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It usually starts on a Saturday morning. Your twelve-year-old plays a game of footy or soccer, pulls up sore, and by Sunday is limping from the car to the house. A few days later they are fine. Then it happens again the next week, and the week after. They start sitting out of training, or worse, they hide it because they don't want to miss a game. When you finally press on the sore spot, there is a hard, tender lump just below the kneecap, or the back of the heel is too sore to touch.
If that sounds like your house, there is a good chance you are dealing with what clinicians call a traction apophysitis. The two you will hear about most are Osgood-Schlatter disease at the knee and Sever's disease at the heel. Despite the word "disease" in both names, neither is an illness. They are overload problems that show up in kids whose bones are growing faster than the muscles and tendons attached to them can keep up.
This guide is written for parents in Truganina, Tarneit and the surrounding growth corridor, where plenty of kids play multiple sports across school, club and weekend competitions. We will go through what is actually happening in the body, how to tell it apart from something that needs urgent attention, why total rest is usually not the answer, and what a good physiotherapy plan looks like from the first appointment through to a confident return to sport.
To understand these conditions you need one piece of anatomy that adults no longer have. In children and teenagers, many bones have a soft growth area near the end called a growth plate, and tendons often attach at a secondary growth centre close by. This region is made of cartilage that has not yet fully turned into bone, and it is the weakest link in the chain during rapid growth.
At the knee, the big quadriceps muscle at the front of the thigh runs down into the patellar tendon, which attaches to a small bony bump on the top of the shin bone, just below the kneecap. Every time your child jumps, sprints, kicks or lands, the quadriceps pulls on that tendon, and the tendon pulls on that growth area. Repeat that hundreds of times in a training week while the shin bone is lengthening, and the attachment point becomes irritated and sore. That is Osgood-Schlatter disease.
At the heel, the same story plays out with the Achilles tendon and the calf muscles pulling on the back of the heel bone, where there is also a growth area. When it gets irritated from running and jumping on a growing foot, you get Sever's disease, more correctly called calcaneal apophysitis. If you want a feel for how the adult version of this tendon behaves, our post on Achilles tendon pain in Truganina and Tarneit covers it, though the kid version is a different problem with a better outlook.
The common thread is a mismatch. The skeleton lengthens first. Muscles and tendons stretch to catch up a little later. During that window, the pull on the growth area is greater than it will be a year or two down the track, and sport that was easy last season suddenly hurts.
Osgood-Schlatter is typically a problem of late childhood and early adolescence. Health service fact sheets in Australia describe it as a frequent source of front-of-knee pain at this age, and note that it is more commonly reported in boys, although girls get it too and numbers have been moving closer as more girls play organised sport. Sever's disease tends to show up a little earlier, in the years leading into the early teens, again during a growth phase.
Timing varies. Girls usually hit their growth spurt earlier than boys, so a ten or eleven-year-old girl and a thirteen or fourteen-year-old boy can end up with the same complaint. What matters more than the exact age is the combination of fast growth and a lot of running, jumping or kicking. Football, soccer, basketball, netball, gymnastics, athletics and dance are the usual suspects, but a kid who is not especially sporty can get it too if there is a sudden jump in activity, such as starting pre-season training or a school athletics carnival block.
Many kids have both conditions at different times, or the same one on both sides. It is quite common for the other knee to start hurting a few weeks after the first, and that does not mean the treatment failed.
The story parents describe is surprisingly consistent. For Osgood-Schlatter you will usually hear about:
For Sever's disease the picture is similar at the other end of the leg:
Both conditions have a sensible rhythm. They hurt after you load them and settle with rest. If your child is limping at rest, waking at night with pain, or the pain does not follow any activity pattern at all, that is not the typical presentation and it deserves a proper look rather than a wait-and-see approach. We will come back to the warning signs further down.
Many parents are alarmed by the bump at the top of the shin and want to know if it is permanent. In Osgood-Schlatter, the repeated pulling of the tendon can stimulate the bone to lay down extra material at the attachment site. The lump is real and it is bone. For many kids the pain settles and the lump stays, a bit like a knuckle that never quite shrank back. It does not usually cause problems later, though some adults notice it is tender if they kneel on it, for example when laying floors or gardening.
That is worth knowing, because it changes the goal. We are not trying to make the bump vanish. We are trying to settle the pain, keep your child in sport as much as is sensible, and get them through the growth spurt without the condition running their year.
