Sever's Disease - Achilles Heel Pain (Children 8-15 years old)

Sever's disease affects growing adolescents in the 8-15 age category. A child suffering with Sever's will complain of pain around the back / base of the heel bone (called the calcaneus).

The basics 

Put simply the Achilles tendon, at it's attachment to the heel, becomes inflamed. This can occur for a few reasons however normally the primary issue is that the growth plates in children at this age are yet to full develop and are therefore more susceptible to 'overuse' type injuries. In a growing child weight bearing activity will generally aggravate the injury. This occurs because there is too much force being placed on the tendon attachment during weight bearing activity.

Risk factors

Sever's disease is a very similar issue, in nature, to Osgood Schlatters (OSD) and is effected by many of the same risk factors, e.g. increased activity, leg length discrepancies, recent growth spurts, poor bio-mechanics in sporting activities, tight calf musculature or being over weight / obese.

|| Osgood Schlatters occurs at the knee ||

|| Severs Disease occurs at the Achilles heel ||

Treatment / Management

The good news is that most children will 'grow out' of this injury within 2 week - 6 months. It is important it's managed carefully in the mean time though. If managed incorrectly there is the possibility of a calcification (permanent bony deposit) developing at the base of heel.

Generally decreased activity will be required. This is usually on a the basis of pain free activity, meaning that pain free activity is fine, painful activity is not. 

As with OSD the same treatment options are applicable for Sever's Disease: 

Treatment for Sever's will involve:

1. Rest (or relative rest) - by 'relative rest' I mean that ALL activity must be pain free. If an activity causes pain then rest must be enforced. 
2. Soft tissue techniques (massage) to free up the tight muscular tissue. 
3. Bio-mechanical screening - to make sure no unnecessary force is being generated at the foot, ankle or heel. 
4. Light stretching - only when appropriate. 
5. Ice / cold treatment - to help manage the inflammation. 

Two things you must not allow your child to do if they have Sever's disease:

1. Train / play through pain. 
2. Stretch heavily if it causes pain.

A - Z of Sport Therapy

A fun post here with some common terms that Sports Therapists, Physiotherapists and other musculoskeletal therapists regularly use.

A = Achilles Rupture - for a complete rupture surgical repair of the tendon will be required in most active patients.

B = Bursitis - Bursas are small, fluid filled sacks that protect a tendon where it attaches to the bone. If the bursa becomes injuried and inflammed you have a condition called Bursitis.

C = Calcaneus - also know as the heel bone.

D = Draw Test. A test for damage (rupture) to the Anterior Cruciate Ligament of the knee - see this link for a video of the Draw Test.

E = Electromyography - is used for recording the work produced by a muscle. The technique measures the amount of electrical activity that is produced by a muscle.

F = Facet joint - the small joints between each vertebrae. There are two joints at each segment of the spine.

G = Gait - refers to the movement patterns of our limb, however Sports Therapist's will most often be talking about the movement at the foot and ankle, when talking about your gait.

H = Hemarthrosis - is bleeding into the joint spaces. This many occur due to a traumatic injury for example a heavy twisting injury to the knee.

I = Inguinal hernia - is a type of hernia found in the lower part of the abdomen. Treatment of this will often be surgical.

J = Jumpers Knee - is more accurately known as a patella tendinopathy. If you suffer from this pain will be present just below the knee cap when exercising.

K = Kyphosis - refers to the curvature of the thoracic spine. Over kyphosis will lead to a rounded posture in the upper back.

L = Lumbar spine - the lower 5 vertebrae in the spine (lower back).

M = Meniscus - the cartilage that acts as shock absorbers in the knee. Unfortunately this cartilage can be torn relatively easily.

N = Navicular - is one of the tarsal bones found in the foot. It is the 'key stone' bone on the inside arch of your foot.

O = Osgood-Schlatters disease - a problem found in active children between the age of 10-16. See my blog post on it here.

P = Patellofemoral Joint Pain - joint pain at the front of the knee. Pain found just underneath the knee cap can indicate Patellofemoral Joint Pain.

Q = Q-angle - is the angle from the hip to the knee. It's important as individuals with a large Q-angle are more susceptible to certain types of knee pain.

R = Rotator cuff muscles - are 4 muscles that act to stablise the shoulder joint. Rotator Cuff Impingement Syndrome is a common injury.

S = Sciatica - the sciatic nerve is the largest nerve in the body. Sciatica is caused by injury to or pressure on the nerve.

T = Tendinitis - is inflammation of a tendon. Examples are Achilles Tendinitis & Patella Tendinitis.

U = Ultrasound therapy - used to enhance cell repair during inflammation.

V = Venous Thrombosis - a blood clot that forms in a vein. There will be a higher risk of this down wind of surgery.

W = Wry neck - also known as Torticollis, is a deep spasm of the neck (side) flexors.

X = X-ray - Used to image 'boney' injuries.

Y = Yellow Elastic Tissue - is one of 3 forms of dense connective tissue.

Z = Zygomatic arch - is more commonly known as the cheek bone.

Knee pain in children 10 - 16yrs (Osgood-Schlatters?)

This is a post for any parents who have children that are complaining of knee pain... Their pain may be Osgood-Schlatters Disease (OSD).

OSD is a problem seen in active children between the age of 10-16yrs.

The reason I'm writing about this injury now is that I've had 3 different sets of parents bring in their children who have been complaining of symptoms of OSD over the last 6 weeks.

They were ALL aged 14yrs (2 girls / 1 boy) and had varying degrees of knee pain.

The main symptom of OSD is pain which will be felt at the front of the knee just below the knee cap (where the quadriceps attach to the bone).

Symptoms are most commonly found after a 'growth spurt' - though not always. The pain is caused by the muscle pulling on the site where it attaches to the bone (the Tibial Tuberosity). This pulling causes inflammation at the attachment site.

The reason this problem occurs in children aged between around 10 - 16yrs is because at this stage their bones are still developing and yet to fully harden. This leaves the boney attachment vulnerable to heavy loading.

In severe cases the bone can start to be pulled away causing a calcification at the knee. The picture above (taken from the British Medical Journal) shows what can occur in a severe case of OSD - note the 'bump' on the child's knee.

In most cases your child will eventually 'grow-out' of OSD, however it must be managed carefully in the interim.

It is a relatively common issue, my sister had it on and off for about 18 months as a child - unfortunately for her it wasn't managed very well at the time!

Treatment for OSD will involve:

1. Rest (or relative rest) - by 'relative rest' I mean that ALL activity must be pain free. If an activity causes pain then rest must be enforced.
2. Soft tissue techniques (massage) to free up the tight muscular tissue.
3. Bio-mechanical screening - to make sure no unnecessary force is being generated at the knee
4. Light stretching - only when appropriate.
5. Ice / cold treatment - to help manage the inflammation.

Two things you must not allow your child to do if they have OSD:

1. Train / play through pain.
2. Stretch heavily if it causes pain.

N.B. As always this is a very brief overview of this type of injury, there are many other problems that can occur at the knee that will need to be ruled out in an assessment.