Casey Bass: I have just got this email from my producer, Amy. We are getting ready to go shoot over a children's healthcare with Dr. Marshall and say something about SLJ. As far as I know that stands for Standard Long John. So I am not sure what Dr. Marshall is going to tell us about long underwear but stay tune to ClubHouse Gas and find out for yourself. We are honored once again to be joined by friend of the show and Director of Sports Medicine here at Children's Healthcare, Atlanta, David Marshall. David, thank you so much for joining us.Dr. David Marshall: Thanks for having me.Casey Bass: Who is this good-looking young man you have got with us here?Dr. David Marshall: This is my son, Grant, he is a third grader at Wesleyan School and he is going to be helping us out with some of the anatomy of these growth plate injuries. Casey Bass: Good! So there is, at least, somebody here who is smarter and better looking than the two of us.Dr. David Marshall: It's not you and I.Casey Bass: So we are talking about SLJ today and I have no idea what SLJ is. I have read it but I can't pronounce it. So could you please fill me in?Dr. David Marshall: Yeah, SLJ stands for Sinding-Larsen-Johansson syndrome and it's a condition that affects the growth plates of young athletes between the ages of 7 and 12 so really before they reach those pubertal or adolescent ages. And that's an injury that involves an injury to the growth plate because the muscle or tendon pulls on that growth plate and that seems to be the weak link which causes the pain. Casey Bass: Alright! So where does that exist on this young man?Dr. David Marshall: On Grant, you can see I drew a couple of pictures on him. The first larger circle that's the knee cap, what we call the patella and if you think of the patella or the knee cap, it's kind of shape like an egg or a football, it's the bottom pole or the inferior pole of the kneecap or the patella we call that and there is a growth plate there. And that growth plate is a big block of cartilage that serves with the anchor point for the thigh muscles. The largest and strongest muscle he has in his body is the quadriceps and those quadriceps muscles are attached right to that area. Straight your leg and bend it like four or five times all the way up. So you can see, as those quadriceps muscles pull, it has to pull in the bottom of that kneecap and that's sets up a traction tie force, a very similar to a cable attached to a screw, screwed into a plaster wall. If you keep pulling on that very thick powerful tight cable, something has to give and what gives is the screw starts to come out of the wall a little bit or a little tiny microscopic cracks in that cartilage and that's exactly what causes the pain here. Casey Bass: Alright! Well Grant, we are going to let you go do your math homework, so me and your dad can talk a little more. We won't make you sit here for the rest of this.So we know what SLJ is. What are the symptoms?Dr. David Marshall: Basically, it's pain. They get pain right at the bottom, pull of that kneecap and then it will usually occur after workout. So kids will come back from a game, from a workout. They are just playing outside with their friends and they will come in and they will complain of pain in the front of their knee.Casey Bass: Is that the main cause or just another one of those overuse injuries? Dr. David Marshall: It's just one of those overuse injuries, just like when anytime there is a muscle or a tendon that attaches to one of those cartilage weak growth plates and they play a sport or do an activity that uses that tendon a lot, that growth plate is the thing that fails. If it starts to break apart little bit in advanced condition, then they might get a little bit of swelling. So pain and swelling in that area are really the two key points in diagnosing this. Casey Bass: So my kid gets the pain in front of his knee, I bring him in, you diagnose him with this syndrome, how do you treat him? Dr. David Marshall: Well, the treatment for overuse injuries number one is to under-use it. So you try to identify the activity or the part of that activity that really causes the discomfort and maybe really back off on the running, the sprinting, the jumping. Some of these younger kids are starting to do speed and agility training where they are doing ladder drills and they might be doing weightlifting for the quadriceps such as squats, power cleans, lunges, all those things that are avoidable should be cut out of their workout.Second thing they need to do is ice it. I think ice is a real nice anti-inflammatory treatment. The best anti-inflammatory treatment is to avoid the inflammatory activities that we just talked about. The second thing is ice and I like to have the kids do what's called ice cup massage. Simply get the Styrofoam coffee cups like this, fill it to the very tippy top with water and maybe put three of them in the freezer. So that way they are always there and as soon as they come in from a workout and they are sore, before dinner, before homework, sorry moms, but before all that's done, go right to the freezer, take one of these cups out, and you can peel back an inch of the paper around the rim of the cup. Then we have nice little frozen snow cone like a push-up pop that we used to enjoy. It's insulated so your fingers don't freeze and just do some circular massage right over that sore spot for about 8-10 minutes; when it goes numb, you can stop. Wait an hour to 90 minutes after homework, after dinner, when you are watching the Braves on TV, get that cup out again and ice it for another eight minutes before bed time. That can be a very effective anti-inflammatory treatment. Casey Bass: The most important question according to some of our posters is, can he pitch, can he play linebacker? If your kid gets tied off with SLJ, can he go or just can be one of those things that puts him on the shelf?Dr. David Marshall: Yeah, that's not always an easy question to answer, because some of these growth plate injuries, it's okay to play with a little bit of discomfort and endure the pain. As long as they are modifying their workouts, they are using ice cup massage, they are using anti-inflammatory medicine like Alive or Advil or Motrin, as long as we can keep the pain level down to a minimum, then some of these injuries, that's okay to return to play. We have talked about Little League Elbow in the past and the answer is, no, they really should not play with any discomfort or they shouldn't pitch or throw with any discomfort in the elbow because the risks of having that growth plate completely separate are too great. Down here in the knee, we are talking about Sinding-Larsen-Johansson, with that one, the risk of having a complete separation is much less to where I think it's okay to play as long as the pain is decreasing and is under control.Casey Bass: Alright, well thank you so much, Dr. Marshall, we really appreciate it.Dr. David Marshall: Thank you!Casey Bass: We would love to have you back and we will have your back. Dr. Marshall is going to join us next Tuesday and we will see you right back here then for another great edition of ClubHouse Gas.