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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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Foot Pain: Could It Be Plantar Fasciitis?

Posted on 8th October 2016 by

We are seeing and hearing from an increasing number of people who are suffering with quite debilitating pain on the sole of their foot. This common complaint is often the result of a condition known as Plantar Fasciitis.

Interestingly, over the last week I’ve met 8 people hobbling about with this painful foot condition and not one of these people were aware of what physio could do for plantar fasciitis.

So today’s blog is to educate you about plantar fasciitis and help you banish it for good.

What is Plantar Fasciitis?

Fascia is connective tissue which is found all over the body in various forms for different functions. It’s most common forms are sheaths surrounding muscles and ligaments to compartmentalise and  protect these tissues or thickened fascial bands or sheets in certain areas of the body.Plantat Fasciitis

The plantar fascia is a thickened sheet of fascia on the sole of the feet, running from the inside base of the heel bone and fanning out into the base of the toes. It’s elasticity gives us a spring in our step when walking or running.

Plantar fasciitis is an overuse injury to the fascial sheet on the sole of the foot.

Causes of Plantar Fasciitis

The main cause of plantar fasciitis is caused by

the plantar fascia being put under excessive stretch for prolonged periods of time. This can happen for example when your foot arches are too flat, so that as you push off when you’re walking or running the fascia excessively overloaded and stretched. Over time microtrauma, injury and pain result.

The foot can also be termed the “rubbish bin” of the body, where asymmetries further up the body can result in compensations in the foot. The body will compensate up to a point, but due to the excessive forces during the propulsion as you move that go through your feet, the foot may adapt by stiffening up and thickening of the plantar fascia. So sometimes, it can be something going on further up the body that may put too much stress on your foot, that will in turn cause this problem.

Symptoms

Plantar fasciitis is normally felt as a pain on the bottom of your foot, sometimes going into your heel.

Unfortunately plantar fasciitis is often confused with another foot problem called calcaneal bursitis heel pain). Without a thorough examination, most plantar foot problems are diagnosed as plantar fasciitis.

So a quick test you can do yourself to indicate whether your foot pain is plantar fasciitis or not is to see which is more painful; walking on your tip toes or your heels.

If it is painful to walk a few steps on your heels, you may have an element of calcanea bursitis. If it’s more painful too walk on tip toes (stretching plantar fascia), it’s likely you havre plantar fasciitis.

Why is it so painful 1st thing in the morning or after I’ve been sat for a while and then get up?

Plantar fasciitis is usually painful after a period of rest. The reason being is that when you’re sat for a while or asleep in bed, the fascia is off loaded and re-tightens. When you get back up on your feet, you are re-stretching the tight, painful fascia. It may ease a little as you start to move around as it effectively ‘warms up’ and stretches.

What can affect recovery?

There are many factors that will affect the speed of recovery. Seeing an expert Physiotherapist who has a wide range of experience treating lower limb overuse injuries is vital to identify all the factors and work towards removing or modifying the triggers unique to you.

The most common triggers for foot problems such as plantar fasciitis are:

Biomechanics It’s crucial to assess whether your foot and leg biomechanics (e.g. flattened arches, knocked knees etc.) are contributing to your injury and may need correcting. Here at goPhysio, our Physio’s can do this quite easily as part of your initial session by combining their physical assessment findings with performing a computerised foot screen using our cutting edge Gaitscan system.

Training Patterns and Intensity If a runner or keen walker has the condition, it’s vital to look at the historical loading of the fascia and modify their training schedule to a level that allows the condition to heal. Without breaking the cycle, the tissues won’t be able to recover. However, we like to keep people doing what they love, so rather than advise complete rest, we try wherever possible, to modify your activity or suggest alternatives in the short term that will promote recovery.

Lower Limb Stability Often muscle imbalances further up your body in your knee, hip or pelvis, will have an impact on the foot. As part of your recovery we will always address these elements too to help prevent re-occurrences.

