If you child has knee pain, it is unlikely to be growing pains – they may have Sinding Larsen Johansson Syndrome (we’ll call it SLJS). SLJS is inflammation of the growth plate. Our blog covers the causes and treatment of SLJS – as well as common misdiagnoses.
True ‘Growing pains’ are very very rare. Unfortunately, medical professionals are not trained in paediatric growth and development, and many do not know the common conditions that cause children’s pain. Therefore, many children suffer with pains when there is often a very simple diagnosis, and treatment can be quick and easy – but this needs to be done by someone who has additional training in ‘child growth.’
The growing child has several tissue imbalances over the course of growth. This is not a linear pattern and depends on hormones and other factors, like diet and sport. This is poorly understood outside of the world of paediatric physio or medicine. There are many conditions that children have depending on the area of the body effected.
Children are not small adults, and they do not have the same conditions as adults and, treatment must also be different, for the correct quick healing!
All about Sinding Larsen Johansson Syndrome
Sinding Larsen Johansson Syndrome is a condition seen only in a growing, normally pubertal child. We don’t have the stats (lots of ethical reasons why not as it’s hard to study children!) but it is one of the three main reasons for knee pains in childhood. It’s not the most common pain, and can be accompanied by other conditions as well. If left untreated it can really impact them and continue to get worse whilst the body continues to grow. These factors determine how quickly it resolves.
This needs a specialist to manage when cases are more advanced, or to prevent the more severe cases. Therefore, the assessment and treatment are not the same as would be for an adult. This is where, many assess or treat SLJS incorrectly and the child either doesn’t get better or does but has repeated relapses over the coming years – all because the correct approach has not been applied. Paediatric Physios see this pattern frequently.
Misdiagnoses
SLJS is commonly misdiagnosed. The classic is ‘growing pains’, anterior knee pain, osgood slatters or fat pad syndrome. It is important to differentiate the condition, as treatment varies.
What is SLJS?
- SLJS is when there is pain at the tip of the bottom of the kneecap, where the knee tendon joins the bone and growth plate.
- SLJS is ‘inflammation of the growth plate’ in the patella (kneecap), generally seen in the pre pubertal or pubertal growth phases.
- It is a form of Apophysitis – other forms are Osgood Slatters and Severs.
- Growth plates are only found in a growing bone.
- The whole time the growth plate is open / active – the child can develop SLJS or experience a relapse. The growth plates are open in the knee until mid to late teens in females and later in males.
- Both girls and boys suffer.
- Having a primary episode of SLJS and not receiving the appropriate care, is a big predictor for reoccurrence, or other growth plate problems – there are lots!! It is not unheard of, to have it for several years – especially when treated incorrectly or develop other pains in the knees and hips.
- Once the growth plate closes, then SLJS cannot come back.
- SLJSs will therefore, not affect the individual in later life; It does not occur in adults – it is biologically impossible!
- Every bone in the body grows and reaches skeletal maturity at different times and rates…. there is a general pattern known to those that work with children, but a specialist can calculate this, depending on an appropriate assessment of the child.
- An x-ray is not required to diagnose SLJS – it is not seen on imaging.
How does SLJS impact your child?
The pain can be very uncomfortable – even ‘disabling’ normal function on an intermittent or day-to-day basis. It can come on suddenly or sometimes triggered by a bit of another twist or jump or knock. There is often no cause’ and why it’s often just labelled as a ‘growing pain’. The child may limp and it can occur in one or both knees. The pains can stop them doing things they love.
It can hang around for a few weeks and then go, but then comes back again, often getting worse at each episode. It can get better over times of more rest – e.g. school holidays but come back quickly with the return to the normal routine. This is why the Autumn term is a classic time these patients end up in the clinic – following the long summer holidays and return to full on sport in the new term! There are many factors the specialist will consider. This is when a paediatric physio, finally assesses the child; Unfortunately, this is when it is harder and takes longer to treat. Many parents wish they had seen the right therapist at the start because many of the more complicated and severe issues associated with Severs would have been, almost certainly, avoided.
The severity of symptoms is dictated by many variables and that is the job of a paediatric therapist to unpick and come up with the correct treatment plan and order. There is not a one size fits all. It must be tailored to the child and the maturation of their bones and their risk factors.
Causes of SLJS
Common presentations are in children who do a lot of sport. It is often associated with increase in or change in training, moved up a level or age group or return from a holiday or a period away from less activity. There is often, but not always, a growth spurt in height, and sometimes body weight. It can even occur when the school rotates at half term into the next activity, e.g. the transition into summer athletics is common! Others, suffer who are not the ‘sporty, active type’ and perhaps have done more activity than they are used too and this is the trigger.
SLJS is sometimes described for this reason as an ‘Overuse injury’.
SLJS generally occurs around the pubertal growth phase, which is one of the fastest growth phases of the child’s life (except their first year of life!) but can also be later, especially in boys. Girls often suffer younger than boys, because their pubertal growth phase and typical pattern of onset is 10-14yrs, however, not all children follow these rules!
Treatment for SLJS
The growth plate in the kneecap becomes inflamed because of a variety of factors, as described above. Other causes can be the type of footwear or perhaps having a flat foot.
Therefore, assessment determines the course of treatment.
Basics include anti-inflammatory treatments which range from rest, ice, NSAIDs and footwear advice. There will be a biomechanical imbalance of bone and soft tissues, and this is addressed with exercises for the relevant areas. Because the child will not grow under predictable patterns, the monitoring and treatment adjustments are important. The paediatric physio works closely with the child and family to try and ensure a smoother recovery and a faster return to sport – but ‘flare ups’ can be a natural part of the treatment processes and again where the specialist will know and support any worried child or parent.
To conclude – if a child has pain, this is highly likely NOT a ‘growing pain’ and there is often a diagnosis, which requires assessment and appropriate treatment. We recommend seeing a paediatric physio (not a physio who can treat children) because they are highly trained to then refer to other specialists if needed.
Is your child suffering from knee pain? Get them booked today with our specialist paediatric physio based in our Woking clinic. If you would like to book an appointment get in touch. Book an appointment online.
