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What is Sinding Larsen Johansson Syndrome?
Sinding-Larsen-Johansson syndrome is a painful knee condition that causes pain and swelling in the front of the knee, at the bottom of the kneecap (patella).
3 Interesting Facts of Sinding Larsen Johansson Syndrome
- Traction apophysitis of inferior pole of patella
- Pathology is similar to that of Osgood-Schlatter disease, except that it involves inferior pole of patella
- Differentiated by:
- Physical examination with tenderness localized to inferior patella
- Plain radiographs may show separation and elongation or calcification at inferior patellar pole
- After acute trauma, this may also represent a sleeve fracture of patella
What are the causes?
This condition is caused by damage or irritation to the patellar tendon, which is a tough cord of tissue that connects the bottom of the patella to the top of the shin bone (tibia).
This condition results from frequent and forceful pulling (traction) on the kneecap by the patellar tendon.
What increases the risk?
This condition is more likely to develop in athletes who:
- Are 10‒14 years old.
- Train too hard.
- Participate in activities that require running and jumping, such
as:
- Basketball.
- Football.
- Running.
- Figure skating.
- Volleyball.
- Gymnastics.
What are the symptoms?
The main symptom of this condition is pain in the front of the knee. Pain usually starts slowly and then it gradually gets worse. Other symptoms include:
- Pain when straightening the leg.
- Pain with repetitive use, such as running or jumping.
- Tenderness when pressing on the bottom of the patella.
- Swelling in the knee.
How is this diagnosed?
This condition is diagnosed based on your symptoms, your medical history, and a physical exam. During the exam, your health care provider may check for tenderness and pain when you straighten your knee. Your health care provider may also order imaging tests, such as:
- X-rays to check your condition and the hardness of your patella.
- MRI to check for tears in your tendon.
- An ultrasound to check the thickness of your tendon.
How is this treated?
This condition is usually treated with rest and physical therapy. In younger athletes, the condition may improve as the patella matures over time. Treatment may include:
- Avoiding activities that cause pain.
- Icing.
- Taking medicine to reduce pain and swelling.
- Doing stretching and strengthening exercises (physical therapy) when pain and swelling improve.
Follow these instructions at home:
Managing pain, stiffness, and swelling
- If directed, apply ice to your knee.
- Put ice in a plastic bag.
- Place a towel between your skin and the bag.
- Leave the ice on for 20 minutes, 2–3 times a day.
- Raise (elevate) your knee above the level of your heart while you are sitting or lying down.
Activity
- Avoid activities that cause pain.
- Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
- Do exercises as told by your health care provider.
Safety
- Do not use the injured limb to support your body weight until your health care provider says that you can.
General instructions
- Take over-the-counter and prescription medicines only as told by your health care provider.
- Keep all follow-up visits as told by your health care provider. This is important.
How is this prevented?
- Warm up and stretch before being active.
- Cool down and stretch after being active.
- Give your body time to rest between periods of activity.
- Make sure to use equipment that fits you.
- Be safe and responsible while being active to avoid falls.
- Do at least 150 minutes of moderate-intensity exercise each week, such as brisk walking or water aerobics.
- Maintain physical fitness, including:
- Strength.
- Flexibility.
- Cardiovascular fitness.
- Endurance.
Contact a health care provider if:
- Your symptoms are not improving with home care.
- Your symptoms are getting worse.
Sinding-Larsen-Johansson Syndrome Rehab
Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse. Do not begin these exercises until told by your health care provider.
Stretching and range of motion exercises
These exercises warm up your muscles and joints and improve the movement and flexibility of your knee. These exercises also help to relieve pain, numbness, and stiffness.
Exercise A: Hamstring, doorway
- Lie on your back in front of a doorway with your left / right leg resting against a wall and your other leg flat on the floor in the doorway. There should be a slight bend in your left / right knee.
- Straighten your left / right knee. You should feel a stretch behind your knee or thigh. If you do not, scoot your buttocks closer to the door.
- Hold this position for __________ seconds.
Repeat __________ times. Complete this stretch __________ times a day.
Exercise B: Quadriceps, prone
- Lie on your abdomen on a firm surface, such as a bed or padded floor.
- Bend your left / right knee and hold your ankle. If you cannot reach your ankle or pant leg, loop a belt around your foot and grab the belt instead.
- Gently pull your heel toward your buttocks. Your knee should not slide out to the side. You should feel a stretch in the front of your thigh and knee.
- Hold this position for __________ seconds.
Repeat __________ times. Complete this stretch __________ times a day.
Exercise C: Gastrocnemius, standing
- Stand on the edge of a step on the balls of your feet. The ball of your foot is on the walking surface, right under your toes. For balance, rest your hands on the wall or on a railing.
- Slowly lift your left / right foot, allowing your body weight to press your other heel down over the edge of the step. You should feel a stretch in your left / right calf.
- Hold this position for __________ seconds.
Repeat __________ times. Complete this stretch __________ times a day.
Strengthening exercises
These exercises build strength and endurance in your knee. Endurance is the ability to use your muscles for a long time, even after they get tired.
Exercise D: Quadriceps, isometric
- Lie on your back with your left / right leg extended and your other knee bent.
- Slowly tense the muscles in the front of your left / right thigh. When you do this, you should see your kneecap slide up toward your hip or see increased dimpling just above the knee. This motion will push the back of your knee down toward to the surface that is under it.
- For __________ seconds, hold the muscle as tight as you can without increasing your pain.
- Relax the muscles slowly and completely.
Repeat __________ times. Complete this exercise __________ times a day.
Exercise E: Straight leg raises (quadriceps)
- Lie on your back with your left / right leg extended and your other knee bent.
- Tense the muscles in the front of your left / right thigh. When you do this, you should see your kneecap slide up or see increased dimpling just above the knee.
- Keep these muscles tight as you raise your leg 4–6 inches (10–15 cm) off the floor.
- Hold this position for __________ seconds.
- Keep these muscles tense as you lower your leg.
- Relax your muscles slowly and completely.
Repeat __________ times. Complete this exercise __________ times a day.
