Sever’s Disease is a condition caused by the overloading of Achilles Tendon near the heel, and the growth plate in the area.
It is common in physically active boys between 10 to 12 years old and active girls aged 8 to 11 years old. Usual signs and symptoms experienced by the child are:
Redness and/or swelling in the heel
Heel pain during running or jumping that usually goes away after some rest
Difficulty walking or running
Most parents get highly worried about the pain that their child is experiencing and at times, they may feel helpless on what to do. Here are 3 most common questions asked by parents who come through our physiotherapy clinic:
Can my child continue his/her physical activity?
Yes, he/she can continue with physical activity provided that the pain does not occur.
Will the pain go away?
Yes, the pain should go away. However after knowing this fact, parents should not push their child to continue with pain during physical activities. Avoiding the pain is very important.
Is there anything my child can do to recover faster?
An appointment with a physiotherapist is highly recommended. A professional can assess your child’s flexibility, strength, muscle control and biomechanics. From the assessment, we can then prescribe your child with a specific rehabilitation program which will consist of stretches and strengthening exercises.
Most of the times, we also find that children who suffer from Sever’s disease lack strength in their hip muscles, which is important for activities such as running and jumping. Knowing and working on the right exercises that will build strength in your child’s hip is crucial in the treatment of Sever’s disease.
Remember, do not force your child to continue with pain during his/her physical activity. Even though your child may grow out of the pain, it is important to exercise within pain free limits!
Tendon injuries in children - What are they and how do we fix it?
The last thing we want our active and growing children to experience is growing pains. Growing pains can be a very broad term, but it generally refers to injuries experienced by adolescents as they advance in both height and weight during puberty. Typically the injury and pain is not caused by a single ‘strain’ or ‘sprain’, but a gradual and insidious onset.
Common injuries that affect tendons in children:
Osgood schlatters disease (pain at the front of the knee)
Sever’s disease (heel and Achilles pain)
Traction apophysitis – rectus femoris (front of the hip joint)
These conditions all have a few things in common:
All lower limb based
Linked to muscles that provide power when running
The injury process for these conditions is based at the tendon to bone attachment at the site of the growth plate. It relates to the excessive pull of the muscle from the bone, via the tendon. This creates a microtrauma close to the growth plate, a structure that is busy building new bone. This process will only become a problem when the rate of tendon injury is faster than the body's ability to heal the structure. This is often the case in very active children, who are playing multiple sports throughout the week. The tendon simply does not have adequate time to heal itself.
Causes of tendon injuries in children:
Unfortunately its not as simple as just a ‘growth spurt’. The following factors will lead to an increased chance of experiencing these injuries:
As we grow, our skeleton grows slightly faster than the muscles that attach to it. Essentially, our bones grow quicker than our muscles. This leaves us with tight muscles, relative to the longer bones. This will increase the physical pull and tension from the muscle into the tendon, attaching onto the bone.
Any number of biomechanical faults will increase the load on different tendons.
Pronation - flat feet cause our knees to turn inwards, changing the line of pull through the calf and quad muscles.
Running technique – altered landing patterns, dropping hips and poor upper body rotation can all place extra pressure on the tendons in the leg.
Sports specific repetition
Simply put, the more sports played, the higher the risk of sustaining such injuries. I often see children who engage in 6-7 sessions per week of running/weight-bearing activity. This is not to say that children should stop doing this amount of activity - my advice to patients and their parents is to listen to your body. If you start to feel any isolated ache or pain in the hip, knee or foot, then seek treatment to remedy the situation. If not, lengthy delays in returning to sports are often required - patients need to be most diligent when monitoring excessive running loads before and after growth spurts.
Part of growing is also increasing your body weight. This will naturally place extra gravitational load through all structures in the body. Continued sports and exercise while this weight is increasing is one of the risk factors for growing pains.
Reduce inflammation around the tendon to bone attachment
This is crucial in the early stages to reduce pain and to reduce the excessive inflammation that can slow healing. Taping is also very helpful. Icing and anti-inflammatories are commonly used, but have a debatable effect, as shown by literature.
It may be as simple as reducing the amount of exercise that involves running, jumping and other power-based sports. This allows time for the body to heal the affected structures, while corrective massage and strength exercises take hold.
Reducing the tension on the tendon to bone structure is paramount. This will include a mix of therapist massage and self massage at home with a foam roller and release ball.
Massage mixed with a stretch program will provide the best way to lengthen muscle. This will be a mix of static (very short duration only) and dynamic stretches.
Strengthening to correct biomechanics
Depending on what the physiotherapist assesses as the main muscles that need strengthening, an individual plan will be provided to target the muscles that need the most work. This could include gluteal, core, quads or calf muscles. This will all then come together with exercises that are specific to your sport, to best train the body to return to full fitness.
Overall, the treatment is very successful for children with tendon injuries. If managed correctly, no long-term effects should be experienced. If there's a delay to the treatment or poor management early in the process, lengthy time on the sidelines can be a common and frustrating part of tendon injuries in children.