Rafael Nadal Announces He Has “Hoffa’s Syndrome”, He Hopes To Return For Davis Cup [Video]
by Tom Gainey | August 17th, 2012, 12:09 pm

In a press conference today in Mallorca, Rafael Nadal shed more light on his injury situation. The 26-year-old revealed that he has been suffering from “Hoffa’s Syndrome”, which is a fat pad impingement in his left knee (read more here). The injury has now forced him out of the US Open and he says he will only return when the knee is 100% OK.

“Now the most important thing is to recover well and today my knee is not ready to compete in a ‘Grand Slam’, I will try to recover as soon as possible to return with a good feeling, with guarantees to compete and train all the best I know,” Nadal said via Marca through Google translation.

After missing all of July and August, Nadal is still hopeful on returning for Spain’s Davis Cup tie at home on clay against the U.S. the weekend after the US Open.

“We’ll see if I will be ready for Gijon, for the Davis Cup,” Nadal told Reuters. “My goal, my dream is to be there if the captain has confidence in me, but it always depends on the captain and the knee.”

Nadal’s absence will hurt his ranking, but the 11-time Grand Slam champion also said that he isn’t worried what position he will be when he returns.

Rafa’s coach and Uncle, Toni Nadal, added yesterday that he wants Rafa only to return when fully healthy.

Nadal hasn’t played since his shock loss to Lukas Rosol in July 28 at Wimbledon. He said this injury is related to the knee issues he had earlier in the year in Miami.

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55 Comments for Rafael Nadal Announces He Has “Hoffa’s Syndrome”, He Hopes To Return For Davis Cup [Video]

skeezer Says:

Tom and Tennis X,

Thanks for being on top of all this. Great reporting!


From the link:

Treatment of Fat Pad Impingement

“Rest and avoiding aggravating activities – stop running.’

Seems like Fishing and swimming are in order for Rafa the next few months…..

Sienna Says:

I just wondered who the heck is Hoffa and where is he?


Dr Chong has the answer….. but listen we shoudl stop this nonsense Nadal will be playing next month. People wit serious fat pad syndrome are being operated.
So we will just find out if it is the thruth or (when he starts playing in a mondth) it is really a Jimmy Hoffa kind of cover up.

Mark Says:

Get well soon Rafa! Tennis is not the same without you!

Brando Says:

Thanks tom and tennis-x!

It’s a RELIEF to at least know what the issue is as opposed to guessing, which usually means assuming the worst!

It seems that this is a different knee issue- one that requires r and r.

IMO, he best thing for rafa would be to just shut down for the rest of the season.

Short term benefit would be that hopefully it would mean he’ll recover from this issue.

Long term, his body would have received the much needed extended break.

Quite honestly speaking, i do not really see any benefit in him returning for the indoor season at all.

Polo Says:

I am glad it is not something very serious. He needs a lot of rest and physiotherapy. If those don’t work, he can have surgery to cut off that impinging fat pad that causes Hoffa’s disease. The surgery is not a serious procedure. I will be happy to see him play again. Even if it means he may be beating up on my idol again. Or maybe Federer can improve on their head to head numbers. Whatever happens, Federer-Nadal matches are still the most exciting matches to watch, for me at least.

jane Says:

It’s good to know the diagnosis; hope he recuperates well, ideally without surgery.

Rick Says:

SIENNA! You are a crazy Fedthug!

roy Says:

i wonder who he got it from.

zola Says:

It is actually very serious. It is very painful ( I read somewhere else that Rafa’s doctor confirmed that he played the whole FO with injections to his knees and Pete Bodo wrote from London that he had three MRIs in one week while he was there).
If it is not cured, it can calcify the knee and the only way is to operate. But it takes up to two years for the fat to be regenerated. I hope RAfa takes the rest of the year off. I would love to see him play, but for many years not just the 2012 DAvis cup.

conty Says:


found that link for ‘hoffa’s syndrome.’ what is scary to me is that at this point, i doubt it’s acute. chronic condition like that will be challenging to treat, i would think. but if there is s science available for its treatment, his doctors will do all they can and Rafa sounds like he has the right attitude: forget the rankings and points. focus on rehabilitating the knee, however long it takes, and go for some career longevity and more big titles, like he mentioned, the summer Olympics, 2016, and play mostly on clay; if he manages it right, at least he could rack up more FO titles and perhaps an olympic gold, if Rio is on clay.

