Pain at the front of the knee is the most common complaint in teenagers. This is particularly the case for teenagers who enjoy sport or regular exercise, resulting in an overuse injury. Adolescent knee pain can be caused by a number of contributing factors, which are usually related to growth and maturation of bones and muscles. This does mean that these conditions are usually self-limiting and resolve with self-management.

Children and young adults have soft areas called growth plates on the end of their long bones which enable them to grow. Some growth plates serve as attachment points for strong muscle tendons. As we grow our bones lengthen quicker than our muscles, an imbalance with makes some areas much more susceptible to injury. This development phase tends to end at around sixteen years old at which some conditions will end.

Common symptoms include a slow onset of pain which is aggravated by repetitive knee motion (e.g. running, jumping, or other exercise) and prolonged periods of sitting. There may also be some signs of swelling.

Common conditions

Osgood-Schlatter’s Disease is the most common overuse injury. When children and teenagers over-exercise the group of muscles at the front of the thigh (the quadriceps) this can pull on the growth plate at the front of the shin causing pain and inflammation. The growth plate may also become enlarged, and later in life becomes a hard bony lump just under the knee cap.

Tendinitis is inflammation of a tendon. This occurs in the quadriceps tendons of the knee due to repetitive contractions of the thigh muscles. This again is n overuse injury caused by over-aggressive training, or exercise on poorly conditioned muscles.

Patello-femoral pain syndrome is a cause of knee pain in all age groups. This is caused by inflammation between the knee cap (patella) and the thigh bone (femur).  This is thought to be a result of abnormal movement of your knee cap due to an imbalance in muscle strength or joint movement.

How much exercise is too much?

Many adolescents may be upset to hear that their favourite sport may be doing them harm. It is important to consider that children and young adults bodies are still growing and this requires a certain amount of rest necessary for development and function.

The recommended amount of exercise for adolescents in seven hours per week (one hour per day).  Research has shown that teenagers who exercise for more than fourteen hours per week were in worse health than those who did the recommended amount, showing that benefits of exercise decline after a certain threshold.

How do I fix it?

  • REST! It is important to stop the activity causing the pain in order to allow recovery. This does not mean the end of your sporting days but the enhancement of your performance in the future
  • A course of ice treatment (under professional guidance) will reduce inflammation and pain
  • Manual therapy such as osteopathy can help to speed up recovery time through massage therapy, mobilisation, and exercise of the knee
  • STRETCH! Improving your muscle flexibility will reduce pressure on you knee and chances of injury. Pay particular attention to quadriceps, hamstrings, and calf muscles
  • Rehabilitation and return to exercise, finally, is to be done gradually after pain and swelling has gone. A continued stretching and exercise plan is vital

It is important not to ignore pain in children and young adults. Please do seek professional advice if encountered.


By Hannah-Rose Charters M.Ost