Severs Week 1 - Pain Science, Foam Rolling And Calf isometrics

This week's activities

Welcome to your first weekly checkpoint. If you haven't already be sure to read the Getting started page as it has crucial info to help you throughout the program. Getting started →

Severs quick links:

Download the Severs program workbook here →

Join the Facebook support group →

Read the Severs Knowledge base →

Foam rolling and Stretching quick guide PDF →

Every week of the program contains one of these boxes to help guide you through the program, pointing out clearly what you need to be doing each week and any changes that have occurred. The modifications will be highlighted in bold for clarity. You will find detailed instructions, photos and short videos explaining all the new exercises below this orange box.

Perform the daily routine at least once per day. This week it contains:

Download and print a copy of the program workbook.
Foam rolling, 10 rolls each position
Standing calf isometrics, three sets of 45 seconds each leg
Log your pain levels before and after the days exercises.

Instructions for all of these steps can be found further down this page.

Some common questions in Week 1:

Can I foam roll more than once every day?

‍Some people like to roll twice, it won’t do any harm if you have the motivation. The foam rolling routine should take ten minutes, and you need to roll each position ten times.

When should I do the calf isometrics?‍

Perform the calf isometric exercises immediately after your foam rolling. Be sure to pay close attention to the instructions below when performing this exercise. You will do four 30 second holds on each leg, alternating legs. Many people like doing both these activities prior to sport or activity as it can warm the heels up.

I only have heel pain in one side, should I still train the pain-free side?‍

Even if you only have heel pain on one side, you should still do all the exercises for both legs, this will keep you balanced and prevent future heel pain in that leg.

The calf raises and holds were really painful, what do we do?

The most important factor to get right with the iso holds is how high are the heels off the ground? It should be that the heel is almost touching the ground, so you can just slide a sheet of paper under the heel

Try the following to make them more comfortable:
- Swap from single leg to double leg
- Do the holds only, skip the calf raises for the first two weeks
- Use a bench/ rail to hold and support some of his weight with his arms
- Do shorter holds, breaking each hold into 2 or 3 shorter hold durations

If all else fails you may need to skip the raises and holds for week one and just do the rolling before trying again in week 2. Lastly, failing all these suggestions do not continue with the heel holds if they cause pain. Continue the foam rolling, but stop the heel isometrics until you have better understanding of the problem.

Pain Science, Foam Rolling And Calf isometrics

Welcome to Week 1 of the Severs Pain Elimination Program.

Now it’s time to get into the training, this week will include three components:

The science of pain and heel rehabilitation
A full body foam rolling routine
Calf isometric holds

You will do the rolling and isometrics daily for this first week.

Week 1 Instructions & Resources

Keep Scrolling below to learn about this weeks exercises, routine and activities

The Science Of Pain And Heel Rehabilitation

Being in pain is the worst. You can’t play the sport you love, climbing stairs is a struggle and you can feel isolated, alone and frustrated. But pain doesn’t define who we are, it’s simply a hurdle that we have to overcome.

We will be asking you to report your heel pain levels throughout the next seven weeks of this program, so it’s worth taking a little time to understand exactly what pain is and what is happening in our bodies and brains when we are injured. This short video is a great starting place to better understand what is happening when we are injured and the mindset we should be focusing on as we aim to become pain free and go back to normal movement. We recommend you and your parents (and even coaches) watch this video, maybe even refer back to it throughout the program.

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This short video below explains how we score pain levels with Osgood Schlatters, the same principles apply to the Severs training plan, just pay attention to calf and heel pain in the squat and less to the knees. We recommend doing one or two squats to a moderate depth and then scoring the amount of pain out of ten, with ten being the worst pain you have ever experienced, and 0 being I cannot feel anything. To keep this consistent do the test squats to the same depth every time, using a chair or stool is a great way to control this.

Foam Rolling

Foam Rolling for myofascial releasing and lengthening the muscles of the lower body, in particular the calves to take pressure off the painful calceneal tuberosity (achilles tendon insertion on the heel bone).

The first and most important thing to do when trying to fix Severs Disease is to create some length and flexibility in the calf to accommodate the rapid bone growth and take the pressure off the attachment site at the heel.

The problem is that by stretching the calf you are actually pulling on the sore bit and potentially making it worse. This is not fun, especially if your heels are sore and flared up.

This is what trips up most people. As their soreness increases, they stretch less and less which makes it harder and harder for the calves to stay loose.

Enter foam rolling

Foam rolling for self-myofascial release provides the perfect solution. Rolling allows you to create length in the calf and entire lower body without pulling directly on the sore tendon as you would with stretches.

‍WARNING: Foam rolling can be quite painful on the muscles when you first start. It is important that you persist and continue rolling as this is critical to curing Severs Disease. The good news is the more you roll the less it will hurt until eventually, it will even feel good! You just have to push through the first few days where it really hurts the tight and weak muscles.

The video below shows instructions for how to perform the foam rolling routine - pay close attention to the slow controlled motion and the alignment of James’ limbs in each position.

Standing calf isometrics

Isometric holds (or ‘Isos’) with the heel just slightly above the ground are amazing at helping settle down sore heels and strengthen the calf muscles that support it. They work in three ways.

They promote analgesia (pain relief) at the tendon, which will be incredibly beneficial in the weeks to come when we add the strength component of the program.
They activate and strengthen the calves and muscles of the foot to support, protect and deload the heel.
They take advantage of a phenomenon called mechanotransduction which in the case of Severs, is the tendons way of responding to isometric loading to heal the tendon tissue and stop the pain cycle. We have found three sets of 45 seconds (each leg) to be the perfect dosage.‍

WARNING: These might cause a slight amount of discomfort in the heels or calves during the hold or while lifting the weight into place. If this happens to you, swap to double leg holds, or try holding in a lower position. Some low level pain during these holds is normal, so do not be alarmed by this.

NOTE: If the pain is in a different location to your usual Severs pain, or feels different to the normal pain then stop immediately and get in touch with us so we can troubleshoot your specific situation.

NOTE 2: The most important factor to get right with the iso holds is how high are the heels off the ground? It should be that the heel is almost touching the ground, so you can just slide a sheet of paper under the heel

The video below shows instructions on how to perform the standing calf isometrics - pay close attention to the alignment of the foot.

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