Growing pains that aren't just growing pains: knee and heel pain in adolescents and how we can help
Over the past two posts, we've looked at anterior knee pain in gym-going adults, patellofemoral pain and patellar tendinopathy caused by overloading and poor technique. Today we're looking at a different but closely related picture: the young, active child or teenager who starts complaining of knee or heel pain during or after sport.
If your child has been limping off the football oval, wincing on the stairs, or waking up with aching knees and heels, there's a good chance they're dealing with one of two very common and very treatable growth-related conditions: Osgood-Schlatter disease (knee) or Sever's disease (heel).
Despite their alarming-sounding names, both conditions are manageable, and with the right support from a physiotherapist or exercise physiologist, most young athletes can continue playing sport throughout treatment.
Why adolescence is a vulnerable time for bones and tendons
During growth spurts, bones can grow faster than the muscles and tendons attached to them. As bones grow faster than muscles and tendons, the muscles and tendons can become tight and pull on the growth plates, causing inflammation and pain.
Growth plates, the areas of developing cartilage near the ends of long bones, are the weakest link during this phase. They haven't yet hardened into solid bone, which makes them significantly more vulnerable to the stresses of repetitive sport and physical activity than the same tissues would be in an adult. This is why these conditions only occur during childhood and adolescence, once growth is complete and the plates have closed, the pain resolves.
Osgood-Schlatter disease - knee pain below the kneecap
Osgood-Schlatter disease is one of the most common causes of knee pain in active young people. It occurs most often in active eight to fifteen year old children during periods of rapid growth, typically affecting males aged 12–15 and females aged 8–12. It usually lasts anywhere from 12 to 24 months and can affect both knees in 20–40% of cases.
The condition occurs where the patellar tendon attaches to the top of the shin bone (tibial tubercle), just below the kneecap. During a growth spurt, the quadriceps muscles, which are working hard during running, jumping and landing, repeatedly pull on this attachment point through the patellar tendon. Both conditions are overuse injuries caused by repetitive stress on the growth plates. Over time this creates a painful, sometimes visible bony bump at the front of the knee.
The hallmarks of Osgood-Schlatter are pain and tenderness directly at that bony bump below the kneecap, pain that worsens with sport and eases with rest, and stiffness or aching the morning after a heavy training session. It's particularly common in sports involving running, sprinting, jumping and direction changes. Football, basketball, netball, athletics and dance are frequent culprits.
The important message for parents is this: Osgood-Schlatter is not dangerous and doesn't cause permanent damage when managed properly but if left unaddressed, symptoms can worsen and recovery can be prolonged.
Sever's disease - heel pain in active children
Sever's disease (calcaneal apophysitis) is the heel equivalent of Osgood-Schlatter — and it's the most common cause of heel pain in growing children. It occurs when the growth plate in the heel becomes inflamed due to repetitive stress or overuse. It's most common in active children aged 8 to 14 who participate in sports that involve a lot of running and jumping.
The Achilles tendon — the large tendon connecting the calf muscles to the heel — attaches directly onto the heel bone at the site of the growth plate. During periods of rapid growth, tight calf muscles and the repetitive impact of sport create traction on this vulnerable growth plate, leading to inflammation and pain.
Sever's typically presents as heel pain during and after sport, often described as a squeezing or aching sensation at the back of the heel. It's worse first thing in the morning or after sitting for extended periods, and tends to improve with a gentle warm-up only to return again after activity. Running on hard surfaces or in worn-out footwear significantly aggravates the condition.
One important distinction from Osgood-Schlatter: unlike Osgood-Schlatter where footwear makes little difference, heel wedges and orthotics can be genuinely helpful for Sever's disease by reducing strain on the Achilles tendon and growth plate.
What makes these conditions worse?
Both conditions are driven by the same core factors: a growth spurt increasing the vulnerability of the growth plate, high sporting loads without adequate recovery, tight muscles pulling on the affected area, and weak supporting muscles that increase the load on those attachment points.
