| What We Treat
Fat Pad Impingement
A sharp, pinching pain right at the front of the knee, worse when you straighten it fully or stand for long periods? The infrapatellar fat pad is one of the most pain-sensitive structures in the knee — and one of the most commonly missed.
Overview
What Is Fat Pad Impingement?
The infrapatellar fat pad sits directly behind the patellar tendon, filling the space at the front of the knee. It is richly supplied with nerve endings, making it one of the most pain-sensitive structures in the joint. Impingement occurs when it becomes pinched between the kneecap and the thigh bone, most often when the knee is forced into full extension. It is frequently mistaken for patellar tendinopathy, and the treatments pull in opposite directions.
Tap a structure, or use the buttons, to see how the presentations differ.
The Infrapatellar Fat Pad
A wedge of fatty tissue behind the patellar tendon, densely innervated and capable of producing considerable pain when irritated. It becomes pinched when the knee is pushed into full or hyperextension, particularly under load.
Symptoms
How It Tends to Feel
Fat pad pain has a distinctive quality — sharp rather than aching, and provoked by straightening rather than bending:
Pain on Full Straightening
Locking the knee straight, particularly under load or when standing for long periods, is the classic aggravator.
Pain Either Side of the Tendon
Tenderness in the soft areas flanking the patellar tendon, rather than on the tendon itself.
Sharp and Pinching
Often described as a catch or pinch rather than the dull ache typical of tendon or joint pain.
Worse With Prolonged Standing
Standing still, particularly with the knees locked back, tends to build symptoms.
Puffiness at the Front
Visible fullness either side of the tendon compared with the other knee.
Worse Wearing Heels
Footwear that pushes the knee into extension can noticeably increase symptoms.
Causes & Risk Factors
What Drives It
Fat pad irritation comes from repeated or sustained compression, and there are usually identifiable contributors.
Knee Hyperextension
A tendency to lock the knee back beyond straight, whether from habit or natural joint laxity, compresses the fat pad repeatedly.
Direct Trauma
A blow to the front of the knee, or a fall onto it, can irritate the fat pad directly and start a persistent cycle.
Prolonged Standing
Occupations involving long periods standing still, particularly with locked knees, are a common context.
Post-Surgical Irritation
Fat pad problems are common after knee arthroscopy or replacement, where the tissue has been disturbed.
Quadriceps Weakness
Reduced quadriceps control makes it more likely the knee will be held in extension rather than actively controlled.
How We Can Help You
Treatment & Management
Fat pad impingement responds well once it’s correctly identified. The single most useful change is usually learning to stop locking the knee back.
What the evidence says
The infrapatellar fat pad has been shown in studies using injections into the knee of healthy volunteers to be among the most pain-sensitive structures in the joint, producing more pain than the synovium or the joint surfaces themselves.
The evidence base for specific treatments is limited compared with other knee conditions, but taping to unload the fat pad and retraining to avoid hyperextension are widely used, low-risk, and often produce a rapid response that itself supports the diagnosis.
When to Seek Help
Red Flags — Don’t Ignore These
Front-of-knee pain is usually benign. Seek assessment if you notice:
⚠ Seek prompt medical assessment if you notice:
- A hot, red, swollen knee with fever or feeling generally unwell (possible joint infection — seek emergency care)
- Marked swelling of the knee joint itself appearing rapidly after an injury
- A knee locked in a bent position that cannot be straightened
- Inability to weight-bear after an injury
- Constant night pain unrelated to position, particularly in an adolescent or with a history of cancer
These symptoms can point to a cause that needs medical rather than physiotherapy assessment. Please don’t wait for a physiotherapy appointment — contact your GP, call 111, or attend A&E as appropriate.
Common Questions
Frequently Asked Questions
Why has this been called tendinitis before?
Because both produce pain at the front of the knee and the two sit millimetres apart. The distinguishing features are where exactly the tenderness sits and what provokes it — fat pad pain worsens with straightening, tendon pain with bending and jumping. It’s a common mix-up and worth getting right.
Why does taping help so much?
Unloading tape lifts the fat pad slightly away from the space where it’s being compressed. When it produces immediate relief, that’s both useful in itself and strong supporting evidence for the diagnosis. It’s a bridge, not a long-term solution.
Am I really standing wrong?
Not wrong exactly — but many people rest on their joints rather than holding themselves with muscle when standing still, and locking the knees back is comfortable until it isn’t. Learning to stand with a few degrees of bend is often the single most effective change.
How long does it take to settle?
Often faster than other knee conditions — many people notice substantial change within two to four weeks once the compression is removed. Persistent cases usually have an ongoing source of hyperextension that hasn’t been addressed.
Often Missed, Usually Fixable
A careful assessment to identify exactly which structure is involved, and a plan that takes the pressure off it.
Book Your Initial AssessmentThis page is for general information only and isn’t a substitute for individual medical advice. If you’re experiencing any of the warning signs above, contact your GP or seek emergency medical care as appropriate.