Growing Pains or Sports Injury? What Parents Should Know About Osgood-Schlatter and Sever's Disease

Knee pain below the kneecap or heel pain after practice isn't always "just growing pains." Here's what parents should know about two of the most common growth-related sports conditions.

Is it just growing pains?

It's one of the most common questions sports parents ask. Maybe your 11-year-old is limping after soccer practice, or your 13-year-old basketball player is rubbing the bump below their knee after every game, and you're not sure whether to wait it out or get it checked.

Sometimes the pain settles down on its own. But two of the most common causes of activity-related pain in young athletes, Osgood-Schlatter disease and Sever's disease, are directly tied to growth and can linger for months if they aren't managed well. The good news is that both are very treatable, and most kids can stay active while they recover.

Here's how to tell what might be going on, what helps, and when it's time to get your athlete checked out.

Why Growing Athletes Get These Injuries

Children's bones have growth plates, areas of developing cartilage where new bone forms. Some growth plates sit right where a strong tendon attaches to the bone. These spots are called apophyses, and they are softer and more vulnerable than mature bone.

During a growth spurt, bones can lengthen faster than the muscles and tendons attached to them. That leaves the muscles relatively tight, so they pull harder on those growth plates. Add the repetitive running, jumping, and cutting of youth sports, and the growth plate gets irritated.

That irritation is called apophysitis, and it's the root of both Osgood-Schlatter and Sever's disease. Despite the name, neither one is a "disease" in the way most people think of the word. They're overuse conditions that happen at a specific stage of growth.

Osgood-Schlatter Disease: Pain Below the Kneecap

Osgood-Schlatter disease affects the bony bump just below the kneecap (the tibial tubercle), where the patellar tendon attaches to the shinbone.

Who gets it: It usually shows up during the early teen growth spurt. Girls tend to develop it earlier, often around 8 to 12, and boys a bit later, often around 12 to 15. It's especially common in athletes, affecting up to about 1 in 5 active adolescents.

Common signs:

• Pain, swelling, or tenderness at the bump just below the kneecap.

• A bump that becomes more prominent over time.

• Pain that gets worse with running, jumping, squatting, kneeling, or going up stairs.

• Pain that eases with rest.

• Often one knee, but it can affect both.

  
  

Sports where we see it most: basketball, volleyball, soccer, track, gymnastics, and dance, or any sport with a lot of jumping and sprinting.

Sever's Disease: Heel Pain in Active Kids

Sever's disease (also called calcaneal apophysitis) affects the growth plate at the back of the heel, where the Achilles tendon attaches.

Who gets it: It typically affects kids around 8 to 15, most often between about 9 and 13. It's one of the most common causes of heel pain in young athletes.

Common signs:

• Pain at the back or bottom edge of the heel, especially during or after activity.

• Tenderness when you squeeze the sides of the heel.

• Limping, walking on tiptoes, or avoiding putting weight on the heel after practice.

• Pain that's worse at the start of a new season or after switching to cleats or a harder playing surface.

• Pain in one heel or both. Many kids feel it on both sides.

  
  

Sports where we see it most: soccer, basketball, baseball, football, gymnastics, and running sports.

Is It Really Just "Growing Pains"?

True growing pains are a little different. They're typically achy, cramp-like pains in the thighs, calves, or behind the knees that show up in the evening or at night, often in both legs. They usually aren't tied to a specific spot on the bone and aren't made worse by a particular sport movement.

Osgood-Schlatter and Sever's disease are different:

• The pain is in a specific, pinpoint spot: the bump below the knee or the back of the heel.

• It's linked to activity and usually worse during or after sports.

• The area is often tender to the touch.

  
  

If your child can point to the exact spot that hurts and it flares up with practice, it's worth a closer look.

How Long Does It Last?

Both conditions are self-limiting, which means they eventually resolve once the growth plate matures and closes. But "eventually" can mean months, and symptoms often come and go with growth spurts and sports seasons.

That's why the goal isn't just to wait it out. It's to manage the load on the growth plate so your athlete can keep playing with less pain, and to address the factors that contributed in the first place. Osgood-Schlatter that isn't managed well can also leave some young adults with a tender bump and discomfort when kneeling years later.

