Adolescent Sports Injuries: Growth Plates, Knee Pain & Overuse

If you’ve got a sporty adolescent, you’ve probably heard phrases like “my knee hurts” after training or matches. Rapid growth combined with high activity levels can stress immature bones and growth plates. Conditions like Osgood‑Schlatter, Sinding‑Larsen–Johansson, and apophyseal injuries are common. In this post, I’ll walk you through how to assess them, conservative care strategies, and when it’s time for referral to a specialist.

1. Understanding Growth Plates

Growth plates (physes) are soft cartilage zones at the ends of long bones, guiding bone growth. Open until mid‑teens or later, they’re more fragile than mature bone and susceptible to injury from both acute trauma and overuse . When repetitive strain or a sudden force impacts these areas, we must act quickly to prevent growth disruption, deformity or length discrepancy .

Signs to watch for:

Localised pain/swelling over a bone’s growth region
Activity‑related discomfort that eases with rest
Tenderness on palpation, limited adjacent joint movement

In primary care, a detailed history (e.g. sports volume, mechanism of injury) and physical exam are key, followed by imaging if growth plate fracture is suspected .

2. Overuse Knee Conditions in Teens

Rapid growth + sports = hotspot for overuse injuries at knee apophyses. The most common are:

Osgood–Schlatter Disease

Occurs in adolescents (boys 12–15, girls 8–14) with tenderness at the tibial tubercle, often bilateral (20–30%) .
History: gradual anterior knee pain worsens with running/jumping, relieved by rest. Physical exam: swelling or prominent bump, pain on resisted knee extension .

Sinding–Larsen–Johansson (SLJ) Syndrome

Affects the inferior patellar pole in ages 10–13. Presents similarly to Osgood–Schlatter but with pain below the kneecap .
Other overuse injuries:
‘Little League elbow/shoulder’ from throwing
Sever’s disease (heel pain)
Iliotibial band syndrome etc.

Initial steps:

Use PRICE (Protect, Rest, Ice, Compress, Elevate)
Modify or pause the aggravating sport
Gentle quadriceps and hamstring stretching, bracing (e.g. patellar straps)

Recovery timeframe:

Osgood–Schlatter/SLJ: symptom resolution often within weeks, sometimes up to 1 year; full recovery after growth plate fusion, though a bony bump may persist .

3. Growth Plate Fractures: Red Flags & Referral

While overuse is common, growth plate fractures (physeal injuries) are more serious. They require prompt diagnosis and possibly imaging plus specialist care .

Red flags include:

Sudden, sharp pain following a fall or collision
Obvious deformity, inability to bear weight
Persistent swelling or warmth around the joint
Pain unrelieved by rest or worsening over days

What to do next:

When to X‑ray: Any post‑traumatic knee pain with concerning signs (deformity, swelling, night/rest pain) warrants imaging.
Who to involve: Displaced fractures or physeal separations should be co-managed with a paediatric orthopaedic or sports medicine specialist; they may require pinning, immobilisation, or surgery to maintain growth plate integrity .

4. When Specialist Review is Warranted

In many cases, adolescent sports injuries settle with rest and physiotherapy — but there are times when referral to a specialist is important. Consider a referral if:

There is a suspected growth plate (physeal) fracture

Especially Salter–Harris types I–V. These require radiographic confirmation and specialist management.

An avulsion injury involves displacement

For example, a tibial tubercle avulsion in Osgood-Schlatter that pulls bone away — this may need surgical fixation.

Pain persists beyond 3 to 6 months despite rest and physiotherapy

Chronic symptoms may indicate underlying pathology or ossicle formation that could require further imaging or intervention.

Night pain or pain at rest

This is unusual for typical overuse injuries and could point to infection, tumour, or other less common conditions — prompt imaging and referral are critical.

There is a recurrent or severe limp

Any gait abnormality that interferes with daily life or sport warrants further evaluation.

A persistent bony lump (e.g. Osgood-Schlatter ossicle) remains painful after growth has finished

In rare cases, these may require surgical excision if conservative treatment fails.

If you're unsure, it’s always reasonable to refer for further assessment — particularly when pain affects school, sport, or quality of life.

5. Conservative Management – A Physio‑Active Approach

Most adolescent overuse injuries heal well with time and movement-based rehab .

Plan includes:

Activity modification – avoid aggravating loads, cross‑train with low-impact options (e.g. swimming).
Pain relief – NSAIDs (ibuprofen, paracetamol) short‑term with medical guidance.
Stretch & strengthen – focus on quadriceps, hamstrings, hip/glute muscles; foetal‑based rehab for patellar tendon health .
Neuromuscular control drills – improve landing technique, coordination (beneficial in Osgood–Schlatter) .
Gradual sport reintroduction – once pain‑free at sports‑specific levels.

Goal: Maintain functional activity but avoid excessive load that hinders healing.

Final Summary

Growth plates are vulnerable during adolescence—know the red flags.
Osgood–Schlatter and SLJ are common and resolve with conservative care over 6–12 months.
Fractures need imaging and ortho referral, especially if displaced or painful.
Specialist escalation is warranted for chronic pain, deformity, non‑healing injuries or red-flag symptoms.
Balance rest and rehab, plus strength and coordination — don't rush return to sport.

Frequently Asked Questions (FAQ)

Q1: How can I tell if my child’s knee pain is just “growing pains” or something more serious?

“Growing pains” usually cause vague aches in both legs at night without joint swelling or tenderness. If the pain is one-sided, focused on a specific spot (like below the kneecap or shin), worsens with activity, or is accompanied by swelling, limping, or tenderness to touch — it’s worth getting checked.

Q2: Is it okay for my child to continue sport with Osgood-Schlatter or Sinding-Larsen?

Yes, often it’s safe to continue sport as long as the pain is mild and doesn’t cause limping or interfere with function. If pain worsens during or after activity, a temporary rest or switch to low-impact exercise is best. A physiotherapist can help guide safe participation levels.

Q3: Will Osgood-Schlatter disease affect my child’s ability to play sport long-term?

Not usually. While symptoms can last months to over a year, especially during growth spurts, most teens recover fully without permanent damage. A small bony lump may remain below the knee, but it typically doesn’t cause long-term issues.

Q4: Do these conditions need surgery?

Very rarely. Most overuse injuries in adolescents respond well to rest, activity modification, and physiotherapy. Surgery may be considered only in specific cases — like a painful ossicle (bone fragment) after growth has finished — and only if symptoms persist despite all non-operative measures.

Q5: How do I know if it’s a growth plate fracture and not just a strain?

Growth plate injuries often follow a sudden injury and cause sharp pain, swelling, and trouble bearing weight. If your child can't walk, has deformity, or the area is tender to touch after an injury — especially around the knee or ankle — it’s safer to get an X-ray and consult a specialist early.