Dave Says:

Assuming Nadal has Hoffa’s syndrome, then it is good news for tennis fans: this ailment is unlikely to be career threatening. It’s treatable and not a serious knee ailment compared to, for example, forms of patella (knee cap) chondropathy — such as osteoarthritis of the knee cap — which can be career threatening. Nadal’s knee is continually examined and scanned by his doctors so it is highly unlikely unlikely his knee will calcify — this stuff tends to happen to ordinary people who are diagnosed too late (when the damaged is already done). It’s highlylikely his doctors would have realized that he had Hoffa’s syndrome since Miami — but he still continued to play throughout the clay season (even played minor tourneys like Barcelona and Halle for the points or money) so his injury was probably never that serious and they realized that they would eventually have to take a break to rest and treat the Hoffa’s syndrome probably after going to Wimbledon final (but Rosol happened first). Many pro athletes play with injections to mask pain, even Federer, so nothing new as it’s part of the job. Now it’s been two months: I’m surprised that it’s taking that long to treat Nadal’s Hoffa’s Syndrome since I don’t think Nadal has gone for surgery.

Translate from spanish:

The Singapore orthopaedic surgeon (from Tom Gainey’s excellent link) provides some useful information on Hoffa’s syndrome. Singapore is medically very advanced. Here are relevant excerpts from his Q&A:
“It will be painful when the fat pad is inflamed and impinged. The fat pad is very well innervated and hence a rich source of pain.”
“I tend to agree with your doctor that she should rest, ice the knee and take anti-inflammatory medications. Such simple measures should bring about some results in 1 to 2 weeks’ time.”
“Try to avoid surgery and see if conservative treatment works. Surgery should only be done if a trial of non-surgical treatment has been attempted and failed.”
“If the pain is definitely from the fat pad, removal of the impinging portion will usually solve the pain. Recovery is generally fast. The surgical wounds heal in 10 days. The knee swelling will reduce over 3 weeks. The quadriceps muscle will need to build up again over time. Most patients return to work within a week of the surgery.” “Recovery to return to sports is about 6 weeks to 3 months.”

Once his Hoffa’s syndrome is treated, the other issues with his knees will remain or happen again unless Rafa makes fundamental changes to the way he runs/moves and plays on non-clay courts. I believe that Nadal is talented enough that he really should take the next few months to make these changes. That’s the best way for him to improve his longevity. Almost every fan of tennis would want to see him keep playing. Unfortunately, if he continues moving and playing the way he currently does, even reputable sports doctors who specialize in knee problems have said that Nadal’s only hope is to play on clay or risk his tendinitis degenerating into osteoarthritis (which is career threatening). By playing the way he does, it may have — in the short-term — won Nadal titles he otherwise would not have won. But in the long term, this takes its toll: Nadal is basically pushing and abusing his body beyond its genetic capabilities — and continuing to do this is reckless and irresponsible. Nadal cannot expect the ATP tour to be made easier to revolve around the needs of his body. It’s time for Nadal to take responsibility for his own body. Translate the following from German (same link I gave two days ago):

Federer and Djokovic move more efficiently because they practice and work hard on their movement. Every player is personally responsible for working on their movement to prevent injuries.

conty Says:

the good news, dave: you never know what they’ll (his team and doctors will come up with) maybe a some nano tech solution for a bionic fat pad and knee cap? who knows….??

