Knee Pain in Teens

Overview

Why would a teenager have knee pain?

Knee pain isn’t a condition that only happens to older people. Despite being young, your teenager can develop knee pain too.

Knee pain in teens is a common result of overuse, but also results from specific knee injuries (from a blow to the knee, falls, or abnormal twisting or bending) and medical conditions that affect the knee. Knee pain can also be temporary and not related to an injury, but rather a change in your teen’s level of activity or sport.

Because of the many different reasons for knee pain, if your teen complains of pain, it’s wise to get it checked. Never think that knee pain in your teen is simply growing pains. This is not a typical cause of knee pain in a teenager.

Symptoms and Causes

What are the causes of knee pain in teenagers?

Common knee pain problems in your teenager can be generally divided into three types:

  • Anterior knee pain, also called patellofemoral pain.
  • Injures to ligaments and tendons of the knee or to the kneecap itself.
  • Medical conditions that affect the knee.

Anterior knee pain happens when your teen’s kneecap is pulled out of its groove from increased pressure. Increased pressure on the knee joint is caused by:

  • Abnormal hip rotation due to imbalances in muscle strength and flexibility around the hips.
  • Improper training methods or equipment.
  • Poor flexibility of the thigh muscles, which support the knee joint. Thigh muscle weakness or tightness.
  • Overuse of the knee from repetitive bending of the knee during running, jumping, and other activities.
  • Problems with alignment, for example, the kneecap not being properly aligned within the knee or having flat feet, which changes the normal gait.

Knee pain resulting from sprains, strains and tears to ligaments and tendons or injuries to other soft tissues. These conditions include:

  • Meniscal tears: Cartilage between the upper leg bone (femur) and lower leg bone (tibia) tears.
  • Ligament injuries: These are injuries to the anterior cruciate ligament (ACL), posterior cruciate ligament, lateral collateral ligament and medial collateral ligament.
  • Tendonitis: Tendons become inflamed or irritated due to an injury. Tendons of the knee include the quadriceps tendon (connects the front thigh muscles to the kneecap) and the patellar tendon (connects the kneecap to the tibia).
  • Bursitis: Swelling of one of the fluid sacs in the knee, which cushion the knee.
  • Dislocated kneecap. This is the out-of-place positioning of the kneecap.

Medical conditions that can affect your teen’s knee include:

  • Osgood-Schlatter disease: This painful condition happens about an inch below the kneecap, where the patella tendon attaches to the bony raised area on the tibia (shin bone). This condition is more common in males and thought to be due to overuse of the muscles of the thigh.
  • Sindling-Larsen Johansson syndrome: This is an injury to the growth plate at the bottom of the kneecap. The injury is caused by repeated contractions of the thigh muscle (such as running or jumping) during a period of growth.
  • Juvenile arthritis: This is rheumatoid arthritis, which causes pain, swelling, stiffness and loss of movement in joints, which may include the knee.
  • Osteochondritis dissecans: This is a separation of part of the joint cartilage and the bone directly beneath it from the rest of the bone. As far as the knee, this condition can happen on the top part of the thigh bone (femur) called the medial femoral condyle.

What sports cause knee pain in teens?

Any sport or activity that involves running and jumping are usually the ones that can cause knee pain in your teen. Playing on multiple teams and in multiple sports are more likely to cause knee pain.

What conditions can affect both knees at the same time?

Conditions that can affect both of your teen’s knees at the same time include:

  • Anterior knee pain (one knee may be more affected than the other).
  • Osgood-Schlatters disease.

What are the symptoms of knee pain in teens?

Symptoms depend on what’s causing your teen’s knee pain.

Anterior knee pain:

  • Pain begins gradually; worsens with activity.
  • Dull, aching pain behind the kneecap, below the knee or on sides of the kneecap.
  • Pain flares and grinding sensation with repeat knee bending (jumping, running etc).
  • Thigh muscle (quadriceps, “quads”) weakness (late symptom).
  • Knee buckles (gives way) (late symptom).

Trauma (hit) to knee:

  • Popping, clicking, crackling in the knee when bending (walking, climbing sit-to-standing position).
  • Knee that locks or buckles.

Osgood-Schlatter:

  • Pain on the bony prominence.
  • Pain that varies and gets worse during or just after the activity.
  • Reduced range of movement.
  • Gait (walking) problems.
  • Weakness.
  • Balance problems.

Sindling-Larsen Johansson syndrome:

  • Pain, tenderness and swelling at the bottom of the kneecap.
  • Balance problems.
  • Gait problems.
  • Stiffness.

Juvenile arthritis:

  • Trouble putting weight on the affected leg; limps first thing in the morning.
  • Redness, swelling, warmth, stiffness and soreness in joints, including the knee.
  • Symptoms come and go.

Osteochondritis dissecans:

  • Dull ache, stiffness and swelling at the knee.
  • Joint clicking.
  • Gait problems.
  • Weakness.
  • Balance problems.

Diagnosis and Tests

How is knee pain in teens diagnosed?

Your healthcare provider will ask about your teen’s knee pain:

  • Is there a known cause for the knee pain (for example, got hit in the knee) does it happen with certain movements (for example, hurts when running, jumping or bending the knee) or is there no specific known event?
  • How long has the pain been present?
  • Where on or around your knee do you feel pain?
  • Does the pain wake you up at night?

Your provider will perform a physical exam, checking:

  • Kneecap and knee stability.
  • Alignment of lower leg, kneecap and thigh.
  • Range of motion of hips and knees.
  • Thigh muscle strength, flexibility, firmness.

