Why Does My Child’s Knee Hurt Below the Kneecap During Sports?

Why Does My Child’s Knee Hurt Below the Kneecap During Sports? A Physical Therapist Answers

By Nova Physical Therapy | North Hollywood, CA

Patient Question

“My child complains of pain or tenderness at the bump just below the kneecap after soccer, basketball, running, or jumping. What could be causing it, and can physical therapy help?”

The Short Answer

Pain around the bony bump just below the kneecap is relatively common in active, growing children and adolescents.

One condition associated with this pattern is Osgood-Schlatter disease, a growth-related overuse condition involving the area where the patellar tendon attaches to the upper shinbone.

It is especially common during periods of rapid growth and among young athletes participating in sports involving:

• Running
• Jumping
• Sprinting
• Cutting
• Landing
• Repeated knee bending

APTA's ChoosePT guidance describes Osgood-Schlatter disease as one of the most common causes of front-of-knee pain in children and estimates that it affects approximately 1 in 10 children, particularly active children between roughly 8 and 15 years of age.

However, pain below the kneecap does not automatically establish Osgood-Schlatter disease.

Children can experience knee pain for several reasons. A physical therapist can evaluate mobility, muscle performance, balance, movement, activity tolerance, and functional limitations and determine whether the presentation is appropriate for physical therapy or whether referral for additional medical evaluation is indicated.

What Is Osgood-Schlatter Disease?

Despite the word “disease,” Osgood-Schlatter disease is generally considered a growth-related overuse condition rather than a systemic disease.

It affects the region known as the tibial tubercle, the bony prominence near the top of the shin where the patellar tendon attaches.

During periods of growth, this area is still developing.

Repeated pulling from the quadriceps and patellar tendon during activities such as running and jumping may irritate this growth region.

APTA identifies Osgood-Schlatter disease as an overuse injury occurring specifically in growing children.

What Does Osgood-Schlatter Pain Usually Feel Like?

Children may describe:

• Pain below the kneecap
• Tenderness over the bony bump at the top of the shin
• Pain during running
• Pain during jumping
• Pain when squatting
• Pain while climbing stairs
• Discomfort after sports practice
• Pain when kneeling
• Local swelling or prominence around the tibial tubercle

Symptoms may affect one or both knees.

APTA reports that bilateral symptoms occur in approximately 20% to 40% of affected children.

Why Does This Happen During a Growth Spurt?

Children do not grow at a perfectly uniform rate.

During rapid growth, bones, muscles, tendons, and other tissues may adapt at different rates.

At the same time, young athletes may dramatically increase their participation in:

• Club soccer
• Basketball
• Volleyball
• Track
• Football
• Gymnastics
• Dance
• School athletics
• Tournament schedules

This combination of rapid physical development and repeated loading may contribute to symptoms.

That makes training volume and recovery particularly relevant during growth spurts.

Why Is This Topic Especially Relevant Right Now?

Late summer and the beginning of the school year often create sudden changes in youth sports workload.

A Pasadena physical therapy and sports medicine clinic highlighted this issue on August 13, 2026, noting that youth athletes may move from relatively modest school-year participation to camps, tournaments, and practices occurring five or six days per week.

This does not mean sports participation is bad for children.

Sports provide tremendous physical, psychological, and social benefits.

The concern is more specific:

A sudden increase in physical demand may exceed what a developing athlete is currently prepared to tolerate.

That is a different message from telling children to avoid sports.

Which Sports Commonly Aggravate This Type of Knee Pain?

Activities involving repeated quadriceps loading can increase symptoms.

APTA identifies several common examples:

• Soccer
• Track
• Football
• Basketball
• Volleyball
• Gymnastics
• Ballet
• Sports requiring cutting and repeated landings

These sports are not inherently harmful.

The issue is whether the athlete's current workload, recovery, strength, and physical capacity are appropriate for their stage of growth and development.

Does My Child Have to Stop Sports Completely?

Not necessarily.

The answer depends on symptom severity and functional limitations.

The American Academy of Orthopaedic Surgeons notes that many children with Osgood-Schlatter disease can remain active as tolerated and that continued participation does not automatically cause long-term knee damage. More significant activity modification may be necessary when pain becomes severe, causes limping, or interferes meaningfully with participation.

A physical therapist may consider:

• Pain during activity
• Symptoms afterward
• Next-day response
• Limping
• Running mechanics
• Jumping tolerance
• Strength
• Participation volume
• Competition demands

The goal is generally to find an appropriate level of participation rather than applying the same restriction to every child.

Should a Child Play Through Knee Pain?

Pain should not simply be ignored.

There is a major difference between:

Mild, predictable discomfort that remains manageable

and

Pain that progressively worsens, causes limping, changes movement, or makes the child unable to participate normally.

Children may need help recognizing when symptoms are signaling that their workload needs modification.

APTA's pediatric guidance emphasizes educating families about when to modify activities, when to stop painful activity, how long to reduce stress, and how to return progressively.

What About the Bump Below the Knee?

Some children with Osgood-Schlatter disease develop a noticeable prominence around the tibial tubercle.

The area may be:

• Tender
• Sensitive during kneeling
• Swollen during symptomatic periods
• More prominent than the opposite side

The prominence itself does not necessarily mean the knee joint is being damaged.

However, a new painful bump after significant trauma, substantial swelling, or unusual symptoms should receive appropriate medical evaluation rather than being assumed to be Osgood-Schlatter disease.

Does My Child Need an X-Ray?

Not automatically.

The American Academy of Orthopaedic Surgeons notes that Osgood-Schlatter disease is generally identified clinically and that X-rays are not routinely required unless the healthcare provider has another concern about the source of knee pain.

Imaging may be considered when the presentation is unusual or another injury needs to be excluded.

Examples might include:

• Significant trauma
• Inability to bear weight
• Severe or unexplained swelling
• Persistent night pain
• Symptoms that do not behave like a typical activity-related presentation
• Concern for another bone or joint problem

Physical therapists screen for findings that may require referral.

Can Physical Therapy Help?

Yes.

Physical therapy may help young athletes with appropriate musculoskeletal knee presentations manage symptoms, improve physical capacity, and return progressively to desired activities.

Depending on the examination, treatment may include:

• Quadriceps strengthening
• Hip strengthening
• Hamstring strengthening
• Calf strengthening
• Mobility exercises
• Flexibility exercises when deficits are identified
• Balance training
• Neuromuscular training
• Functional movement exercises
• Squatting progression
• Running progression
• Jumping and landing progression
• Sport-specific exercise
• Activity modification education
• Home exercise programs

APTA notes that physical therapists may help children with Osgood-Schlatter disease reduce pain, improve muscle performance and flexibility, restore movement and function, and guide safe participation in activity.

Does My Child Just Need to Stretch?

Not necessarily.

Stretching is often discussed with Osgood-Schlatter disease, particularly when relevant flexibility limitations are identified.

However, rehabilitation should not automatically consist only of stretching the quadriceps and hamstrings.

A young athlete may also demonstrate limitations in:

• Strength
• Balance
• Landing control
• Single-leg performance
• Running tolerance
• Movement coordination
• Overall conditioning

The treatment plan should reflect the child's actual examination findings.

Is Strengthening Safe During a Growth Spurt?

Appropriately prescribed strengthening is commonly included in pediatric rehabilitation.

The important considerations are:

• Appropriate exercise selection
• Appropriate resistance
• Technique
• Progression
• Supervision
• Response to exercise
• The athlete's developmental level

The goal is not maximal lifting.

The goal is to develop the muscle performance and movement capacity required for everyday activities and sport.

Why Is Hip Strength Sometimes Addressed for Knee Pain?

The knee functions as part of the entire lower extremity.

Running, jumping, cutting, and landing require coordinated contributions from the:

• Trunk
• Hips
• Knees
• Ankles
• Feet

For that reason, a physical therapist may identify hip or lower-extremity muscle-performance deficits that are relevant to the child's function.

