# Osgood-Schlatter disease > Osgood-Schlatter disease is a growth-related knee problem that causes pain and a tender bump just below the kneecap, mostly in active teenagers. It usually settles once growth finishes, though the bump often stays. Easing activity, ice and gentle stretching are the usual first steps. Guide in [Children's feet](https://footanklelowerlimb.com.au/learn/topics/childrens-feet), from Foot Ankle Lower Limb: https://footanklelowerlimb.com.au/learn/osgood-schlatter-disease Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod (Podiatrist) on 11 November 2026. Next review by 11 November 2027. - **It's a growth-related knee problem:** it causes pain and a tender bump just below the kneecap, mostly in active teenagers. - **It usually settles as growth finishes,** though the bump often stays. - **Easing activity, ice and gentle stretching come first,** and most young people don't need more than that. - **Some features point to something else,** such as swelling that doesn't settle, night pain, fever or a sudden limp. ## What is Osgood-Schlatter disease, and how common is it? Osgood-Schlatter disease is an overuse injury that causes pain and inflammation at the tibial tubercle (the bony bump just below the kneecap, where the patellar tendon attaches to the shin bone). It mostly affects young people who are still growing [1]. The clinical name is tibial tubercle apophysitis, which means irritation of the growth area at that spot. It's the most common cause of knee pain in active teenagers, and the bump often stands out [2]. Up to 10% of adolescents have it [3][4]. It's more common in young people who play sport [3], and in boys. It usually appears between about 11 and 15 years of age [5]. ## What causes it, and who gets it? It comes from repeated pulling. During running, jumping and bending, the thigh muscles (quadriceps) pull through the patellar tendon on the growth area at the top of the shin bone, and the area becomes inflamed [6]. Growth spurts add to this. Because the skeleton lengthens ahead of the muscles, those muscles must lengthen to keep pace and can end up tight. Tight muscles pull harder on the bump, which causes pain, particularly during exercise [7]. Kneeling can also make it worse [8]. Sport is linked with higher rates, and sport is likely to increase how often it happens [3]. That doesn't prove sport is the cause in any one child. The people most affected are active teenagers going through a growth spurt [8]. ## What does it feel like, and what else could it be? The usual picture is pain, swelling or tenderness just below the knee, which tends to be worse during or after activity. Running, kneeling, jumping and stairs often bring it on [9]. The pain varies in how strong it is, and a small tender bony bump may develop [10]. Diagnosis is usually based on the typical symptoms and an examination. The examination looks for tenderness over the bump and pain when the knee is straightened against resistance [11]. When the picture is typical, X-rays or scans aren't normally needed [8]. When young people have knee pain, serious causes such as infection and tumour are ruled out [12]. Some features aren't typical of Osgood-Schlatter disease and can point to another cause: - swelling or bruising that doesn't improve with rest or elevation - regular or constant night pain - numbness or persistent pins and needles - fever, or redness and heat around the hip, knee or ankle - a sudden, unexplained limp, or being unable to walk on the leg [10] In children, pain that wakes them at night is linked with tumour. Redness, swelling or stiffness of a joint is linked with infection or inflammatory joint disease. Weight loss, fever, night sweats or tiredness can go with tumour, infection or inflammation [13]. Septic arthritis (a joint infection) is an emergency, because it can destroy a child's joint within 24–48 hours [13]. Swelling soon after an injury, with a large, tense swollen knee, can mean bleeding into the joint [11]. A tibial tubercle fracture is a separate injury at the same spot, with a considerable risk of complications and repeat operations [14]. A knee that locks, gives way or clicks painfully is also worth knowing about, while painless clicking is normal [15]. ## What helps first? Care starts with simple steps at home. Several of them work together: - **Adjust activity.