Osgood–Schlatter and Sinding-Larsen–Johansson in Young Athletes

Anterior knee pain in kids and teens is one of the most common reasons young athletes scale back sports. Two names come up repeatedly in clinics and on the sidelines: Osgood–Schlatter disease and Sinding-Larsen–Johansson syndrome. Both are “traction apophysitis” problems—meaning irritation at a growth area where a tendon pulls on developing bone—and both tend to flare during growth spurts in active children. ^[1]

They can look similar at first glance: pain with running and jumping, tenderness around the front of the knee, and symptoms that build over weeks. But they are not the same condition, and the location of pain is the key to telling them apart.

This article breaks down the differences, explains what causes each problem, and gives a practical, evidence-informed roadmap for treatment and return to sport—without panic and without unnecessary scans or surgery.

• Osgood–Schlatter disease: Pain and swelling at the tibial tubercle, the bony bump just below the kneecap where the patellar tendon attaches to the shin bone.^[2]
• Sinding-Larsen–Johansson syndrome: Pain at the inferior pole of the patella, the lower tip of the kneecap where the patellar tendon starts. ^[1]

Both are self-limiting growth-related conditions in most cases, meaning they tend to improve with time and appropriate management. ^[3]

In children and adolescents, tendons attach near growth plates (apophyses). These growth areas are made of cartilage and are more vulnerable than mature bone. Repetitive pulling from strong muscles—especially the quadriceps—can irritate the growth region and cause pain, swelling, and tenderness. ^[1]

During growth spurts, bones lengthen quickly. Muscles and tendons can temporarily feel “tight,” increasing traction at tendon attachment sites. Add high-volume jumping, sprinting, and changes of direction, and the risk rises. This pattern is widely described in primary care and orthopedic references for apophysitis injuries. ^[1]

• Osgood–Schlatter disease is common in growing adolescents, especially those who run and jump (soccer, basketball, volleyball, gymnastics, track). ^[2]
• Sinding-Larsen–Johansson syndrome most often affects active children around 10 to 14 years and is associated with jumping and sprinting sports. ^[4]

Primary care reviews note that Osgood–Schlatter disease is more common in athletes than non-athletes (figures such as 21% vs 4.5% are cited in clinical literature), and it can be bilateral in a meaningful proportion of children. ^[1]

Young athletes often describe:

• Pain just below the kneecap at the tibial tubercle
• Pain that worsens with running, jumping, stairs, kneeling
• A visible or palpable “bump” at the tibial tubercle
• Tenderness and sometimes swelling at the attachment point ^[2]

Common features include:

• Pain at the lower tip of the kneecap (inferior pole)
• Pain triggered by jumping, sprinting, squatting, stairs
• Tenderness right at the bottom of the patella
• Sometimes mild swelling or thickening where the patellar tendon begins ^[4]

Both conditions often start subtly and build:

• “It only hurt after practice… then during warmups… now it hurts climbing stairs.”
   That progressive pattern is typical for traction apophysitis. ^[1]

For both conditions, diagnosis is often based on history and physical exam:

• Location of tenderness (tibial tubercle vs inferior patella).
• Pain provoked by resisted knee extension or squatting.
• Swelling or bony prominence in Osgood–Schlatter disease.^[2]

Imaging is not always needed, but it can be useful when:

• Pain is severe, atypical, or worsening rapidly
• There is a concern for fracture, infection, tumor, or other causes
• Symptoms persist despite good conservative care
• There was an acute traumatic event and significant swelling^[2]

Radiology references describe Osgood–Schlatter disease as tibial tubercle apophysitis related to repetitive microtrauma, sometimes with fragmentation at the tibial tubercle on imaging. ^[5]

Reviews of Sinding-Larsen–Johansson syndrome also discuss imaging features (inferior patellar pole changes) and emphasize that conservative management is standard. ^[6]

Osgood–Schlatter disease and Sinding-Larsen–Johansson syndrome overlap in risk factors and treatment style, but the stress point is different, which changes how athletes modify training:

• Osgood–Schlatter disease often flares with kneeling and direct pressure over the tibial tubercle and heavy quad loading.^[1]
• Sinding-Larsen–Johansson syndrome often flares with jumping and explosive knee extension that increases traction at the inferior patella.^[1]

The right plan targets the right tissue, reduces the right triggers, and keeps the athlete active in a safe way.