Your provider may order imaging tests including X-rays (to examine bones) or a CT scan or MRI (to look at soft tissues, such as tendons, ligaments).

Management and Treatment

How is knee pain in teens treated?

Treatments depend on the cause of your teen’s pain.

Pain from overuse and general knee pain management tips include:

  • Apply ice to the knee. Ice, wrapped in a towel, relieves inflammation and swelling. Apply up to 20 minutes at a time.
  • Take anti-inflammatories, such as ibuprofen (Advil®, Motrin®), naproxen (Aleve®) or aspirin, to reduce pain and swelling.
  • Rest. Rest allows tissue to heal. Your teen should take some time off from the activity that caused the pain.
  • Use compression (elastic bandages) around your knee if prescribed by your healthcare provider or physical therapist.
  • Elevate the knee to reduce swelling. Keep the injured knee elevated above the level of the heart anytime your teen is sitting or icing their knee.
  • Follow through with the physical therapy plan. Physical therapy can help relieve pain, reduce swelling, increase strength and flexibility, improve range of motion, increase speed and endurance and improve coordination and balance. Physical therapists teach strengthening and stretching exercises and can suggest braces, insoles or other orthotics as appropriate.
  • Lose weight if overweight. Extra weight puts strain on the knee joint.

Osgood-Schlatter disease:

  • Take anti-inflammatories to reduce pain.
  • Apply ice to reduce pain and swelling.
  • Commit to an exercise program.
  • Relieve pain and discomfort through electrotherapy (uses electrical current) and/or hydrotherapy (uses water).

Sindling-Larsen Johansson syndrome:

  • Take anti-inflammatories to reduce pain.
  • Apply ice to reduce pain and swelling.
  • Commit to a stretching and strengthening program.
  • Relieve pain and discomfort through electrotherapy (uses electrical current) and/or hydrotherapy (uses water).
  • Manipulation and massage.

Juvenile arthritis:

  • Adhere to the exercise program to strengthen muscles.
  • Use splints, braces and/or orthotics as prescribed.
  • Consider hydrotherapy.
  • See a rheumatologist.

Osteochondritis dissecans:

  • Cryotherapy (cold therapy).
  • Electrotherapy and/or hydrotherapy.
  • Exercise program.
  • Soft tissue treatments, including myofascial release, trigger points, massage.

Ligament treatment:

  • Retrain jumping technique through physical therapy.
  • Strengthen hips and thighs to better protect knees.
  • Surgery.

Simple nonsurgical remedies are all that is needed for managing most knee pain in teens. However, because there are so many potential causes of knee pain, some conditions many require surgery – especially those due to soft-tissue tears and trauma that break bones. You and your healthcare provider will discuss all treatment options and development a treatment plan that usually starts with nonsurgical methods, unless surgery is the only treatment method.

Prevention

Can knee pain in teens be prevented?

Most knee pain that is caused by injury or overuse (not those caused by medical condition) can be prevented with some attention and work by your teen, including:

  • Make sure your teen wears proper shoes for the activity/sport and wears knee pads and leg guards (as appropriate to the activity). Replace worn out footwear and gear.
  • Engage in muscle strength training exercises. Check with a trainer to make sure proper form and body alignment are being followed. Always do warm up and cool down exercises before and after workouts.
  • Keep your muscles flexible by proper stretching exercises or yoga.
  • Don’t engage in activities that cause or worsen knee pain.

Outlook / Prognosis

What's the outlook for teenagers with pain in their knees?

Most knee pain in teenagers can be managed with simple treatments. However, many soft-tissue tears and bone breaks require surgery. Most teenagers recover without long-term problems if they follow the recover plan provided by their healthcare providers. Because there are many causes of knee pain, be sure to ask your healthcare provider for specific information on long-term prognosis for your teen's knee condition.

Living With

When should I get my teen’s knee pain evaluated by a healthcare provider?

Make an appointment to see your healthcare provider if:

  • Your teen’s pain has lasted longer than two weeks or anytime there’s an increase in pain level.
  • Your teen’s knee is red, swollen or warm to the touch.
  • Your teen can’t put weight on their leg; they limp.
  • Your teen’s knee “locks’ and can’t move.
  • Your teen’s kneecap feels like it slides out of place or the knee looks twisted.
  • Your teen has knee pain during or after activity.
  • There’s painful popping or clicking sound in your teen’s knee.
  • Your teen’s knee doesn’t have strength or full range of motion.
  • Your teen’s pain wakes them up at night.

Last reviewed by a Cleveland Clinic medical professional on 04/30/2021.

References

  • American Academy of Orthopaedic Surgeons. Adolescent Anterior Knee Pain. Accessed 4/22/2021.
  • Wolf M. Knee Pain in Children: Part I: Evaluation. Pediatr Rev 2016;37(1):18-23. Accessed 4/22/2021.
  • American Medical Society for Sports Medicine. Johnson R. Patellofemoral Knee Pain. Accessed 4/22/2021.
  • Wolf M. Knee Pain in Children, Part II: Limb- and Life-threatening Conditions, Hip Pathology, and Effusion. Pediatr Rev 2016;37(2):72-77. Accessed 4/22/2021.
  • Wolf M. Knee Pain in Children, Part III: Stress Injuries, Benign Bone Tumors, Growing Pains. Pediatr Rev 2016;37(3):114-119. Accessed 4/22/2021.

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Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy