Managing Your Sever's Disease: Steps to Fix Your Heel Pain
It is possible to drastically reduce your heel pain caused by Severs in just a matter of days and weeks, and even completely eliminate your Sever's heel pain in seven short weeks.
At Core Advantage, we have helped hundreds of young athletes rehabilitate and train their way out of Sever's Disease heel pain in a matter weeks. Here's how we do it.
Sever’s Disease Training Program
In this article we will outline everything you need to know about Sever's Disease, how to rapidly get relief from your Sever’s pain and get back to playing the sport you love.
After seeing the success of our online Osgood Schlatter treatment program in helping thousands of young athletes successfully eliminate their knee pain and return to sport fast, we have launched a Severs-specific treatment plan, available right here on this website.The Sever's treatment program is a progressive, age-appropriate seven week training plan that you can complete at home in just a few minutes a day. Written by the sports science and strength and conditioning coaches at Core Advantage, it includes everything you need to get on top of your heel pain fast. You can purchase our Severs rehabilitation plan here →
Understanding Sever's Disease
Sever's Disease (calcaneal apophysitis) is a common growth-related condition causing heel pain in active children and adolescents aged 8-14. Despite its name, it's not actually a disease but rather an overuse injury that occurs during growth spurts.
The condition develops when a child's heel bone grows faster than their calf muscles and Achilles tendon can adapt to. This growth mismatch creates increased tension where the Achilles tendon attaches to the heel bone. During activities like running and jumping, this tight tendon pulls on its attachment point at the heel, eventually leading to inflammation and pain.
This explains why Sever's is particularly common in young athletes involved in sports with lots of running and jumping, such as soccer, basketball, and gymnastics. It also helps us understand why proper treatment needs to address both the tight muscles causing the problem and the irritated attachment point where the pain occurs.
A Sever’s Disease Treatment Plan
To beat your Sever's Disease heel pain, we need more than just random exercises – we need a strategic, progressive program that addresses all aspects of the condition. Understanding that Sever's occurs due to growth-related muscle tightness and heel bone irritation, successful treatment requires a carefully planned approach that both relieves current symptoms and prevents future flare-ups.
The Three Phases of Sever’s Rehabilitation
Rather than jumping straight into stretching or strengthening, effective Sever's Disease treatment follows a specific progression:
- Pain Management Phase
During this initial phase, our focus is on calming down the irritated heel and reducing pain levels. We'll introduce gentle exercises that don't stress the heel while ensuring proper footwear and activity modifications are in place to prevent further irritation. - Muscle Release & Strengthening Phase
Once pain levels are under control, we begin working on the tight muscles that contributed to the condition in the first place. Through a combination of foam rolling, gentle mobility work, and progressive strengthening exercises, we create positive changes without aggravating the heel. - Return to Sport Phase
The final phase focuses on building resilience and preparing for a return to full activity. We'll incorporate sport-specific training, improve running technique, and carefully manage training loads to ensure a successful and lasting return to sport.
Our 7-week Severs Pain Elimination Program guides you through all three phases with detailed instructions and guidance, ensuring you're taking the right steps at the right time for optimal recovery.This structured approach ensures we're not only solving your current Sever’s symptoms but also building a strong foundation for lasting recovery, rather than just temporarily masking symptoms or potentially aggravating the condition with inappropriate exercises.The online program includes:
- Progressive Strength Training: Age-appropriate exercises that build resilience in the right muscles at the right time
- Smart Load Management: Balancing activity levels to allow healing while maintaining fitness
- Movement Technique Work: Learning proper patterns to reduce stress on the heel
- Recovery Strategies: Including proper footwear, activity modification, and strategic rest periods
You can learn more about our 7-week Sever's Disease Program here, or read on to learn more about each component through a case study of an athlete who successfully beat his Sever’s Disease with our methods.
Severs Disease Case Study: Jack
We see young athletes crippled by heel pain all the time. One great case study that can help us highlight the Sever's treatment process is 12 year old soccer athlete Jack.
Jack come to see us at Core Advantage after having struggled on and off with Sever's Disease for more than 6 months!
Three weeks after starting at Core Advantage, his Severs heel pain had gone from a 6/10 to a 1/10 on both heels, and he had returned to full training and playing participation for his soccer. Two weeks later he was at a 0/10 in both heels.
Jack’s Sever's treatment plan
Jack had been seeing a physiotherapist (physical therapist) on and off, and while he was doing his home exercises (standing calf raises, calf stretches) consistently he was not seeing any lasting improvements in his pain levels, and when he came to us we reached out to compare notes and get a detailed history to help inform our programming.
