Knee advice on Sinding Larsen Johannson

[Andre.g]

Hi guys, I am certainly puzzled about my condition (Sinding Larsen Johansson) as this condition normally attacks children. I am 24 years of age and yes the X rays show the small pole on my knee cap that impinges the fat pad. MRI says my tendon fibers are fine. I can't really walk for longer than 15 minutes and I say no to stairs.

My question is:

1. When knees are overused, my whole knee inflames including the ligaments connecting the quad and calves. I expected the fat pad area to be in pain but others are painful too. I don't understand why the other ligaments are inflammed. Also, how does exercise help this condition if my patellar tendon is fine.

2. I'm eager to get back to sports. Physio says I can do it in 3-4 months with exercise. I'm not so sure about this because i know my recovery rate is slow and any over usage of knees will prolong recovery. Can I recover to a state where I can say good bye to this condition?

Any advice is really appreciated, I'm really frustrated especially when I know at my age, I am meant to go out there and make my life. Thank you.

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[ginger]

Andre, ordinarily I ignore requests for diagnostic or treatment advice from patients, forums like this idealy provide a means to connect and share comment and detail between physios ( and others ) without the sometimes odious and frustrating elements that go with attempting to diagnose from only written information. Having said that I do have an interest in knee problems generaly and yours sounds just fascinating enough to prick me to ask the following.
Can you provide more detail.
ie, when pain began, ( total time complaint has been present), where in your knee did symptoms begin, do you have pain elsewhere, any disabilities, any history of lumbar pain, any injuries, surgery, major illnesses. Does pain in your knee increase /decrease at any time of day, with activity?, if so what activity.
Answers to these may provide enough data to make useful comment, possibly an interim diagnosis. Be prepared however that I/we may disagree with the one you already have.

[Andre.g]

Thanks ginger, i wanted to explain my history but it is quite long, please bear with me. I had this condition a 1.5 years ago when i played basketball for long periods of time. I usually play basketball about 2 times a week and in those days, I played up to 6 hours with some rest but i never sat down to rest(I stood). I also want to note that my methods of playing is punishing to the knees with agility runs and constant high jumps. The pain initially was the lower knee cap where it continued to inflame and my knees will make a shiver (shakeness). I would claim this was grade 1 or 2 and my first physio told me to do eccentric exercises, cycling, and use sports tape (which helped a lot). The sports tape pushed up the kneecap and I assume less fat impingement less inflammation. At this stage, pain was only evident in the bottom knee cap. It can get slightly sharp but nothing to scream about.

Ok... after exercising continuosly for a year in the gym and feeling confident, I chose to take up competitive basketball. Apparently the more distances i ran the worst it became. It get's inflammed, I iced it and basketball time soon became a 30 minute thing. The later result of my ignorance inabled me to climb stairs and walk or stand more than 15 minutes. Inflammation was everywhere, from upper calves to lower quads which is basically and like a flammed fibre connecting my calves and quads. Pain is also evident on the whole circumference of knee cap. Bearable sharp pains below knee cap.

Yes knee pain increases exponentially if I push my legs to run or walk further than the limit. My limit now is 30 minutes walk. Climbing up hills, stairs are the bane of my legs. I would presume this is jumpers knee but doc says my tendon fibres are fine. I have not gone under any surgery at all and I have no pains at anywhere besides my knees. I however agree there is something impinging the fat pad.

Sorry for the long essay but I can't really explain it short. Thanks a lot man.

[ginger]

Andre, thanks for the details. I would hope you bear in mind that my post is written in the spirit of making informed comment, nothing would connect the dots with more emphasis and likely value for you than seeing a physio who is capable of understanding your problem and offering apropriate therapy.
From the detail you offer it appears you have what is commonly known as PFPS. Or patello femoral pain syndrome. This was once thought to be an arthritic disease and called Chondromalachia Patella, during which period ( medically speaking )it was treated with a combination of exasperation and ill conceived surgery.
More recently however it is better understood to be a referred pain and dysfunction problem arising from protective behaviour in the mid lumbar spine. In particular L3.
I have explained protective spinal behaviour elsewhere on these pages so I won't go into detail on this here. Suffice to say it is entirely treatable in the right hands with no attention whatever required at the knee. You will however find many therapists who have yet to be aquainted with Continuous Mobilisation as a method to restore a non threatened, normaly mobile spine. with this hands on method . It is possible with , usually , the first treatment ( according to my own experience and that of those I have trained ) to reduce pain , using, for instance, a full squat as a test, in under thirty minutes, by up to 80 percent, by treating only L3 with Continuous Mobilisation. Further attention with this method will restore , in most cases , a fully mobile joint to this part of the spine, allowing irflammatory irritation to be resolved at the point where that part of the Femoral nerve exits the spine.
A full consideration of factors associated with these non pathlogical spinal behaviours will be of value in ultimately eliminating this problem in the long term.
Attention to the vastus medialis oblique muscle with either taping or exercise may yield temporary , or even no result. This is because the poor holding patterns seen in cases of PFPS, to this important patella guiding and holding muscle ( on the inside of your knee ) is often disturbed by the same mechanism that causes pain , that being, irritation to the relevant nerve root at the spine.
This may sound persuasive or not , but the only way to find out ultimately is to have someone examine and treat your mid lumbar spine with CM.
For those therapists taking an interest in Cm and other aspects of this approach , further detail is available on this site , or Rehabedge.com, using key words PFPS, Ginger,CM etc., where I have discussed this on previous posts.
best of luck.

[Andre.g]

Once again, thank you for responding. I did forget to mention that my knees do make a 'click' sound when i jump which and the fact I had poor cushioning with high arc feet. With all the symptoms mention in PFPS, in sounds pretty much like my condition. Not to mention my family does have some knee history problem.

As much as I read about PFPS on the web, I hardly come across the with 'Spinal Protective Behavior'. I remember my physio said something about nerves but never went deeply into it. I'm quite interested to know more about it and more about the treatment of Continuous Mobilization. I currently live in Sydney, if you do know someone who specializes in it, let me know.

Thanks ginger