Knee Pain in Young Athletes: Osgood-Schlatter Disease and the Growth Plate
Front-of-knee pain in children who play football or basketball may be Osgood-Schlatter disease. Symptoms, treatment and when to see a doctor.
Short answer: In children aged about 10 to 15 who play sports with a lot of jumping, such as football, basketball and volleyball, pain just below the kneecap on the bony bump is usually Osgood-Schlatter disease. The kneecap tendon pulls on and irritates the still-soft growth area. The condition is harmless, needs no surgery and settles as growth finishes. But if there is night pain, swelling, locking, a limp or fever, an examination is needed.
Dr Ahmet Şadi Kılınç, Orthopaedics and Traumatology Specialist, Bahçeşehir, Istanbul
“My son’s knee hurts below the kneecap when he runs at football and he wants to quit training.” I hear this at the start of every season. Most of the time it is not an injury but an adjustment problem of the growing years. In this article I explain the cause, how it is recognised and managed, and whether the child should stop sport.
I also explain it in a short video, in Turkish: watch on YouTube.
What is Osgood-Schlatter disease?
The front thigh muscles (quadriceps) attach through a tendon over the kneecap to a bump at the top front of the shin bone. In children this bump is not yet fully bone but a soft area containing growth cartilage. With repeated running and jumping, the tendon pulls on this area again and again, causing pain, tenderness and, over time, a more prominent bump.
It is not an infection, a tumour or a lasting disease; it is a growing-years condition caused by overload.
Who gets it?
- Usually boys aged about 12 to 15 and girls about 10 to 13 (the growth spurt)
- Children who play football, basketball, volleyball, gymnastics or run
- One or both knees
Symptoms
- Pain and tenderness just below the kneecap, on the shin bone
- Pain that increases with running, jumping, stairs, squatting and kneeling
- Pain that eases with rest
- Swelling or a more prominent bump at that spot
- Tightness in the front thigh muscle
Diagnosis
Diagnosis is usually made by examination; pain and tenderness at the typical spot is enough. An X-ray is often not needed, but imaging is requested if the pain is unusual, one-sided and severe, follows an injury or occurs at night.
Treatment
Treatment is non-surgical and aims to manage the symptoms:
- Adjust the load: Reduce training that triggers the pain. Complete rest from sport is often unnecessary; the child can continue at a level that keeps pain under control.
- Cold: 15 to 20 minutes of ice after activity helps.
- Stretching and strengthening: Stretching the front and back thigh muscles and strengthening the hip and core muscles reduce load on the knee.
- Support: A knee sleeve or a strap below the kneecap helps some children.
- Pain relief: A short course, if needed and advised by a doctor.
When growth is complete, usually within 1 to 2 years, the pain settles by itself. In some children the bump below the knee remains but usually does not hurt.
Should the child stop sport?
In most cases, no. Activity should not be banned but adjusted to the pain. If pain is mild and does not worsen during sport, the child can continue. If pain prevents sport, a few weeks of rest and treatment are planned before returning, ideally with a sports doctor or orthopaedic specialist.
What else can cause similar pain?
- Sinding-Larsen-Johansson disease: A similar pain at the lower tip of the kneecap in younger children (10 to 12 years).
- Patellofemoral pain syndrome: Pain at the front of the knee, worse with squatting and stairs.
- Hip problems: Hip pain can be felt in the knee, so the child’s gait and hip movement are also checked.
- Fracture, ligament or meniscus injuries: Considered when pain follows a fall or twist.
When to see a doctor
- Pain at rest or at night
- Marked swelling, redness or warmth in the knee
- A limp or being unable to put weight on the leg
- Locking or a feeling that the knee gives way
- Fever
- Pain that does not settle after a few weeks of rest and treatment
For knee problems in children, see our Paediatric Orthopaedics page and book an appointment. To tell apart leg pains in children, read our article on growing pains.
This article is for general information and does not replace an examination.
Frequently asked questions
What is Osgood-Schlatter disease?
A harmless growing-years condition in sporty children in which the kneecap tendon pulls on the soft growth area at the top front of the shin bone, causing pain and tenderness below the knee.
At what age does Osgood-Schlatter occur?
Usually around 12 to 15 years in boys and 10 to 13 in girls, during the growth spurt.
Does Osgood-Schlatter go away?
Yes. It settles by itself when growth is complete, usually within 1 to 2 years.
Can a child play sport with Osgood-Schlatter?
In most cases yes. Sport should be adjusted to the pain, not banned. A few weeks of rest may be needed if pain prevents sport.
When should I take my child to a doctor for knee pain?
If pain is present at rest or at night, or comes with swelling, a limp, locking or fever, or does not settle in a few weeks.
The information on this page is general and does not replace an examination. An examination is needed to decide which treatment suits you.