Patient information · Orthopaedics
Osgood-Schlatter and Sever's
growing bones under too much load
These are the two commonest causes of knee and heel pain in active children and teenagers. Both are irritation where a tendon pulls on a growth plate, both are self-limiting, and both are made worse by the two things families usually try: complete rest, or pushing through.
Seek assessment rather than assuming growth plate pain if there is
- pain at rest or at night, waking the child
- swelling, redness or heat over the joint, or fever
- a limp with no clear cause, or refusal to weight bear
- hip or groin pain in a child — this needs urgent assessment
- weight loss, tiredness or bruising alongside bone pain
- pain following a specific injury, or that is worsening despite treatment
Night pain, systemic symptoms or hip pain in a child require prompt assessment — slipped upper femoral epiphysis, Perthes disease, infection and bone tumours all present with limb pain in this age group and are managed entirely differently.
Which is which
- Osgood-Schlatter — pain and a tender bony lump just below the kneecap, where the patellar tendon attaches. Typically boys 12–15, girls 10–13. Worse with running, jumping, kneeling and stairs.
- Sever's disease — pain at the back or underside of the heel, worse during and after sport, often with a limp at the end of a game. Typically ages 8–14. Squeezing the sides of the heel reproduces it.
- Both are commoner during growth spurts, in children playing multiple sports, and on hard surfaces.
Why it happens now
During a growth spurt, bones lengthen faster than muscles and tendons adapt, so the tendon becomes relatively tight and pulls harder on a growth plate that is still soft. Add three football sessions and a match a week on hard ground, and the plate becomes irritated. Nothing is torn and nothing is damaged permanently — but the load has outstripped what that particular area can currently tolerate.
Load management, not rest
Complete rest settles the pain and it returns within a fortnight of going back, because nothing has changed. What works is reducing load enough to bring pain to a tolerable level, then rebuilding gradually while strengthening.
- Use a pain scale. Pain up to about 3 or 4 out of 10 during activity, settling within 24 hours, is acceptable. Above that, reduce.
- Cut volume, not everything. Drop from four sessions to two, shorten them, avoid the highest-impact elements — sprinting, jumping, hills.
- Strengthen. Quadriceps and calf work respectively, done consistently. This is the part that changes the outcome.
- Stretch the quadriceps, hamstrings and calves daily — tightness during a growth spurt is a major contributor.
- Rebuild gradually over weeks once pain settles, adding one element at a time.
What else helps
Helps
- Ice for 10–15 minutes after activity
- Good footwear with cushioning; heel raises or gel cups for Sever's
- A patellar strap for Osgood-Schlatter during sport
- Kneeling pads, and avoiding prolonged kneeling
- Explaining to coaches so training is adjusted rather than the child dropped
Avoid
- Complete rest for weeks — deconditioning makes the return worse
- Playing through pain above 4/10, or pain that lingers next day
- Barefoot on hard floors with Sever's
- Multiple teams and sports simultaneously during a growth spurt
- Assuming it will settle without changing anything
How long
Symptoms typically fluctuate over several months to two years, settling once the growth plate closes at the end of the growth spurt. In Osgood-Schlatter, a painless bony lump below the knee usually remains permanently — harmless, but it can be uncomfortable to kneel on. Neither condition causes arthritis or long-term damage.
Why come to us. Young athletes are frequently told to rest and come back if it persists, which loses a season and fixes nothing. Our orthopaedic and physiotherapy teams assess the child, exclude the conditions that must not be missed, and build a load-management and strengthening programme that keeps them playing where possible. Ultrasound is available on site, and X-ray through our CQC-registered partners if needed. Seven days a week, so appointments fit around school.
Keep them playing, safely
Physiotherapy and orthopaedics on site, appointments around school.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.