Knee Pain

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The infrapatella fat pad (sometimes known as Hoffa’s pad) is a soft tissue that lies beneath the patella (kneecap) separating it from the femoral condyle (end of the thigh bone).

In situations where forces are directed at the patella it acts as a shock absorber, thus protecting the underlying structures.

In the case of a forceful direct impact to the kneecap, the fat pad can become impinged (pinched) between the femoral condyle and the patella. As the fat pad is one of the most sensitive structures in the knee, this injury is known to be extremely painful. This condition is normally long-standing as it is aggravated by extension or straightening of the knee joint.

Hence the fat pad comes under constant irritation and may become significantly inflamed.


Injury to your infrapatellar fat pad can happen for a number of reasons. It’s sometimes as a result of a sudden (acute) injury to your knee, and sometimes it develops gradually over time. Fat pad impingement is usually caused by repeatedly overextending your knee. This is when your knee is forced beyond its fully straightened normal position – this happens especially if you lift weights incorrectly.

Signs & Symptoms

As the fat pad has many nerve endings, infrapatellar fat pad impingement can be extremely painful. You’ll usually have an aching or burning pain at the front of your knee, around the bottom of your kneecap. This pain may be worst when your leg is completely straight or when you are going up stairs. The area around the bottom of your kneecap may also feel very tender to the touch. You may have some swelling there too. If the condition goes on for a long time your knee may stiffen and lose its full range of movement.



Patellar tendinitis is an injury to the tendon connecting your kneecap (patella) to your shinbone. The patellar tendon works with the muscles at the front of your thigh to extend your knee so you can kick, run and jump.

Patellar tendinitis, also known as jumper’s knee, is most common in athletes whose sports involve frequent jumping — such as basketball and volleyball. However, even people who don’t participate in jumping sports can get patellar tendinitis


Patellar tendinitis is a common overuse injury, caused by repeated stress on your patellar tendon. The stress results in tiny tears in the tendon, which your body attempts to repair. But as the tears in the tendon multiply, they cause pain from inflammation and weakening of the tendon. When this tendon damage persists for more than a few weeks, it’s called tendinopathy.

Signs & Symptoms

Pain is the first symptom of patellar tendinitis, usually between your kneecap and where the tendon attaches to your shinbone (tibia).

The pain in your knee may:

  • At first be present only as you begin physical activity or just after an intense workout
  • Worsen until it interferes with playing your sport
  • Eventually interfere with daily movements such as climbing stairs or rising from a chair



Patellofemoral pain syndrome is pain at the front of your knee, around your kneecap (patella). Sometimes called “runner’s knee,” it’s more common in people who participate in sports that involve running and jumping.


PFPS occurs when the patella (kneecap) rubs on the femur bone underneath. It is often thought that incorrect tracking or rubbing of the patella over the femur bone is a significant factor and results in damage or irritation of the articular cartilage underneath the patella.

  • Overuse. Running or jumping sports puts repetitive stress on your knee joint, which can cause irritation under the kneecap
  • Muscle imbalances or weaknesses. Patellofemoral pain can occur when the muscles around your hip and knee don’t keep your kneecap properly aligned. Inward movement of the knee during a squat has been found to be associated with patellofemoral pain.
  • Injury. Trauma to the kneecap, such as a dislocation or fracture, has been linked to patellofemoral pain syndrome.
  • Surgery. Knee surgery, particularly repair to the anterior cruciate ligament using your own patellar tendon as a graft, increases the risk of patellofemoral pain.

Signs & Symptoms

Patellofemoral pain syndrome usually causes a dull, aching pain in the front of your knee. This pain can be aggravated when you:

  • Walk up or down stairs
  • Kneel or squat
  • Sit with a bent knee for long periods of time



Iliotibial band syndrome is inflammation of the Iliotibial band on the outside of the knee as it rubs against the outside of the knee joint.


Iliotibial band friction syndrome occurs when the long tendon of the tensor fascia latae muscles which runs down the outside of the thigh to the knee (called the illiotibial band) rubs against the outside of the knee joint causing friction, pain and inflammation.

Certain factors may make you more susceptible to developing runners knee or iliotibial band syndrome. A naturally tight or wide IT band may make someone more susceptible to this injury. Weak hip muscles, particularly the gluteus medius are also thought to be a significant factor.

Over pronation or poor foot biomechanics may increase the risk of injury. If the foot rolls in or flattens, the lower leg rotates and so does the knee increasing the chance of friction on the band. Other factors include leg length difference, running on hills or on cambered roads.

Signs & Symptoms

Symptoms of ITB syndrome consist of pain on the outside of the knee, more specifically at or around the lateral epicondyle of the femur or bony bit on the outside of the knee.

It comes on at a certain time into a run and gradually gets worse until often the runner has to stop. After a period of rest the pain may go only to return when running starts again. The pain is normally aggravated by running, particularly downhill.

Pain may be felt when bending and straightening the knee which may be made worse by pressing in at the side of the knee over the sore part. There might be tightness in the iliotibial band which runs down the outside of the thigh.



Shin splints is the common name often given to pain at the front of the lower leg. Usually symptoms occur at the front inside of the shin bone but can arise from a number of causes.

The muscles of the lower leg pull on the periosteum or sheath surrounding the shin bone causing pain and inflammation. This is an over use injury resulting from increasing running mileage too quickly, excessive training on hard surfaces and running on your toes as in sprinting repetitions.


Although too much running, jumping or sprinting is the obvious cause, there are a number of factors which can increase the likelihood of shin pain developing.

  • Overpronation
  • Over supination
  • Inadequate footwear
  • Increasing training too quickly
  • Poor flexibility

Signs & Symptoms

Symptoms often come on gradually and consist of pain over the inside lower part of the tibia or shin bone. There may be pain at the start of exercise which often eases as the session continues only to come back worse later in the training session or afterwards.

Pain is often worse the next morning but may ease off over time with gentle use, often to become painful again later on. Swelling or lumps and bumps felt along the inside of the bone, particularly in more chronic cases where new bone growth as occured through repeated trauma. Occasionally in severe cases reddening of the skin over the inside of the leg from acute inflammation may be seen.