and i get the notion that there is a credibility factor among many tennis fans, due to team Nadal exaggerating in the past; but I’ve never doubted the seriousness of his condition. It was hopeful and gave him more time having the prp injections since 2009. But, there was always the 2 questions in my mind: a) how long would prp treatment be effective b) could he modify his movement and tennis game to make it less physically demanding, thereby changing the underlying problem.

noogie Says:

Lol, lol, lol. Jimmy Hoffa got killed and the Mafia were the main suspect. Rafa lost and guess what. Rosol is the Mafia. I always knew fat-pad Kneedal had a Mafia connection.Fake ass.

skeezer Says:


Wasn’t the prp injections for something else in the knee? Or is this what is has been along ( Fat knee )?

Sienna Says:

I kid you not. I was right the whole time around. IF this was clay seson he would have stayed and try to win the tourneys. BECAUSE HE COULD WIN and he did win.

On this fast surface they have noticed in Halle and in Wimbly that he loses to mediocre and even very poor players. So they took the luxuary of resting his ailing body for good purposes.

Dave my main man.
You said it first. He probably will play the semis in Davis Cup on clay.

I can understand him resting but please if he plays on for clay he could play for Wimbly or olympic or US open, but because he doesnot stand a chance they OPT to not enter and withdraw.

It is as easy as that.

Have a good one and see you tomorrow.

Do I smell a Fish?Hope not am counting on the Fed to give me a semi when I wake up…..

Dave Says:

Hi conty, nano tech? You really want to turn Rafa into the Borg don’t you :) But, yeah nano tech is possible in future.

Given his knees are continually monitored by his doctors, it’s unlikely his doctors would have allowed him to play if they detected his fat pad disappearing.

Nadal claims that his “tendons are highly recovered compared to three years ago have regenerated well”. If that’s true then his chronic tendonitis has improved and his PRP injections may have worked. But I don’t know if anyone knows how long the PRP injections would continue to be effective or if side-effects might appear later from repeated use.

Simplistically, I think there are three factors: Nadal’s genetic inflammatory response in his knees; his physical style of movement and tennis game; and the conditions he plays under (hard courts, etc.). The PRP injections are probably enhancing his healing, but the three factors prevent the injury in the first place.

Dave Says:

Skeezer, the PRP injections were to help the healing of Rafa’s tendinitis (inflmmation of the tendons of his knee cap). I’m not sure if his doctors used the PRP injections for his Hoffa’s syndrome (I don’t think it’s used for that purpose yet).

The Hoffa’s syndrome is something new his doctors detected by Miami (I think they claimed the ailment was first detected in February, just after the Australian Open). Hoffa’syndrome (which affects the fat pad) is directly unrelated to tendinitis which affects tendons. In any case, the way Nadal moves seems to be imposing so much force on his knees that he has already two admitted ailments of the knees (tendinitis and Hoffa’s) — we don’t know what else they are not telling us.

In any case, this is not a sudden acute injury. The fact that Nadal knew about his Hoffa’s since February/March yet chose to continue to play the entire clay and grass season (barcelona and halle included) suggests that his Hoffa’s syndrome was manageable. In other words, if Rosol had not beaten him, Rafa probably would have kept on playing Wimbledon as far as he could go. At some point, Nadal would have had to take a break to heal the Hoffa’s syndrome. So this current break he is on was probably going to happen regardless of what Rosol did to him at Wimbledon unless he could keep playing with injections throughout the season. The life of every pro athlete is about playing with injury to as far as you can push it.

conty Says:

dave, don’t laugh too hard. you have seen this, no? it’s a couple years old. i assume the top cyclists and athletes have these installed to augment their already high altitude trained respiratory systems.


knee problems? create that fat pad in a laboratory test tube or petrie dish, hahaha…

also, they add all kinds of ‘stuff’ into those prp injections to speed recovery and reduce the inflammation there. whether or not something prp-like can be applied in rafa’s hoffa syndrome to stimulate those cells, i have no idea; but certainly there are other evolutionary science applications to solve the problem, if not permanently, at least for enough time to get rafa a few more gs titles, by targeting a season, say clay season ; )

wada? no ethical problem. scan for micro chips? are they even detectable? therapeutic excuse rule (tue’s) applies for the prp injection additives, certainly.

