In this blog you can learn about what pain below the patella or "Knee Cap" can be caused by. In adolescents during their growth spurt the large quadriceps tendon can become overloaded at the point that it attaches to the tibia. At this point there is a growth plate that reacts to some of the excessive load placed on it by trying to lay down more calcified bone. This can lead to a painful swollen lump over the top of the shin. It can be contributed to by many factors such as tight muscles struggling to keep up with the rapidly growing bones. Weak muscles and hypermobile joints that cause a lack of control at the knee or poorer shock absorption can also contribute. These factors can be improved with a supervised and gradually increased exercise program.