His therapist had tried every conventional intervention in the Sever's textbook; orthotics and heel lifts, manual therapy, needling, activation and mobilisation prescribed, but nothing had any more than minor and temporary relief for Jack's heel pain.
Jack and his parents sought a second opinion and a sports doctor insisted that all he could do was wait it out, ceasing all sport and waiting the 6-18 months for his teenage growth spurt to finish and let the Sever's naturally heal on its own!
If you have already read my Osgood case-study on Sarah from back in 2014, you can probably guess what I am going to say next!
Once again, Jack’s rehab plan was all frosting and no cake. It was a perfectly “textbook” treatment for Severs Disease, but did not include any of the key methods we apply at Core Advantage or in our online programs that make them so effective.
While the idea of waiting out a potential 18-months for his growth spurt to come and go was out of the question for Jack, his parents and for us. For a young athlete that is the kind of gap in sport that Jack may never catch back up on.
Assessing Jack’s Sever's case
Armed with this knowledge, and with a focus to look at his Sever’s as a tendon injury and not as a disease, we got to assessing Jack and began devising a plan.
Unlike most Sever's cases we see, Jack wasn't yet in the peak of his growth spurt. This meant that while rapid bone growth wasn't the primary culprit, leaving the condition untreated would likely lead to more severe symptoms once his growth acceleration began.
The most striking observation during our assessment came from his movement patterns.
Jack was not a good runner.
His mother's observation that he was "one of the slowest in his team" pointed to a deeper issue. Despite his small frame, Jack was heavy on his feet, slow in his motions and got tangled up in his limbs with the most basic of agility drills.
These movement inefficiencies had created a problematic cycle: the pain from his Sever's caused him to modify his running style, which in turn led to muscle weakness and stiffness, heaviness and a lack of speed in his movement, further compromising his athletic performance and potentially worsening his condition. Combined with the reflexive muscle inhibition in the calves that comes from Sever’s Disease and Jack was in a bad place.
Jack not only needed pain management to get him out of pain, but also a complete movement retraining approach to break the cycle and prevent his Sever’s coming back in the future.
Step one: Create length in the calf muscles without pulling on the Severs attachment
The first and most important thing to do when addressing Sever's Disease is to create some length and flexibility in the calf. This accommodates the rapid bone growth, and takes pressure off the attachment site of the achilles tendon into the heel.
Typically, people make the mistake of simply stretching the calf at this point. Unfortunately by jumping straight to stretches for Sever's you are pulling on the sore attachment point - literally the thing that triggers Severs pain!
Foam rolling for Sever's Disease
Instead we leverage foam rolling as the first and most crucial intervention.
Rolling for self myofascial release becomes essential for active young children. Rolling allows you to create length and improve flexibility in the calf and entire lower body without pulling directly on the sore tendons as you would with stretching.
For Jack, he started completing rolling on his calves & feet twice a day. We also had him complete a lower body rolling routine most days of the week to improve flexibility and mobility through his entire lower body — something he would be needing in the coming weeks as we start to retrain his movement skill.
Stretches for Sever’s Disease
Later in the program, we carefully introduced targeted stretches for Jack's calves - but timing is crucial here.
Stretching for Sever’s is a tricky balance — increasing flexibility is a key part of managing the pain and adding length to the calves but the best stretches also pull directly on the heel bone, potentially exacerbating the problem.
For Jack, this meant we started general hip and thigh stretches in week two of his training, and targeted calf stretching in week 3 when his pain was starting to come under control and the stretches did not cause any direct irritation of the heels or Achilles.
For the online Severs program we follow a similar approach beginning gentle stretching exercises in the middle stages of the program and once the initial pain has settled. The key is to never stretch to the point of pain and always warm up the tissue first through light walking or foam rolling.
Heel lifts, Cups and Orthotics for Sever’s
Because Jack was experiencing pain when walking, we suggested he wear a pair of heel lifts temporarily to further take the tension off this Achilles and heel bone.
Heel lifts are far from a magic solution for Sever’s but they can be a great short term support, the same as using tape to strap for Severs, or a knee strap with Osgood.
You can read more about heel lifts and Severs in this article →
Step two: Create strength with isometrics
A lack of strength in the calves and foot muscles is a common cause of Sever's for young athletes. It can be hard to spot this weakness directly, as it’s tricky to measure and doesn’t always show up in general activity or sport — especially in athletic strong-looking bodies.
