Osgood-Schlatter, Sinding-Larsen-Johansson, or Jumper's Knee?
Which Knee Pain Does Your Child Have?

Most parents first notice it on the ride home from practice: a wince climbing out of the car, a hand rubbing the front of the knee, a complaint that kneeling in class hurts. Then comes the search online, and three unfamiliar names pop up at once: Osgood-Schlatter, Sinding-Larsen-Johansson, and jumper's knee.

Before anything else, one reassurance. You may see the first one written as "Osgood-Schlatter disease," but nothing about it is a disease in the way we normally use that word. Your child isn't sick, nothing is spreading, and no lasting harm is being done to the bone. Doctors also call it tibial tubercle apophysitis, which translates to "inflammation of a growing bone's attachment point." A tight thigh muscle tugs, again and again, on the soft growth plate at the top of the shinbone until it gets sore. Sinding-Larsen-Johansson is the same kind of irritation, just a couple of inches higher. Both fade for good once your child finishes growing, and both usually settle much sooner with the right care.

So which one does your child have? Usually, you can get a pretty good idea at home in under a minute.

Three Names for Pain Along the Front of the Knee

Picture a rope running down the front of your child's leg. It starts at the big thigh muscle, the quadriceps, wraps over the kneecap, continues as a short, thick tendon called the patellar tendon, and anchors into a bump at the top of the shinbone. Every sprint, jump, and kick pulls on that rope.

In a growing child, the anchor points are still partly soft growth plate, so they're the first places to complain when the rope is pulled too tight. Which anchor gets sore, or whether the tendon itself does, is what separates these three conditions.

Find the Sore Spot With One Finger

• 1
  Have your child sit with the knee bent and relaxed A chair or the edge of a couch works well. A relaxed knee makes the landmarks easier to feel.
• 2
  Ask them to press on the single most tender spot One fingertip, not the whole hand. Kids are usually very accurate about this.
• 3
  Compare it with the other knee Look for a bump that's larger or more swollen than on the other side, and check whether pressing the same spot on the other knee is comfortable.

Matching the Tender Spot to the Name

Some parents describe any of these as "growing pains in the knee," and in a loose sense that's fair. The difference is that true growing pains are vague, usually come at night, and don't settle into one tender spot you can press on.

Why a Knee Problem Usually Starts at the Hip

Here's the part most parents don't expect. In my experience, all three of these are really a kinetic chain problem. The knee is simply where the tension ends up.

The muscles that control the knee don't live at the knee. They run up into the hip and down to the ankle, in four connected groups: along the front of the leg (hip flexors and quadriceps), along the back (glutes, hamstrings, and calves), along the outside, and along the inside. During a growth spurt, the bones lengthen faster than those muscles can keep up, and the whole system gets tight. Add three or four practices a week, and the pull concentrates on the most vulnerable point at the front of the knee.

That's also why the same approach works for all three conditions, even though they hurt in slightly different places. Loosen the chains, and the pull on the sore spot lets go.

What Happens at Your Child's Appointment

We begin with a thorough exam, and you're welcome to stay in the room and ask questions the entire time. From there, treatment follows two main steps.

First, I release all four chains. Using sustained myofascial pressure, I work through the front, back, outside, and inside of the leg. The hip flexors and glutes are always included, because they're so often where the tension begins.

Then I treat the knee itself. I use Active Release Technique directly on the painful spot and around its edges, whether that's the bump below the kneecap, the kneecap's tip, or the tendon.

Adjustments are usually not necessary for these knee problems. If your child would like one, I'm happy to include it, but they aren't needed to get better. Kids tend to respond quickly, and three or four visits is typical, sometimes fewer. For more on how we work with young athletes and students, visit our Kids & Teens page.

Sports, Rest, and Knee Straps

I rarely pull a child out of their sport right away. For most kids, I'd rather keep them playing at first and see how the knee responds to treatment, and many improve without missing a game. If the knee keeps flaring even with treatment, I may recommend a short break while we continue working on it, and I'll be straightforward with you about when that's the case.

Signs That Need a Pediatrician's Eyes

The Takeaway for Parents

Where your child points tells you a lot. A sore bump below the kneecap points to Osgood-Schlatter, a sore tip of the kneecap to Sinding-Larsen-Johansson, and a sore tendon in between to jumper's knee. None of them is a disease, all three trace back to tight muscles pulling from the hip down, and all three tend to improve quickly once those muscles are released.

See how we care for kids and teens, book an appointment online, or call or text 650-735-1716. Dealing with knee pain yourself? Our knee pain page covers how we treat adults.