Treatment should address the whole movement task rather than assuming the painful structure is the only area that matters.

Is Sport Specialization a Concern?

It can be.

Playing one sport intensively throughout the year may reduce opportunities for movement variety and recovery.

APTA has long highlighted the association between high levels of youth sport specialization and overuse injuries. Its patient education emphasizes diversification of physical activity and appropriate recovery for developing athletes.

That does not mean a child must abandon a sport they love.

It means parents, coaches, healthcare professionals, and athletes should consider the total training load placed on a growing body.

What Does Research Say?

Current evidence and professional guidance support activity modification rather than automatic long-term shutdown, along with progressive rehabilitation when functional impairments are present.

APTA's ChoosePT guidance identifies Osgood-Schlatter disease as a common growth-related overuse injury and recommends individualized management addressing:

• Symptoms
• Strength
• Movement
• Flexibility when appropriate
• Activity participation
• Recovery
• Sport-specific demands

The American Academy of Orthopaedic Surgeons similarly notes that most cases are treated conservatively, with strengthening, stretching when appropriate, symptom management, and temporary activity adjustment based on severity.

The practical message for parents is:

The goal is not to make a growing athlete afraid of running or jumping. The goal is to appropriately match activity demands with the child's current ability to tolerate them.

What Happens During a Physical Therapy Evaluation?

At Nova Physical Therapy, an evaluation for youth knee pain may include:

• Medical history review
• Symptom history
• Review of recent growth and activity changes
• Knee mobility assessment
• Hip and ankle mobility assessment
• Lower-extremity strength testing
• Quadriceps muscle-performance assessment
• Hip muscle-performance assessment
• Balance assessment
• Walking assessment
• Squat assessment
• Single-leg movement assessment
• Running assessment when appropriate
• Jumping and landing assessment when appropriate
• Sport-specific movement assessment
• Activity tolerance assessment
• Review of training schedule
• Goal setting

Your physical therapist also screens for findings suggesting that the child should be evaluated by a physician or other appropriate healthcare professional.

Under California's Physical Therapy Practice Act, physical therapists evaluate and treat movement and functional impairments within the legal scope of physical therapy and refer patients when signs or symptoms indicate a condition requiring care beyond that scope.

When Should You Seek Medical Attention?

Knee pain in a child should not automatically be assumed to be a routine overuse problem.

Seek appropriate medical evaluation when symptoms include:

• Significant trauma
• Inability to bear weight
• Significant or rapidly increasing swelling
• Visible deformity
• Persistent locking
• Significant instability
• Fever with a hot or swollen joint
• Unexplained pain at rest
• Persistent or significant night pain
• Progressive weakness
• Symptoms that are rapidly worsening
• A limp that persists or becomes significant

These findings may require evaluation beyond routine physical therapy.

Why Patients Choose Nova Physical Therapy

At Nova Physical Therapy, our mission is simple:

We Care.

Young athletes should not automatically be told that every episode of knee pain means they need to stop the sport they love.

At the same time, pain should not simply be ignored.

Our approach focuses on understanding:

• What activity causes the symptoms
• How much activity the athlete is performing
• Whether the athlete recently went through a growth or training change
• What physical impairments are actually present
• What the athlete needs to do to participate successfully

Our treatment philosophy emphasizes:

• Evidence-based care
• Individualized treatment plans
• Patient and parent education
• Progressive strengthening
• Balance and movement training
• Functional outcomes
• Sport-specific rehabilitation
• Appropriate activity progression
• Long-term participation in physical activity

Our goal is to help young athletes continue developing strength, movement skills, and confidence while appropriately managing symptoms and physical demands.

Frequently Asked Questions

Why does my child's knee hurt below the kneecap?

Pain at the bump below the kneecap may occur with growth-related conditions such as Osgood-Schlatter disease, but several conditions can cause pediatric knee pain. The symptom alone does not establish a diagnosis.

What age does Osgood-Schlatter usually occur?

