Young Athlete with Knee Pain? It Might Be a Growth Spurt

Sinding-Larsen-Johansson syndrome is easy to treat
Young Athlete with Knee Pain? It Might Be a Growth Spurt

By: Paul Saluan, MD

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It’s always scary when a young athlete injures a knee. A torn anterior cruciate ligament (ACL), for instance, is painful and can bring an early end to your child’s sports season. But not all knee injuries are so severe. The lesser-known Sinding-Larsen-Johansson syndrome also causes knee pain, but it’s easy to treat.

Young athletes affected most

The main risk factor for Sinding-Larsen is simply being a physically active adolescent going through a growth spurt, says orthopedic surgeon Paul Saluan, MD, Director for Pediatric and Adolescent Sports Medicine at Cleveland Clinic.

During a growth spurt, your child’s bones may grow faster than the surrounding tendons. This can cause traction, tightness and, eventually, inflammation.

Combine that with sports that require sprinting, jumping or squatting, and that puts stress on the front part of the knee at the base of the kneecap.

Symptoms start slowly

With Sinding-Larsen, there isn’t a single episode that initiates pain. “There’s no pop or feeling like something goes out of position,” Dr. Saluan says.

Instead, symptoms begin slowly, with an ache in the knee when your child performs the offending activity. When he or she rests, it fades. Over time, your child likely will “push through the pain” enough that it’s sore even when the leg is at rest.

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There is not typically any major swelling or loss of motion with Sinding-Larsen. If your child has knee pain that doesn’t improve within a couple of days, visit your doctor within a week or two.

If there is major swelling or he or she can’t move the knee fully, see the doctor as soon as possible. It’s likely a more severe injury, Dr. Saluan says. 

Easing the pain

Medication – Your child’s doctor may prescribe anti-inflammatory medication for one to two weeks to help quickly reduce swelling. Adolescents shouldn’t take them longer because they may increase the risk of gastrointestinal issues such as acid reflux and ulcers, Dr. Saluan says.

Physical therapy – Working the leg in physical therapy will help stretch the muscles and tendons surrounding the knee.

Icing the knee – Dr. Saluan recommends freezing small paper cups filled with water. Then, tear off the cup and rub the ice in a circular motion on the affected area. Doing this twice a day reduces inflammation better than an ice pack, he says.

Returning to sports safely

One of the most important aspects of treatment for Sinding-Larsen is activity modification, Dr. Saluan says. Your child will need to slow down to let the inflammation subside.

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Treatment for each person is slightly different, he says. It will depend partly on what sport your child plays.

Sometimes moving to a different position on the team will work. Or, it may help to skip practice and just play in games. But he or she must avoid the activity that initially caused the problem, he says.

For the first couple of weeks, a child typically can work at about 25 percent intensity and slowly increase it. It will take about eight to 10 weeks before he or she can safely return to full activity.

“We don’t like people sitting still. That doesn’t help; they should stay active,” Dr. Saluan says. “But even the pros know they have to back off and try to heal, so if it’s good enough for LeBron, it’s good enough for 12-year-old Joey.”

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