In this post, friend of Body Helix, Amy Mierzwa, shares with us her expertise on Sever's Disease, which is something that affects many young athletes as they experience growth spurts during adolescence. Mierzwa is a Doctor of Physical Therapy and is the founder of Performance Solutions Physical Therapy in Charlotte, NC. Join us as she shares her knowledge of this painful disorder and how she is able to help young athletes recover.
AMY MIERZWA: As a Doctor of Physical Therapy for the past 20 years, my passion lies in working with youth and adult athletes, anywhere from recreational to professional level. I am the founder and owner of Performance Solutions Physical Therapy in Charlotte, NC, specializing in sports medicine and orthopedics. I am married with two children and our whole family stays active in a variety of sports. I am a runner and triathlete, but also have a love for yoga and Pilates to balance out the endurance sports.
BH: Do you work with a lot of young athletes? If so, what types of sports do they play?
AM: Yes I work with a lot of middle and high school athletes in a variety of sports including soccer, baseball, swimming, volleyball, dance, gymnastics, lacrosse, cross country and track.
BH: Do you treat young athletes who have been diagnosed with Sever’s Disease?
AM: Yes, I have seen youth athletes with Sever’s that have ranged in severity from being in a walking boot for several weeks to more mild cases where they are continuing to play in their sport with modifications as appropriate.
BH: Can you tell us (in layman’s terms) what Sever’s Disease is and what types of symptoms kids experience with it?
AM: Sever’s Disease (a.k.a calcaneal apophysitis) is an inflammation in the growth plate on the heel bone, near where the Achilles’ tendon attaches at the back of the heel. It typically occurs in young athletes who are undergoing repetitive stress to the heel (i.e. running/jumping). Oftentimes Sever’s presents in a child/adolescent during a growth spurt, where the muscles/tendons are not growing as quickly as the bone, causing the Achilles’ tendon to pull on the bone at its attachment and thus cause irritation and pain. Symptoms include localized pain in the back of the heel during and/or after athletic activity, often causing a limp due to pain. It may also cause pain with walking, especially after sports activity. It can occur in one or both heels.
BH: If a child begins having these symptoms, is there anything specific that they can do at home for treatment, relief, or even prevention?
AM: If a child presents with these symptoms and they are mild in nature, or if one is looking to be proactive for injury prevention, I would recommend a twice daily stretching regimen for hamstrings and calves (see photos below), as well as having adequate warm-up and cool-down before and after exercise. The exercises should be done three times each, with a hold of 30 seconds for each one. Discontinue the exercises if they cause increased pain. In addition, I recommend icing the area for ten minutes/twice a day after activity.
Secondly, I would recommend ensuring they have adequate arch support in their footwear. Kids with flexible feet that are prone to excess rolling in or out (pronating or supinating) can be more susceptible to excess strain on the heel area, and may benefit from trying over the counter arch supports and/or compression garments such as the Body Helix ankle compression wrap.
BH: At what point should a parent consider taking their child to a doctor and/or PT for treatment of Sever’s Disease?
AM: If symptoms are moderate to severe and last more than 1-2 weeks, and/or if the child is having difficulty weight bearing, I would recommend seeing a doctor who may take X-rays to assess any injury in the bone or growth plates. They may or may not recommend a walking boot for a period of 2-6 weeks. If symptoms are mild but not improving with home remedies listed above, it may be beneficial to have a physical therapy evaluation and treatment. In many states (including NC) a doctor’s referral is NOT required to go directly to PT.
BH: What types of things are you doing in your PT practice to help the young athletes who are dealing with Sever’s Disease?
AM: I typically treat Sever’s using a combination of modalities to help speed up the healing process including infrared and red light therapy, Thermostim (heat or cold massage combined with electric stimulation), massage to calf muscles/feet, therapeutic exercise, Kinesio® Taping (to assist with arch support, decreasing calf muscle/Achilles tendon tension, and reduction of inflammation), and custom foot orthotics. I use Sole Supports® orthotics which provide customized arch support as they are made from a mold of the child’s foot, and are calibrated for rigidity based on body weight and foot flexibility.
BH: Do your patients get pain relief with the above treatments? If so, how long would a parent have to commit, on average, to PT sessions with you (or another qualified therapist) to get their child some relief?
AM: Most often my patients do get relief with the above mentioned treatments. Depending on the severity, I may see these kids anywhere from 3-8 visits over several weeks. If they are getting custom orthotics, the break-in process takes about 2-3 weeks until they are wearing them for sports. Often PT is combined with activity modification (or complete rest from sport activities depending on severity).