What do Wayne Rooney, Michael Owen, Steven Gerrard, Paul Scholes, Marcus Rashford, and Jordan Henderson have in common?
England internationals at World Cups. League Cup winners. Premier League goalscorers (more than 700 between them). But they were also all affected by a knee condition, Osgood-Schlatter disease, during their academy days, which put their long-term development in doubt.
And they are not alone.
“I remember times when I cried because I couldn’t train.” That’s Manchester United centre-back Raphael Varane.
“There were two years when I literally did nothing,” says Everton’s Jarrad Branthwaite, recently called up by England. “My knees were gone because I had grown so quick. I couldn’t run, it was so painful.”
“My bones were growing quicker than my muscles,” says Danny Welbeck of his time in Manchester United’s academy. “Afterwards you’re in agony every single time you play football.”
Charlie Wakefield, a former long-time Chelsea youth player who has just helped Braintree Town to the fifth tier after a series of debilitating injuries, summarised the experience as part of a TikTok trend.
“I’m a footballer,” he wrote. “Of course I had Osgood-Schlatter when I was 13.”
A whole week since Charlie Wakefield did this 🫢#GOTD | @braintreetownfc pic.twitter.com/sRK5fCoJrk
— The National League (@TheVanaramaNL) May 13, 2024
Physiologically, Osgood-Schlatter is the inflammation of the tibial tubercle, which connects the knee with the tibia, known as the shinbone. It can be felt as a small bump at the base of the knee. Highly active teenagers, with a large exercise load, are especially susceptible.
“Typically, you see it in children who are mid-growth spurt,” says Ruben Jongkind, former head of talent development at Ajax’s academy. “Why? Because the bones grow faster than the tendons. If you take the skeleton as the basic framework for the body, and everything else is hung up on that, then muscles are connected to the bones by tendons. And it is those tendons that are the most delicate part of that movement system.”
Boys are more susceptible than girls (with the male-female ratio ranging from 3:1 to 7:1), though this comes with the proviso, as is common in women’s sport, that the impact on female athletes has not been studied in as much detail.
Several studies have provided estimates that at least 20 per cent of elite-level academy sportspeople have suffered from the condition — although anecdotally, and in certain academies, the prevalence is higher.
It is clear how the condition actively shapes academy football — and the elite game.
Everton and England forward Dominic Calvert-Lewin, while coming through at Sheffield United, moved to striker from centre-midfield after missing several months. In his words, it helped him “get used to my long, gangly body again”.
Conor Gallagher was another to be afflicted. “I had it quite severely for a few years,” he told Chelsea’s website. “I couldn’t run or sprint properly, which means you won’t be as effective in games, but Chelsea were brilliant, they believed in me and I came back stronger.
“I had to change my position a little bit, I moved out from the middle to the right where I didn’t need to be as athletic, but I grew through it.”
Most notably, it is understood that Osgood-Schlatter was one of several factors behind Declan Rice’s release from Chelsea at the age of 14, after it led to him losing coordination.
“No one’s got a crystal ball, but you definitely need to have the experience of knowing where players are in their maturation curve,” former Chelsea scout Harry Watling told The Athletic last year. “Then you can go, ‘OK, this boy has just gone through a period of growth. His coordination is totally gone, he can’t run at the moment. He’s going to go through some Osgood-Schlatter, maybe some shin splints’ — but you have to give the players a chance to get used to their bodies again.”
At the Qatar World Cup, three of England’s centre-midfield options had needed that opportunity. Rice, Gallagher, and Henderson all suffered from Osgood-Schlatter growing up — as well as manager Gareth Southgate, who missed almost a year while at Crystal Palace’s academy.
Jongkind was at Ajax’s academy between 2011 and 2016 when the Amsterdam club’s youth system produced Frenkie de Jong, Matthijs de Ligt, and Donny van de Beek. At the beginning, Jongkind had worked intensively on improving player health and welfare under the so-called ‘Cruyff Plan’ — with Osgood-Schlatter being one important component.
