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Sever’s Disease

Posted on 13th August 2017 by

What is Sever’s Disease?

Sever’s isn’t really a ‘disease’ as such. Sever’s is an inflammation of the growth plate at the back of the heel, which occurs in growing, adolescent children.

What causes Sever’s?

As children go through their ‘growth spurts’, bones will grow faster than muscles and tendons. Because of this, in Sever’s, the tendon at the back of the heel (Achilles tendon) pulls at the heel bone. Thus, due to repetitive stress, it is particularly common in active children.

Sever's Disease How is Sever’s diagnosed?

Sever’s is pretty easy to diagnose through a thorough assessment. The history, your symptoms and the pattern of the problem will paint a picture that leads to the diagnosis. A thorough assessment involves matching the symptoms reported to a physical examination of the heels, alongside discussing activity level and participation in sports.

What might Sever’s feel like?

Sever’s presents as pain in the back of the heel, often present in day to day activities such as walking, and made worse during or after physical activity – especially sports involving running and jumping.

How do the symptoms of Sever’s progress?

The pain caused by Sever’s tends to be directly linked to activity levels. What’s most frustrating about this is that it’s often the most active kids that suffer with it, so limiting their activity can be quite distressing.

The condition may get worse and may be more difficult to treat if you ignore the symptoms and carry on high levels of activity through it. Therefore, without the correct management, the symptoms of Severs can persist until growth stops. Whilst there is no direct treatment that can stop the pathology of Severs, there are many things physiotherapy can do to help relieve and manage the symptoms.

What is the best treatment for Sever’s?

One we have a diagnosis of Severs, we will really focus on helping your child manage the condition.

This can include:

  • Advice on pain relief and managing the symptoms
  • Guidance on sport and activity modification, a term we call ‘relative rest’
  • Exercises to stretch and strengthen muscles in the lower limb, foam rolling can be great
  • Shoe modifications, such as heel pads that cushion the heel as it strikes the ground, heel lifts that reduce strain on the Achilles tendon by raising the heel, or arch supports that hold the heel in an ideal position

The outlook for Sever’s 

The sooner Sever’s is managed, the quicker recovery can be, and with correct management, the condition usually goes away within a few months. The problem does not cause problems later in life.

Related injuries

Severs in very similar in nature to Osgood Schlatter’s of the knee. However, other conditions we consider when children present with heel pain include:

Severs Case Study 

11 year old Joe came to see us complaining of a 3 month history or worsening heel pain. Joe was an extremely enthusiastic grass roots football player, training and playing 4 times a week. He’d recently started trampolining, which he loved! However, his heel pain was starting to get so severe, it was limiting his ability to play football, with him often limping off the pitch after 30 minutes.

When he came to see us, we found he had:

  • A significant tender spot on both heels
  • Naturally flattened arches in his feet
  • Very tight, painful and tense calf muscles

Joe’s Management 

The first steps we took, were to educate and reassure Joe about his condition. Sometimes this reassurance and understanding can be a turning point in recovery – it isn’t anything serious and it will get better!

We taught Joe’s parents a treatment protocol, called The Strickland Protocol. This is a set and timed programme of rest, muscle release and re-introducing activity and stretching.

Joe was advised a short period of complete rest from any impact activity (with the reassurance of the long term gains of this) with a gradual re-introduction. In Joe’s case, he was advised to stop trampolining and football completely for a few weeks, to try and help settle his symptoms as they were so severe. He started a daily treatment programme at home that his parents could help with – the aim of this was to reduce tension of calf muscles and start to reduce the pull on his heel bone. He also used ice on his heels and painkillers when necessary to ease the pain.

As his symptoms eased, stretching and foam rolling of his calf muscles was started and activity was carefully re-introduced.

It was concluded that trampolining was likely to have been one of the main triggers of his problem. Given that returning to football was his upmost priority, it was decided in conjunction with his parents that returning to trampolining was not advisable. Instead, Joe started swimming regularly. The benefits of this were that swimming would help maintain and improve his fitness, whilst being low impact and not irritating his heel pain. He gradually increased his football playing time, using pain levels as a guide and building on time gradually.

We also guided him on his choice of footwear – to wear supportive and cushioned trainers and school shoes and a really good, supportive football boot. Many of the football shoes that are now on the market look great but offer absolutely no cushioning or support. Particularly astro boots, which are like running around on a piece of cardboard! Joe opted for a traditional leather boot, which offered much more support. He was advised to minimise playing in astro boots as much as possible.

It has taken almost a year of guided management for Joe to return fully to normal activity free from pain. What has reassured Joe and his parents is that they understand what’s going on, have made the right informed choices to help recovery and enabled Joe to get back to doing what he loves, playing football! Much of this management was advice and education and Joe doing a regular programme of exercises himself at home.

Had he not had the right advice, Joe could have gone down a route of spiralling inactivity and developed secondary issues – not only physical but also psychological, if he couldn’t play football.

If you’d like some advice on managing Sever’s or any other growing pains, give us a call on 023 8025 3317. 


 

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Treatment of Calf Pain in Runners

Posted on 11th August 2017 by

Calf pain for runners is common complaint. Your calf muscles are used extensively and repeatedly during running, so it’s no surprise that sometimes they can become overloaded and develop pain. Here’s a great infographic from Tom Goom from the PhysioEdge series of podcasts, that highlights the recommendations for the treatment of calf pain.

