Is Your Teen’s Knee Pain Normal? What Every Parent Should Know

Knee pain is common in active teenagers, and it is sometimes dismissed as “growing pains.” But persistent knee pain deserves more attention than that.

One of the most common causes of knee pain in adolescents is patellofemoral pain (PFP)—pain around or behind the kneecap. It can affect both teenagers and adults, and unfortunately, it doesn’t always disappear with age. Research suggests that a large percentage of adolescents with patellofemoral pain are still experiencing symptoms a year after their pain begins.

So, why does this happen, and what can we do about it?

Why do teenagers develop knee pain?

Patellofemoral pain usually doesn't have one single cause. Instead, it tends to develop when several factors come together and the demands placed on the knee exceed its current capacity.

This is especially important for teenagers because they are often very active. A young athlete may be practicing or competing in multiple sports while also dealing with everyday activities like walking up and down stairs, standing for long periods, squatting, kneeling, and running around at school.

Sometimes, the problem isn't that the knee is “bad”, it's simply being asked to do more than it is currently prepared to handle.

That’s why one of the first things we look at in performance rehab is how much load the knee is experiencing.

This doesn't necessarily mean stopping everything. Instead, we can temporarily modify activities that are irritating the knee, allow symptoms to settle, and then gradually build the knee's strength and capacity back up.

Load management can make a big difference

One study in adolescents with patellofemoral pain used a structured approach to reduce the amount of stress being placed on the knee for several weeks. Exercises were performed at home, activity was gradually increased, and athletes were eventually guided back toward their sport.

The results were encouraging: 68% were back to sport within three months, 79% by six months, and 81% by one year.

The takeaway? Knee pain doesn't necessarily mean a teenager needs to stop being active. It often means we need to temporarily adjust the amount and type of activity while building the knee's ability to handle those demands again.

Knee pain can affect much more than the knee

It's easy to focus only on pain levels and physical symptoms, but persistent knee pain can have a much bigger impact on a teenager's life.

Teens with ongoing knee pain may begin avoiding activities they enjoy, worry about making their knee worse, or feel frustrated that they can't participate in sports or activities with their friends.

Some may become fearful of certain movements because they associate those movements with pain.

This is why education is such an important part of treatment.

Teenagers need to understand:

• What is causing their pain?

• Is movement actually damaging their knee?

• Which activities are currently irritating their symptoms?

• What can they safely continue doing?

• What can they do to make their knee stronger?

• How can they gradually get back to the activities they enjoy?

  
  

Understanding what is happening can help take away some of the fear surrounding pain and give teenagers a sense of control over their recovery.

Sometimes the kneecap itself is part of the problem

Not every adolescent with knee pain simply has an “overuse” problem.

For some teenagers, patellar instability may contribute to their symptoms.

The kneecap normally sits within a groove at the end of the thigh bone called the trochlea. This groove helps guide and stabilize the kneecap as the knee bends and straightens.

When the kneecap moves more than it should, we can describe this as patellofemoral or patellar instability.

Instability exists on a spectrum. Some people may simply experience pain or a feeling that the kneecap isn't moving normally, while others may experience episodes where the kneecap partially slips out of place (subluxation) or completely dislocates.

There are also anatomical factors that can make someone more prone to instability. For example, some people naturally have a shallower trochlear groove or a higher-riding kneecap. These are things we can't change through exercise, but that doesn't mean there is nothing we can do.

Instead, we can focus on improving the things we can influence, such as strength, coordination, balance, movement control, and the ability of the muscles around the hip and knee to help stabilize the leg.

What does performance rehab look like?

There isn't one exercise or treatment that works for every teenager with knee pain. The best program is individualized based on the person's symptoms, sport, strength, movement patterns, goals, and contributing factors.

However, there are several important pieces of the puzzle.

1. Education and confidence

A teenager should understand what is happening with their knee and what they can do about it.

Our goal isn't simply to tell them what not to do. We want them to leave therapy feeling confident about what they can do.

2. Calm things down enough to move forward

If the knee is highly irritated, we may need to temporarily modify activities that are causing a flare-up.

The goal isn't complete rest. It's finding the right amount of activity that allows the knee to settle while still maintaining movement and strength.

3. Build strength

Strengthening the quadriceps, hips, and other muscles throughout the leg can help the knee tolerate more load.

We often begin with exercises that are comfortable for the individual and gradually increase the challenge as their symptoms and strength improve.

4. Improve movement control

Strength is only part of the equation.

We also want the teenager to learn how to control their leg during activities such as squatting, jumping, landing, running, cutting, and changing direction.

This is particularly important for athletes who need their knee to remain stable while moving quickly.

5. Train the whole body

The knee doesn't work in isolation.

The muscles and joints of the foot, ankle, knee, hip, and trunk all contribute to how forces are transferred through the leg.

That's why a good rehabilitation program looks beyond the painful area and considers the whole kinetic chain.

6. Gradually return to sport

Finally, getting out of pain is not the only goal.

We want teenagers to be able to return to the activities they love and tolerate those activities well.

That means gradually increasing running, jumping, practice time, strength demands, and sport-specific movements rather than going from “I haven't done anything for weeks” straight back into full competition.

Don't ignore persistent knee pain

Not every episode of adolescent knee pain is serious, and not every case requires extensive treatment. But persistent or recurring knee pain shouldn't automatically be written off as “growing pains.”

A thorough assessment can help determine whether the problem is related to activity load, strength and movement capacity, patellar instability, or another condition that needs attention.

The good news is that there is a lot we can do.

With the right combination of education, load management, strength, movement training, and a gradual return to activity, many teenagers can get back to the sports and activities they enjoy with greater confidence in their knees.

Knee pain may be common in teenagers, but that doesn't mean they simply have to live with it.