“When I started, I remember seeing our under-14s,” he says. “It was eliminating maybe half, three-quarters of the team. Eleven of the 18-person squad had the problem.
“The coach was not really looking at the individuals. He was running his programme with field hockey shuttle runs for conditioning, with no strength training. The medical department didn’t have influence.”
One of Jongkind’s first steps was to restructure the relationship between the coaching and medical teams, encouraging them to work together more holistically.
“So why doesn’t everybody get this problem?” Jongkind asked himself. “It depends on four factors. The first is simple: how is the tendon growing compared to the bone? The second is biomechanical: how does the body move? How does the knee joint catch the load? The third is strength; some children lack the muscles to physically take the load.
“And then the fourth is psychological: it is the pressure children endure in professional academies. That can make the healing go less rapidly.”
In the past, and still at amateur level, Osgood-Schlatter has been reduced to ‘growing pains’ — a catch-all term that, when used casually, appears to demean the severity of the condition. Its susceptibility is still closely linked to rapid growth spurts.
Jayden Danns, who broke through into Liverpool’s first-team this season, went from 5ft 2in to 6ft (157cm to 188cm) in under a year, and was out for eight months as his tendons caught up. “It was a tough time,” he told the club’s website. “You’re thinking: ‘Why is this happening to me?’.”
Across the city at Goodison Park, former Everton academy manager David Unsworth introduced measures to flag when a player was high risk. He had experienced Osgood-Schlatter as a trainee.
“Three times a season, we would do a full body screening for the players — some of the growth spurts these boys would have were incredible,” he says. “Because of it, when I became academy head, I made the 12-to-16-year-olds go down from four days a week training to three.
“Osgood-Schlatter would generally present around the 14-to-16-year-olds, and as soon as we discovered it, we’d shut the boys down. We were always much more worried about stress fractures because they’re the ones that can impact you long-term — but the boys with Osgood-Schlatter would come in once or twice a week for physio.”
Another complicating factor is the player, who will almost always want to play, despite the pain.
“I did training sessions where it hurt but I didn’t say anything,” said Varane, who, as a teenager, was desperately trying to retain his place in France’s elite CRAF academy. “Then I’d come back, put ice on it, and keep on going. When I couldn’t take any more, when it got too painful, I’d stop.” The cruelty of Osgood-Schlatter is that it presents at the age players are battling to sign scholarship forms as under-16s — already the most brutal cull of the academy process. Many players will take risks to play, or fall out of the game altogether.
Branthwaite was almost released by hometown club Carlisle United after missing 18 months, but kept his place after being talked around by his parents, who convinced him to embark on a six-week post-recovery boot camp.
“It felt like the end of the world for players because they weren’t allowed to play,” says Unsworth. “But for us, if there was ever a question about their future potential, and they were injured, we’d always err on the side of giving them an offer. Six months out with an injury would not deter us. We wouldn’t concentrate on the physical side because that would come.”
Some players still slip through. Nordin Amrabat, brother of Manchester United midfielder Sofyan, was released by Ajax at 13 due to the condition, before Jongkind’s time.
Tashan Jordan, 31, was considered the best talent in his age group by Queens Park Rangers. From the age of 14, however, he began to experience issues.
“My knees would just stiffen up,” the winger says. “I didn’t know if it was the kind of player I was, sharp turns, that was putting pressure on it. The pain would increase after the game, and I couldn’t sit down for too long. I was always icing.
“I remember playing against Portsmouth and other clubs outside of London. Imagine playing that game, having Osgood-Schlatter, and then the car ride home for a couple of hours. My knees were in so much pain, and I had to be quiet about it. Those journeys killed me.
“I went to the physio, and obviously, when they told me what it was, I hadn’t heard the word before. Osgood-Schlatter — I thought it was another player coming in.”
