Experience with a Knee Fat Pad Impingment ?

I think I may be experiencing something similar. I'm in a less competitive phase of life right now, so I haven't really tried that hard to get rid of this ailment, other than seeing a physiotherapist a couple of times.

My symptoms are:

* pain under the patellar tendon. It usually feels okay while I'm running, but can become quite sore afterwards for a couple of days.

* kneeling on the affected knee is painful.

* when the inflammation is particularly bad, I can't extend and straighten my leg by flexing my quadricep.

* sitting for long periods in a slight recline (eg driving) causes the knee to become quite painful. I often can't drive for more than an hour without having to stop.

* rest doesn't seem to help. I didn't run for three weeks in the fall, and when I started again the knee was worse than before. It seems that if I do some easy running every other day the pain doesn't get worse, but if I try to do more it does.

I'm curious to hear what you or anyone else manage to do to help this condition. I've found that stretching the quads is essential, but not enough to make this go away. Another exercise that helps is to lie on your side with the bad leg on top, rotate your leg so that the toes point up, and then lift your leg. These things help me get around without limping, but it would be nice to get rid of this problem.

An orthopedist diagnosed chondromalacia grade II in late 2005. I had been away from the sport for 10 years and came back to quickly after all that time off and putting on about 30 pounds.

I had many of the same symptoms: my knee became extremely painful after prolonged periods of sitting down, rest didn't seem to help that much once the condition developed, and walking down stairs became painful. Curiously, the knee never hurts when I run. Anyone else find this to be true?

I have taken a multiprong approach, mostly because there are a number of reasons why a person may develop patellar pain.

First, I got orthotics. While they aren't for everyone, they were for me. I had numerous other problems, including plantar fasciitis, hamstring strains, and achilles' problems. I exhausted all options before the orthotics, but none worked. I simply pronate way too much on my right side, and minimalist shoes didn't help and neither did severe motion control shoes with super feet. With the orthotics, all my other problems went away, and they have helped some with the knee.

Second, I went to work on strengthening my VMO. Not everyone agrees, but most studies conclude that strengthening this muscle gives some relief of patellar pain (because the VMO can keep the patella from tracking laterally outside of the femoral groove, which leads to the friction on the cartilage). That has been my experience. People often recommend straight leg raises and isometric flexing of the quads. These help, and I do them, but I find other exercises are better. One is to do quad extensions with the bad leg, but only for the last 20 degrees of the extension. Doing the full range puts too much pressure on the patella. But those last 20 degrees really works that VMO. I also do wall squats, again only for the final 20-30 degrees. I don't flex to 90 degrees. It's somewhat hard to balance, but I try to do these with one leg in front of a mirror and really make sure my knee is aligned properly on these.

Third, glucosamine-chondroitin. Again, I think the studies are inconclusive on this, but I figured what the hell.

Fourth, stretching the IT band, strenghthening the hip abduction muscles, and hip flexors. Some say that a tight IT band pulls the knee laterally getting it off track, so stretching and strengthening these areas may also help.

Fifth, for whatever reason, hiking helps my chondro. I'm not sure why, but it does, so I try to hike every so often just for a change of pace and the relief it provides.

I'm now running again, about 20-25 miles a week, getting back into it again. It's not a lot of mileage, but I was away from the sport for many years, and this is more mileage than I was able to do before the orthotics and strengthening exercises.

Good luck to you both.

To both:

Can you describe your pain as occasionally "sharp", or just "dull" all the time?

I'm looking forward to what the knee surgeon has to say.. I've done enough squats and functional training prescribed by numerous P/T's that never say the same thing (probably enough to make the problem worse).. but I've already sort of heard from his secretary that he doesn't want to touch me, even though I've never met the guy.

Ugh, maybe I'm just trying too hard, or looking for problems that aren't there, but usually runners knee and what not clears up pretty quickly.

never had an impingement, but a few years back at the Mt. Marathon race in alaska, I hyperextended my knee pretty good on the descent and bruised and pinched the hell out of the fat pad. I thought I had torn my ACL.