What Is Sever’s

Sever’s disease is an overuse condition typically seen in young athletes aged 7 to 15. The heel bone (calcaneus) is an attachment site for the Achilles (Calf) tendon. During explosive activities such as running and jumping, this attachment site is subject to high amounts of stress. Overuse or overtraining can lead to micro-trauma and heel pain, often referred to as Sever’s Disease.

Common Symptoms

The typical signs of Sever’s Disease include:

Heel pain that increases with weight bearing activities such as running and jumping

Stiffness/tightness in the heel and Achilles tendon 

Limited range of motion in the ankle

Limping following physical activity. 

Who Gets Sever’s Disease?

Sever’s disease is an overuse condition typically seen in young athletes aged 7 to 15. In children and adolescents, part of the heel bone is a growth plate and therefore not yet fully formed. It is therefore more susceptible to high stresses. Symptoms of Sever’s disease typically flare up during a growth spurt or at the start of the sports season. Explosive sports such as basketball, volleyball, gymnastics and football require high loading of the Achilles tendon which increases the risk of developing Sever’s Disease. 

Other factors that can contribute include:

Sudden or excessive changes in exercise load – As with any overuse condition, Sever’s Disease can occur when suddenly increasing your physical activity. A quick increase in activity doesn’t give the body enough time to adapt to the new workload and becomes overloaded.

Limited mobility – As the body grows, it is common for the bones to lengthen faster than the muscles. As a result, the calf muscles, Achilles tendon and muscles of the feet can become very tight and increase stress on the heel bone.

Limited strength – A lack of strength and balance can reduce the ability of the body to control high forces during explosive activities. This places more stress on the joints and the bones which when repeated, can lead to an overuse injury.

Poor technique – Inefficient running or landing technique places additional stress on the Achilles tendon and heel causing it to become overloaded overtime. Poor technique can often be a result of limited mobility or strength.

Sever’s Disease usually has a gradual onset but can quickly worsen without adequate management. 

Treatment For Sever’s Disease

Short-term management:

These methods can be used to manage pain and swelling and can be very effective in the short term. However they do not address the underlying problems are unlikely to provide long term relief.

RICE (Rest, Ice, Compression, Elevation) – These methods can be used after exercise to manage pain and swelling.

Taping: Certain taping techniques can be used to reduce the stresses on the Achilles tendon and heel tendon during activity.

Long-term management:

Load management (relative rest): Modifying your training load can be used to reduce repeated stresses on the heel and allow time for recovery while still participating in sport/exercise.

This may involve:

1. Temporarily reducing total training load.

2. Scheduling longer rests between training days. 

3. A gradual return to activity following relative rest. Proper planning and timing of your return to sport will allow time for the body to adapt to training.

Strengthening: Specific exercises can be used to increase the strength and loading capacity of the calf and Achilles tendon, making it more resilient to the demands of sport/exercise.

Mobility: Poor mobility and muscle length can be addressed through the use hands on therapy (including soft tissue massage, joint mobilisations, and stretching), mobility exercises, stretching, and specific strengthening.

Technique modification: Improving strength and control of the knees, ankle, hip and trunk, and practicing better movement helps to reduce the loading of the Achilles Tendon/heel.

Exercises for Sever’s

Calf Stretch 

Tights calf muscles and Achilles tendons are commonly seen in patients with Sever’s disease. In order to reduce this tightness, and improve ankle mobility, stretching can be very effective.

Calf Stretch: 

• Stand on a step with your heels hanging off the edge and your knees straight (as shown above)

• Slowly lower your heels off the edge of the step until you feel a stretch through your calf muscles

• Hold this position for 45sec-1min 

• Give yourself a short rest (1-2 min) and repeat the stretch 3 times. 

• Perform this exercise daily to improve ankle mobility 

Calf pin and stretch (self release)

Start with your calf on a foam roller and put pressure downwards, moving it around until you find a trigger spot (Ie. when you go “ouch!”). 

Maintain pressure on this spot and slowly bend and point your ankle. Making sure to take deep breaths throughout. Aim to hold the spot for 10-20 seconds. Then move the foam roller to find another trigger spot on the same calf. 

Perform this exercise daily to improve calf stretch during activity and reduce pain.

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Do you still have heel pain? Or do you just want a comprehensive assessment and management plan to guide your recovery? Call us today on 9629 6169 to book an appointment or enquire online here.