So, what does it mean for you if you’re a runner with calf pain?

  1. Exercise Therapy is a crucial part of the treatment of calf pain. Exercises should be specifically targeted to increase your calf’s capacity for the demands of running. There are some great examples below. Your Physio would be able to identify exactly where any weakness may lie and subsequently advise on the most effective exercises for you. It may not only be your calf muscles that are weak, muscles around your hip and knee support the work of the calves during running, so strengthening these muscles is crucial too. Pilates is great for this! And don’t forget your feet. Working on the static strength of the muscles in your feet that bend your toes can help your running technique.
  2. Neural Mobility is how well your nerves ‘slide’ or move in your body. We all know that our joints and muscles move and stretch but our nerves also have to be able to move freely. When they don’t, this itself can cause pain and restricted flexibility. Reduced neural mobility may not be local to your calf, it could be originating from a more central source (your back/spine). Your Physio would be able to identify whether you have reduced neural mobility and advise on the best exercises to improve neural mobility. It may be that some manual therapy would help too.
  3. Training Loads, so distance, time, speed, terrain, will all have an impact on calf pain. Our aim is to always try and keep you running wherever we can (always keeps runners happy!). So, we offer customised advice in modifying your load to keep you running whilst your calf pain is addressed. This is not always possible though and there are cases where resting from running and doing some specific rehabilitation is essential to your recovery.
  4. Gait Retraining can have a massive impact on recovery and prevention of calf pain. Your running technique and style can improve your efficiency of your running and reduce demands on the structures involved in running. Here at goPhysio we offer a specialist Running Rehab service, where a biomechanical and video running analysis is carried out to guide any beneficial changes to your running technique. Small adjustments to technique can often have a massive impact on your running.

Treatment of calf pain in runners

The trap many runners fall into when they get calf pain is to stop running, rest completely until their pain is gone and then go straight back to their normal running routine. Then they’re frustrated when the pain comes back again and they repeat the cycle. When you pick up an injury, particularly an overuse injury like calf pain, it is crucial to identify and address the cause to prevent the potential long term cycle of injury.

Read More

What’s physiotherapy got do with a dripping tap? Overuse injuries explained.

Top 6 Pilates Exercises for Runners

Top Tips for Injured Runners

Running Rehab Service


Get your running back on track!

Posted on 4th August 2017 by

Every year around 80% of runners will develop a running related injury – these are often caused by inefficient techniques, muscle imbalances, poor training habits and incorrect footwear. Here at goPhysio, we want to keep runners running so our expert physiotherapists are here to help!

Our Running Rehab service is designed for runners of all levels so whether you’re starting out with the ‘Couch to 5K’ or you’re a seasoned marathon runner; if you have a niggling injury that is affecting your running we can help. We can also offer training and technique guidance for those that are new to running, returning after a long break or are struggling to get past a certain mileage.

The Running Rehab assessment includes:

  • A detailed history of your injury, training programme and goals
  • Comprehensive lower limb strength and flexibility assessment to look for muscle imbalances
  • Running assessment on a treadmill with slow motion video analysis and feedback
  • Personalised recovery plan which may include strength and conditioning exercises, running drills, training programme or integrated physiotherapy follow up for specific injury management

Common running conditions that we see include:

Should I book Running Rehab or a Physio Appointment? 

If you can still run at least 1km we would recommend the Running Rehab service as your first port of call for the most comprehensive assessment, however if your pain is stopping your running completely its best to start with normal physiotherapy assessment and treatment until the pain settles. All of our services are integrated so there’s no problem transferring between services, in fact that’s the best way to ensure a full recovery.

The slow-motion video allows us to look at your running style from top to toe, and whilst there is no one perfect technique, it does allow us to easily identify subtle movement dysfunctions or imbalances that are hard to perceive at normal speed. These imbalances can often lead to inefficiencies and even injury in a repetitive sport like running. You will be given instant feedback on how to correct your running style with simple cues and running drills. Together with your injury history this helps us develop an individual personalised recovery programme for you to resolve your injury and improve your running performance.

Benefits of Running Rehab 

  • Speeds up recovery from injury
  • Get back to running as soon as possible
  • Confidence to progress running in the knowledge that you are not causing more damage
  • Comprehensive plan to improve running efficiency, performance, strengthen areas of weakness to help prevent future injuries
  • Achieve your running goals!

Read More

Running Rehab Service 

Common Triathlon Injuries

 


Sports Massage? Not just for the Sporting Type!

Posted on 4th August 2017 by

You think that sports massage is primarily for the gym bunnies, marathon runners or the elite sporting teams? Right? Wrong! Sports massage is a great way to help all individuals with aches and pains, no matter what type of lifestyle you lead –  it’s accessible to all! Whether you are stuck at a desk every day or are running around after the kids, sports massage can target those problem areas you have and alleviate the pain.

Through a variety of techniques, sports massage will help promote flexibility and reduce fatigue, while also emphasising on the prevention and healing of injuries or repetitive strains to the muscles and tendons. Here at goPhysio, we are able to target those long term aches and pains you’ve been having, and we’ll work together to get you back on track to a pain free lifestlye.

So, say goodbye to the lower back pain and that tension headache, sports massage will make you feel great!

We provide massage appointments at goPhysio 6 days a week, with appointments up until 8pm during the week and a Saturday morning. You can book your appointment by giving us a call on 023 8025 3317 or book online 24/7 here.

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