Sinding-Larsen-Johansson syndrome

This leaflet provides information on Sinding-Larsen-Johansson syndrome and suggests some exercises to help improve symptoms.

Sinding-Larsen-Johansson syndrome is a cause of knee pain in children and adolescents, especially those who are sporty.

What is the cause?

Sinding-Larsen-Johansson syndrome affects those individuals who have gone through a rapid growth spurt. The muscles at the front of the thigh are called the quadriceps and join the patella tendon at the base of the knee-cap (patella). The patella tendon attaches to the bottom of the kneecap. If the patella tendon is subjected to a lot of repetitive stress through high impact activities, such as running, the tendon can become inflamed and swollen. A sudden increase in physical training will increase the thigh muscle (quadriceps) pull. This in turn will increase the stress through the patella tendon where it attaches to the bottom of the kneecap, potentially causing pain.

Who is affected?

Children and teenagers who are very sporty and take part in physical activities that place a high level of stress on the knee, such as football, rugby, ballet and gymnastics.

What are the symptoms?

• Pain and swelling at the bottom of the kneecap (patella).
• The young person may limp after physical activities due to the pain.
• One or both knees can be affected.
• Pain increases with high impact exercises that put extra stress on the patella tendon, such as squatting and hopping.
• Bony prominence at the bottom of the patella.
• Repetitive activities that increase the force through the knee joint (patella-femoral joint) are painful, such as stair-climbing.
• Kneeling is painful.
• Thigh muscles (quadriceps) may be tight.
• The level of the pain may fluctuate.

Getting better

Sinding-Larsen-Johansson syndrome generally resolves when individuals stop growing and with limitation of strenuous activities and sports. It can take several weeks or months for the pain to settle. Generally, the symptoms settle with rest and time.

The following can help to relieve symptoms:

Activity modification

• If the individual continues to play sport, the pain may take longer to settle. There is however no evidence to suggest that continuing to play sport with pain results in any damage to the structures involved.
• It may be helpful to avoid high impact sports that involve running and jumping until the pain stops. Cycling and swimming are low impact activities and are good alternatives allowing the individual to strengthen the muscles and maintain stamina.
• Rest is essential to allow swelling and pain to subside.
• Once the pain has stopped, it is important to gradually build up participation in activities and sport. For those who have suffered from the syndrome, activities should be confined to those with which they are comfortable.
• Sports training regimes should be carefully planned to avoid completing too much intensive high impact exercise that will place stress on the base of the kneecap.

Ice and elevation

• Ice the affected area for 10 to 15 minutes, especially after activity, making sure the skin is protected by wrapping the ice in a towel. Monitor the skin regularly.
• Elevating the leg after sport activity, if it is painful and swollen, can be beneficial.

Lower limb stretches

Following a stretching regime may help to improve muscle flexibility. The stretches shown below may be helpful.

Quadriceps stretch (thigh muscle at front)

• Lie on your front and turn your head to the side
• Place a stretchy band or long towel around the ankle and pull it gently towards your buttocks until you feel a stretch in your thigh.
• Hold 20 seconds.
• Repeat x4 reps, x2 daily.
• Repeat on both legs.

Hamstring stretch (thigh muscle at back)

Stretch one:

• Sit on the bed with one leg straight, and the other leg resting off the edge of the bed. Reach forwards with your hands down your leg as far as you comfortably can. Keep the knee straight.
• You should feel stretch at the back of your thigh.
• Hold for 20 seconds.
• Repeat x4 reps, x2 daily.
• Repeat on both legs.

Stretch two:

• Lie on your back with your head supported by a pillow.
• Place a stretchy band or long towel around the sole of your foot and hold the band in your hands.
• Lift your leg up to 90 degrees as demonstrated in picture A.

• Straighten your leg upwards towards the ceiling as far as you comfortably can as demonstrated in picture B. It doesn’t matter if there is a small bend in the knee.
• You should feel a stretch in the back of your thigh.
• Hold for 20 seconds.
• Repeat x4 reps, x2 daily.
• Repeat on both legs.

If the individual goes through another rapid growth spurt, the pain could return again. Therefore, it is important they keep doing the stretches and pace physical activity carefully. High impact activity should be balanced with strengthening, core stability exercises (exercise that strengthens the back and abdominal muscles) and stretches.

Please be aware this leaflet is only a guide. Please consult a physiotherapist for individual advice.

Contacts/ Further information

Physiotherapy outpatients: 01223 216633