What Helps

Most kids don't need to stop sports completely. Treatment focuses on calming down the irritated growth plate and building the body's ability to handle the demands of their sport.

Adjust the load, not necessarily the sport. Pain is a useful guide. A little discomfort that settles quickly may be okay, but pain that changes how your child moves, lasts into the next day, or keeps getting worse means the body needs a break. Temporarily cutting back on jumping, sprinting volume, or back-to-back practices and tournaments can make a big difference.

Improve flexibility. Tight quadriceps and hamstrings are associated with Osgood-Schlatter, and tight calf muscles with Sever's disease. Gentle, consistent stretching helps reduce the pull on the growth plate.

Build strength. Strengthening the hips, thighs, calves, and feet helps muscles absorb force so the growth plate doesn't take all the stress. This needs to be progressed carefully so it doesn't aggravate symptoms.

Look at how they move. How an athlete lands, decelerates, and changes direction affects how much force goes through the knee and heel. Improving these movement patterns is one of the best ways to reduce flare-ups.

Check footwear and surfaces. For Sever's disease, worn-out cleats, shoes with little heel cushioning, or a sudden switch to hard surfaces can add stress. Heel cups or cushioned inserts sometimes help.

Manage symptoms after activity. Ice after practice can help with soreness. Talk with your child's doctor before using over-the-counter pain medication regularly.

When to Get Your Child Evaluated

It's a good idea to have a professional take a look if:

• Pain has lasted more than a couple of weeks or keeps coming back.

• Your child is limping or changing how they run or jump.

• They're missing practices or games, or avoiding activities they used to enjoy.

• You're not sure what's causing the pain.

  
  

Seek medical care promptly if your child has:

• Pain at night or at rest that wakes them up.

• Significant swelling, redness, or warmth, especially with a fever.

• Pain that started with a specific fall, collision, or "pop."

• Inability to put weight on the leg.

• Knee pain along with hip or groin pain, or a new limp without a clear cause. Hip problems in growing kids can sometimes show up as knee pain.

These can point to other conditions that need medical attention.

How Physical Therapy Helps

At The Performance Lab, we see Osgood-Schlatter and Sever's disease often in young athletes around Charlotte. Our goal is to help kids stay active, stay in their sport when it's appropriate, and come out of their growth spurt stronger.

A physical therapy plan may include:

• A thorough evaluation to confirm what's causing the pain and rule out other issues.

• Guidance on adjusting training load around practices, games, and tournaments.

• Flexibility work for tight muscle groups.

• Progressive strengthening for the hips, legs, and feet.

• Jumping, landing, and change-of-direction training.

• A clear plan for returning to full activity, and for handling future flare-ups.

  
  

As a physical therapist, my biggest piece of advice is not to ignore it. These conditions are common, but common doesn't mean your child has to play through pain for months. With the right plan, most young athletes feel better and get back to doing what they love.

Quick Answers for Parents

Can my child keep playing sports with Osgood-Schlatter or Sever's disease?

Often, yes, with adjustments. Most kids can keep participating if symptoms are managed and training load is modified. Pain that causes limping or keeps getting worse is a sign to scale back and get it evaluated.

Will Osgood-Schlatter or Sever's disease cause permanent damage?

Both usually resolve without long-term problems once growth is complete. Some people with Osgood-Schlatter keep a visible bump below the knee and may have discomfort when kneeling as adults.

Do these conditions need X-rays?

Not always. They're usually diagnosed based on your child's age, symptoms, activity, and a physical exam. A doctor may order imaging to rule out other causes, especially if symptoms are unusual.

Can they come back?

Yes. Symptoms often flare during growth spurts or at the start of a new season, which is why building strength and flexibility, not just resting, matters.

The Bottom Line

Pain below the kneecap or at the back of the heel in an active, growing child is common, but it isn't something your athlete should have to push through. Osgood-Schlatter and Sever's disease are temporary, treatable conditions, and the right plan can help your child stay in the game while their body catches up.

Is your young athlete dealing with knee or heel pain? Reach out to The Performance Lab to schedule an evaluation and get a plan to keep them moving, growing, and performing their best.