Sinding Larsen disease and osteopathy

Sinding-Larsen-Johansson disease is a specific form of osteochondrosis affecting the lower part of the patella, often found in young, growing athletes. The condition is mainly characterized by pain and inflammation around the patella and patellar tendon. In this article, we'll deepen our understanding of the symptoms, causes and treatment options associated with this condition. We will also discuss effective prevention strategies to reduce the risk of future complications associated with this condition.

Sinding-Larsen-Johansson (SLJ) disease generally affects young athletes, particularly those in their rapid growth phase, often seen during adolescence. Typically, the condition is most common in individuals aged between 10 and 15, coinciding with periods of rapid growth spurt.

Young people involved in sports involving a lot of jumping, running, or movements that put repeated pressure on the knees and in particular the patella, are more likely to develop this pathology. This includes sports activities such as basketball, gymnastics, soccer and athletics, where the tensile forces exerted on the patellar tendon region during intensive sports movements can cause damage to the patella's growth zone.

FLS is a pathology of overuse, usually resulting from repeated loads on the knee, and is most common in teenagers engaged in high levels of competition or intensive training. However, it's important to note that although active teenagers are the most affected, the disease can sometimes affect young people who aren't necessarily involved in high-level sporting activities, simply because of the stresses associated with rapid growth during puberty.

Sinding-Larsen-Johansson disease typically manifests itself as pain localized under the patella, precisely where the patellar tendon attaches.

The intensity of this pain can vary considerably, from mild discomfort to acute pain capable of restricting sporting or physical activities. These symptoms are particularly exacerbated during exercise involving jumping or other movements that exert pressure or tension on the patellar tendon.

In addition to pain, this condition can also manifest itself as increased tenderness around the kneecap, swelling in the same area, and joint stiffness in the knee. Without an adequate reduction in physical activity and appropriate therapeutic management, these symptoms can gradually intensify.

It's important to note that, in some young people, the pain may be more pronounced at night or after prolonged periods of inactivity. What's more, due to the constant strain on the patellar tendon during typical adolescent activities such as running, jumping and bending, symptoms can sometimes become a constant obstacle to participation in usual sports and school activities.

The origin of Sinding-Larsen-Johansson disease lies essentially in the overuse of the patellar tendon, which plays a crucial role in stabilizing the patella during knee movements. This overuse is often the result of a combination of factors, including participation in sports requiring frequent jumping and dynamic knee movements, combined with the rapid growth typical of adolescence.

This repeated, excessive strain on the patellar tendon can lead to small traumas where the tendon attaches to the kneecap, triggering inflammation and pain. Young people actively involved in sports such as basketball, volleyball, soccer or gymnastics are more at risk of developing this condition.

In addition, certain biomechanical anomalies or postural disorders can aggravate the situation by exerting additional traction on the patellar tendon. These factors include :

• Hyperpronation of the feet, where the feet roll inwards excessively when walking or running,
• The presence of flat feet, characterized by a collapse of the plantar arch,
• A valgus foot formation, where the foot turns outwards in relation to the axis of the tibia,
• The genu valgum, a condition where the knees come together while the ankles remain apart.

These abnormalities can alter normal knee mechanics, increasing stress on the patellar tendon and, consequently, the risk of developing Sinding-Larsen-Johansson disease. It is therefore crucial to monitor these aspects in adolescents engaged in sporting activities, to prevent the onset of this pathology.

Although clinical examination can provide solid indications, X-rays are often necessary to confirm the diagnosis of Sinding-Larsen-Johansson disease. X-ray images typically show a small area of calcification at the tip of the patella. This distinctive feature differs from the bone fragmentation often associated with another adolescent knee pathology, Osgood-Schlatter disease.

In addition to X-rays, other imaging tests such as ultrasound or MRI may be useful, particularly if the diagnosis is unclear or to assess the extent of tendon damage. Ultrasound can be particularly informative in examining the structure of the patellar tendon and detecting any abnormalities at its insertion. MRI, on the other hand, offers a detailed view of the soft structures and may be necessary to rule out other conditions that may cause similar symptoms.

These complementary examinations are crucial to establishing an accurate diagnosis and guiding appropriate treatment. They help not only to confirm the presence of Sinding-Larsen-Johansson disease, but also to assess the extent of tendon damage, which is important for planning a rehabilitation and return-to-physical-activity strategy.

Osteopathy, which focuses on the diagnosis and treatment of disorders affecting the musculoskeletal system, offers a global and holistic perspective in the management of Sinding-Larsen-Johansson disease. The osteopath will carry out a complete assessment of the patient, focusing in particular on muscular imbalances, limitations of movement, and postural compensations that may exacerbate pain.

In the osteopathic treatment of this condition, the following methods are commonly employed to alleviate pain, reduce inflammation and encourage tissue repair:

• Gentle joint manipulations: The osteopath can perform subtle joint adjustments to improve knee mobility, focusing on the patella and tibiofemoral joints.
• Soft-tissue release: Soft-tissue relaxation techniques, including stretching and massage, can be applied to relieve tension and loosen adhesions in the muscles, tendons and ligaments surrounding the patella and patellar tendon.
• Postural and muscular readjustment: The osteopath will focus on re-establishing the patient's muscular and postural balance, detecting and rectifying imbalances likely to overload the patellar tendon.
• Practical advice and exercises: Recommendations on suitable physical exercise, specific stretching and strengthening, and ergonomic adjustments can be provided to minimize stress on the knee.

• Application of Kinesio-Taping: The use of kinesiology strips can bring immediate relief and prolong the beneficial effects of manual care, supporting healing and reducing discomfort.

These osteopathic interventions aim not only to treat the symptoms of Sinding-Larsen-Johansson disease, but also to address the underlying causes, with a view to a full and lasting recovery.