The number of young children participating in organized sports has grown to more than 30 million. With that comes an increase in knee pain in youth athletes. One particularly troubling condition, characterized by a painful lump in the patella tendon right below the kneecap, is known as Osgood-Schlatter disease (OSD).

Affecting kids whose bones are still growing, OSD is commonly detected in children between the ages of 8 and 15. It causes an increase in joint stiffness and muscle tightness in the lower body. In less severe cases, affected athletes can still train with Osgood-Schlatter exercises and participate in their sports at a lower intensity. Other cases will sideline athletes.

OSD can be quite painful, but some exercises can help. I have trained children with this disease, and I’ve worked with sports orthopedic doctors to develop a training plan for them. Here are five things I’ve learned through research and observation that can help kids dealing with OSD return to training.

1. Relative body strength exercises

Relative body strength is the strength an athlete has in relation to his or her own body weight. Push-Ups, Chin-Ups, Dips, Inverted Rows and Bodyweight Squats are some of the best exercises to build relative body strength. Having great relative body strength will increase body control and joint stability.

2. Icing

Icing at the site of OSD, right under the patella tendon, is a key way to reduce the inflammation. Keep the ice on for 20 minutes at a time when the pain is at its worst. Icing immediately after a training session is recommended to keep the inflammation under control and decrease the pain.

3. Balance

Working on balance is a key to overall athletic development. Focus on two types of balance: joint stabilization and muscular function.

• Joint stabilization helps the ligaments and tendons around the joint become stronger, reducing the chance of severe injuries like breaks and dislocations.
• Muscular function balances the body. If you are a right-handed baseball hitter, practice batting lefty to balance out the other side of your body so your agonist and antagonist muscles can strengthen equally. Favoring your agonist over your antagonist muscles can result in overuse injuries.

4. Flexibility

OSD increases tightness and stiffness in the muscle and joint, so flexibility therapy is very important. Performing stretches of the quadriceps and hamstring muscles is great for alleviating pain. Stretching with a band or rope is a good way to hold the leg in the stretch position for the amount of time necessary. Try to stretch two or three times a day (in the morning, after training, and before bed) to help alleviate symptoms. Hold each stretch for 30 seconds. Stretches elongate muscles and allow them to relax as the bones grow. Here are two stretches I always have my OSD-affected athletes perform:

• Lying Hamstring Stretch. Lie flat on your back with one end of the band/rope under the ball of your foot and the other end in your hand. Slowly pull your leg up while keeping your opposite leg flat on the ground. Take deep breaths and exhale slowly as you increase your range of motion in the stretch. Hold the stretch for 30 seconds.
• Lying Quadriceps Stretch. Lie on your stomach with one end of the band/rope around the top of your foot and the other end in your hand, over the opposite shoulder. Slowly pull your quad up off the ground until your hip comes off as well. Hold for 30 seconds. Take deep breaths and exhale slowly. You won’t be able to increase range of motion very much in this stretch, but try to resist twisting your hips. This will allow for a deeper stretch in the muscle. You should feel this stretch at the site of the OSD and it should help alleviate tightness and discomfort. The aim is to lengthen the muscle so that the tightness, stiffness and swelling can decrease, as well as the pain.

If you don’t have access to a band or rope, perform these stretches from a standing position. Simply standing with your feet together and reaching for the ground is an alternative to stretch your hamstrings. Hold onto something for support, grab your foot with your opposite hand and pull the bottom half of your leg up toward your butt until you feel the stretch in the quad muscle as well as the hip and knee.

5. Running on a soft surface

Running on a soft surface such as turf or grass allows you to absorb most of the force being displaced into the ground and back into the lower leg. Running on a track, hardwood floor or concrete will only make matters worse. I’ve put all my athletes with OSD on turf and have gotten positive feedback from them after they run on a soft surface versus. I allow them to run at a pace anywhere from 50% to 85% of their maximal effort.

Exercises to Eliminate

• Jumping. Jumps put a lot of stress on the knee joint. Continuing to jump makes the problem worse and increases OSD inflammation. Coaches should eliminate all types of jumping exercises when dealing with athletes who suffer from OSD.
• Long Sprints. If your athletes need to run, have them complete short sprints (10-20 yards) at 50% to 85% of their maximal effort. Teach them the basics of body mechanics and foot placement so they will learn the proper way to run without extra pounding and high stress on their lower extremities. Keep everything short and at a low intensity.
• Lower-Body Weight Training. Building lower-body strength increases the muscles’ firing rate and recruitment pattern, but it can be too risky for athletes with OSD. Avoid any type of lower-body weight training. It will keep the muscles tight, joints stiff and the area of pain inflamed. Performing bodyweight exercises such as bodyweight Squats and Lunges, focusing on the eccentric phase, is more beneficial than lifting weights.
• High-intensity. We all want to see improvements from our training, but with OSD sufferers, progress takes a back seat while rest and recovery are emphasized. Stay away from doing anything at full speed. This will only prolong the recovery process. Meet with your athlete’s physician and decide together on the proper course of treatment and how to properly progress.

Read More:

• 5 Bodyweight Exercises You Should Be Doing
• 3 Key Hamstring Stretches for Athletes
• Two Ways to Relieve Post-Training Muscle Soreness

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