Sever’s Disease Treatment With John Gallucci
Sever’s Disease is painful but usually not long-lasting — and due to inflammation in the heel but can be a real problem for youth soccer players. Here is information from John Gallucci:
As a youth soccer player reaches his or her teenage years, growing pains require parents to have an in-depth understanding of how to address certain setbacks. Sever’s disease is a common condition that youth players encounter while spending extensive time on the pitch.
Here are tips on monitoring the disease from John Gallucci Jr., MLS Medical Coordinator and medical analyst for coverage of the 2015 FIFA Women’s World Cup 2015.
Soccer News: Sever’s disease is a common cause of heel pain in growing kids, especially those who are very active. This condition typically arises during the pubescent years when growth spurts are occurring; between the ages of 8 and 13 for girls, and 10 and 15 for boys. During these years, adolescents are experiencing rapid growth with immature bone transforming into fully matured bone. Sever’s disease rarely occurs in older teenagers because the growth plate in the heel typically hardens by age 15.
What is it?
Sever’s disease, also known as calcaneal apophysitis, is a painful bone disorder resulting from inflammation or swelling in the calcaneal epiphyseal plate, or growth plate, in the heel. A growth plate is an area of growing tissue at the end of a maturing bone. Over time, cartilage cells change into bone cells and the growth plates expand and join together, which is how bones grow.
How does it happen?
During a growth spurt, the heel bone can grow faster than the leg muscles and tendons around it. This causes the muscles and tendons, especially the Achilles tendon, to become very tight and to pull directly on the growth plate in the calcaneus, or heel bone.
Over time, repeated stress can damage the growth plate, causing the swelling, tenderness and pain of Sever’s disease.
Though Sever’s disease can occur in any growing child, certain conditions, such as flat or high arches, short leg syndrome, where one leg is shorter than the other, and childhood obesity may increase the chances of its development.
Signs and Symptoms of Sever’s Disease
The symptoms of Sever’s disease are seen most often in the running athlete (which of course includes soccer). Complaints most often include heel pain, tightness, swelling and sometimes bruising. The pain will increase with running and jumping activities, and may be exacerbated with a tight sneaker or cleat.
Treatment of Sever’s Disease
The initial goal in the treatment of Sever’s disease is pain relief through a decrease in inflammation.
The best way to accomplish this is with the RICE protocol: Rest, Ice, Compression and Elevation.
- Rest: Remove the stress. This means take a break from, change, or altogether stop any activity that increases pain or soreness.
- Ice: Icing at the heel is best done with an ice cup for approximately 15 minutes, 3-4 times per day. To make an ice cup: freeze water in a Dixie cup, peel away the excess paper and use the cup to massage the area.
- Compression: Wrap the injured area with an elastic bandage to aide in limiting inflammation.
- Elevation: use pillows to elevate the injured area while sitting or lying down. Gravity will help to pull the inflammation back towards the core of the body.
Once pain and swelling have minimized, a flexibility program for the Achilles tendon should be started to limit the tension being placed on the growth plate.
The goal is to increase the elasticity of the calf muscles and associated tendons that insert at the calcaneus.
We also need to remember to not neglect the foot! Elasticity within the plantar fascia (or tissue underneath the foot) can also be helpful in decreasing the symptoms of Sever’s disease.
Simple stretching, by pulling the toes toward the head is beneficial. Deep-tissue massage is even better and can be done by rolling the foot on a tennis or lacrosse ball to break up any adhesions.
This same method can and should be done at the calf muscles.
We cannot not stop a growth spurt from occurring, however, should symptoms arise, they must simply be treated appropriately with rest and modified activity. Rest is most important in the resolution of Sever’s disease, so stress on the heel bone can be relieved.
Athletes will often have to sit out for a period of time to allow the pain and swelling to subside.
Once the athlete can walk without pain, a protocol designed by a certified athletic trainer or physical therapist will be implemented to improve the strength and flexibility of the foot and Achilles’ Tendon.
As the rehabilitation progresses, the certified athletic trainer or physical therapist will begin functional and sport-specific activities to physically prepare the athlete for a partial return to sport.
In the beginning of this stage, the athlete can participate at a 50-75% of their normal soccer workload and will progress from there as pain allows. For this athlete, it should be noted that low-impact soccer drills and skills are better than more stressful long runs.
For more information in regards to this topic, please be sure to check Soccer Injury Prevention and Treatment: A Guide to Optimal Performance for Players, Parents, and Coaches written by John Gallucci Jr., MS, ATC, PT, DPT.
John Gallucci’s book is available on Amazon on his JAG Physical Therapy site.
RELATED ARTICLES: John Gallucci Jr. On What Coaches Need To Know, Soccer Players: Risk of Tendonitis; Soccer Players: Groin Injuries – Don’t Come Back Too Soon