Growing Pains

Being a teenager is not an easy time in anyone’s life. We all know that at this stage numerous emotional and physical changes come into play. We often overlook the effects of these physical changes on the adolescent especially when participating in sport.

There are two common complaints from adolescents namely anterior knee pain and shin splints. This article will focus on explaining some of the causes, treatment and prevention of these to you.

Anterior Knee Pain


  • The most common symptom is a dull, aching pain in the front of the knee that begins gradually and is most often directly related to activity.

Other common symptoms include:

  • Pain at night
  • Pain during activities that repeatedly bend the knee (jumping, squatting, running etc)
  • Pain related to a change in activity level or intensity, playing surface or equipment.

The knee joint is a complex structure made up of:

  • Bones
  • Muscles
  • Ligaments (joining bone to bone for stability)
  • Tendons (joining muscle to bone)
  • Meniscus (small pad within the knee to allow smooth movement of the bones on one another)

All of these structures work simultaneously to allow smooth, painless movement, when functioning normally. So why do adolescents so often complain of pain in this area?

When analyzing the knee joint we need to remember that this joint is in fact in the middle of two other joints: the hip, and the ankle. We tend to forget that fact that any abnormality (alignment or otherwise) in either of these two joints could play a role in the pain that we experience in the knee joint itself. A lack of strength in the stabilizers or any malalignment of either the ankle or the hip could lead to pain in the knee joint.

We also need to consider that all of the above-mentioned structures need to be working together correctly in order to allow pain-free, normal movement. Below we will discuss some of the other causes of pain.


  • If the quadriceps (thigh muscles) are too tight we may experience pain below the patella (knee cap), this is caused by the fact that the quadriceps tendon (joining the muscle to the bone) runs over the knee cap and only attaches below the joint. If the muscle is very tight the patella is pushed downwards onto the bones below it not allowing adequate space for smooth movement to take place.
  • If the quadriceps muscle is weak the kneecap may move slightly out of the groove in which it is meant to move. This may place additional strain on the tendons or irritate the cartilage lining on the underside of the kneecap, leading to pain.
  • Imbalance in strength between the quadriceps and hamstrings could lead to incorrect movement patterns.
    Growth Spurts with rapid increase in bone length without time for the muscles and soft tissues to adapt.
    Imbalance between muscles/connective tissue on inside and outside of the leg.

Adolescent Disorders

  • Osgood Schlatter Disease: Common in active adolescents, possibly caused by multiple small avulsion fractures (bone fracture that occurs when a fragment of bone tears away from the main mass of bone) from contractions of the quadriceps muscles at their insertion into the tibia. The strength of quadriceps, in children regularly practicing sports that involve running and jumping, may exceed the ability of the tibia to resist that force. The common age for boys is between 12 and 15 years and for girls, between 8 and 12 years.

Technique & Training

  • Coaches need to ensure that sporting techniques are correct and that training is progressed slowly allowing adequate time for muscles to adapt.
  • Changes in footwear or playing surface may lead to pain. Always ensure that your footwear is correct depending on your particular anatomy. In the case of athletics, football and hockey we do not advise wearing spikes/ boots immediately at the beginning of preseason training, rather wear trainers initially and allow your body to adapt to the training first.
  • We also need to ensure that we have a balance between training and participation in sports and our very important rest/recovery time. Many keen sports enthusiasts will play both school and club sports thus not allowing adequate time for recovery. It is important to remember that rest should be considered as part of your training program.

What Can we do to Relieve the Pain?

  • Activity changes: Switching to low-impact activities while you have pain will put less stress on your knee joint. Biking and swimming are good low-impact options. If you are overweight, losing weight will also help to reduce pressure on your knee.
  • Technique: Your knee pain may be related to your exercise technique. A trainer at school or physiotherapist may be able to help you evaluate and improve upon your technique – such as how you land from a jump or push off from a starting block. Daily activities or movement pattern may be causing your pain, such as stair climbing or a particular sitting position. These can be adapted with the help of your Physio.
  • Stretch tight muscles before and after participating in sport, warmups are imperative and their importance should never be overlooked.
  • Ice: Applying ice after physical activity may relieve some discomfort. Apply some ice for about 10 minutes at a time.
  • Be sure that your athletic shoes provide the correct support for your activity, Your physio can advise and steer you in the right direction.
  • Seek medical advice before using anti-inflammatory drugs on an ongoing basis.
  • If you are unsure of the cause of your pain and do not seem to be able to manage it, seek advice from your Physio. They are able to assist in terms of postural or biomechanical correction (correction of movement patterns), strengthening of weak muscles (movers or stabilizers), advice on footwear, supportive strapping and pain relief.

Shin Splints

knee2What are Shin Splints?
Otherwise known as Medial TibialStess Syndrome (MTSS), shin splints are categorized by pain or tenderness which occurs on the inner part of the shin bone (Tibia). This pain is worsened by exercise and often decreases with rest. You may also note slight swelling of the lower leg. Shin splints are common in runners, fast bowlers, tennis/squash players, and dancers.

What are the main causes of shin splints?
The pain is usually brought about during strenuous activity, commonly stop-start type sports (tennis, squash, cricket etc.) as well as running continuously on a hard surface.

This could be due to:

  • Excessive pressure on the muscles of the lower legs, especially without adequate warm-up.
  • A decrease in strength in the muscles in the lower leg and hip stabilizers, therefore causing an abnormal movement pattern when participating in the chosen activity
  • Poor foot position due to incorrect footwear or muscle weakness


What are the common mistakes people make regarding shin splints?
Running through the pain! We need to remember that pain is the only means in which our body is able to communicate to us that structures in our body require attention. In the case of shin splints, pain is the body’s attempt to ensure that we rest and allow the injured structure to recover. It is important to note that training continuously on untreated shin splints can cause stress fractures.

How can we treat shin splints?

  • Ice your shins immediately after exercise (10min at a time x 3)
  • Stretch your shins
  • Work alongside a Physio to assist you in pain management (Soft tissue release, dry needling, taping )and strengthening of the necessary muscles

What can we do to prevent shin splints?

  • Ensure correct footwear
  • Always warm up before participating in sport or exercise
  • Progress your training program slowly to allow the muscles to adapt to the intensity and surface that you are training on (especially if changing from a soft to a harder surface)
  • Ensure that the mobility and stability in your ankles and hips is maintained to allow the correct movement patterns
  • Stretch the muscles in your legs especially after workouts
  • Listen to your body and stop performing the activity when it is causing pain, rest and ice the painful structure.


If you are unsure about any of the above-mentioned information contact your physiotherapist for a consult.

Houghton, KM (2007) Review for the generalist: evaluation of anterior knee pain. Paediatric Rheumatology Online Journal 5 (8) Thacker, SB., Gilchrist, J., Stroup, D., Kimsey, C. (2002) The prevention of shin splints in sports: A Systematic review. Medicine and science in sports and exercise.Journal of the American College of Sports Medicine. 34(1): 32-4

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Dee Walsh BSc Physiotherapy (US)

Dee qualified from the University of Stellenbosch in 2013 and completed her community service year at St. Appolinaris Hospital in Creighton, rural Kwa-Zulu Natal. Dee is passionate about sport and worked closely with Durbanville Rugby Club in the Western Cape throughout her studies as well as assisting at the ABSA Cape Epic in 2013 and 2015.

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