Most reputable clinical references agree on core management:

• Relative rest and activity modification (not necessarily complete rest)
• Ice after activity to reduce pain
• Stretching and strengthening, especially quadriceps and hamstrings
• Pain control when needed
• Gradual return to sport guided by symptoms ^[2]

A key point from orthopedic and health-system guidance: these are usually self-limiting conditions that “burn out” over time, and surgery is rarely needed in typical adolescent presentations. ^[3]

Instead of shutting sports down completely, many athletes do better with a “pain-guided” approach:

• Temporarily reduce high-impact drills (jumping, sprint repeats, deep squats)
• Keep low-impact conditioning (cycling, swimming)
• Avoid kneeling on hard surfaces when tender^[2]

OrthoInfo and pediatric resources commonly recommend ice after activity for symptom relief. ^[2]

For medication: families should follow pediatric clinician guidance. Anti-inflammatory medicines are often used short term for pain in many clinical settings, but they do not replace load management.

Primary care and orthopedic guidance commonly includes:

• Quadriceps flexibility work
• Hamstring flexibility work
• Progressive strengthening of thigh and hip muscles ^[1]

A notable prospective cohort intervention in adolescents using activity modification plus strengthening showed meaningful improvements over time and increasing return to sport rates at follow-up. ^[7]

Some athletes feel better with a patellar tendon strap during activity to reduce symptoms by altering tendon load. While response varies, this can be a practical tool alongside rehab.

Osgood–Schlatter disease symptoms often improve as growth slows and the growth plate matures. However, a persistent bony prominence may remain, and some individuals can have ongoing discomfort with kneeling. AAOS notes it is a common adolescent knee pain cause centered at the patellar tendon attachment on the tibia. ^[2]

Cleveland Clinic guidance emphasizes that rest and quadriceps stretching are common treatments, with temporary stopping of the triggering sport to let the tendon and growth area settle. ^[4]

Many pediatric sports medicine resources advise a gradual return once:

• Tenderness is gone
• Swelling is gone
• Motion and strength are normal
• Running and cutting drills can be performed without limping ^[8]

Lurie Children’s provides practical return-to-sport checkpoints that include pain-free bending and straightening, regained strength, and the ability to jog, sprint, cut, and perform figure-of-eight runs without limping. ^[8]

A recent clinical review highlights that Sinding-Larsen–Johansson syndrome mainly affects physically active adolescents and that conservative measures like rest and cryotherapy are commonly recommended. ^[6]

Regardless of which condition your child has, the safest return is criteria-based rather than calendar-based. A practical checklist (aligned with pediatric sports guidance) includes:

• Pain-free walking and stairs
• Full knee bending and straightening without pain
• No focal tenderness at the tibial tubercle (Osgood–Schlatter disease) or inferior patella (Sinding-Larsen–Johansson syndrome)
• Strength near normal compared to the other leg
• Ability to jog without limping
• Ability to sprint without limping
• Gradual reintroduction of jumping and cutting drills without next-day flare ^[8]

Mass General’s pediatric rehabilitation protocol for Osgood–Schlatter disease includes a return-to-sport phase that emphasizes maintaining motion, improving strength and endurance, sport-specific training, and ensuring there is no pain or swelling during or after exercise at the tibial tuberosity. ^[9]

These are traction injuries. Repetitive painful loading delays recovery.

Complete rest can reduce pain temporarily but may lead to weakness and poor movement control—then symptoms return as soon as training resumes.

Many flare-ups are driven by abrupt training spikes: tournaments, new teams, more practice days, or adding extra plyometrics.

Anterior knee pain in youth can also come from patellofemoral pain, tendon disorders, meniscus injury, hip problems, or—rarely—serious conditions. Persistent night pain, fever, severe swelling, or unexplained weight loss require medical assessment.

Prevention is not perfect during growth spurts, but you can lower risk:

• Increase training loads gradually (avoid sudden spikes in jumping and sprint volume)
• Maintain year-round hip and thigh strength (gluteal, quadriceps, hamstrings)
• Prioritize warm-ups that include dynamic mobility and gradual intensity ramps
• Add recovery days during tournament-heavy months
• Use cross-training to keep fitness without constant impact
• Monitor pain early and treat “small pain” before it becomes daily pain ^[1]

Get medical evaluation if:

• Pain is severe or worsening quickly
• The child is limping or cannot bear weight comfortably
• There is significant swelling, redness, warmth, or fever
• Pain persists despite 4–6 weeks of solid activity modification and rehab
• There was a clear traumatic event and the knee is unstable

• Osgood–Schlatter disease causes pain at the tibial tubercle (below the kneecap), while Sinding-Larsen–Johansson syndrome causes pain at the inferior pole of the patella (lower tip of the kneecap). ^[2]
• Both are traction apophysitis conditions linked to growth spurts and running/jumping sports. ^[1]
• Most cases improve with conservative care: activity modification, ice, flexibility work, strengthening, and a gradual return to sport. ^[2]
• Return to sport should be based on pain-free function and strength, not just time. Pediatric sports resources provide practical return criteria like pain-free motion and running without limping.