Mid-Season Breakdown: Why Your Young Athlete's Knee Pain Isn't "Just Growing Pains"

Published: October 26, 2026

Service area: San Jose, Santa Clara, Milpitas, Fremont, Cupertino, Los Gatos, and Sunnyvale

The athlete who felt fine in August may now be limping after practice, icing a knee every night, or asking to sit out. Across the South Bay, fall soccer, flag and tackle football, volleyball, cross country, and club basketball are in full swing. By mid-season, often after six to eight weeks of repeated practices and games, the training load has had time to accumulate.

It can be tempting to call recurring pain "just growing pains." But pain brought on by sport, a limp, or a swollen joint should not be brushed aside or played through. Many mid-season complaints follow recognizable overuse patterns. The sensible response is to manage the load and arrange a proper assessment, not to wait indefinitely for pain to disappear, and not to push on until the problem becomes more serious.

What "Growing Pains" Usually Means

"Growing pains" is a familiar name for a specific pattern of benign leg discomfort in children. It typically affects both legs, is felt in the muscles rather than at a joint, and occurs in the evening or at night. It is not usually triggered by sports activity, and it does not cause swelling or a limp. Symptoms generally settle by morning.

One-sided pain, pain centered at a joint, pain that comes on during sport, or pain accompanied by swelling, morning stiffness, or limping does not fit that classic pattern. It deserves assessment rather than an assumption that growth is the cause. This is general education, not a diagnosis; a clinician needs to consider the athlete's history and examination. See the review on growing pains and when to investigate.

Four Common Mid-Season Overuse Patterns

1. Front-of-knee pain in jumpers and runners

Soccer players, volleyball players, and basketball players repeat sprints, jumps, and landings. Pain around the patellar tendon, often just below the kneecap, or at the bony tibial tubercle below the knee can develop as repeated loading outpaces recovery. In a growing athlete, Osgood-Schlatter type pain involves irritation where the patellar tendon attaches to that growth area; patellar tendinopathy involves the tendon itself. Their symptoms can overlap, so location and age alone do not establish the cause.

2. Heel pain in running athletes

Sever's type heel pain is associated with irritation at the heel's growth area, particularly in growing athletes who run and jump frequently. It often hurts during or after activity and may be influenced by running volume, footwear, and calf tightness. A clinician should assess persistent or worsening heel pain, especially if it changes how the athlete walks.

3. Low-back pain with repeated extension or heavy loading

Football linemen, gymnasts, and young weightlifters may accumulate stress through repeated back extension, rotation, or heavy carries. Some back pain relates to muscles; other causes, including stress injury to a vertebral structure, need medical assessment. Persistent, focal pain or pain that worsens with activity should not be written off as routine soreness.

4. Shoulder and elbow overload in overhead athletes

Swimmers, volleyball players, and pitchers repeat overhead movements through training and competition. Throwing and serving volume can strain developing tissues around the shoulder and elbow. Pain during or after activity, loss of control or velocity, or symptoms that return when throwing resumes warrant an assessment and a review of the athlete's total throwing or serving workload.

These descriptions help explain common patterns; they do not identify what is causing a particular athlete's pain. Examination is what helps distinguish an overuse complaint from a more serious injury. The American Academy of Orthopaedic Surgeons' overview of overuse injuries in children explains why repeated stress deserves attention.

Why the Whole Movement Chain Matters

The body handles sport as a linked system. Force travels between the foot and ankle, knee, hip, trunk, and upper body. When pain develops, an athlete may guard the sore area or change how they run, land, lift, or throw. That adjustment changes how force moves through the kinetic chain and can place different demands on other areas.

This is why an assessment focused only on the sore spot can miss useful information. A "mechanical" evaluation looks at how the athlete moves as a whole, including ankle mobility, hip and trunk control, strength, and sport-specific demands. Pain also involves the nervous system, which processes sensation and helps coordinate movement. Addressing movement and training load is not the same as claiming that one joint or spinal finding explains every symptom.