am i jaded? um, probably. it’s really our future reality as humans = evolution. what starts out as tests in lab rats –> goes to ill patients for study—> elite athletes. think about the mid – late 80’s and hematopoietic colony simulating factor development and the discovery of synthetic epogen given to stimulate bone marrow production of RBC’s and how such things revolutionized cancer treatments and entered some sports at the same time.

and Federer is through to meet stanley!

Kimberly Says:

Dave, who would win the 100m sprint out of the top 4? 200m? My money would be on rafa for both.

conty Says:

i think you’d win, kimberly! ; )

Alok Says:

I googled Hoffa syndrome and this is what part of the article states:

“What Are the Symptoms of Fat Pad Impingement?
■Pain and/or swelling around the bottom and under the kneecap
■Patients may have a history of knee hyper-extension (called genu recurvatum)
■ Positive Hoffa’s test (with the patient in lying with their knee bent, the examiner presses both thumbs along either side of the patellar tendon, just below the patella. The patient is then asked to straighten their leg. Pain and/or apprehension of the patient is considered a positive sign for fat pad impingement)

Treatment of Fat Pad Impingement

Treatment of this condition is normally by conservative methods such as:
■Rest and avoiding aggravating activities – stop running.
■Ice or cryotherapy to reduce pain and inflammation.
■Physiotherapy modalities such as ultrasound and TENS.
■Muscle strengthening exercises to maintain the strength and fitness of the surrounding muscle groups
■Taping the patella may help. One method involves taping the upper surface of the patella to allow more space for the structures beneath the lower surfaces i.e. the fat pad. This leads to less stress and impingement on the fat pad.

If conservative treatment does not work then surgery may be advised. This may involve the complete or partial removal of the fat pad itself.”

If Nadal had this since Miamai, from what the article states, how could he have played tennis?

I hope his doctors know what they are doing and/or that they have diagnosed his knee problems correctly.

Don’t understand how he can play DC with this condition.

Alok Says:

I also googled PRP injections, and it’s not for inflammation but for healing of tears. Thye seem to use the patient’s blood only, with nothing added.

conty Says:

all sorts of ideas how he can play DC, alok , look:


conty Says:

oh, they add to prp. i’ll get you a link or two later, alok.

Alok Says:

@conty, OK< I see. I guess all the players would like to win that way. he he

conty Says:

Alok. exactly right, lol…truth is stranger than fiction.

metan Says:

Thank you tennis-x for posting it, specially for Tom Gainey!

Have a good rest champion , and come back whenever you are ready. VAMOS RAFA!

jane Says:

conty – that’s a great link! Thanks for sharing it.

Ray Says:

Tennis is exciting without rafa.

fed, nole, murray and delpo. I dont mind who wins. fun and exciting tennis.

may the new big 4 continue forever.

bye bye rafa! keep running 100m sprints to keep your fans happy.

cheerios Says:

Thanks for posting this update, millions are truly missing him and wants to know more about his injury.

Funny how the haters take time to read up on Rafa and REALLY post their comments, heehee you guys are still in denial of your big fascination for him that you try very hard to hide it by being mean online, harharharharhar!

cheerios Says:

Ray, enjoy your moment now as a tennis watcher while Rafa is resting, because when he comes back to the Top 4, bye bye to you!! Harharharhar!

cheerios Says:

So, Sienna you are sorta complaining he wins everytime on clay, then you should be thankful tennis is not clay all the time, or else your fave players will have ZERO chance to win anything.

Mark Says:

Tennis is so borrrrrrrig without Rafa and ever so much more borrrrrring with fed. It is obvious fed can’t run 100m sprints. He played for 4 and a half hours in the semis of OG against Delpo and rested for 48 hrs and was still too pooped to pop come the finals!