This is the question every parent asks, and the truthful answer is: longer than you want, and variable. Osgood-Schlatter and Sever's disease are self-limiting, which means they settle once the growth area matures and the bone fuses. That is the good news. The tricky part is that this can take many months, and sometimes the better part of a couple of years for the knee, with flare-ups that come and go along the way.
Clinic and hospital resources quote ranges that vary. Some talk about recovery over a growth phase of a year to two, and specialist referral is suggested if symptoms drag on well beyond that or do not respond to sensible conservative care. Sever's disease usually has a shorter course than Osgood-Schlatter, but a child can still have it on and off across a season or two.
What physiotherapy does is not so much hurry the biology along as change the experience in the meantime. A good plan keeps symptoms at a level your child can live with, protects them from the "boom and bust" cycle of playing flat out, crashing, resting totally and starting again, and builds the strength that helps the growing leg cope with load. In the research literature on Osgood-Schlatter, the evidence base for specific treatments is honestly thin, and passive approaches like simply stopping everything are still commonly prescribed. A structured programme built around managing load, monitoring pain and progressing strength has shown promise in a cohort study, but it is not the last word. Anyone who promises a quick cure is selling something.
The instinct is to pull the child out of everything until it stops hurting. It makes sense. Unfortunately it tends to backfire for three reasons.
First, rest alone does not change what caused the problem. Quadriceps and calf muscles keep tightening as the bones grow, and strength falls away while they are on the bench. The first game back brings the same pain, often worse, because the tissue has lost conditioning.
Second, long breaks cost kids more than just fitness. For a thirteen-year-old, team sport is often where their friends are. Being told to sit out an entire season can hit confidence and mood hard, and some kids start to avoid movement because they associate it with pain. Surveys of clinicians who work with these conditions list load management, pain levels and psychological factors as the things that most influence how quickly a young athlete gets back to activity. That last item is not an afterthought.
Third, a child with a sore growth area is usually not damaging themselves when they play at a tolerable pain level. Health service guidance in Australia notes that continuing sport is not harmful in itself, but that changing the painful activities and reducing the load helps. The skill is in finding the right amount, which is where a physio earns their keep.
So the better word than "rest" is "adjust". Cut back the things that flare it, keep the things that don't, and build a ladder back up.
If you book your child in at our Truganina clinic or at the Tarneit location, the first visit is largely a conversation and an examination. It tends to follow this shape.
The story. We want to know when it started, what sports your child plays and how many hours a week, whether there has been a recent jump in training or a new competition, and what makes it better or worse. We ask about growth: have they shot up in height recently, are shoes getting too small quickly. We also ask what they want. Some kids are desperate to play finals; others are happy to take a break. That shapes the plan.
The examination. The physio will look at how your child stands, squats, hops and lands. They will feel the sore spot and compare it with the other side. They will test the flexibility of the quadriceps, hamstrings and calves, and check strength through the hips, thighs and lower legs. For heel pain, they will check the foot and ankle, how the foot rolls in and out, and the range of the ankle. They will also check that nothing else is going on: the hip, the knee joint itself, the back, and the surrounding structures.
A point many parents are relieved to hear: these conditions are usually diagnosed from the history and examination. Most children do not need an X-ray or scan to confirm Osgood-Schlatter or Sever's disease. Imaging is kept for cases that do not fit the typical pattern or that fail to improve as expected.
The explanation. This is often the most valuable part. Kids and parents hear what it is, why it hurts, why it is not dangerous, and what to expect over the next few months. When a child understands that the pain is a sign the growth area is irritated and not a sign that something is breaking, they often relax, and so does their movement.
The plan. You leave with a clear, written plan: what to change this week, what to keep doing, a couple of simple exercises, and what we will check at the next visit. It will not be a list of fifteen things. Kids do not do fifteen things.
Load management sounds technical, but it comes down to a simple question: how much running, jumping and kicking can this leg handle right now without the pain building up?
The physio will usually work with your child on a simple pain monitoring approach. Many clinicians use a zero-to-ten scale, where a bit of discomfort that settles within a day is acceptable, and pain that climbs during activity, lingers into the next morning or changes how your child moves is a signal to scale back. The exact numbers vary from clinic to clinic, but the principle is the same everywhere. A little soreness that is gone by morning means you are in the right zone. Limping, sharp pain or a swollen lump the next day means you went too far.
