The Secret to Beating Sever's Disease Heel Pain Forever
You do not have to suffer with Sever's DIsease for months or even years.
It is possible to drastically reduce your heel pain in just a matter of days and weeks, and even completely eliminating your Sever's heel pain in seven weeks or less.
At Core Advantage, we have been helping young athletes rehabilitate and treat their Severs disease for as long as we have been fixing Osgood Schlatter. In this article we will outline everything you need to know about Sever's Disease, and then through a case study with one of our Sever's success stories share some of the key first steps to solving your heel pain.
Update 2021: After seeing our online Osgood Schlatter treatment program help thousands of young athletes successfully eliminate their knee pain and return to sport, we have now launched a Severs-specific treatment plan, available on this website.
The Sever's treatment program is a seven week training plan that you can complete at home in just a few minutes a day. You can purchase our Severs rehabilitation plan here, it includes everything you need to get on top of your heel pain fast.
What is Sever's Disease?
Sever's Disease, also known as calcaneal apophysitis, is a common condition affecting children and adolescents, particularly those who are physically active. It's characterized by heel pain and discomfort, often intensifying during and after physical activities. Despite its name, Sever's Disease is not actually a disease but rather an overuse injury that occurs during growth spurts.
This condition typically affects children between the ages of 8 and 14, coinciding with periods of rapid growth. It's particularly prevalent in sports that involve running and jumping, such as soccer, basketball, gymnastics, and track and field.
What causes Sever's Disease?
Sever's Disease occurs due to a mismatch in growth rates between bones and soft tissues during adolescence or in children.
Put simply, Severs heel pain occurs when the shin bones (tibia and fibular) are growing too fast for the calf muscles (Soleus and Gastrocnemius). These rapidly growing bones put extra tension onto the muscles and tendons, pulling through the Achilles and putting stress on the insertion point where the achilles attaches to the heel bone (calcaneus).
Because of this tension, every step, jump or landing the athlete takes the achilles tendon is pulling at its attachment on the heel bone (the calcaneus). Over time these tight muscles and tendons will overload the boney attachment site causing pain, tenderness and irritation in the ankles, heels and even under the feet.
Factors that cause Sever's Disease Heel Pain
Growing bones are only one part of the problem when it comes to Sever's Disease, there are multiple factors that also need to be considered:
- Rapid Bone Growth. During growth spurts, the shin bones (tibia and fibula) grow rapidly, sometimes outpacing the growth of surrounding muscles and tendons.
- Tension on the Achilles Tendon. As the bones lengthen, they pull on the calf muscles (Soleus and Gastrocnemius) and the Achilles tendon. This creates increased tension at the point where the Achilles tendon attaches to the heel bone (calcaneus).
- Immature Bone Structure. In growing children, the attachment point of the Achilles tendon to the calcaneus (known as the growth plate or apophysis) is not fully developed. It remains cartilaginous and pliable to allow for further growth, making it more susceptible to irritation and inflammation.
- Repetitive Stress. Every step, jump, or landing puts stress on this attachment point. Over time, the combination of tight muscles, tendons, and repetitive stress can overload the bony attachment site, causing pain, tenderness, and irritation in the ankles, heels, and sometimes even under the feet.
- Biomechanical Factors. Children with flat feet or high arches may be more prone to developing Sever's Disease due to altered foot mechanics that can increase stress on the heel.
- Movement Skill/Motor patterning. This one is such a crucial factor that it gets it's own section below.
It's important to note that this condition is exacerbated in tall, active children who may have weak calf muscles and glutes, coupled with inefficient running styles that put additional stress on the heel area.
Sever's Disease and Movement Skill
The relationship between Sever's Disease and movement skill is crucial, both in terms of how movement patterns can contribute to the condition and how the condition can impact an athlete's performance.
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.
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.
Sports-Specific Risks for Sever's
Sports that involve frequent running, jumping, and quick changes of direction (like soccer, basketball, tennis, and volleyball) pose a higher risk for developing Sever's Disease.
Dance & gymnastics, with its high volumes of training hours, emphasis on pointed toes and high powered jumping and landing, can also put significant stress on the Achilles tendon and heel.
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 started with us having struggled on and off with Sever's Disease heel pain 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.
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 Sever's case
Jack was actually not yet in the most rapid portion of his growth spurt, so his Sever's was only partially to blame on his growing bones. The biggest factor that stood out to us was Jack's movement skill. 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.
