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!).

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.

IRONMAN

June 1, 2025
Interstate visitor Client D came in two days before the Melbourne Ironman. Despite treatment interstate he had persisting leg soreness which had stopped him running for a week and had serious doubts on finishing, let alone doing well enough to earn him what he entered for: a qualifying position in the Hawaiian Ironman. He had some back joint stiffness and lateral hamstring trigger point muscle spasm and after loosening these up he felt better. However running a full marathon after the 3.8 kilometre swim and 180 kilometre cycle would be a massive test! The news post race was that he had got though the event and even with a puncture on the cycle grabbed a spot in Hawaii!  Well done to him! (And a bit to me too!)