Kathy Says:

Dave said “Federer and Djokovic move more efficiently because they practice and work hard on their movement. Every player is personally responsible for working on their movement to prevent injuries.”

That is not necessarily the case. The article attached to this post, whilst a little dramatic in its’ style does give some insight into the problems that Rafa has with his knees. This information has been available for sometime, but people generally choose to ignore it. They prefer instead to place all the blame upon Rafas style of play


alison Says:

I have no idea what Hoffas syndrome is,so it was great to read posts from Dave,Conty,and Alok with some outside knowledge on the condition,instead of the usual haters venting and breathing hot air,due to lack of intelligence and limited vocabulary.

alison Says:

Whatever happens Rafa should just rest and come back when hes 100 percent fit and ready to play,the tour will miss him,and most sensible fans of tennis will miss him,nice words from Fed,Nole,Muzza and Delpo etc,who as fellow players have only Rafas best interests,much more class than some of their so called fans.

Kathy Says:

Totally agree with you alison.

Colin Says:

Kimberley, at the 200m I’d definitely back Murray.

Noogie, you say Jimmy Hoffa was murdered. What evidence do you have for that?

John Says:

Nadal will be ready for Davis…hes already practising and its on clay so go-figure.

Best Wishes to the Bull

Sienna Says:

cheerios Says:
So, Sienna you are sorta complaining he wins everytime on clay, then you should be thankful tennis is not clay all the time, or else your fave players will have ZERO chance to win anything.

August 18th, 2012 at 2:04 am

Cheerio this year was not about Garros. Fed only played clay tourney Won one and reached semis.

But the big prices for Fed where WImbly,Olympic US Open Of course Garros and AU Open where important bu you gotta know when to pick your battles.

So I am sure he will get a second Garros slam. That is just a matter of prioritizing.

Dan Martin Says:

I do wonder at what point does Nadal say to himself, “I have a ton of money, I am an all-time great, maybe getting injections before matches, constant MRIs, PRP treatment etc. is no longer worth it.” Resting is great, but if a player loses some conditioning and precision due to the rest, the field will gain on him. I hope that Rafa gets his health as right as it can be and plays for another 3-5 years at a high level. If he can’t train or practice as much, how well will he play? That will all get sorted out, but reading about this did not make me think quick recovery.

Dave Says:

Spain’s largest newspaper: Nadal faces the Hoffa syndrome


conty, that was a good read. Tennis players could use those lung chips to test the air just before the coin toss. Enviromental toxins or allergens? Not playing today!

You’re definitely not jaded. There are many hundreds of mind-boggling innovations out there already in research and testing that we haven’t even heard about.

And there are many ways to possibly solve Nadal’s hoffa syndrome (which his own doctor has since said admitted was not important, significant or serious — depending on which newspaper you read — because of misleading reports that it was career threatening). In theory, PRP injections could be prepared for hoffa’s syndrome. At the moment, Nadal’s rehabilitation programs consists of manual physiotherapy, iontophoresis (it’s like an injection without the needle — it uses a small electric charge to deliver a medicine through the skin), lasertherapy and heat therapy.

There are also simpler ways of healing Nadal’s hoffa syndrome. Most of the stuff I had posted one or two weeks ago about magnets, creams and supplements should work to deflate his swollen fatty tissue — except for the collagen stuff since this is fatty tissue, not tendons. Like I said before even Nadal’s doctor said it — Nadal’s condition is not serious. They detected it in February but instead of fully treating it in February they decided to control and anage it while Nadal continued play with it. Had Nadal beaten Rosol in five sets, he would have likely continued playing as far as he could, even into the Olympics. Then once he lost, this whole drama would have unfolded at that point. Poor Rosol, he earned his victory.


Kimberly, tough question because I’ve seen Federer’s explosiveness to retrieve drop shots — on those very rare ocasions when he goes all out, he seems as fast or faster than Nadal.