Though several team-mates had it, Jordan’s case was severe. He missed two years and though QPR were supportive, keeping him in the building and offering treatments, Jordan found it difficult to cope mentally.
“I don’t want to speak for everyone,” he says. “But we were kids — we didn’t have the emotional intelligence to look it up. We just wanted to play.”
This feeling meant that Jordan pushed to return, scrabbling to be offered a contract. “Mentally, it was draining. A lot of those players who I might not have thought were better than me, they’re out on the pitch. There might be some training sessions which I’m speeding through to get back. There were times when I lied and said, ‘OK, I’m fit to play’, when I wasn’t. You’re easily replaceable.
“I put a lot of pressure on myself to make it professional. I didn’t have a Plan B. Growing up, especially, I was broke. When I was so focused on football, I didn’t even think of the possibility of getting injured.”
After two years, Jordan returned. QPR had offered him a non-contract, where he was still part of the club but not yet on professional terms, which he was grateful for. But soon after came another devastating diagnosis. Jordan developed tendonitis in his knee, and this time, QPR were not prepared to wait. He was released, and is still unsure whether his tendonitis was related to the Osgood-Schlatter.
“You know that stigma of when you’re trying to impress a girl? ‘Hey, I would have made it pro, but for my knees?’. It’s like that — but if I didn’t have these issues, I believe it would have happened.
“I suffered for years to get over it. I had depression and was suicidal. As much as I was injured in my knees, I was injured within the brain.”
Jordan is now back playing at a semi-professional level, in the ninth tier of the English football pyramid, and is pain-free. He has changed his game, allowing the younger players to do more of the running — but is at peace.
“I feel like I’m 29 when I’m playing, so I’m getting those two years back (from Osgood-Schlatter),” he says. “It made me who I am today. I’m thankful. There’s more depth to me now.”
Jordan came through in the late noughties, though the experiences of many of the England squad demonstrate how it still permeates academy physio rooms. What has improved are ways to adapt.
Alex Allen works for the NFL UK academy in Loughborough, but was an academy physio at Manchester United and Nottingham Forest.
“At Forest, we grouped the system from stages one through three,” he says. Like Everton, Forest would monitor heights and weights to flag potential susceptibility.
“During stage one, we’d try to avoid hard surfaces, stopping them from training indoors by playing futsal, for example,” he says. “Grass is better. Under no circumstances would we ever tell them to stretch — because they’ll just pull even more on the bone, causing more issues.
“Stage two is when it starts to affect their ability to perform, and we’ll take them off training sessions and replace that with gym-based rehab. Hopefully, we can then control their game time and load as they return.
“When they end up in stage three, we completely offload them from a form of exercise that will basically contribute to their symptoms. So even gym-based stuff, we say it’s non-contact, to give the symptoms an opportunity to climb down.”
Part of the challenge is about communication — ensuring that the staff are sufficiently informed to carefully follow and support a rehabilitation programme. It is an issue across football.
“If you have a good multidisciplinary team where everyone is communicating effectively, you won’t have issues,” says Allen. “There have been times at clubs I’ve worked at where the communication hasn’t always been clear, when you’ve specified something but the coach goes against you.
“So you’ve said: ‘OK, they need to play 25 minutes this weekend’, and then come back in on Monday to find out they’ve been played for 45. That’s double the amount — and you realise their symptoms have got worse as a result. That happens a lot.”
The Athletic has been told from other sources, which cannot be shared due to medical confidentiality, of players who were forced to play through so much pain in academy football that they still have associated knee conditions.
Osgood-Schlatter is as much an issue of culture as physique. After several years, Jongkind helped virtually eliminate Osgood-Schlatter at Ajax.
“Though they sometimes may play less, it’s in the interest and health of the children,” says Jongkind. “That’s the task of the leadership of the club — to create a culture where the potential is more important than the results. That’s always the balance.
“We, as adults and football people, have to create an environment to accommodate the children, and not use the children to accommodate our environment.”