Weakness is at least in some part connected to the muscle inhibition in the calves triggered by Sever's pain. This muscle inhibition reflex is a natural response to pain that prevents us from pushing injured body parts reducing stress on the injured sited and reducing risk of further injury, but when left unchecked this inhibition and weakness worsens further exposing the injured and painful heels to stress.
This creates a vicious cycle where heel pain leads to calf inhibition which leads to weakness, leading to changes in movement patterns, further loading the heels and opening the door for more pain!
Where normally the calves act as springs and shock absorbers, In Sever’s cases (just like when treating Osgood Schlatter), the calves become inhibited and unable to absorb the kinetic energy during running, jumping and landing. The injured and painful joints, bones and tendons end up taking all the forces from running, jumping.
For our purposes in Sever's disease treatment we need to break this inhibition reflex loop through pain-free strengthening exercises.
For this, we use calf isometric holds.
Isometrics strengthening for Sever's Disease
Isometric holds (or ‘Isos’) with the heel hovered just slightly off the ground are incredible. We often see a single dose of isometric holds take someone from as much as a 7/10 soreness to a 0/10 in just a few short minutes.
Building Isos into a daily rehabilitation plan and progressing strength improvements over weeks is consistently effective on the path to treating Severs.
For Jack, he would do his calf isometrics in the gym with us 3x a week as part of his strength training program. For the online program, we encourage athletes to do the isos more frequently, ideally every day.
Step 3: Relearn how to run with Sever’s Disease
Inefficient running styles, characterised by heavy landings or overstriding, can increase the stress on the heel and Achilles tendon. Combine this with weak muscles in the calves, feet and core and rapidly growing and changing bones can lead to compensatory movements that put extra strain on the lower legs and feet. For Jack to solve his Sever's Disease, reprogramming his movement patterns, specifically, his running technique was crucial.
Compensatory patterns and growing pains
Over time, athletes with Sever's Disease may unconsciously alter their movement patterns to avoid pain, potentially leading to inefficient techniques and increased risk of other injuries. This is called a compensatory pattern, and while it may help the athlete alleviate their pain during sport in the short term it can also lead to other injuries or reduced performance in the long term.
This aspect of rehabilitation is the most often overlooked part of returning from Sever’s Disease, yet it plays a pivotal role in not only returning from the current injury but also prevention of future issues. Movement skill training is essential because it directly addresses one of the primary root causes of Sever's Disease, helping young athletes be lighter on their feet and more efficient with how they absorb and create energy when moving rapidly, while providing numerous benefits to the young athlete.
To do this we use progressively more complex and more intense running drills like skipping patterns, foot quickness drills like those used by track sprinters to help young athletes groove new, smooth motor patterns. Later, when the heels are settled and pain free we reintroduce progressive exposures to running, first slow then faster, in controlled doses to lock in these new patterns.
Even though this was Jack’s #1 priority and likely the leading trigger for his Sever’s it was still only initiated after steps 1 & 2 were well underway. Movement skill training requires doing movements that mimic jumping, landing and running which can be the exact cause of the Sever’s pain in the first place, so settling his heel pain must be addressed first.
The Three Elements for Treating Your Sever's Disease
There you have it, three crucial elements to successfully start fixing your Sever's Disease and get back to playing sport today. The program focuses on integrating and progressing you along the rehabilitation process with all three three essential components working together to create lasting relief and improved athletic performance:
1. Creating Length and Mobility
We begin by carefully addressing tight muscles through targeted foam rolling and progressive stretching techniques, taking pressure off the painful heel without aggravating the condition.
2. Building Strength and Stability
Once we've created better tissue mobility, we introduce specific strengthening exercises that help your muscles keep pace with bone growth and create resilient, adaptable tissues.
3. Developing Movement Skill
The final piece transforms how young athletes move, teaching them to run, jump, and change direction efficiently. This not only reduces stress on the heels but creates faster, more coordinated athletes.
Proven Sever’s Disease Program from Core Advantage
We've packaged this comprehensive approach into our online seven-week Sever's Disease Treatment Program. This age-appropriate program guides you through every step with detailed video demonstrations, a progressive training plan, and a comprehensive exercise logbook to track your progress. Plus, you'll gain access to our supportive online community where you can connect with others on the same journey and receive expert guidance from our coaches on your way out of pain and back to sport.
Don't let Sever's Disease hold your young athlete back from reaching their potential. Join the thousands of athletes who have successfully overcome heel pain and returned to sport stronger than ever.
