Bodyworks: Hoffar's Syndrome

How to recognise it, how to overcome it

by Patrick Milroy

You will tend to notice a tender swelling in the hollows normally found between the patella and the lower leg. As the discomfort may be worse after runs, it may limit training.

Your doctor will see exactly the same as yourself, although he may be more expert than you at eliciting tenderness!

Medical investigation
As the diagnosis is often obtained from the history and requires little in the way of investigation, a detailed training history is important. It is an over-use injury, more noticeable at the end of a run or if you have increased your mileage too quickly. A sudden switch to hill training may bring it on.

What else could it be?
All the other causes of anterior knee pain may need to be eliminated, such as patellar problems, and cartilage tears and strains, as well as arthritis and internal damage, which produces fluid on the knee.

Rest, ice and anti-inflammatories with training modification may well be sufficient to settle the problem.

Medical treatment
If physiotherapy, usually in the form of ultrasound, fails to settle Hoffar’s syndrome, a cortisone injection will usually suffice. A need for surgery is unlikely.

Can you run through it?/Recovery time
Training modification and sticking to sensible terrain may well be all that’s required, and some athletes don’t let it interrupt the flow of their training.

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Discuss this article

Help! I've been experiencing knee pain when I run.

I'm fairly new to running but already addicted. Trouble is I have been having knee pain at the front/lower part of my knee - and its quite swollen after a run. I have been to see a physio and they have said it's my "fat pads"?!?! A bit of searching on the internet has revealed it could be Hoffa's Syndrome. They strapped up my knees to see if this helped with a run. It did but I still experienced some discomfort. I'm sooo worried I will have to give up running. Has anyone else had something like this? If so how did you get over it? (I cant afford to pay for alot of physio...)

Posted: 04/07/2003 at 17:09

Ok, it could be a number of things, but my first suggestion which is probably a bit annoying is to see a specialist sport physio. I have done 2 London Marathons now and am also a fellow addict, however when I first had problems I saw a non sports physio who did not help @ all. It could be a number of things, but a good physio will help you get through it and it is very doubtful you will have to stop running if you stop running now and get decent help. I have had many panics over the years and more recently have had a knee problem myself, but my very good physio and a podiatrist (long overdue for me as i knew my feet were crap)have put me on the road to recovery. One thing I will say is do not strap it up and run with the pain. I did that post Marathon this year with some piriformis (muscle problem) and this caused my knee problem as i was overcompensating. Get good help. I have been told by my pod and physio that there will be no problems eventually and I should be able to continue marathon runing as long as I look after myself.

In the meantime to try and pinpoint the problem what sort of distances are you running, on what surface and how have you built up to the distance. Also what kind of shoes are you wearing and does it hurt more going up or downhill or just all the time.

It is possibly patella tendonitis which is inflamation of the patella tendon below the knee cap. Hoffa's syndrome is usually found in adolescents..are you young??

There is a good product called a knee strap which I have used for my chondromalacia which is good for patella tendonitis (see proline sports website), but you need to find the cause of the problem to prevent it happening again.

Last not run if it hurst. Rest and ice also tske some anti inflammatories, but not to mask the pain so you can run. When I had my problems I took them after my run so I was laways aware of the depth of the pain.

Let me know how you get on, but you will run again!!
Posted: 04/07/2003 at 18:54

Hi Kinkyrunner

Thanks so much for your reply - sorry for not replying sooner (pc trouble).

Been to see a couple of physios now - its definitely my fat pads (my kneecap isnt tracking properly). This is because I overpronate.

Strapping my knees before I run to help my kneecap track is helping and I'm doing lots of exercises and runs on grass.

I'm waiting now to see a Podiatrist to get some orthotics sorted...... So I'm getting there. Thanks for your advice. I'm sooo pleased I can get it sorted and like you should soon eventually be able to run without any problems. (That fact this I'm excited by this must mean I really am a runner surely!!!)
Posted: 27/08/2003 at 13:16

I presume that when you sat strapping that you are TAPING the patella ?? If maltracking than this certainly can help.
Also please you are having a poditry check up.
The other thing to consider in knee pain is your quads, Along with taping of the patella- strengthening of the inner quad muscle ( called VMO) may well also help. Ask physio what they think re this.
Fat pad impingement is the same as Hoffas Syndrome.

I am addicted too. But remember gradually increase- not too much too soon !
Best wishes

Posted: 27/08/2003 at 14:48

piriformis (muscle problem) and this caused my knee problem hi kinkyrunner just checked the website and pasted this from one of your replies to a runner. was this problem in your bum muscles that were not stretched out causing the knee problem, as ive had problems with my piriforma for while and today my knee started to give me grief(right lower inside of knee)would more stretching solve this? hope you can advise best wishes
Posted: 12/11/2006 at 19:44

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