Osgood-Schlatter Disease: Why Knee Pain in Growing Athletes Shouldn’t Be Ignored
If your child has developed pain just below the kneecap during football, netball, basketball or running, there’s a good chance someone has already told you, “It’s just growing pains.”
While Osgood-Schlatter disease (OSD) is one of the most common causes of knee pain in adolescents, it should never be dismissed as something they simply need to “push through”.
The good news? With the right diagnosis and management, the vast majority of young athletes make a full recovery and continue participating in the sports they love.
At SportsFit Physio and Health, we regularly assess and treat Osgood-Schlatter, growth plate knee pain and other adolescent sporting injuries in young athletes from Glen Iris, Malvern East, Ashburton and surrounds.
What is Osgood-Schlatter Disease?
Osgood-Schlatter disease is an overuse injury that causes pain and swelling below the knee joint. In medical-terms it is a traction apophysitis of the tibial tubercle — the growth centre on the front of the shinbone where the patellar tendon attaches.
During adolescence, this growth plate is made of cartilage and is significantly weaker than mature bone. It is placed under stress and load when the quadriceps muscles contracts and pull through the patella tendon onto this developing growth centre.
Some activities that can put high stress on this area include:
- Sprinting
- Jumping
- Kicking
- Changes of direction in running
- Landing from a jump
In isolation or small amounts, these activities are generally safe to do. But when training loads increase faster than the body can adapt, then inflammation can occur, resulting in pain, swelling and tenderness.
Importantly, this isn’t tendon damage. It isn’t arthritis. It isn’t permanent damage. It is a growth-related overload injury.
Why Does it Happen During Growth Spurts?
One of the biggest risk factors for Osgood-Schlatter disease is rapid growth.
During a growth spurt:
- It’s the bones growing and lengthening initially;
- Muscles and tendons often struggle to keep up, and as a result;
- The muscles (quadriceps) become relatively tighter and flexibility decreases;
- Strength and co-ordination will reduce, as muscles now have to move heavier and longer bones;
- The growth plate remains the weakest link
This creates increased tension through the patellar tendon during sport.
Throw in multiple sports, representative teams, school sport, strength training and weekend games, and the developing growth plate may simply be asked to tolerate more load than it can currently handle.
What Does Osgood-Schlatter Feel Like?
Typical symptoms include:
- Pain just below the kneecap
- Tenderness over the tibial tubercle (“the bump”)
- Pain during running
- Pain while sprinting
- Pain jumping or landing
- Pain after games or training
- Pain kneeling
- A gradually enlarging bony prominence
Many athletes are completely comfortable walking around school but become sore as soon as sport starts. Others can warm into activity before becoming increasingly sore afterwards.
Pain During Sport is Not Normal
One of the biggest misconceptions surrounding adolescent growth plate knee pain is that athletes simply have to “play through it.”
They don’t.
In adolescent athletes, pain during sport is always a sign that something deserves assessment.
Ignoring ongoing pain often leads to:
- Longer recovery times
- Reduced performance
- Compensatory movement patterns
- Reduced strength
- Increased frustration
- Higher risk of developing additional injuries elsewhere
The aim is rarely to stop sport altogether. Instead, we modify loads so the irritated growth plate can settle while maintaining overall fitness.
Why Getting the Diagnosis Right Matters
Not every painful bump below the kneecap is Osgood-Schlatter disease.
Other conditions can produce very similar symptoms, including:
- Patellar tendinopathy
- Tibial tubercle avulsion injuries
- Patellar sleeve fractures
- Fat pad irritation
- Bone stress injuries
- Referred pain from elsewhere around the knee
One of the biggest differences between managing adolescents and adults is recognising that growth plates behave very differently to mature tendons and ligaments.
This is why an accurate assessment by a physiotherapist experienced in adolescent sporting injuries is so important.
Occasionally, imaging such as X-ray or ultrasound may be indicated, but diagnosis is usually made through a thorough clinical assessment.
