Adolescence can be a turbulent time for the body—full of growth spurts, hormonal changes, and a whole lot of sport. As physiotherapists, we regularly assess and treat injuries that are unique to this age group. Here are the most common adolescent injuries I see in clinic, how we assess them, and how we help manage recovery.
1. Osgood-Schlatter’s Disease
What is it?
An overuse injury affecting the tibial tuberosity (just below the kneecap), where the patellar tendon inserts. It’s common in sporty teenagers during growth spurts, especially in footballers, sprinters and jumpers (1).
Physio Assessment
- -Palpation of the tibial tuberosity reproduces sharp pain (2).
- -Resisted knee extension may aggravate symptoms.
- -Thomas Test may reveal tightness in the rectus femoris.
- -Observation of movement patterns during:
○Double-leg squat
○Single-leg hop test
○Step-down test
- -Muscle imbalance testing, especially between quads, hamstrings and glutes.
Management
- -Activity modification – temporary reduction of high-impact activities.
- -Patellar tendon taping to offload the tibial tuberosity.
- -Isometric quadriceps exercises to maintain strength without irritating the tendon.
- -Foam rolling and stretching for tight quads and hip flexors.
- -Progressive loading programme: leg press, wall sits, and step-ups.
- -Education about the self-limiting nature of the condition, often resolving after growth (3).
2. Sever’s Disease (Calcaneal Apophysitis)
What is it?
Inflammation at the growth plate in the heel, often seen in children aged 8–13 involved in football, rugby, or gymnastics (4).
Physio Assessment
- -Medial-lateral heel squeeze test (positive when painful).
- -Thompson test to rule out Achilles tendon rupture (usually negative in this condition).
- -Gait analysis may show antalgic gait or toe-walking.
- -Calf length test (weight-bearing lunge test) to identify gastrocnemius and soleus tightness.
- -Foot posture assessment – identifying overpronation or flat feet that may contribute to increased load (5).
Management
- -Heel lifts or gel heel cups to cushion the calcaneus and reduce strain.
- -Gastrocnemius and soleus stretches.
- -Isometric and later concentric heel raises to maintain calf strength.
- -Advice on supportive footwear.
- -Load management and structured return to activity with minimal impact (6).
3. Patellofemoral Pain Syndrome (PFPS)
What is it?
Patellofemoral pain syndrome (PFPS) is a broad term used to describe pain in the front of the knee and around the patella, or kneecap, often linked with weak glutes, poor biomechanics, or sudden increases in training load (7).
Physio Assessment
- -Patellar grind test (Clarke’s test) – pain during quadriceps contraction while compressing the patella (8).
- -Step-down test – identifies poor dynamic knee control.
- -Trendelenburg test – indicates glute medius weakness.
- -Ober’s test – to assess iliotibial band tightness.
- -Squat and lunge observation to identify altered movement patterns and alignment issues.
Management
- -Strengthening of glute medius, glute maximus, and quadriceps (with a focus on VMO activation).
- -Hip and core stability work to support lower limb biomechanics.
- -Gradual return to sport using controlled progressions (9).
- -Education around training load, footwear, and posture.
4. Scoliosis (Mild Postural or Structural Curves)
What is it?
A lateral curvature of the spine, often first noticed during growth spurts. Mild, non-progressive cases can usually be managed conservatively (10).
Physio Assessment
- -Adam’s Forward Bend Test – highlights any rib humps or rotational elements.
- -Postural analysis – checking for shoulder and pelvic asymmetry.
- -Spinal mobility assessment, especially in the thoracic region.
- -Muscle length testing for tightness in quadratus lumborum or hamstrings.
- -Core strength assessment using plank and balance-based tasks.
Management
- -Postural education and ergonomic advice (11) .
- -Core strengthening with a focus on transverse abdominis and spinal stabilisers.
- -Thoracic mobility work including foam rolling and mobility drills.
- -Functional strengthening for glutes and back extensors.
- -Monitoring for progression and referral to specialist services when indicated.
5. Spondylolysis (Lumbar Stress Fracture)
What is it?
A stress fracture of the pars interarticularis, often affecting adolescent athletes in sports involving repeated spinal extension (12).
Physio Assessment
- -Single-leg hyperextension test (Stork test) – pain indicates stress on the pars (13).
- -Palpation over the lumbar spine, especially L4-L5.
- -Passive lumbar extension test – checks for pain with controlled overpressure.
- -Assessment of core control and muscle activation using tasks like dead bugs or bird-dogs.
- -Evaluation of hip range of motion and movement compensations.
Management
- -Immediate modification or cessation of aggravating activities (14).
- -Core stability programme focusing on activation of deep spinal muscles (TA, multifidus).
- -Anti-extension exercises (planks, side planks) and glute strengthening.
- -Gradual reintroduction of sport-specific tasks with emphasis on technique.
- -Referral for imaging if pain persists beyond conservative treatment timelines.
Final Thoughts
Adolescents are not simply smaller adults, they need tailored assessments and a flexible approach to rehab. The key lies in early recognition, patient-specific education, and progressive, well-structured management. As physiotherapists, our role is to keep young people moving, supported, and confident in their recovery.
If you’re concerned about a young athlete’s pain or movement, don’t wait for it to become chronic, get it looked at early and avoid unnecessary setbacks.
Our Barnet, Cockfosters & Enfield Physio’s have tons of experience and are specialists in treating adolescents. Have confidence that our specialist Physiotherapists will closely assess, diagnose & treat you in the correct & evidence-based way for all injuries. You can book an appointment here.
Blog By: Emre Oz (Musculoskeletal Physiotherapist at Crouch Physio).
References
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conservative treatment options for OSGOOD-Schlatter disease.” Physical therapy in sport 49 (2021):
178-187. - Nieto-Gil, Pilar, et al. “Risk factors and associated factors for calcaneal apophysitis (Sever’s disease): a
systematic review.” BMJ open 13.6 (2023): e064903. - Velasquez, Brett T. Physical Therapy Diagnostic Process in Patients with Sever’s Disease and Bilateral
Heel Pain: A Case Report. Diss. University of Iowa, 2021. - Hernandez-Lucas, Pablo, et al. “Conservative treatment of Sever’s Disease: a systematic review.” Journal
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- Nijs, Jo, Catherine Van Geel, and Bart Van de Velde. “Diagnostic value of five clinical tests in
patellofemoral pain syndrome.” Manual therapy 11.1 (2006): 69-77. - Vikhe, Chaitali S., Swapnil U. Ramteke, and Sharath Hullumani. “Effect of physiotherapy interventions on
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protocol.” PLoS One 19.12 (2024): e0312279. - Hresko, M. Timothy. “Idiopathic scoliosis in adolescents.” New England Journal of Medicine 368.9 (2013):
834-841. - Berdishevsky, Hagit, et al. “Physiotherapy scoliosis-specific exercises–a comprehensive review of seven
major schools.” Scoliosis and spinal disorders 11.1 (2016): 20. - Lawrence, Kevin J., Tim Elser, and Ryan Stromberg. “Lumbar spondylolysis in the adolescent athlete.”
Physical Therapy in Sport 20 (2016): 56-60. - Moeller, James L. “Spondylolysis in Adolescent Athletes: A Descriptive Study of 533 Patients.” Clinical
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