Warning Signs That Need Medical Evaluation

Some symptoms call for medical evaluation, not a routine chiropractic appointment. Seek prompt medical care if an athlete has:

• Pain that repeatedly wakes them at night, particularly if it is focal or persistent.
• Joint swelling, locking, or giving way.
• Inability to bear weight.
• Pain after a direct impact or a twisting injury accompanied by a "pop."
• New numbness or weakness.
• Back pain with fever, or with bowel or bladder changes.
• Back pain that is constant rather than related to movement.

When symptoms are severe or rapidly worsening, seek urgent care. If you are unsure how quickly to act, contact the child's physician or an urgent medical service for guidance.

The Load Conversation: A Practical Place to Start

A useful first question is not only "How long was practice?" but "What was the total load this week?" Count games, practices, conditioning, school teams, club teams, private sessions, and independent training. Sudden increases or a congested schedule can leave too little time for recovery.

The "10 percent rule," increasing weekly training by no more than 10 percent, is sometimes used as a rough guide, but it is not a universal law or a guarantee of safety. The International Olympic Committee's consensus statement on load and injury risk supports individualized load management rather than relying on one number for every athlete.

Build in at least one full day each week away from organized sports, and plan time away from a particular sport during the year. The American Academy of Pediatrics' guidance on preventing overuse injuries discusses rest and reducing repetitive training stress.

Recovery also includes sleep and adequate fueling. Adolescents generally need consistent, sufficient sleep; training demands do not replace that need. As fall routines and daylight shift, families may also notice changes in energy or sleep. Persistent fatigue should not be dismissed as seasonal tiredness. Under-fueling, when intake does not meet the needs of growth and activity, is an under-recognized concern in teen athletes and can contribute to bone and soft-tissue problems. Concerns about food intake, body composition, growth, or ongoing fatigue belong with a physician or registered dietitian. See this review of sleep, nutrition, and injury risk in adolescent athletes.

What an Assessment and Care Plan Can Include

At Kim Dynamic Body Chiropractic, P.C., an evaluation begins with the athlete's history, symptoms, training schedule, and goals. When appropriate, we assess the kinetic chain, including joint mechanics in the ankle, hip, and thoracic spine, along with strength and movement control. We also consider footwear and cleats, training demands, and the movements that reproduce symptoms.

Care is individualized. The plan may include movement guidance, rehabilitation strategies, and adjustments to activity with the aim of keeping the athlete participating where it is safe to do so, not defaulting to full rest or encouraging them to push through pain. On-site Digital Radiography is available when imaging is clinically indicated; imaging is not needed for every complaint. Our sports chiropractic experience includes amateur and professional athletes. We also offer massage therapy with a certified massage therapist, ergonomics education, and fitness guidance. We treat the whole family.

For families looking for a sports injury chiropractor in San Jose, an individualized examination helps determine what care is appropriate for that athlete. We also welcome patients seeking a chiropractor in San Jose, chiropractic care in Santa Clara, or back pain relief in San Jose. Learn more about our practice at dynamicbodychiro.com or explore our exercise and recovery library.

What Parents Can Do This Week

1. Ask the coach about total weekly training volume, not just practice length.
2. Keep a simple log of symptoms, activity, and how the athlete feels afterward and the next morning.
3. Do not use pain-masking strategies simply to get through a game or practice.
4. Make sleep a priority and check that the athlete has time to recover.
5. Check shoes and cleats for fit and wear.
6. Arrange an assessment early when pain persists, recurs, or changes how the athlete moves.

Mid-season pain is common, often mechanical, and often manageable with timely attention to symptoms and training load. Athletes who finish the season strong are not necessarily the ones who ignore discomfort; they are the ones whose needs are recognized and addressed early. The right plan depends on the individual athlete, the examination, and the demands of their sport.

Clinical References

• American Academy of Pediatrics. Care of the Young Athlete: How to Prevent Overuse Injuries
• American Academy of Orthopaedic Surgeons. Overuse Injuries in Children
• Lehman, P. J., & Carl, R. L. Growing Pains: When to Be Concerned
• Soligard, T., et al. International Olympic Committee consensus statement on load in sport and risk of illness
• Sleep, Nutrition, and Injury Risk in Adolescent Athletes: A Narrative Review