Why Your Knee Hurts at the Start of the Season

(And Why It Comes Back Later Too)

Dr. Tyler Centner, PT, DPT

10/27/20265 min read

Here's a pattern we see every single year. An athlete's knee starts acting up in the first couple weeks of tryouts or practice. It calms down. Then, right around week six or seven of the season, it flares right back up.

Most people lump both of these under expected "knee pain", suck it up, and move on. I push back on that. They're usually two completely different problems. Each one is caused by something different, and each one needs a different fix. Treating them the same way is often why the knee never fully settles down.

The good news first: in both cases, the knee usually isn't damaged. It's just being asked to do more than it's ready for. Once you understand which version you're dealing with, the fix gets a lot simpler.

Why It Shows Up Right When the Season Starts

Think about what your body actually goes through in the first two weeks of a new season. Most athletes go from a slow, easy off-season into full-speed practices almost overnight, with sprinting, jumping, and cutting nearly every day. That alone can pack more hard running and jumping into two weeks than the previous two months combined.

Your knee just hasn't caught up yet. The tendons and muscles around the kneecap need time to adjust to that kind of demand. In younger athletes, even the growth plates near the knee need that same adjustment period. Skip that adjustment period, and things get cranky.

In younger athletes, roughly middle school through early high school age, this often shows up as pain right at the top of the shin bone or just below the kneecap. It's commonly called Osgood-Schlatter, and it sounds scarier than it is. It's not a growth plate injury in the dangerous sense. It's more like a tug-of-war spot. The leg bone is growing faster than the muscle and tendon can keep pace, and all that jumping and sprinting pulls on that spot harder than it can handle right now.

In older teens and adults, it usually shows up differently. Sometimes it's a dull ache around or under the kneecap that gets worse going up and down stairs or squatting. Other times it's a pinpoint sore spot right below the kneecap that gets worse with jumping.

There's real research behind this, and the short version is simple: injuries spike when training jumps up faster than an athlete's body is ready for it. Ramp up too fast, and risk goes up. Stay too inactive in the off-season, and risk goes up too. The sweet spot is somewhere in between, and how you get there matters more than how much you eventually do.

So what actually helps? Two things. First, don't jump from zero to full-intensity scrimmages in the first week back. Build into it over three or four weeks instead. Second, and more important long-term: strength training shouldn't stop when the season ends. It should run all year. Your body's capacity, how strong your legs are, how well you can absorb landings and change direction, needs to stay ahead of what your sport demands from it. When training falls behind that demand, the knee is usually the first thing that pays for it. Year-round strength work is what keeps that gap in your favor, so the season never asks for more than your body's already prepared to give.

Why It Comes Back Weeks Into the Season

This one's a different story entirely. By week six or seven, the knee isn't reacting to a sudden jump in activity anymore. It's reacting to weeks of games and practices piling up. Often there's a second sport or club team stacked on top of that. And usually, strength training has quietly disappeared from the schedule, because "there's no time" once the season gets going.

Fatigue builds up faster than the body can recover, and the knee is usually the first place that shows.

Sometimes it looks like that same tendon soreness from earlier in the season, except now it hurts during practice instead of just after. That's a sign the body isn't keeping up with the demand anymore, not just a one-off bad day. Other times it shows up as soreness around the kneecap that gets worse as an athlete gets tired. Tired legs tend to be sloppier legs. When the muscles around the hip and knee fatigue, form breaks down a little. That means the knee ends up absorbing more stress with every landing and cut.

This kind of overuse pain is incredibly common in young athletes, though it hits some sports and some athletes harder than others. The athletes who get hit hardest are usually the ones playing one sport year round with no real break. Same joints, same tissues, loaded over and over, with nothing else to balance out that stress.

Here's what helps. Strength training shouldn't disappear once the season starts, it just needs to shrink down. Even one shorter session a week keeps the body more resilient than skipping it entirely. It also helps to build in an easier week every few weeks instead of running full speed for the whole season. And if an athlete is playing on two teams at once, someone needs to be tracking the total load across both, because most of the time nobody is.

The Knee Is Usually Just the Messenger

In both situations, the knee tends to be the first thing to complain when something else is out of balance. That imbalance could be how fast training ramped up, how much rest an athlete is actually getting, or how strong the hips and legs are overall. Either way, the knee itself is rarely the actual site of a serious problem.

That said, don't brush off every ache as normal. If you notice any of the following, get it checked out instead of pushing through: swelling that doesn't go down after a day or two, the knee catching or locking, a feeling like it might give out, pain that wakes someone up at night, or pain that's still just as bad after three full days of rest. None of those are "just ease off training" situations. They need an actual look.

For everything else, the fix usually isn't rest until the pain disappears, followed by jumping straight back into full activity. It's figuring out which of these two problems you're actually dealing with, and adjusting from there. If a knee issue has stuck around longer than a few days, or keeps showing up game after game, don't wait on it. Book an evaluation with us at The Platform before it turns into missed playing time. Catch it early, and it usually never turns into a bigger story.

- Dr. Tyler Centner, PT, DPT

About The Author

Dr. Tyler Centner, PT, DPT is a Doctor of Physical Therapy who specializes in working with basketball and volleyball athletes. With a background as a collegiate basketball player and extensive training in strength and conditioning , Tyler understands the unique physical demands placed on athletes in and out of season.

After rehabbing hundreds of athletes through knee injuries, Tyler has developed a passion for helping athletes understand how strength, mobility, and physical preparation can complement an athlete on and off the court.

Tyler's goal is to help athletes become not only stronger players, but also more resilient athletes by developing the strength and physical capacity needed to support the demand on their bodies during and after season.

If you are looking for help with a knee injury or your ability to play at a higher level on the court, please reach out to The Platform, as Tyler will help you reach your goals.