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Physiotherapists And Doctors Services - Sever's

Sever's

Presentation
- Pain at heel – insertion of Achilles to calcaneum (heel) – tenderness/pain on jumping/running/landing. Caused by general overload of growing heel bone at attachment for achilles tendon
Contributing factors
- Young athlete – 9-12 years old - increased volume running, jumping, landing (either within gymnastics or general loading from outside sports)
Key management points
- Reduce overall loading until no impairment in function
- Can resume loading with some pain, so long as no alteration of technique (e.g. limp/loss of power etc)
- Seek physio advice for confirmation of diagnosis, identification of possible contributing factors   
Management strategy
- Identify periods of increased growth (spurts) and reduce overall trainingloads until spurt over
- Reduce overall volume of aggravating factors – start with activities outside of gym (minimise loading school, other sports, home etc). If symptoms persist begin to reduce aggravating gym skills/apparatus – e.g. floor and vault numbers until pain manageable.
- Keep diary of activity levels → if symptoms increasing, reduce overall activity levels until pain begins to subside
- Use heel lift (e.g. heel cups) in shoes for school/home (all times until symptoms subsiding)
- Calf flexibility
- Ice baths post training if symptomatic
- Continue lower limb conditioning calf/quads/gluts (low impact) to assist muscular ability to absorb loads when landing etc.   
Flexibility
- General lower limb flexibility
- Calf stretches
- Ankle stretches on incline board
Strength/conditioning
- Trunk endurance exercise all planes of support
- Hip/pelvic/lower limb control exercises in position of support
- Calf raises
CV fitness
- E.g. exercise bike intervals (long/low intensity) to maintain general aerobic fitness – reduce running volume
Physiotherapy
- Ankle mobilisations, soft tissue mobilisation of calf, and progression of conditioning exercises, review of suitable training progressions and timelines
Return to sport
- Progression and increased loading depending on pain. If pain levels reduced to level allowing normal function, can resume activity. If pain increases causing modification of technique, then athlete to reduce overall volume of loading of heel.
Key management points
- Reduce overall loading until no impairment in function
- Can resume loading with some pain, so long as no alteration of technique (e.g. limp/loss of power etc)
- Seek physio advice for confirmation of diagnosis, identification of possible contributing factors, management outline   
- Coaches to monitor for ‘growth spurts’

 
 
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