Is it growing pains when my child’s knees hurt after football?

No. Growing pains come in the evening or at night, and the child is fine during the day (1177). Pain below the knee when running, jumping or after training fits an overloaded tendon attachment instead, such as Osgood-Schlatter disease. If it hurts during the day, in one leg only, or your child limps, contact a health centre.

Can my child play football with Osgood-Schlatter disease?

Your child does not have to give up all sport, but should avoid what hurts. Sometimes it is enough to skip the hardest training or the matches (1177). Do not play on painkillers. If it hurts in everyday life too, a month’s rest from all sport can be a good investment (Läkartidningen 2013).

When should we seek care?

Contact a health centre if the pain does not ease or comes during the day, if your child limps, has pain in one leg only or always in the same place, or if the knee is swollen or does not get better with rest. Seek care straight away if the knee gets stuck, or if your child has hip pain with a fever or cannot stand on the leg. If you are unsure, call 1177.

For parents

Growing pains hurt at night. Pain after training is something else.

By Gustav, founder of Breakout · 6 min read

Growing pains come in the evening or at night, usually affect both legs and are gone by day. If your child has pain below the knee or in the heel when running, jumping or just after training, it is not growing pains but usually an overloaded tendon attachment in a skeleton that is still growing. It is common and usually passes. Training needs adapting, and some signs mean you should seek care.

Growing pains come at night, not on the pitch

According to 1177, the Swedish public health guide, a child with growing pains wakes at night with pain in the thighs, shins or around the knees, usually in both legs and for a couple of hours. During the day the child is completely fine. Growing pains are most common between 3 and 10 and are not harmful. Massage and warmth can ease them.

The cause is unclear, even if growing pains, according to 1177, “occur more often in periods when the child is growing faster”. A research review (Evans 2008) lists what argues against growing pains: pain in one leg only or in a joint, pain that is still there in the morning, swelling or redness, a limp, and the child cutting back on activities.

“Growing pains do not come during the day or when the child is moving”, 1177 writes. So a twelve-year-old with pain below the kneecap after training does not have growing pains.

Osgood-Schlatter disease is common in children who do sport

1177 calls it Schlatter’s disease. It is common between 8 and 15, “above all in those who do sport”, and can come when the child “grows quickly and at the same time overloads the knees”. The bump below the knee becomes tender and swollen and hurts when jumping, running and on stairs. “Most are better within two years”, some later.

It is an overloaded tendon attachment. The Swedish Medical Journal (Läkartidningen) described in 2013 small avulsions and microfractures where the kneecap tendon attaches to the shinbone. Around 10 per cent of 12- to 15-year-olds have the condition, twice as many among those who do sport, and in 30 to 45 per cent of cases both knees are affected.

If the pain sits just below the kneecap, it may instead be Sinding-Larsen-Johansson disease, small tears in the tendon that according to 1177 occur “also in children who, for example, play football”.

Heel pain after training is very common

According to 1177, heel pain is “very common, above all in boys between 11 and 14”, especially in those who play football or basketball. It hurts at the back of the heel, mostly in the evening after activity. The condition is called Sever’s disease and is the same kind of problem as Osgood-Schlatter, only in the heel.

According to 1177, studded football boots are not always raised under the heel, and silicone heel inserts or shoes with a thick heel can ease the pain. The symptoms can come and go for two to three years, but they “do not lead to any complications”.

In a randomised trial of 101 children aged 8 to 15, those who waited, those who got heel inserts and those who got physiotherapy all improved, with no clinically relevant difference after three months (Wiegerinck 2016).

The growth spurt is the risk period

The International Olympic Committee’s (IOC) 2015 consensus places puberty and the growth spurt between 9 and 15 and states that growth can make some young athletes prone to overloaded tendon attachments such as Osgood-Schlatter and Sever’s disease.

Football data shows the same. Among 76 English academy players there were more than twice as many overuse and non-contact injuries when height growth was at its fastest as before: 24.5 against 11.5 per 1,000 match hours (Johnson 2020).

So two children born the same year can be in entirely different phases. More on biological age and on training volume is in the guide on training by age.

Adapt training before you stop it

“The first thing the child should do is avoid activities that hurt”, 1177 writes about Schlatter’s disease. “Sometimes it may be enough to avoid the very hardest training or competitions.” Stretching, strength training, physiotherapy and tape can ease the symptoms.

Läkartidningen 2013 takes the same line: the child does not have to give up all sport, but frequency, intensity and type of training are adapted. If the child has pain in everyday life too, “a month’s rest from all sporting activity can be a good investment”. A cold pack after training is recommended. Painkillers to keep playing are the wrong route: “It is not appropriate to give NSAIDs to a growing individual so that he or she can continue with their sport.”

Expect months. In a study with no control group, 51 children aged 10 to 14 with Osgood-Schlatter disease had four weeks of reduced sport followed by strength training and a gradual return (Rathleff 2020). After twelve weeks 80 per cent were better but only 16 per cent were back in their sport, after a year 69 per cent.

Some signs mean you should seek care

Most of these problems you can handle at home and with the coach. Two situations are urgent: if the knee gets stuck so that it cannot be straightened or bent, and if your child has hip pain together with a fever or cannot stand on the leg. Then contact a health centre or out-of-hours clinic straight away, or an emergency department if they are closed (1177).

One uncommon condition can be felt in the knee: slipped capital femoral epiphysis, where the hip joint slips at the growth plate. It comes “just before and during puberty”, more often in boys and in tall or overweight children, and can cause pain in the groin, the thigh “or at the knee joint” (1177). Diagnosis is often delayed, “particularly in cases where the first symptom is knee pain” (Läkartidningen 2023). Our advice: if your child has long-lasting knee pain or a limp, ask whether the hip has been examined.

If you are unsure, you can call 1177 for medical advice. Contact a health centre if any of the following applies:

The pain does not ease, or it hurts during the day.
Your child limps or has difficulty walking.
It hurts in one leg only or always in the same place.
The knee does not get better with rest, or the knee joint is swollen.
Your child cannot do sport as usual because of the knee.

Adapting training is for you and the coach, not your child

This is advice, not research.

Ask where it hurts, when, and what makes it worse. You will need the answers if you seek care.
Do not praise your child for gritting their teeth. The pain signals that the body is overloaded (Läkartidningen 2013).
Tell the coach yourself, so that the adaptation is not something your child has to negotiate at every session.
Point the coach to the Swedish FA’s short course Fotbollsfys – Tillväxt & mognad (growth and maturation).

Common follow-up questions

Is it growing pains when my child’s knees hurt after football?: No. Growing pains come in the evening or at night, and the child is fine during the day (1177). Pain below the knee when running, jumping or after training fits an overloaded tendon attachment instead, such as Osgood-Schlatter disease. If it hurts during the day, in one leg only, or your child limps, contact a health centre.
Can my child play football with Osgood-Schlatter disease?: Your child does not have to give up all sport, but should avoid what hurts. Sometimes it is enough to skip the hardest training or the matches (1177). Do not play on painkillers. If it hurts in everyday life too, a month’s rest from all sport can be a good investment (Läkartidningen 2013).
When should we seek care?: Contact a health centre if the pain does not ease or comes during the day, if your child limps, has pain in one leg only or always in the same place, or if the knee is swollen or does not get better with rest. Seek care straight away if the knee gets stuck, or if your child has hip pain with a fever or cannot stand on the leg. If you are unsure, call 1177.