Jacob was not a good runner. 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.
Jack’s Sever's treatment plan
Jack had been in the care of an excellent practitioner, and when he came to us we reached out to compare notes and get a detailed history to help inform our programming.
They had tried every intervention in the Sever's textbook; orthotics and heel lifts prescribed, manual therapy, needling, activation and mobilisation prescribed, but nothing had any more than minor and temporary relief for Jack's heel pain.
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, this medical 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.
Just like with Osgood Schlatter (a growing condition that affects the knees), 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 and waiting the 6-18 months for the growth phase stops and for Sever's to naturally heal on its own!
Our approach to growing pains tackles Severs & Osgood as tendon injuries, instead of the traditional view of incurable diseases of the bones, and as a result we unlock a huge number of highly effective methods and treatment interventions that allow athletes to rapidly make massive improvements to their movement skill and pain levels in just a few weeks.
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 gentle Sever's relief
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.
Step two: Create calf and tendon strength with calf raises isometrics
A lack of strength in the calves and foot muscles is a common root cause of Sever's for younger athletes. It can be hard to spot this weakness directly, especially in athletic strong-looking bodies.
Additionally, weakness is made worse from the muscle inhibition triggered by Sever's pain. This muscle inhibition reflex is a natural response to pain that prevents us from pushing injured body parts into the risk of further injury, but when left untreated it leads to ongoing weakness in the muscles that are supposed to be supporting the injured joints. This creates a kind of viscious cylce where pain causes inhibition which further leads to weakness, opening the door for more pain!
In the case of Severs (just like when treating Osgood Schlatter) this inhibition means the muscle we need to absorb kinetic energy during running, jumping and landing is unable to do its job fully. Where normally the calves act as incredible springs and shock absorbers, the joints end up taking all the forces from running, jumping and moving generally.
Reversing calf weakness in Sever's
For our purposes in Sever's disease treatment we need to break this inhibition reflex loop through pain-free strengthening exercises.
For severe cases of Sever's even typical calf raises can be too painful. The great news is there is an even better starting point, that causes less pain, builds strength in the muscles and helps to promote healthy tendon recovery too.
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 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 treating their Severs.
For Jack he would do his calf isometrics in the gym with us 3x a week as part of his strength training program. More recently, we encourage our athletes completing the Sever's plan to do the Isos more frequently, ideally every day.
Step 3: Reprogramming movement skill
The final crucial step in effectively treating Sever's Disease is reprogramming movement skill. This aspect is often overlooked in traditional treatment plans, yet it plays a pivotal role in both recovery and prevention of future issues. Movement skill training is essential because it directly addresses the root causes of Sever's Disease while providing numerous benefits to the young athlete.
One of the key aspects of movement skill training for Sever's Disease is to improve running mechanics, helping young athletes be lighter on their feet and more efficient with how they absorb and create energy when moving rapidly.
To do this we use progressively more complex and more intense running drills like those used by track sprinters to help athletes re-learn smooth efficient 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.
A progressive approach to Sever's rehabilitation
It's important to note that movement skill training should be progressed appropriately and done in conjunction with the other steps mentioned earlier, such as creating length in the calf muscles and building strength through isometrics. This integrated approach ensures that as flexibility and strength improve, the athlete can safely and effectively apply these gains to functional movements. At Core Advantage, we carefully design and monitor the progression of movement skill training, starting with basic drills and gradually increasing complexity and intensity as the athlete shows improvement in both skill and pain management.
By learning correct movement patterns, athletes not only overcome their current bout of Sever's Disease but also build a foundation for long-term prevention of this and other overuse injuries. This forward-thinking approach sets our treatment method apart, focusing not just on immediate relief but on long-term athletic development and injury prevention.
Treating growing pains in the heels
If you're dealing with Sever's Disease and want a comprehensive, proven approach to treatment, our online Severs program might be just what you need.
This program incorporates all the steps we've discussed, including detailed guidance on movement skill training, into a structured, easy-to-follow format that you can do at home. Don't let Sever's Disease hold you or your young athlete back. Take action today and join our program to start your journey towards pain-free, improved performance. Click to learn more about the Sever's Disease Treatment Program and get started on your path to recovery.
All of these components, and step-by-step instructions to complete the plan are included in our online 7-week Severs Disease Treatment Program. You will receive a 7-week training plan, exercise logbook, instructional videos and photos, along with access to our online community for support to help you rapidly beat Severs Disease and return to sport pain-free.
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