Specialista in Ortopedia Pediatrica
Osgood-Schlatter disease
Home Exercise Program
Not every exercise listed here is suitable for every child: the selection is individual and is defined during the consultation.
1.Quadriceps and iliopsoas stretch
Reduce muscle tension pulling on tibial tuberosity
QUADRICEPS: Standing, heel toward buttock, knees together. Feel stretch in front of thigh. ILIOPSOAS: Lunge with back knee on ground. Squeeze glute of back leg and push hips forward. Stretch felt in front of back leg's hip. Don't arch back!
3 × 30 seconds each side, 2-3 times daily (morning, evening, after sports)
2.Isometric wall sit (low range)
Quadriceps strengthening without movement - safer in acute phase
Back to wall, slide down to 30-45° (NOT too deep!). Higher position = less stress on tibial tuberosity. Hold position without moving. If knee hurts, go higher. Exercise must be PAIN-FREE.
3-5 × 15-20 seconds. Increase duration when easy (max 45 sec)
3.Progressive quadriceps and glute strengthening
Gradual progression as pain decreases
PHASE 1 (pain present): Glute bridge + low-range wall sit. PHASE 2 (decreasing pain): Add mini-squat (shallow). PHASE 3 (minimal pain): Add step-up on low step. Rule is: if exercise causes pain, return to previous phase or reduce intensity.
Bridge: 3 × 15. Wall sit: 3 × 20 sec. Squat: 3 × 10
4.Sports load management
Activity modification is fundamental - not just exercises!
ACUTE PHASE: Drastically reduce jumping, running and high-impact sports. Maintain low-impact activities (swimming, cycling). GRADUAL RETURN: 50% normal load for 1-2 weeks → 75% → 100%. If pain increases, go back. Specific plan discussed during visit.
Personalized plan discussed during visit
5.Hip and ankle mobility
Reduce compensations that increase knee stress
Hip or ankle mobility limitations force knee to work harder. HIP: Flexor stretch (see above). ANKLE: Knee-to-wall for dorsiflexion (see foot section). If ankle is stiff, knee compensates.
3 × 30 seconds per mobility exercise
6.Isometric quadriceps hold with knee semi-extended
Sustained contraction: reduces apophysitis pain without stressing the tuberosity
Sit on a chair with the knee bent to about 60°, foot locked under a table leg or against a strong band. Push the leg into extension WITHOUT moving it, at about 70% of maximum effort. Hold 30-45 seconds breathing normally, then release slowly. Isometric exercises have an analgesic effect lasting a few hours: useful before sport or on more painful days.
5 × 30-45 seconds, 1-2 minutes rest, 1-2 times a day
7.Slow heavy squat (heavy slow resistance)
Slow progressive loading is one of the treatment options for Osgood-Schlatter
Squat with your back on the wall or with light support, within the pain-free range (often 0-60°). Lower in 3 seconds and rise in 3 seconds, without pausing. Start bodyweight; when 3 × 15 is easy and pain-free, add load (backpack with books, dumbbells) reducing to 3 × 8-10. Pain during the exercise is acceptable up to 5/10 and must settle within 24 hours.
3 × 8-15, on alternate days (3 times a week)
8.Hamstring strengthening
Strong, flexible hamstrings reduce quadriceps pull on the tuberosity
Single-leg bridge: lying on your back, one foot on the floor, lift the pelvis with that leg only, keeping the pelvis level. Alternative: heel curls on a sliding chair or a gym ball. Hamstring stretching (straight leg on a step, back straight, 30 seconds) completes the work: hamstring tightness is one of the most frequent factors in Osgood-Schlatter during growth spurts.
3 × 10-12 each side + 3 × 30 second stretch
9.Gluteus medius strengthening (clamshell)
Hip control reduces the dynamic valgus that overloads the patellar tendon
Lie on your side, knees bent 90°, feet together. Open the top knee like a clamshell without rolling the pelvis back. Hold 2 seconds, lower slowly. To progress, put a band above the knees. This exercise does not load the tibial tuberosity and can be done even in the most painful phase.
3 × 15 each side
10.Return to sport with pain monitoring
Clear criteria for safely resuming training and matches
Progress when: daily pain is ≤ 2/10, you can do 3 × 15 slow squats with pain no higher than 5/10, and you can hop on one leg 10 times pain-free. PHASE 1: easy running on flat ground. PHASE 2: running with changes of direction. PHASE 3: jumping and sport-specific work. Each phase lasts at least 1 week and you progress only if next-day symptoms are unchanged. The bump below the knee may remain: it is not a reason to stop.
Weekly staged progression, guided by symptoms
RED FLAGS - When to stop and contact the doctor immediately
Stop the exercises immediately and contact the specialist (or go to the emergency department if severe) if any of the following occur:
- Pain preventing normal daily activities
- Significant swelling of tibial tuberosity
- Pain present even at rest
- Obvious limitation of knee extension
- Fever, redness or warmth of the joint, or inability to bear weight
In case of doubt, always prefer a check-up over continuing the exercises.
Dott. Daniele Priano
Ortopedia Pediatrica - ASST Gaetano Pini-CTO
ortopediaevolutiva.com • 26/08/2026
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MioDottoreBefore You Start
Who is this guide for?
Athletic adolescents (10-15 years) with tibial tuberosity pain. Acute phase: reduce activity. Maintenance: stretching and strengthening.
What you need
Clear floor space, mat or soft surface, comfortable clothing. Some exercises may require resistance bands or supports.
Suggested frequency
Usually 1-2 times daily, as directed during the visit. Consistency is more important than intensity.
