If your child has been complaining about pain just below their kneecap — especially after running, jumping, or sports — you’re not alone. As a physiotherapist in Sandton, I see this often in active kids going through growth spurts.

You might notice a small bump under their knee or that they limp after sports. While this can be worrying, the cause is usually something common and treatable. This condition is called Osgood-Schlatter disease, and it affects up to 10% of active adolescents, especially boys between 12 and 15 years old⁸.

It happens when the thigh muscle pulls on the shinbone during growth, causing irritation at the tendon’s attachment. It’s not serious, but it can cause ongoing pain if not managed the right way — and that’s where the right physiotherapy plan can make a big difference.

What is Osgood-Schlatter Disease?

Osgood-Schlatter disease (OSD) is a common cause of knee pain in growing children and teenagers, especially those who are active in sports.

It’s not actually a disease in the usual sense — it’s more of a temporary overuse injury that happens during the growth years when bones, muscles, and tendons are all changing quickly.

What’s Really Going On?

Osgood-Schlatter disease happens when the thigh muscle (quadriceps) pulls on the patellar tendon, which is the band that connects the kneecap to the shinbone. This pulling creates stress at the tibial tuberosity — the little bump on the upper part of the shinbone just below the kneecap.

Over time, this stress can cause pain, swelling, and a visible bump that gets worse with activity like jumping, running, or climbing stairs.

This usually affects just one knee but can happen in both. Some kids might only feel mild discomfort, while others may struggle to play their usual sports.

Who Gets Osgood-Schlatter disease (and Why)

Boys aged 12–15 and girls aged 10–13 — this is when growth spurts usually happen.
Kids involved in high-impact sports like soccer, basketball, volleyball, rugby, or athletics⁶.
Studies show a 10% point prevalence in children aged 12–15, which can jump significantly in young athletes⁴.
Boys tend to get it more because their bones grow faster and they often engage in higher-impact activities. The risk nearly doubles in kids who play competitive sports.

Is It Serious?

Thankfully, Osgood-Schlatter disease is not dangerous and most kids grow out of it once their bones stop growing. But without the right care, the pain can hang around for months — even years — and make it hard to stay active. That’s why early recognition and proper physiotherapy in Sandton or wherever you are can make a huge difference.

Common Signs and Symptoms of Osgood-Schlatter Disease

Pain just below the kneecap (at the shinbone) that gets worse with running, jumping, squatting, or going up stairs
A hard, bony bump on the front of the shin, just below the kneecap — this is often sore to touch
Tenderness and swelling around the bump, especially after sports or physical activity
Stiffness in the knee first thing in the morning or after sitting for a while
Limping after exercise or favouring one leg
Pain that improves with rest but comes back during activity
Tight thigh muscles, especially in the front (quadriceps) and back (hamstrings)
Kneeling becomes painful — especially on hard surfaces
Discomfort that lasts for weeks or months, and may shift from mild to sharp depending on the activity level
One knee is usually worse, but both knees can be affected in some cases

Why Does Osgood-Schlatter Disease Happen?

Growth Spurts and Stress on the Knee

Osgood-Schlatter disease usually happens during puberty, between ages 10 and 15, when the bones grow quickly. But muscles and tendons don’t grow at the same pace. This creates pulling tension at the spot just below the kneecap — the tibial tuberosity.

Every time your child runs, jumps, or kicks, the quadriceps muscle pulls on the patellar tendon, which tugs on the shinbone. If this happens a lot — like in sports — it causes irritation and swelling. This is what leads to the pain and that noticeable bump under the knee⁶.

Why It Happens to Active Kids

Osgood-Schlatter disease affects up to 10% of adolescents, but it’s much more common in kids who play sports. Running, jumping, and changing direction all put extra load on the knee. These high-impact movements pull harder on the tendon, especially during growth spurts.

Boys are more likely to get it than girls, mostly because they have more rapid bone growth and are often involved in more intense sports⁴. Muscle tightness, poor flexibility, and even posture or movement habits can add to the problem¹⁰.

What’s Happening Under the Skin

The tibial tuberosity is still soft and forming during the teenage years. Repeated pulling can cause tiny injuries at that spot. Over time, your child’s body responds by laying down extra bone to protect it — that’s the bony bump you can feel below the kneecap.

In some kids, small pieces of bone can form within the tendon itself, which may lead to longer-lasting pain and swelling. Imaging studies show that this irritation is usually clear on MRI scans and sometimes lasts beyond the growth phase¹².

What Other Conditions Could It Be?