Can Osgood-Schlatter Disease Cause Permanent Damage?
One of the most common questions we hear from parents is: “Will this damage my child’s knee long-term?”
Thankfully, the answer is almost always no.
Osgood-Schlatter disease is a temporary irritation of the growth plate where the patellar tendon attaches to the shinbone. Once skeletal maturity is reached and the growth plate closes, the vast majority of athletes experience complete resolution of their pain.
What often does remain is the characteristic bony prominence (or “bump”) just below the kneecap.
For most people, this bump is simply cosmetic and causes no ongoing problems. Occasionally it can remain tender when kneeling directly onto hard surfaces, but it rarely limits sport or everyday activities in adulthood.
The key is ensuring the condition is managed appropriately while the athlete is still growing. Persistently training through significant pain can prolong symptoms and, in rare cases, contribute to complications such as a tibial tubercle avulsion injury.
Early assessment, sensible load management and a structured rehabilitation program help minimise these risks and keep young athletes participating safely throughout adolescence.
Why Rest Alone Usually Doesn’t Work
Many families try: “We’ll just give it two weeks off.”
The knee often feels better → Sport resumes → Within one or two sessions… …the pain returns.
That’s because the underlying problem hasn’t changed. The growth plate still isn’t tolerating the load being placed through it.
Successful management requires improving the athlete’s ability to tolerate sport — not simply waiting for symptoms to settle.
What Does Physiotherapy Involve?
Every athlete is different.
Management should be individualised based on:
- Age
- Stage of growth
- Sport
- Training volume
- Competition schedule
- Strength
- Flexibility
- Irritability of symptoms
A comprehensive physiotherapy program often includes:
Load Management
This doesn’t necessarily mean stopping sport. Instead, we determine:
- How much running is appropriate
- Whether sprinting needs modifying
- Jump volume
- Training frequency
- Game participation
- Recovery between sessions
The aim is to find the “sweet spot” where the athlete continues progressing without repeatedly flaring their symptoms.
Hands-On Treatment
While hands-on treatment doesn’t “fix” the growth plate itself, it can play a valuable role in reducing excessive tension through the knee.
Depending on the athlete, this may include:
- Soft tissue massage to the quadriceps
- Release techniques for the rectus femoris and surrounding muscles
- Treatment to the patellar tendon and adjacent soft tissues when appropriate
- Addressing tightness through the hip and calf muscles
Many young athletes feel immediate improvements in comfort and movement after these treatments, making it easier to complete their rehabilitation exercises.
Flexibility
Growth spurts often leave athletes significantly tighter than they were just a few months earlier.
Targeted stretching may focus on:
- Quadriceps
- Hip flexors
- Hamstrings
- Calves
Rather than generic stretches, these are tailored to the individual athlete’s movement patterns and symptom response.
Strength and Rehabilitation
Rehabilitation is far more than stretching.
A progressive program may include:
- Quadriceps strengthening
- Hip strength
- Gluteal control
- Single-leg stability
- Landing mechanics
- Running progression
- Plyometric progression
- Return-to-sport planning
The goal is to build an athlete who can tolerate the demands of their sport — not just one whose pain has temporarily settled.
Taping Strategies
For some athletes, taping can be a very useful short-term adjunct.
Depending on the presentation, we may use:
- Patellar tendon unloading taping
- Supportive sports tape techniques
- Patellar straps where appropriate
These don’t cure Osgood-Schlatter disease, but they can reduce symptoms enough to help athletes train more comfortably while the underlying problem is addressed through rehabilitation.
Todd’s Top Tip
One of the biggest mistakes we see is young athletes being told to simply “rest until it settles.” While symptoms may improve temporarily, they often return as soon as sport resumes because the underlying strength, flexibility and load tolerance haven’t been addressed.
