Children who play a lot of sport, particularly soccer, rugby, netball, hockey, athletics, gymnastics and dance, often go through a phase of sore knees or heels. Two of the most common causes are Osgood-Schlatter disease and Sever’s disease. Despite the names, neither is really a disease. Both are overuse problems where a strong tendon pulls on a growth plate that hasn’t finished developing.
Osgood-Schlatter: pain just below the kneecap
Who: usually children around 10 to 15, during growth spurts, slightly earlier in girls than boys.
Signs:
- Pain and tenderness on the bony bump just below the kneecap
- Sometimes a visible, tender lump there
- Worse with running, jumping, kneeling, stairs and squatting
- Better with rest
Sever’s: pain at the back of the heel
Who: usually children around 8 to 14.
Signs:
- Pain at the back or bottom of the heel
- Worse during and after running and jumping, especially on hard ground or in flat boots
- Limping or walking on tiptoes after sport
- Pain when you squeeze the sides of the heel
Why it happens
During a growth spurt, bones grow faster than muscles and tendons can lengthen. The muscles get tight, and the tendons pull harder on their attachment points, which in children are still soft growth plates. Add a lot of running and jumping, often across several sports and teams at once, and the growth plate gets irritated.
What helps
- Manage the load. This is the big one. Cut back on the most painful activity for a while, and avoid stacking several sports and practices into the same days. Pain during sport that’s mild and settles by the next day is generally acceptable. Pain that causes limping, or is worse the next morning, means too much.
- Ice after activity for 10 to 15 minutes can ease soreness.
- Stretching and strengthening: quadriceps and hamstrings for knees, calves for heels. A good programme makes a real difference to flare-ups.
- Footwear: supportive shoes, and for Sever’s a small heel cushion can help.
- Patience. These settle as the growth plates mature.
Where a chiropractor fits
I see a lot of young athletes. My role is to make sure the diagnosis is right, treat the tight muscles and any stiff joints that are adding to the load, and put together a stretching, strengthening and training plan that keeps your child playing as much as possible. Adjusting the knee or heel isn’t the treatment here. Load management and exercise are.
See a doctor if
- There’s swelling, redness or warmth around the joint
- Your child has a fever or is unwell
- The pain is constant, at rest, or wakes them at night
- The pain followed an injury, or your child can’t put weight on the leg
- There’s pain in the hip or groin with a limp. In children, hip problems often show up as knee pain, so this always needs a medical check.
Read next: back pain in children or the children’s chiropractic page.
Questions parents and patients ask
Does my child have to stop sport with Osgood-Schlatter or Sever's?
Usually not completely. Most children can keep playing with some changes, such as less running and jumping for a while, more rest between sessions, and a stretching and strengthening programme. If pain is making them limp or stopping them playing, they need a break and an assessment.
How long do Osgood-Schlatter and Sever's last?
They tend to come and go during periods of fast growth and settle once the growth plate matures. That can mean months or, on and off, a couple of years. Managing training load keeps flare-ups shorter and milder.
Are these the same as growing pains?
No. "Growing pains" usually describes aching in the legs, often at night, in younger children, with no tenderness at a specific spot and no limp. Osgood-Schlatter and Sever's cause pain at a specific spot that's worse with activity. Pain at night that wakes a child, or that comes with swelling, a limp or fever, should be checked by a doctor.
This guide is general information, not a diagnosis. If you're worried about yourself or your child, get checked by a health professional. In an emergency, call 10177 or 112 from a cellphone.