Sinding-Larsen-Johansson Syndrome

This condition causes pain at the bottom of the kneecap — not below it on the shinbone. There’s usually no bump, and the pain tends to show up in younger teens during growth spurts¹.

Patellar Tendinopathy (Jumper’s Knee)

This affects the tendon itself and not the bone. It’s more common in older teens and doesn’t cause a visible bump. If left untreated, the pain can become constant².

Tibial Tubercle Fracture

This happens suddenly, not gradually. The pain is sharp, and there’s often swelling after a hard landing or sprint. X-rays are usually needed to confirm it⁹.

Prepatellar Bursitis

In this condition, the swelling is over the top of the kneecap, not below it. It feels soft instead of hard and often happens from too much kneeling or direct pressure¹².

Osteochondritis Dissecans

This causes pain deeper inside the knee and can sometimes make it feel like it’s locking or catching. It’s often picked up with an MRI scan¹².

Common Mistakes When Treating Osgood-Schlatter Disease

Playing Through the Pain

Trying to “tough it out” only makes things worse. Every sprint or jump adds more pulling and irritation to the knee. This can delay healing and increase the risk of chronic pain.

Skipping Stretching

Tight thigh muscles make the pulling worse. Without regular stretching of the quads and hamstrings, your child is likely to keep irritating the same area.

Only Resting and Doing Nothing Else

Rest is helpful, but doing nothing can slow recovery. Active rehab and safe movement are key parts of getting stronger and reducing knee pain over time⁸.

Wearing Bad Shoes

Old, flat, or unsupportive shoes increase impact on the knees. A good pair of well-cushioned, supportive shoes helps take pressure off the shinbone.

Waiting Too Long to Get Help

Many parents wait too long to see a physiotherapist. Without the right advice, symptoms can drag on for months — and in rare cases, it may even lead to surgery³.

If You Ignore It

Ignoring Osgood-Schlatter disease may lead to longer-term problems like chronic pain, trouble kneeling, or a permanent bump under the knee. In some teens, it can even force them to stop playing sport altogether.

Types of Scans for Osgood-Schlatter Disease

X-Ray

This is the first and most basic scan. It helps us see the bones clearly. With Osgood-Schlatter disease, we might spot a small bone fragment pulled off the shin or extra bone forming near the tibial tuberosity. It also helps us rule out more serious injuries like fractures⁹.

Ultrasound

Ultrasound is great for looking at soft tissues — like the patellar tendon and the bursa (the little fluid sac under the tendon). It shows swelling, thickening of the tendon, or fluid buildup. It’s quick, safe, and sometimes done right in the clinic¹².

MRI

MRI gives us the full picture — it shows bones and soft tissue in high detail. If the pain is lasting longer than expected, or if something doesn’t feel quite right, we use an MRI to rule out other issues like cartilage damage or other knee conditions¹².

Most of the time, these scans aren’t needed unless the pain is very severe or isn’t improving. A proper physical exam and rehab plan is usually all your child needs.

Is Surgery Needed for Osgood-Schlatter Disease?

In most cases, surgery is not needed. Osgood-Schlatter disease almost always improves with time and the right treatment. But in rare situations, surgery may be considered.

When Surgery Might Be Needed

Surgery is only recommended if:

The pain is still strong after the bones have stopped growing
A bony lump under the knee is causing ongoing pain when kneeling
There are loose bone fragments in the tendon that haven’t healed on their own
The person has done physiotherapy and rested for more than a year with no improvement

These situations are uncommon. Research shows fewer than 10% of people with Osgood-Schlatter ever need surgery³. If surgery is done, it’s usually minor — a small camera is used (arthroscopy) to remove loose bone or smooth the area.

How Physiotherapy Helps After Surgery

After surgery, physiotherapy plays a big role in helping your child recover. We’ll help them:

Reduce swelling and pain
Get normal knee movement back
Strengthen the thigh and hip muscles
Improve how they move to avoid future injuries
Return to sport safely

Most kids recover well after surgery with the right rehab plan. And in most cases, they get back to their normal activities — without pain.

Treatment Options for Osgood-Schlatter Disease

As a physiotherapist, my goal is to help your child reduce pain, stay active, and return to the sport or movement they enjoy. Osgood-Schlatter disease can be treated very well without surgery. Here are the most effective physiotherapy options we use:

Exercises for Osgood-Schlatter Disease

This is the foundation of treatment. The right exercises will ease pain, improve strength, and support healing:

Stretching – We focus on loosening tight muscles like the quadriceps and hamstrings. This reduces tension on the knee⁸.
Strengthening – Building strength in the hips and thighs takes pressure off the patellar tendon.
Balance and coordination – These drills help the body move better and reduce the risk of future pain.