In practice, that can mean:
Parents in this part of Melbourne often tell us their child plays football on Saturday, has soccer training midweek and joins in school lunchtime games every day. Each activity looks modest. Together they are a lot. Writing down the real week is often the moment it clicks.
If your child plays a lot of sport and you are not sure where to start, our broader guide to sports physiotherapy in Truganina and Tarneit explains how we approach injury management and return to play more generally, and the main sports physiotherapy treatment page sets out what is on offer.
Once the pain is under control, the work shifts to making the leg more resilient. This is where the evidence, thin as it is, points in a sensible direction: progressive strengthening plus a staged return to sport.
For the knee, the focus is usually on the quadriceps, hamstrings and the glutes and hips, since the hips and thighs share the work of absorbing landing forces. Early exercises are gentle and often isometric, meaning you hold a contraction without moving the joint much, such as pushing the leg into a wall or holding a shallow position. These can calm pain while still loading the muscle. As things settle, the physio progresses to squats, step-ups, lunges, calf raises and eventually jumping and landing drills.
Flexibility matters too. Tight quadriceps pull harder on the tendon, and tight calves pull harder on the heel. Regular, gentle stretching is a standard part of the advice from hospital fact sheets, particularly for the quadriceps and hamstrings in Osgood-Schlatter. A stretch that is held for a comfortable thirty seconds, a few times a day, beats a heroic stretch that your child does once and then avoids. If the stretch hurts the sore spot, back off.
For Sever's disease, the calf and Achilles complex gets most of the attention. Calf stretching, calf strengthening, and sometimes a temporary heel lift in the shoes can ease the pull on the heel bone while it recovers. Footwear is worth a look: a thin, flat boot with little heel cushioning on a hard ground in summer can make things much worse, and the right change can make a visible difference quickly.
If your child is also dealing with shin or lower leg pain, our article on shin splints in Truganina and Tarneit covers a related overload problem, and the way we build up running load there will look familiar.
Parents often ask whether their child needs a brace, strap or tape. These can help some kids, but they are a tool, not the treatment.
For Osgood-Schlatter, an infrapatellar strap, a band that sits just below the kneecap, or a simple pressure sleeve can reduce pain during sport by changing how the tendon is loaded or simply by padding the lump. Some kids swear by them; others don't notice any difference. They are cheap enough to try, but they should sit alongside load management and strengthening, not replace them. The same goes for taping, which a physio can apply and teach you to do.
Padding matters if your child kneels or takes knocks on the front of the knee, for example in netball, volleyball or goalkeeping. A bump directly onto an inflamed growth area is miserable, and a knee pad costs very little.
For Sever's disease, heel cups or small heel lifts in the shoes reduce the stretch on the calf and Achilles for a period. Cushioned, supportive footwear with a slight heel rise is often more comfortable than flat boots. If you are shopping for school shoes or footy boots, take the pain history with you, and consider whether the boots have enough heel cushioning for the pitch they play on.
Be wary of pushing expensive custom products without a reason. A good assessment will tell you whether the foot is part of the story or whether the problem is simply load and growth.
One of the most useful ideas in this area is that return to sport happens in steps. Rather than being told "you can play again", your child works through a graded sequence, moving up only when the current step is comfortable.
A typical ladder looks something like this, adjusted for the sport and the child:
The rule is that each step is held for a few sessions with no more than mild, short-lived soreness before moving on. If a step brings back a flare, drop back one rung, not three. Kids find this easier to buy into when it is framed as a plan with a visible finish line, rather than as a vague "see how it goes".
For the winter sports in this part of Melbourne, timing the ladder around the season is often more useful than any specific exercise. A child with a bad flare in pre-season might do much of their strength work early, play reduced minutes at the start of the season, and ramp up in time for finals. That kind of planning is easier to do when we know their fixture list, so bring it along.
Osgood-Schlatter and Sever's disease are common, and most sore knees and heels in active kids turn out to be one or the other. But not all. A good clinician keeps the less common possibilities in mind, and so should you.
See a doctor promptly, rather than waiting it out, if your child has any of the following:
A sudden, severe knee pain with a pop after a sprint or a kick, particularly if the bump below the kneecap looks different, is worth urgent attention too. In rare cases the growth area can separate under a sudden, forceful pull, and that is not something to manage at home.