Our goal is to keep young athletes participating wherever possible while gradually building their capacity to tolerate the demands of their sport. Every treatment plan is individualised, balancing symptom management with progressive rehabilitation so athletes can continue enjoying the sports they love while recovering safely.
FAQ: Can my child keep playing sport?
Usually, yes — but not if they’re simply pushing through worsening pain.
One of the biggest myths surrounding Osgood-Schlatter disease is that complete rest is the only solution.
In reality, the goal is to keep children participating in sport wherever possible while modifying the amount of load their knee is exposed to.
Depending on their symptoms, this may involve:
- Reducing training volume while still playing games
- Modifying sprinting or jumping drills
- Limiting the number of teams or sports they play simultaneously
- Increasing recovery between sessions
- Temporarily reducing playing time during periods of rapid growth
Every athlete is different. Some can continue training almost normally with only minor modifications, while others need a short period of reduced participation to allow symptoms to settle.
The most important principle is simple: pain should guide participation — not determination.
If knee pain is progressively worsening, causing a limp, reducing performance, or preventing them from completing normal training, it’s time to reassess rather than simply “tough it out.”
A physiotherapist experienced in adolescent sporting injuries can help determine exactly how much football your child can safely continue while progressing through rehabilitation.
When Should You See a Physiotherapist?
We recommend assessment if your child:
- Has pain below the kneecap lasting more than 1–2 weeks
- Is limping after sport
- Has pain that is worsening despite rest
- Is avoiding running or jumping
- Has swelling over the tibial tubercle
- Is repeatedly missing training or games because of pain
- Experiences pain that stops them participating in sport
Early intervention is often much easier than trying to manage symptoms that have been present for months.
Concerned Your Child Might Have Osgood-Schlatter Disease?
At SportsFit Physio and Health, adolescent sporting injuries are one of our clinical passions. Our physiotherapists understand that growing athletes require a different approach to adults, combining accurate diagnosis, hands-on treatment, progressive rehabilitation and sensible load management to keep them active throughout their sporting journey.
Whether your child plays football, soccer, basketball, netball, athletics or another sport, early assessment can often prevent months of frustration and unnecessary time away from the activities they love.
If your child has developed pain below the kneecap during sport, we’d love to help them get back to doing what they love — safely, confidently and with a clear plan for recovery.
The Bottom Line
Osgood-Schlatter disease is common — but it shouldn’t simply be accepted as a normal part of growing up.
With an accurate diagnosis, sensible load management, hands-on physiotherapy, targeted stretching, progressive strengthening and a structured return-to-sport plan, most young athletes can continue participating safely while their symptoms improve.
At SportsFit Physio and Health, we have a particular interest in adolescent sporting injuries and understand that growing athletes are not simply “small adults.” Their bones, growth plates and training demands require a different approach.
Todd Grbac
Physiotherapist
References
Blankstein, A., Cohen, I., Heim, M., Salai, M., Diamant, L., & Chechik, A. (2001). Ultrasonography as a diagnostic modality in Osgood-Schlatter disease. Clinical Orthopaedics and Related Research, 395, 191–196.
Circi, E., Atalay, Y., & Beyzadeoglu, T. (2017). Treatment of Osgood-Schlatter disease: Review of the literature. Musculoskeletal Surgery, 101(3), 195–200. https://doi.org/10.1007/s12306-017-0479-7
de Lucena, G. L., dos Santos Gomes, C., & Guerra, R. O. (2011). Prevalence and associated factors of Osgood-Schlatter syndrome in a population-based sample of Brazilian adolescents. The American Journal of Sports Medicine, 39(2), 415–420. https://doi.org/10.1177/0363546510383835
Rathleff, M. S., Rathleff, C. R., Olesen, J. L., Rasmussen, S., & Roos, E. M. (2020). Activity modification and knee strengthening for Osgood-Schlatter disease: A prospective cohort study. Orthopaedic Journal of Sports Medicine, 8(3), 2325967120911106. https://doi.org/10.1177/2325967120911106