Myofascial Release

This is a hands-on technique to release tight muscles and tissues. It helps relax the thigh and reduce pulling on the shinbone. Less tension means less pain.

Orthopedic Manual Therapy

If the knee feels stiff, we can use gentle joint movements to restore motion. This often reduces discomfort after activity⁵.

Dry Needling

We use fine needles to target tight spots in the quads. This helps relieve pain and stiffness quickly. It’s often helpful for tendon pain in young athletes².

Laser Therapy

Low-level laser therapy (LLLT) reduces inflammation and helps tissues heal. It’s painless and especially helpful when symptoms don’t settle easily.

Strapping or Bracing

We may use a patellar strap or tape to reduce strain on the tibial tuberosity during activity. This gives support and helps reduce pain while your child stays active⁷.

Activity Advice

We’ll guide your child on which activities are safe to keep doing, and which ones to modify for now. The goal is not to stop moving — just move smarter.

Conclusion

As your physiotherapist, I want you to know that your child doesn’t have to live with the pain from Osgood-Schlatter disease. It can be tough watching them limp after practice or avoid sport altogether — but this condition is very treatable.

With the right support, smart rehab, and a little patience, most kids start to feel better. I’ve worked with many parents who were worried because the pain just wouldn’t go away — but with consistent physiotherapy, those same kids came back stronger, more confident, and pain-free.

If your child is ready to get moving again, I’m here to guide both of you every step of the way.

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References

Apers, E., Rombauts, M., & Bogaerts, S. (2021). Long-term outcome of conservatively treated lower limb apophyseal injuries in children and adolescents: A systematic review. Translational Sports Medicine, 4(4), 565–586. https://doi.org/10.1002/tsm2.252
Cairns, G., et al. (2018). Therapeutic interventions in children and adolescents with patellar tendon related pain: A systematic review. BMJ Open Sport & Exercise Medicine, 4(1), e000383. https://doi.org/10.1136/bmjsem-2018-000383
Çirci, E., Atalay, Y., & Beyzadeoğlu, T. (2017). Treatment of Osgood–Schlatter disease: Review of the literature. Musculoskeletal Surgery, 101(2), 195–200. https://doi.org/10.1007/s12306-017-0479-7
Haines, M., et al. (2021). Describing frequencies of lower-limb apophyseal injuries in children and adolescents: A systematic review. Clinical Journal of Sport Medicine, 32(5), 433–439. https://doi.org/10.1097/JSM.0000000000000925
Kabiri, L. S., Tapley, H., & Tapley, S. (2014). Evaluation and conservative treatment for Osgood-Schlatter disease: A critical review of the literature. International Journal of Therapy and Rehabilitation, 21(2), 91–96. https://doi.org/10.12968/ijtr.2014.21.2.91
Lucenti, L., et al. (2022). The etiology and risk factors of Osgood–Schlatter disease: A systematic review. Children, 9(6), 826. https://doi.org/10.3390/children9060826
Neuhaus, C., Appenzeller-Herzog, C., & Faude, O. (2020). A systematic review on conservative and non-operative treatment options for Osgood-Schlatter disease. OSF Preprints. https://doi.org/10.31236/osf.io/u4vn7
Neuhaus, C., Appenzeller-Herzog, C., & Faude, O. (2021). A systematic review on conservative treatment options for Osgood-Schlatter disease. Physical Therapy in Sport, 49, 178–187. https://doi.org/10.1016/j.ptsp.2021.03.002
Pretell-Mazzini, J., et al. (2016). Outcomes and complications of tibial tubercle fractures in pediatric patients: A systematic review. Journal of Pediatric Orthopaedics, 36(5), 440–446. https://doi.org/10.1097/BPO.0000000000000488
Rodrigues, D. R., et al. (2025). Biomechanical alterations in Osgood-Schlatter disease: A systematic review. Research in Sports Medicine. Advance online publication. https://doi.org/10.1080/15438627.2025.2467400
Sanderson, A., & Bryant, T. (2015). The effects of low-level laser therapy on tendinopathy: A review. Physiotherapy Theory and Practice, 31(1), 20–27. https://doi.org/10.1089/pho.2008.2470
Sørensen, L. B., et al. (2021). A systematic review of imaging findings in patients with Osgood-Schlatter disease. Translational Sports Medicine, 4(6), 772–787. https://doi.org/10.1002/tsm2.281

Osgood-Schlatter Disease: How to Treat Knee Pain in Kids

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