Physios are trained to screen for these, and part of the first appointment is deciding whether your child's pattern fits the usual story. If it does not, we will say so and help you get the right referral. Sometimes the right answer to "is this Osgood-Schlatter?" is "probably, but let's get your GP to look at this one first".
Between appointments, small habits make the biggest difference. These are the ones we find most useful:
Many of the worst flare-ups happen because a keen kid quietly pushes through. A short, factual note to the coach can change that. It might say that your child has a growth-related knee or heel problem, that they are being managed with a physio plan, that they can take part in certain drills but should avoid others for the next few weeks, and that you would like to hear if they start to limp.
Most coaches are glad to adapt when they understand it is a managed, temporary condition. Many have seen it before. Schools can often arrange modified PE participation too. If your child's team has a trainer or sports first-aider, it helps to have them in the loop.
Where your child is competing at a high level, such as district or state representative squads, it is worth asking your physio to speak directly with the coach or program manager about load across the whole week.
It is painful and annoying but not dangerous. It is an overuse problem at a growth area and it settles as the bone matures. The most important thing is to make sure the diagnosis is right, so that something else is not missed.
Usually not completely. Most kids can keep playing at some level with modifications. The aim is to find the amount of activity their leg tolerates, then build it up over time. A short period of reduced load is common during a bad flare.
Most of the time, no. These conditions are diagnosed by history and examination. Imaging is for cases that look unusual or that do not improve as expected.
They are a sensible part of the plan and widely recommended, though the research on specific programmes is still limited. A structured programme that combines load management, monitored pain, progressive strengthening and a staged return to sport has been tested in at least one cohort study and found workable. It is a reasonable approach, not a guarantee.
Clinical guidance for general practice in Australia specifically advises against corticosteroid injections for Osgood-Schlatter. Systematic reviews have found low-level evidence for both injections and surgery. For the vast majority of children, conservative care is the way to go.
Often not entirely. The pain usually settles once growth finishes, but the bony bump may stay. It rarely causes ongoing problems beyond some tenderness when kneeling.
Yes, at different times or even together. They are separate conditions with the same underlying cause, which is why a plan that addresses growth, flexibility, strength and load often works for both.
If the pain has lasted more than a couple of weeks, is limiting sport or school, keeps coming back, or you are not sure what you are dealing with, an assessment is worthwhile. Early advice tends to shorten the unsettled stretch, because you stop making the common mistakes, like pushing through or resting completely, before they cost you months.
Sports with a lot of running, jumping and kicking carry the highest risk, but it can happen in any child during a growth spurt. Playing several sports at once, or sharply increasing training, raises the odds.
Cover varies by policy and circumstance, so it is worth checking the details of your own plan or asking when you book. Our fees page explains how appointments are billed.
We treat families from Truganina, Tarneit and the surrounding suburbs, and the pattern we see in children is much what you would expect in a fast-growing area: lots of kids, lots of sport and busy calendars. Our approach is practical. We work out what your child is actually doing, explain what is going on in plain terms, set up a plan that fits around their season, and review it as they grow. We do not fill your week with clinic visits when a few well-chosen exercises and a sensible training adjustment will do the job, and we are straightforward about it when something looks like it needs a doctor instead.
If you are not sure which of our locations suits you better, you can read about the Truganina clinic and the Tarneit clinic. You can book an appointment online, and it is worth mentioning your child's age and sport when you do so we can plan the session around them.
Osgood-Schlatter disease and Sever's disease are common, painful and temporary. They happen because a growing skeleton and its attached tendons are out of step for a while, and active kids put that mismatch under load week after week. They are not signs of damage, and they do not mean your child has to give up the game they love.
What helps is the unglamorous stuff done consistently: adjusting load instead of stopping altogether, keeping pain at a manageable level, stretching and strengthening the muscles around the sore spot, choosing sensible footwear and supports, and building back to full sport in steps. Check for the red flags, get an assessment if the pain is persistent or does not fit the pattern, and take the long view. Most kids come out the other side of the growth spurt with strong legs, a good understanding of how their body responds to training, and a lump or two they will happily show their friends.
If your child has been limping off the field and you want a clear plan, we are happy to help you work out what is going on and what to do next.
