How we treat Severs - growing pain in the heel

Similar to Osgood Schlatters, Severs is a growing issue except Severs effects the heels not the knees

At our sports performance gym and clinic we have been fixing Severs disease for as long as we have been fixing Osgood Schlatter.

After seeing our online Osgood Schlatter treatment program help thousands of young athletes successfully eliminate their knee pain and return to sport, we began the work to turn our Severs treatment into an online course as well.

Getting young athletes back to sport pain free is the most incredibly rewarding part of our work as coaches, and I am thrilled to share our approach here and let you know the program is now available! You can find our Severs rehabilitation plan here.

Severs Disease case study: Jack

Most recently in our gym we helped soccer athlete Jack and his sore heels. Jack started with us having carried Severs heel pain for more than 6 months!

Three weeks after starting with us, his Severs heel pain had gone from a 6/10 to a 1/10 on both legs, and he had returned to full training and playing levels for his soccer.

A young athlete with Severs disease

After finishing the full seven week plan, he is a constant 0 out of 10 for pain, and moving around the field with more speed and power than he ever has before.

Examining Jack’s case

Jack is 14 years old and has been sidelined from the pitch for months with severe heal pain.

Despite having a good athletic frame and many years of sport under his belt, Jack was actually not a good mover. In fact, his mum said he is often one of the slowest in his team over short distances and struggles with agility based training drills.

Jack recieved diligent care from an excellent practitioner, and when they came to us were kind enough to forward case notes. There were a massive list of adjustments completed, and activations and mobilizations prescribed, but nothing in the way of lasting progress.

If you have already read my original case-study on Sarah from back in 2014, you can probably guess what I am going to say next!

Once again the medical plan was all frosting and no cake. It was in fact another “textbook” treatment for Severs Disease, but did not include any of our key methods.

Understanding Severs Disease

For me to describe our plan and why it worked for Jack when traditional modalities did not, first we must unpack what Severs really is.

Put simply, Severs heel pain occurs when the shin bones (tibia and fibular) grows too fast for the calf muscles (Soleus and Gastrocnemius) to keep up. This means with every step the athlete takes the achilles tendon is pulling at its attachment on the heel bone (the calcaneus).

Severs disease at the achilles tendon
Here is an image of the calf and achilles tendon from the side. As you can see it connects directly on the back of the heel bone

Tight calves (and potentially muscles of the foot too) unable to keep up with rapidly growing shin bones are going to cause issues at the heels. It’s as though the bones are literally ripping the tendon from its attachment on the calcaneus.

Further, the attachment site is not fully bonded in young bodies, as they need to stay soft to allow for further growth and skeletal maturation.

With tall, active kids who have weak calves and glutes plus heavy inefficient running styles it’s no suprise that we see plenty cases particularly in dance, soccer, basketball, tennis, and volleyball.

Jack’s new treatment plan

Just like with Osgood Schlatter (also fundamentally a condition caused by bones growing too fast for tight muscles holding on to still-developing attachement sites), we can’t just wave a magic want and stop the growth spurt.

But some doctors will insist that is basically all we can do, and recommend ceasing all sport until the growth phase stops!

Our approach tackles Severs as a tendon problem rather than a bone problem, and as a result we unlock the ability to make massive improvements in just weeks.

Step one: Create length in the calf

The first and most important thing to do when addressing Severs 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 stretching the calf, you are pulling on the sore attachment point - literally the thing that triggers Severs pain!

Instead we leverage foam rolling. 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.

Foam rolling for Severs disease
It is very important to do this slowly and release all the trigger points. Throughout the program we provide detailed video instructions on all the exercises you need to eliminate Severs Disease heel pain

Step two: Create strength in the calf

A lack of strength in the calf is often hidden, but typically is a root cause of severs for younger athletes. It can be hard to spot weakness, especially in athletic strong-looking bodies.

Additionally, weakness is increased from the natural muscle inhibition triggered by Severs pain. This localized reflex is a handy response that prevents us from pushing injured body parts into the risk of further injury.

However in the case of Severs (just like Osgood Schlatter) this inhibition means the muscle we need to absorb kinetic energy is not doing its job. Where normally the calves act as incredible springs and shock absorbers, when inhibited and weak the tendons and joints end up taking all the forces from running, jumping and moving generally.

Thus for the purposes of our Severs treatment the inhibition reflex is a bad reflex. The great news is we can address this weakness without further inflaming the problem at the heel by using isometric holds.

Strength exercises for Severs disease
A standing isometric calf raise for the treatment of Severs 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 7/10 soreness to 0/10 in under 5 minutes. Building isos into a daily rehabilitation plan and progressing strength improvements over weeks is consistently effective on the path to curing Severs.

Treating growing pains in the heels

I think Jack’s case really demonstrates how we have re-thought Severs treatment, and is an example amongst hundreds of success stories from clients who have seen us in-person or completed our online Severs treatment program.

In Jack’s case our full course of treatment extended over weeks to avoid a recurrence of the condition in the future, and also tackled his poor running mechanics.

Our online treatment program is something that committed athletes can stick to and follow at-home, ensuring they will be more athletic in the years to come. Most importantly is we can avoid sidelining motivated and active kids for the length of their growth spurt.

All of these components, and step-by-step instructions to complete the plan are included in our online 7-week Severs Disease Pain Elimination Program. You will receive a 7-week training plan, exercise logbook, instructional videos and photos, along with digital support from our certified sports scientist to help rapidly beat Severs Disease and return to sport pain-free.

If you are located in Melbourne Australia please do reach out for an in-person assessment or to apply for our Athletic Development Program. You can find information about our High Performance Centre and physiotherapy clinic on our website.

Safe and effective training programs to relieve knee and heel pain caused by Osgood and Severs

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Osgood Schlatters treatment program

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A comprehensive seven week training plan to treat the cause of growing pain in the knees. Includes helpful resources,  professional support, and access to a supportive Facebook community.

$59.95 USD

Adult Osgood Schlatters program

Over 18 years of age and still struggling with Osgood? This program is designed specifically for you! A comprehensive seven week training plan to relieve your pain and get you back to a full and active life.

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A severs disease treatment training program

Get the Severs treatment program

A comprehensive seven week training plan to treat the cause of growing pain in the ankles and heels. Includes helpful resources,  professional support, and access to a supportive Facebook community.

$59.95 USD

A severs disease treatment training program

Cure heel pain forever by treating the root cause

  • Exercises suitable for athletes of all ages at home or in-gym
  • One payment for lifetime access to the program
  • Online program hub with all the resources you need

$59.95 USD