A sudden increase in training volume, starting a new season, joining an extra training squad, beginning high school sport, is one of the most common triggers. Children who play multiple sports across multiple seasons without adequate rest periods are particularly at risk. Poor footwear and hard training surfaces compound the problem for Sever's specifically.
The instinct to "push through" the pain is completely understandable in a young athlete who loves their sport, but training hard on an irritated growth plate prolongs recovery and can intensify symptoms significantly.
How physiotherapy helps?
A physiotherapist at Colab Health Group will assess your child's movement patterns, muscle strength and flexibility, training load and footwear before developing a tailored management plan. The goal is never to simply tell a child to stop playing sport it is to find the right load for where they are right now, and build from there.
Physiotherapy treatment typically includes stretching exercises to reduce tension in the affected areas, calf and Achilles stretching for Sever's, quadriceps and hamstring stretching for Osgood-Schlatter, alongside strengthening exercises to build support around the affected joints and activity modification to reduce pain and prevent further irritation.
Your physio will also provide guidance on appropriate taping or bracing to support the knee or heel during sport, footwear and insole recommendations for Sever's disease, and ice therapy protocols to manage inflammation after activity. For most children, symptoms can be meaningfully reduced within a few weeks of starting a properly managed programme without stopping sport altogether.
How exercise physiology helps?
Where an exercise physiologist adds particular value is in looking at the bigger picture of your child's overall training load and physical development. For young athletes competing across multiple sports, or those in structured strength and conditioning programmes, an EP can assess the total weekly demand being placed on their body and create a programme that supports both their sport participation and their long-term physical development.
This is especially relevant for adolescents beginning structured gym training alongside their sport. The same principles that apply to overloaded adults as we discussed in our anterior knee pain post apply equally to young athletes, with the added complexity that growing bones and tendons have less capacity to absorb load than their adult counterparts.
An EP will help design age-appropriate strengthening programmes that build the hip, quad, calf and foot strength needed to reduce the load on the affected growth plates, supporting recovery while keeping your child physically active and athletic during what can otherwise feel like a frustrating period of enforced sideline time.
When to come and see us?
Come in to see the team at Colab Health Group if your child:
Has pain below the kneecap or at the tibial tuberosity (the bony bump at the top of the shin) during or after sport
Has heel pain during running or jumping that worsens over the course of a training session
Is limping after sport or first thing in the morning
Has had their pain for more than two to three weeks
Is avoiding sport or activity because of knee or heel pain
These conditions are self-limiting, they will eventually resolve when growth is complete, but the wait can be months to years, and active management makes a significant difference to how comfortable that period is and how much sport your child can maintain throughout it. Early intervention is always better than waiting.
References
American Physical Therapy Association. Physical therapy guide to Osgood-Schlatter disease. choosept.com. Updated 2024.
Ladenhauf HN, Seitlinger G, Green DW. Osgood-Schlatter disease: a 2020 update of a common knee condition in children. Current Opinion in Pediatrics. 2020;32(1):107–112.
Rathleff MS, Winiarski L, Krommes K, et al. Activity modification and knee strengthening for Osgood-Schlatter disease: a prospective cohort study. Orthopaedic Journal of Sports Medicine. 2020;8(4).
Pereira PM, et al. Patellofemoral pain syndrome risk associated with squats: a systematic review. International Journal of Environmental Research and Public Health. 2022;19(15):9241.
Scharfbillig RW, Jones S, Scutter SD. Sever's disease: what does the literature really tell us? Journal of the American Podiatric Medical Association. 2008;98(3):212–223.
James AM, Williams CM, Haines TP. Effectiveness of interventions in reducing pain and maintaining physical activity in children and adolescents with calcaneal apophysitis (Sever's disease). Journal of Foot and Ankle Research. 2013;6(1):16.
East Lancashire Hospitals NHS Trust. Osgood-Schlatter disease — physiotherapy information leaflet. elht.nhs.uk. 2024.