Common mistakes to avoid
- •Performing exercises too quickly without control
- •Pushing beyond the pain threshold
- •Skipping days or doing occasional very long sessions
- •Not warming up before strengthening exercises
⚠️ Red flags — when to stop and contact the doctor immediately
Stop exercises immediately and contact the specialist if any of the following occur:
- Pain preventing normal daily activities
- Significant swelling of tibial tuberosity
- Pain present even at rest
- Obvious limitation of knee extension
Detailed Exercises
- 1
Quadriceps and iliopsoas stretch
Reduce muscle tension pulling on tibial tuberosity
QUADRICEPS: Standing, heel toward buttock, knees together. Feel stretch in front of thigh. ILIOPSOAS: Lunge with back knee on ground. Squeeze glute of back leg and push hips forward. Stretch felt in front of back leg's hip. Don't arch back!
3 × 30 seconds each side, 2-3 times daily (morning, evening, after sports) - 2
Isometric wall sit (low range)
Quadriceps strengthening without movement - safer in acute phase
Back to wall, slide down to 30-45° (NOT too deep!). Higher position = less stress on tibial tuberosity. Hold position without moving. If knee hurts, go higher. Exercise must be PAIN-FREE.
3-5 × 15-20 seconds. Increase duration when easy (max 45 sec) - 3
Progressive quadriceps and glute strengthening
Gradual progression as pain decreases
PHASE 1 (pain present): Glute bridge + low-range wall sit. PHASE 2 (decreasing pain): Add mini-squat (shallow). PHASE 3 (minimal pain): Add step-up on low step. Rule is: if exercise causes pain, return to previous phase or reduce intensity.
Bridge: 3 × 15. Wall sit: 3 × 20 sec. Squat: 3 × 10 - 4
Sports load management
Activity modification is fundamental - not just exercises!
ACUTE PHASE: Drastically reduce jumping, running and high-impact sports. Maintain low-impact activities (swimming, cycling). GRADUAL RETURN: 50% normal load for 1-2 weeks → 75% → 100%. If pain increases, go back. Specific plan discussed during visit.
Personalized plan discussed during visit - 5
Hip and ankle mobility
Reduce compensations that increase knee stress
Hip or ankle mobility limitations force knee to work harder. HIP: Flexor stretch (see above). ANKLE: Knee-to-wall for dorsiflexion (see foot section). If ankle is stiff, knee compensates.
3 × 30 seconds per mobility exercise - 6
Isometric quadriceps hold with knee semi-extended
Sustained contraction: reduces apophysitis pain without stressing the tuberosity
Sit on a chair with the knee bent to about 60°, foot locked under a table leg or against a strong band. Push the leg into extension WITHOUT moving it, at about 70% of maximum effort. Hold 30-45 seconds breathing normally, then release slowly. Isometric exercises have an analgesic effect lasting a few hours: useful before sport or on more painful days.
5 × 30-45 seconds, 1-2 minutes rest, 1-2 times a day - 7
Slow heavy squat (heavy slow resistance)
Slow progressive loading is one of the treatment options for Osgood-Schlatter
Squat with your back on the wall or with light support, within the pain-free range (often 0-60°). Lower in 3 seconds and rise in 3 seconds, without pausing. Start bodyweight; when 3 × 15 is easy and pain-free, add load (backpack with books, dumbbells) reducing to 3 × 8-10. Pain during the exercise is acceptable up to 5/10 and must settle within 24 hours.
3 × 8-15, on alternate days (3 times a week) - 8
Hamstring strengthening
Strong, flexible hamstrings reduce quadriceps pull on the tuberosity
Single-leg bridge: lying on your back, one foot on the floor, lift the pelvis with that leg only, keeping the pelvis level. Alternative: heel curls on a sliding chair or a gym ball. Hamstring stretching (straight leg on a step, back straight, 30 seconds) completes the work: hamstring tightness is one of the most frequent factors in Osgood-Schlatter during growth spurts.
3 × 10-12 each side + 3 × 30 second stretch - 9
Gluteus medius strengthening (clamshell)
Hip control reduces the dynamic valgus that overloads the patellar tendon
Lie on your side, knees bent 90°, feet together. Open the top knee like a clamshell without rolling the pelvis back. Hold 2 seconds, lower slowly. To progress, put a band above the knees. This exercise does not load the tibial tuberosity and can be done even in the most painful phase.
3 × 15 each side - 10
Return to sport with pain monitoring
Clear criteria for safely resuming training and matches
Progress when: daily pain is ≤ 2/10, you can do 3 × 15 slow squats with pain no higher than 5/10, and you can hop on one leg 10 times pain-free. PHASE 1: easy running on flat ground. PHASE 2: running with changes of direction. PHASE 3: jumping and sport-specific work. Each phase lasts at least 1 week and you progress only if next-day symptoms are unchanged. The bump below the knee may remain: it is not a reason to stop.
Weekly staged progression, guided by symptoms
Frequently Asked Questions
Does Osgood-Schlatter go away on its own?
Yes, Osgood-Schlatter resolves when the growth plate of the tibial tuberosity closes, generally between ages 14 and 16. The "bump" below the knee may remain permanently, but pain disappears. Stretching exercises and load management help control symptoms during the active phase.
Can you put ice on Osgood-Schlatter?
Yes, applying ice (wrapped in cloth) on the tibial tuberosity after sports activity for 10-15 minutes is very helpful to reduce inflammation and pain. Don't apply ice directly on skin and don't exceed 20 minutes.
Are knee pads needed for Osgood-Schlatter?
Knee pads with protective cushion over the tibial tuberosity can be useful during sports to protect the tender area from impacts. Infrapatellar straps may help reduce tendon traction. They're not essential but can improve comfort.
