Front of knee pain in the growing child: Osgood-Schlatter Disease

29th Mar, 2021

Oh no! My child is complaining about pain in the front of his knee when he runs or jumps. What could it be?

Pain in the front of your child’s knee is not uncommon. Your child could be suffering from a condition called Osgood-Schlatter Disease (OSD). OSD is an overuse injury and happens when a tendon in the knee pulls against the top of the shin bone, where new bone is forming at the growth plate. As the growth plate is made out of cartilage, it is not as strong as the mature bone. High levels of stress can cause inflammation and pain in the growth plate.

Forces acting on the knee

My child is a healthy and athletic kid, how did the knee pain start?

First, we need to understand what happens to your child’s bones as they undergo puberty.

Babies are born with about 300 bones at birth. These will eventually fuse to form 206 bones that a typical adult has. A large proportion of the baby’s bones are made up entirely of cartilage, while others are only partly made of cartilage. As your child grows, the cartilage grows too, and it is slowly replaced by bone at the growth plate (represented by the blue lines in the diagrams above). As cartilage is softer than bone, the cartilaginous growth plate tends to be weaker as compared to mature bones. During your child’s growth spurt, the bones, muscles and tendons grow at different rates.

In OSD, the tendon that connects the shin bone to the knee cap pulls on the growth plate (see diagram above).

It is rather common in active adolescents involved in sports that involve high loads of jumping and running. Repetitive strain is placed on the shin bone as the thigh muscles work to contract and straighten the knee during those movements, causing excessive pulling force to the growth plate. This then results in pain.

Does it mean we need to stop all activities?!

Good news! There is no need for your child to stop their sports and activities completely!

OSD can be managed rather simply by modifying and monitoring your child’s activity load. More often than not, children with OSD are involved in multiple sports. As such, it might be useful to consider reducing their participation in one or two of the many sports they are involved in. It has been shown that a reduction in activity will improve pain levels and it is not unusual for them to experience some pain during activity. They might still experience pain while doing their exercises or sport. However, it should not exceed a 4 out of 10 on a pain scale and their pain should settle down after the activity and get better after 24 hours with rest. Therefore, it is pivotal that we monitor the levels of pain and adjust their loads accordingly.

How is OSD treated and how can Physiotherapy help?

There are many factors that could contribute to OSD such as weak or tight muscles and biomechanical abnormalities, such as a low foot arch. Our Physiotherapist will conduct a thorough assessment and identify the contributing impairments. From there on, a combination of mobilisation techniques and exercises may be prescribed appropriately to address the relevant impairments which are leading to the pain in the front of your child’s knee. 

With the knee pain, can my child return to sport?

Yes your child can! But HOLD UP!!

First, we have to manage your child’s pain levels and reduce his/her activity load. Next, we have to strengthen your child’s knee and slowly reintroduce loads appropriately. This will of course be done under the supervision of our Physiotherapists. Various tests and assessments will be conducted to ensure safe progression between stages. Once your child is ready, he/she will then get the green light to return to sport. This will be done in a gradual manner, starting with sport-specific drills done in a controlled environment.

Before you know it, your child will be fully back to their sports!

Here are some examples of exercises for your child’s front of knee pain:

For example, if weak buttock muscles are found to be one of the contributing impairments, you could expect your exercise program to look something like this:

Glute bridge

Hip hike

Step up and step downs

Prone hamstring curl

Nordic hamstring curls

Forward lunge

Bulgarian split squat

If tight muscles are found to be a contributing impairment, some other exercises may include:

Hamstring stretch

Quadriceps stretch

Book now or give us a call to schedule an appointment to see our Physiotherapist who will be able to partner you to recovery as we address your child’s knee pain! Don’t let your child’s knee pain stop them from having a fulfiling childhood! 

DISCLAIMER: These advice and exercises should not replace the need for a consultation with a Physiotherapist especially if your child’s condition doesn’t improve. Therapeutic exercise should be carefully selected to suit the condition of your child and their demands! 


Nakase, J., Goshima, K., Numata, H., Oshima, T., Takata, Y., & Tsuchiya, H. (2015). Precise risk factors for Osgood–Schlatter disease. Archives of orthopaedic and trauma surgery, 135(9), 1277-1281.

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