Sinding Larsen Johansson syndrome

The symptoms are:

• Pain and swelling on the bony part at the bottom of the knee cap
• The knee cap can be sore when touched or when you kneel on it.
• Pain during sport at the front of the knee/top of your shin

The diagnosis is often clear from the typical symptoms. No x-rays or scans are necessary.

Your child’s knee pain may improve within a few months if you follow this advice. However in some cases, symptoms can last for 12-18 months.

Reducing pain
The following things may help improve the pain you are experiencing in your knee:

• Taking painkillers as advised by your doctor or pharmacist
• Use of an ice pack – follow the instructions on the pack. It can be helpful to use ice before and after any activities that you know make your pain worse. If you need to, take a break half way through an activity to use ice and settle your pain

Improving tissue flexibility
Follow the exercises in the next tab to make sure the tissues around your knee are flexible. This should help reduce your pain.

Modifying Activities
Pacing your activities is a really important factor in managing your knee pain.

We do not want you to stop all activities, but we do want you to be aware of your pain and know when to stop and take a break to prevent your pain getting too intense.

Try to think of your pain on a scale of 0 to 10. Level 0 means you have no pain, level 10 is the worst pain you can imagine. Using this scale helps us decide when to carry on and when to stop by using a traffic light system.

‘Red’ level pain is too high, you should stop your activity and let the pain settle.

‘Amber’ level activities mean you can carry on, but may need to think about stopping to rest soon.

‘Green’ pain levels mean you can carry on your activity.

Have a think about how much activity you do in a week. Activity is really important to keep you strong and healthy, but we must make sure we are not overtraining.

We recommend having one or two days off from competitive practice or sports-specific training each week to rest or participate in other activities. It is also important to take 2-3 months away from a specific sport during the year.

When thinking about increasing your activity, make sure to not increase your training time, number or repetitions or total distance more than 10% each week (e.g. if you are currently running 10 miles per week, increase total running mileage by 1 mile)

We also recommend making sure you are participating in a variety of activities rather than one particular sport to prevent overuse injuries and burnout.

If any of these exercises increase your pain, seek further advice from your physiotherapist. It is important to complete these exercises at least 3 times a day.It is also important to complete these exercises before and after any activities which bring on your knee pain.  

Standing Quad Stretch 
Stand with your feet together. Bend the knee of the leg to be stretched, use your hand to bring your heel to your bottom. Make sure to stand tall, tuck your bottom in and make sure your knees are level. Hold this stretch for 30 seconds, then release the leg and repeat 3 more times.

Prone Quad Stretch
Lie on your tummy. Bend the knee of the leg to be stretched, hold your foot with your hand and pull your heel towards your bottom. If you can’t reach your foot, wrap a towel around the ankle, hold the towel with your hand and use this to bring the heel towards your bottom. Make sure your hips do not come off the floor, your may need someone to help you keep your hips flat on the floor. Hold this stretch for 30 seconds, then release the leg and repeat 3 more times.

Hip flexor stretch
Come in to a half kneeling position, with the back leg being the leg to be stretched. Lean in to your front leg, making sure you keep your body upright. You should feel the stretch across the front of your hip of the back leg. Hold this stretch for 30 seconds, then release the stretch and repeat 3 more times.