Walking is so painful!

[Claire]

So many of my patients with fat pad problems report walking and standing as incredibly painful. It makes fat pad problems very debilitating. I’d love patients to have a voice here.What are your experiences? Any top tips for other patients?

[Amy Pugh]

Hi Claire
I have just stumbles across your very informative website. I am hoping you can advise me what the best approach is to try and get rid of the a lateral fat pad hard swelling I have under my knee following arthroscopy on 4th Jan this year for a partial meniscectomy.
I am a professional horse rider, we breed and produce horses for jumping and eventing as well as dressage so it is more than just gentle riding and there is lots of walking around in between looking after the horses. This is also my home and livelihood. I am now in a worse position than before the surgery and struggle to walk around for any length of time, even to do basic house chores.
Not only my career but my life feels like its slipping away over the past 3 months- I was so hopeful that the partial meniscectomy would relive my pain and get me back compete at a higher level. I have done loads of icing, physio and spend a good portion of the time resting so have lot a fair bit of muscle. I had an MRI on Friday and yesterday my consultant/surgeon looked at it to confirm the hard swelling was not normal and injected it with a steroid to try and settle the inflammation down. I feel like the lump is pretty hard so i’m sceptical if the steroid injection will work.
I have been told to take it quite easy for 7 days to let it work. What is your experience with steroid injections for getting rid of fat pad hard swellings? Is there anything else you suggest I can be doing? Sorry about the long post, I’m just desperate to get my life back, especially as we are trying to start a family…

[Kay]

I have just found this website. Have been suffering for fat pad impingement for a while now and was wondering if your steroid injection worked.

[Claire]

In my experience of 100 people with steroid into their fat pad, 60 will be no different, 20 improved and 20 worse. The ones who are worse are often very sensitive to start and have an element of what we would call neuropathic pain. I think many don’t respond as the driver isn’t addressed, eg biomechanics, weakness etc.
I wish you a speedy recovery.

[Kay]

I thought that a steroid injection probably wasn’t going to be the answer to my fat pad problems as an MRI scan has shown I have tracking issues. Have been working with a physio on knee strengthening exercises but sometimes wonder if they are aggravating the very sensitive area just below my knee cap on the medial side. Walking too far definitely aggravates this area which is depressing as I love walking. Next thing I’m going to try is a stationary bike, just so I can keep my knees moving without weight bearing. I’m also going to use the ice massage more regularly than before to see if that helps.

[aepiscopo]

Walking is painful. Sitting is painful. Standing is painful. It’s all painful. I’ve had this for 5 months now and my ortho told me to just take a bunch of NSAIDS and it would go away. That has not been the case, and my standard of living has suffered significantly. I had patellar tendinopathy prior to this injury. I had been rehabbing with Jill Cook and Ebonie Rio’s methodology, then I rode a bike for a warm up instead of my usual walk, and two days later my fat pad swelled and hurt. I’ve been taking around 1600 mgs of NSAIDS daily, taping, and icing, but have not experienced significant improvement. I have also tried quad isometric movements to strengthen the quads, but that just makes my knee pain worse. What can I do? I want a cortisone shot to settle the pain enough to rehab a few weeks, but don’t even know where to begin with that. I don’t observe any patellar tracking issues to correct. I also don’t want a surgery to remove the fat pad but I am not experiencing improvement and I need to be able to walk.

[Claire]

So sorry it’s such a problem. Breaking the cycle is key. Steroid injections sometimes help but not always. Measures such as tape, ice and a slight heel lift can be useful. Best of luck with it.

[Kay]

I can sympathise completely, aepiscopo. I have had impingement for nearly 5 months too with symptoms that can vary daily and even hourly. Have tried most things such as taping, rest, icing and have now resorted to using a walking stick! When things seem to be improving, they can suddenly get much worse again. I’m not sure what I can do to improve the situation as I am already getting regular physio to strengthen the muscles around my knee which have become very weak due to the pain and swelling.

[Helen]

I am in the same boat. I had on and off issues until a steroid injection that made things phenomenally worse. Pain, burning, swelling, unable to sleep, tolerate no exercise, ice is hit and miss but mostly miss. Did anyone on here get better. I also lost all the muscles I was supposed to improve, not just the quads but lateral calves. My impingement looks lateral under the patella, but pain and swelling seem to go down to the tibialis anterior muscle.

[Kay]

Helen, I had a steroid injection into the knee joint space, not the fat pad and it improved my over all knee pain a bit, but then my fat pad pain seemed to be emphasised. My quads are atrophied and my calf is smaller now too also in spite of exercises. At the moment I am trying to increase daily steps and get stronger that way and just doing exercises once a day. I need KT tape around knee to stabilise it while I walk. I tried reducing my walking for a while but it did nothing except weaken my leg further so I am trying to carry on daily life as best I can. I’m also seeing a pain management physio to try and get tips on how to divert my attention away from my knee ( not easy ) I’m still icing knee after exercise. Hope you get some relief soon.

[jlinden]

Hi everyone,

After experiencing Patellofemoral pain for almost a year and multiple unsuccessful rounds of PT, I had arthroscopy on my right knee in October 2022. Since then, my PT and I believe I’ve developed Hoffa’s Syndrome. My Ortho doesn’t think I have Hoffa’s (the condition seems to be off his radar), but after listening to Claire’s podcast and research, it is evident that I have all the signs and symptoms (I have hypermobility, severe chronic pain, pain at full extension, walking, excruciating flare ups that are often delayed). I received a cortisone shot a month ago which helped tremendously, and I have experienced strength gains from consistent quad, hip, calf strengthening PT exercises that avoid full extension and deep flexion. However, last week I experienced a significant setback after participating in a yoga class, and my symptoms are now as severe as they were before the cortisone shot.

Claire has talked about the “Settling Period” as the first Phase to treat Hoffa’s to break the inflammation cycle. Yet, I also want to maintain the strength I’ve built. I’m curious if anyone has insight as to what is an appropriate approach to PT and activity at this stage. E.g. should I continue performing PT exercises daily? Revert to easier exercises? Take some time for complete rest?

More generally, if anyone has tips for what has worked, or not worked for them in the past, I would greatly appreciate it!

Hoffa’s is nasty, but I know that with enough education and persistence dedicated to recovery, there is a solution out there for all of us. We all have the power to find it.

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