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Teenage Runner's Knee Pain in Both Knees: Growth Considerations and When to Worry

"I have a 16-year-old son who runs track and cross-country, and he's had knee pain on and off for the past few months. He does pronate — we went back to the running store and got him a shoe with more support, and that helped some. He saw a physical therapist and got exercises, and he seems to do better when he stretches. He's just been fitted with a knee sleeve with a strap on it. He seems to hurt most when he's warming up and after he runs, not so much during the run itself. The thing is, exercises for his quads and hamstrings aggravate his pain — even isometric ones. His pain is general to both knees but concentrated in the medial part. He ices his knees daily and takes Aleve on and off, but not as consistently as he should.

– Ann, Fort Worth, TX

Answer by Dominique: Hi Ann,
Thanks for your question about your son's knee pain. It's hard watching a teenager hurt when he's trying to train.

Let's face it — knee pain that turns up in both knees, and keeps coming back no matter how many things you've tried, is enough to worry any parent. I've spent over 20 years coaching runners of every age, and bilateral knee pain in a teenager is a pattern worth taking seriously without panicking.

So why does this keep happening in both knees? In most teenage runners it's a straightforward overuse pattern — tight or under-strengthened upper-leg muscles, overpronation, and a training load that's outpaced the body — the same broad category as adult medial knee pain. A still-growing athlete, though, gets evaluated a little differently, which the red flags section below covers.

I'll break my response down as follows:

1. Why This Isn't Quite the Same Problem as an Adult's Medial Knee Pain
2. What Generally Helps While You Sort Out the Cause
3. Red Flags in a Growing Runner — When This Needs More Than Home Care

1. Why This Isn't Quite the Same Problem as an Adult's Medial Knee Pain

Most medial knee pain in adults comes down to muscle and tendon — tight quads or hamstrings, weak hips, a kneecap tracking slightly off-centre. In a still-growing teenager, there's one more thing in the mix: the growth-plate area itself can also be involved, a traction-type irritation where a tendon pulls repeatedly on bone that hasn't finished developing.

That's not a diagnosis — it's one more thing a pediatric sports-medicine provider will check for that simply doesn't apply to an adult with the same symptoms. If you want the general adult-oriented picture first, read the fuller breakdown of medial knee pain causes and self-checks — it includes a simple check for whether your pain is impact-driven, and it's a genuinely useful starting point here too. But with pain this persistent and this symmetrical in an adolescent, treat that self-check as a narrowing tool, not a substitute for getting it properly looked at.

2. What Generally Helps While You Sort Out the Cause

While you work out what's actually driving this, there's a sensible, general approach worth starting now. Ease off relative load rather than stopping outright — cut back mileage and intensity rather than training through the pain. Stretch properly after running, not before. Self-massage with a foam roller or massage stick can help loosen up tight upper-leg muscles. And build upper-leg strength gradually and under supervision, rather than pushing through pain on isometrics or any other exercise.

That last point matters a lot here. If an exercise consistently makes the pain worse — as it did for your son — that's a signal to scale it back or pause it altogether, not push through it, until your son has been properly evaluated.

I'll add one coaching-level observation of my own, alongside the general guidance above, not instead of it: in my experience, tight upper-leg muscles can refer pain down into the knee. When I worked through a similar issue myself, good post-run stretching plus a foam roller and the occasional sports massage made a real difference. It's worth trying — but it's one input among several here, not the whole answer.

3. Red Flags in a Growing Runner — When This Needs More Than Home Care

Here's where I want to be direct with you. The letter above ends with a plan to "go get a referral for a magnetic resonance imaging (MRI)" if things don't improve — and for a still-growing athlete, that's too passive a bar to wait for. Any of the following is reason enough for a pediatric sports-medicine opinion now, not a wait-and-see approach:

• Pain that is bilateral and has persisted for months despite new shoes, physio, and stretching — this pattern on its own warrants an evaluation rather than continued self-treatment.
• Pain that is specifically triggered or made worse by strengthening exercises, rather than easing as those exercises take effect.
• Any pain at or near a growth plate, or anything a clinician should check for growth-plate involvement given your son's age — worth raising directly at the appointment.
• The general knee red flags that apply at any age: locking, catching, the knee giving way, visible swelling, pain at night, or being unable to fully bend or straighten the knee. For the fuller list, see general running-injury red flags that apply at any age.

Coaching guidance — mine included — covers training load and biomechanics. A still-growing athlete's persistent, bilateral, strengthening-aggravated knee pain is a pediatric sports-medicine question, not a wait-and-see one. Don't let "he's young, it'll probably heal on its own" delay that visit.
Bilateral knee pain in a growing runner is frustrating precisely because it's easy to wave away as ordinary growing pains. Work through the general approach above, keep a close eye on anything that matches the red flags, and don't let his age talk you out of getting it checked if the pattern here sounds like his. All the best with it.

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