But I suspect that Nadal or Ferrer may be better 100 m and 200 m sprinters than Federer, Djokovic and Murray.

However, Federer, Djokovic and Murray have a good chance of winning some races in those parts of the season where Nadal peters out, lol.


Alison, thanks much.

alison Says:

Dave Thanks should go to you actually,its refreshing to here someone come up with a constructive and positive post,when it comes Rafas knee injuries.

Dave Says:

Kathy, Having read your dramatic article about 19-year old Nadal’s “foot injury gave him hell” during the 2005 Madrid indoors and the doctor’s diagnosis “He was told his career was finished” and “Nadal wept”… how do you reconcile the fact that one month later Nadal and his team flew all the way to China with the expectation that they would compete in the Tennis Masters Cup (World Tour Finals). Presumably they did this because it was expected that Federer had pulled out due to torn ankle ligaments. But Federer unexpectedly showed up hoping to play and guess what? On the day of Nadal’s first scheduled match, he withdrew from the tournament. So maybe Nadal was told his career was finished and he did cry (but he would not be the first tennis player to be told this) but within a few weeks he was already ready to playbefore he pulled out for another two plus months.

You are right: your article is overly dramatic in it’s style, and it sounds like an article the author wrote with Nadal’s publicist. The author Will Swanton is a cricket writer who has been ridiculed for his writing (e.g. see link):

One Aussie described Will Swanton: Ed Williams: “One of the worst sports writers. Has a desperate need to show how macho he is. As a sports fan I’m glad he no longer writes for the Sydney Morning Herald, his contributions to the Saturday sports pages were either stupidly gung-ho or revoltingly mawkish. This nasty little piece on the Brits lacks both wit and courtesy – the Brits behaved like gentlemen and I hope the insults of this goon gave them a laugh in the end. Meanwhile some of us are embarrassed …”

Don’t believe everything you read without cross checking the facts.

Dave Says:

Rafa’s doctor Angel Ruiz Cotorro said Nadal’s injury “is annoying and painful, but not important.” In other words, his own doctor said what I said — that Nadal’s injury is not that serious. According to his doctor, Nadal is doing well. Next week they will test the knee and if the result is positive they will continue with the same treatment. Rafa Nadal is following a rehabilitation process to “deflate” the swollen knee tissue (the fat pad) using manual physiotherapy, iontophoresis, lasertherapy and thermotherapy.

Dave Says:

Spanish newspaper: Nadal’s injuries over the years

Humble Roger Says:

most dislike player of all times.

2008. Nadal. 2009. Murray. 2010. Nadal. 2011. Nadal.

in Mens Tennis Forum.

ugly gamesmanship player Nadal

metan Says:

Nadal is the most popular tennis player in this whole world and he has the most fans, 11 million fans!

Nadal is the warrior in tennis world!

Gaga Says:

Nadal should avoid the HC as much as possible they are detrimental to his knees. Play on clay as much as he can. And don’t come back to the tour until he is 100%
Besides, his best part of the year is April-June, the clay season, it is still far away.
Also train mostly on clay, don’t make the mistake of over training on the HC in Majorca. He should mostly train on clay at home.

metan Says:

@Gaga, are you related to jamie? Your writting style is same.

Steve 27 Says:

is the same person, her dopleganger

Dzigbodi Says:

I have ‘Rafa’ syndrome too. My body is just tired and worn out.

Jeannie Thorne Says:

I have had hoffa’s for the last 4 years. Had surgery – no help. Now tape my knee using Jenny McConnell taping. (Australian Physio)
Now playing 5 days a week – no trouble.

It Sure Sounds Like Rafael Nadal’s 2012 Tennis Season Is Over Says:

[…] up a tennis racquet. That he’s been staying in shape by swimming 1 KM a day. And that his Hoffa Syndrome left knee pain first began at Indian Wells, then resurfaced during the late stages of the French […]

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