The point at which a tendon inserts into a bone in a growing child is called an apophysis. This is an area of cartilage and can become inflamed if excessive stress is exerted upon it by the attached tendon. This will be more likely if the muscle and tendon becomes tight as during periods of rapid growth, particularly in athletic individuals. This inflammation, or apophysitis can occur in several areas but is particularly common in the heel (Severs disease) and the knee (Osgood Schlatters). The classic presentation is in children between 12 and 16 years. Pain is often felt whilst or after exercise. The point of maximal tenderness is below the kneecap at the insertion of the patella tendon to the shin bone(tibial tuberosity). This area often becomes swollen and tender to touch. Symptoms will often settle with rest. More rarely the proximal attachment of the tendon to the patella (kneecap) is affected. This is known as Sindig-Larsson-Johansen syndrome.