** Jumping, running and kicking are limited until they can be done without pain, which can sometimes take several months [2]. Lower-stress options such as swimming, gentle cycling or a cross trainer can keep a young person moving [10]. School can be told, as PE lessons may need to be less vigorous [9]. - **Ice after activity,** with a towel between the ice and the skin [10]. The Try this box below shows how. - **Stretch gently.** Regular hamstring and quadriceps stretching for 20–30 seconds, if pain allows [9]. - **Use simple pain relief.** Paracetamol is often used [6]. Pharmacists can talk through the options [9]. - **Try physiotherapy.** Physiotherapists teach exercises to stretch tight muscles and tendons [6]. Knee immobilisation, such as a splint, isn't recommended [2]. > [!tip] Try this > After sport, wrap an ice pack in a towel and rest it on the sore spot below the kneecap for 10–15 minutes. Never put ice straight onto the skin. How much to cut back depends on the pain. Some advice is to limit jumping, running and kicking until they're pain-free. Other advice is that sport can continue as tolerated, and that over-treatment should be avoided because the condition is benign and settles by itself [5]. Either way, any exercise that increases knee pain is best stopped. Sport is unlikely to cause lasting damage, but it can make the pain worse [8]. Stretching appears to help, but most common treatments aren't well proven [16][4]. It isn't clear yet whether insoles, straps or taping help the knee. In children's heel pain, which is a different problem, foot orthoses made little difference compared with heel lifts [16]. ## What can help if that isn't enough? Most young people don't need more than first-line care. Non-surgical treatment works well for managing Osgood-Schlatter disease, and surgery is uncommon. It appears to be kept for people whose growth plates have closed and whose symptoms persist [1]. Orthopaedic review (by doctors who treat bones and joints) is considered when significant impairment continues despite conservative care [2]. Some young athletes have a separate small piece of bone (an ossicle) in the patellar tendon. It can cause long-lasting pain, and removing it may be considered [5]. How long first-line care should be tried before moving on isn't clear yet. ## How long does it last, and can it come back? Osgood-Schlatter disease settles by itself, and full resolution is expected [2]. Symptoms should go once the young person has finished growing, but the bump will usually stay prominent [2]. The discomfort can last weeks to months, and it may come and go until growth has stopped [6]. Pain can ease before sport is back to normal. Getting back to full sport can take months, so a gradual return guided by pain makes sense [17]. What speeds recovery, and what stops the pain coming back, isn't clear yet. ## Common questions ### Can Osgood-Schlatter disease affect both knees? Yes. It usually affects one knee, but it can happen in both, and in about 20–30% of young people both knees are sore at the same time. If both knees are involved, the same approach applies: easing back on the activities that bring the pain on, and gentle stretching. ### Do we need an X-ray or scan for knee pain below the kneecap? Usually not. When the symptoms are typical, with pain and tenderness at the bump below the kneecap that is worse with activity, the diagnosis comes from the story and an examination. Imaging is generally kept for when something doesn't fit the usual pattern. ## Further reading - [Osgood-Schlatter disease on Clindice](https://clindice.com/osgood-schlatter-disease-podiatry) - [Osgood-Schlatter disease: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/001258.htm), MedlinePlus - [Emergency and Urgent Care - Osgood-Schlatter Disease :: Northern Care Alliance](https://www.northerncarealliance.nhs.uk/patient-information/patient-leaflets/emergency-and-urgent-care-osgood-schlatter-disease?q=%2Fpatient-information%2Fpatient-leaflets%2Femergency-and-urgent-care-osgood-schlatter-disease), NHS - [Osgood-Schlatter's - Resource Library - Sheffield Children's NHS Foundation Trust](https://library.sheffieldchildrens.nhs.uk/osgood-schlatter-disease/), NHS - [Understanding Osgood-Schlatter disease](https://www.nelft.nhs.uk/all-about-osgood-schlatter-disease/), NHS - [Osgood Schlatter’s Disease](https://www.nuh.nhs.uk/osgood-schlatters-disease/), NHS ## Sources 1. Treatments for Osgood Schlatter Disease: A Systematic Review of the Literature · Ndjonko LCM, Klein JH, Chakraborty Y et al. · Orthopaedic Journal of Sports Medicine · 2026. https://doi.org/10.1177/23259671251387354 2. Osgood-Schlatter and Sinding-Larsen Johansson disease · Perth Children's Hospital. https://pch.health.wa.gov.au/For-health-professionals/Referrals-to-PCH/Prereferral-guidelines/Osgood-Schlatter-and-Sinding-Larsen-Johansson-disease 3. Describing Frequencies of Lower-Limb Apophyseal Injuries in Children and Adolescents: A Systematic Review · Haines M, Pirlo L, Bowles KA et al. · Clinical Journal of Sport Medicine · 2022. https://doi.org/10.1097/jsm.0000000000000925 4. A systematic review on conservative treatment options for OSGOOD-Schlatter disease · Neuhaus C, Appenzeller-Herzog C, Faude O · Physical Therapy in Sport · 2021. https://doi.org/10.1016/j.ptsp.2021.03.002 5. Evaluation and management of knee pain in young athletes: overuse injuries of the knee · Patel DR, Villalobos A · Translational Pediatrics · 2017. https://doi.org/10.21037/tp.2017.04.05 6. Osgood-Schlatter's condition · Royal Berkshire NHS Foundation Trust. https://www.royalberkshire.nhs.uk/media/ujaohgl2/osgood-schlatters-condition_apr25.pdf 7. Osgood-Schlatter disease · Cambridge University Hospitals. https://www.cuh.nhs.uk/patient-information/osgood-schlatter-disease/ 8. Osgood-Schlatter's Disease · East Sussex Healthcare NHS Trust. https://www.esht.nhs.uk/wp-content/uploads/2021/03/0907.pdf 9. Osgood Schlatter’s · Bradford Teaching Hospitals NHS Foundation Trust. https://www.bradfordhospitals.nhs.uk/wp-content/uploads/2025/02/25011305-Osgood-Schlatters-Disease-Leaflet-2.pdf 10. Osgood-Schlatter Disease · East Lancashire Hospitals NHS Trust. https://elht.nhs.uk/application/files/3617/4592/2391/PHYSIO-002-Osgood-Schlatter_Disease-2024.pdf 11. Knee Pain in Children - South & West · Devon Formulary Guidance. https://southwest.devonformularyguidance.nhs.uk/referral-guidance/western-locality/paediatrics/knee-pain-in-children 12. Anterior Knee Pain in Children and Adolescents: Overview and Management · Slotkin S, Thome A, Ricketts C et al. · The Journal of Knee Surgery · 2018. https://doi.org/10.1055/s-0038-1632376 13. The limping child - when to worry and when to refer: a GP's guide · Khan SA, Raja H, Waheed A · The British Journal of General Practice · 2020. https://doi.org/10.3399/bjgp20x712565 14. Tibial tubercle fractures are sports injuries in male adolescents with a considerable risk of complications and reoperations: a systematic review · Kalifis G, Fermin TM, Seil R et al. · Knee Surgery, Sports Traumatology, Arthroscopy · 2023. https://doi.org/10.1007/s00167-023-07322-1 15. Knee pain · NHS. https://www.nhs.uk/symptoms/knee-pain/ 16. Non-surgical treatment for lower limb apophyseal injuries · Williams CM, Krommes K, Paterson KL et al. · The Cochrane Database of Systematic Reviews · 2026. https://doi.org/10.1002/14651858.cd015156.pub2 17. Activity Modification and Knee Strengthening for Osgood-Schlatter Disease: A Prospective Cohort Study · Rathleff MS, Winiarski L, Krommes K et al. · Orthopaedic Journal of Sports Medicine · 2020. https://doi.org/10.1177/2325967120911106 --- This is general information, not advice about your own situation. To discuss your issues, book with one of our podiatrists. In an emergency, call 000.