the jab may not solve the problem. If you have shoulder pain that has not responded to injection and/or seeing a Physio who just uses machines and/or exercises, consider manual physiotherapy from someone like me, before we all retire!

SIDE HIP PAIN

July 1, 2025
Pain on the side of the hip from bursitis or gluteal tendon inflammation is an annoying problem often more so at night because lying on it frequently disturbs people’s sleep. It is a reasonably common problem for me to see. Tendons and bursae degenerate as we age and weakness in hip musculature can be a cause. But it can happen to anyone. Guided steroid injections can help, but most people respond well to soft tissue manipulation. The lower back should definitely be assessed and (usually) treated manually as related spinal joint stiffness frequently contributes to the issue. The hip joint should also be assessed and treated if necessary. Exercises can be helpful but need to match the pathology so an Ultrasound image might be needed give a diagnosis.