It occurs during periods of growth and is commonly reported in active children and adolescents roughly between ages 8 and 15.

Is Osgood-Schlatter caused by sports?

Sports involving running and jumping may contribute to symptoms during growth, but the condition reflects the interaction between development and repeated physical loading rather than simply sports being harmful.

Does my child need to stop soccer?

Not automatically. Some children may continue participating with appropriate symptom-based modifications, while others require a temporary reduction in activity.

Can my child play basketball with Osgood-Schlatter?

Participation depends on symptom severity and functional tolerance. Significant pain, limping, or worsening function may indicate the need to reduce activity and receive appropriate evaluation.

Is Osgood-Schlatter permanent?

Symptoms generally improve as skeletal growth progresses and the growth plate matures, although the bony prominence may remain noticeable in some individuals.

Can physical therapy help?

Physical therapy may address strength, flexibility when appropriate, movement, balance, functional limitations, and sport-specific activity progression.

Should my child stretch before sports?

A warm-up and appropriate mobility may be useful, but stretching alone is not a complete injury-management strategy. Exercise should reflect the individual athlete's needs.

Does my child need an MRI?

MRI is not routinely required for a typical presentation. Imaging decisions depend on the history, examination, symptom behavior, and whether another condition is suspected.

Can a growth spurt cause knee pain?

Rapid growth can contribute to certain musculoskeletal presentations in children because bones and surrounding tissues are changing while the athlete may simultaneously be participating in demanding sports.

Should my child play only one sport year-round?

Year-round specialization may increase exposure to repetitive loading. Movement variety, recovery, and total training volume should be considered, particularly during growth.

Schedule an Evaluation

If your child's knee pain is affecting soccer, basketball, volleyball, running, jumping, stairs, school activities, or everyday movement, Nova Physical Therapy can help determine whether physical therapy is appropriate.

Our licensed physical therapists provide individualized evaluations and rehabilitation programs focused on improving strength, movement, activity tolerance, and function.

Contact Nova Physical Therapy today to schedule a comprehensive physical therapy evaluation in North Hollywood.

Disclaimer

The information provided in this article is intended for educational and informational purposes only and should not be considered medical advice, diagnosis, or treatment.

Reading this article does not establish a physical therapist-patient relationship with Nova Physical Therapy or any of its providers.

Knee pain in children and adolescents can have multiple causes. Pain below the kneecap, tenderness around the tibial tubercle, pain with running or jumping, or symptoms during a growth spurt do not establish Osgood-Schlatter disease or any other specific diagnosis.

California physical therapists evaluate movement and functional impairments within the scope established by the Physical Therapy Practice Act and refer patients to appropriate healthcare professionals when findings require medical evaluation beyond physical therapy.

Treatment, exercise, activity modification, and return-to-sport recommendations should be individualized based on a licensed physical therapist's examination, clinical judgment, medical history, patient presentation, current evidence, developmental stage, and applicable California laws and regulations.

Seek appropriate medical evaluation for significant trauma, inability to bear weight, substantial swelling, deformity, persistent locking, fever with a hot or swollen knee, unexplained rest or night pain, progressive weakness, or other concerning symptoms.

Individual results may vary. Nova Physical Therapy does not guarantee specific outcomes, recovery times, injury-prevention results, or return-to-sport timelines from physical therapy or any healthcare intervention discussed in this article.

References

1. American Physical Therapy Association / ChoosePT. Physical Therapy Guide to Osgood-Schlatter Disease.
2. American Academy of Orthopaedic Surgeons. Osgood-Schlatter Disease (Knee Pain).
3. American Physical Therapy Association / ChoosePT. Overuse Injuries in Youth Athletes.
4. American Physical Therapy Association / ChoosePT. Risks of Youth Sports Specialization.
5. Physical Therapy Board of California. Physical Therapy Practice Act.
6. HealthFit Physical Therapy & Chiropractic, Pasadena. Why Kids Are Getting Hurt in Summer Sports (and How to Protect Yours). Published August 13, 2026.

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