Age Research suggests that older people experience more severe and more prolonged episodes of inflammation and pain. So, if you’re 40 years plus and enjoy an active lifestyle, your pain is unlikely to settle with just rest. It will be easily aggravated when you resume normal activities, as the cause and actual injury hasn’t been addressed.

Footwear Unsupportive, flat, old, worn out shoes or trainers can both contribute to causing plantar fasciitis and will inevitably prolong the condition.

Physiotherapy

At goPhysio, with a condition like plantar fasciitis, we always treat the condition as part of the bigger picture. Not only will we treat your foot itself, but we will look from the foot upwards and from the hip downwards, ensuring we leave you with no issues that will contribute to a re-occurrence.

Having identified all the factors unique to your condition, we will then address and correct them in parallel with hands-on physiotherapy treatments and education. It’s crucial to manually release the tight thickened plantar fascia with a variety of release techniques. You will also be provided with a bespoke home exercise programme for you to self treat at home and speed up your recovery in-between physio sessions.

We can also asses you to find out if you’d benefit from orthotics. In most cases of plantar fasciitis there is a biomechanics component that needs addressing. This can be achieved with orthotics. As outlined above, fattened arches will lower your body’s ability to cope with loading either from day-to-day actives or sport. At goPhysio we use a technologically advanced system called Gaitscan, which uses computer scanning to analyse your moving foot Combined with a physical assessment, the physio can identify if you’d benefit from wearing orthotics and subsequently discuss the range of options available to you to get you back on your feet a quickly.

What next?

If you think you may be suffering with plantar fasciitis or you have foot pain and aren’t sure what exactly it is, just give us a call on 023 8025 3317 or book an initial physiotherapy appointment online.

We can also offer you a free computerised foot analysis to see whether you’d benefit from orthotics. These analyses are completely free with no obligation. Call and quote Free Gaitscan to take advantage of this offer and find out whether orthotics could help you.


Growing Pains? Knee Pain in Kids and Teens

Posted on 27th September 2016 by

Growing pains?

Many children experience aches and pains as they grow which are typically written off as ‘growing pains’, told there is nothing that can be done and that they will ‘grow out of it’.

There is some truth to this; during a growth spurt the bones will lengthen first and then the muscles adapt and lengthen to keep up and there can be a period of discomfort around the joints whilst this happens.

However in young sporty children these ‘growing pains’ may well indicate a traction apophysistis (growth plate injury) that needs to be carefully managed to avoid long-term problems and ensure a quick return to sport.

What is a traction apophysitis?

This happens when the muscles are pulling on the growing part of the bone that hasn’t fully fused yet Osgoods Schlatters – like a rope pulling on cement that hasn’t hardened. If this area is overloaded by repeated, forceful muscle contractions, inflammation, pain and microtrauma to the growth plate will result.

This usually happens in very active sporty children who typically play 10+ hours of sport a week – especially kicking, sprinting and jumping activities like football, basketball and gymnastics. It always occurs during a growth spurt and is thought to affect around 20% of 9-16 year olds.

The main areas affected are the knee (Osgood-Schlatters disease) giving pain below the knee cap, or the ankle (Severs disease) giving pain above the back of the heel. Both conditions are associated with tightness of the muscles surrounding these joints pulling on their respective growth plates.

What can be done about it?

Rest, ice and anti-inflammatories can be helpful but most kids won’t want to wait months and months for their bones to stop growing before they return to sport, particularly if they are a budding athlete.

Will stretching help?

If the muscles are tight why don’t we just stretch them?

Well this actually pulls on the area where the muscle attaches to bone, potentially making it worse, not better!

So in response to this dilemma the Strickland protocol has been developed by a Physiotherapist to address the cause of the pain (tight muscles pulling on the growth plate) and to help guide return to sport and activity.

What is the Strickland Protocol?

The Strickland Protocol involves:

  • Applying a specific type of massage towards the insertion of the muscle to improve a muscle’s length and reduce its tightness, which reduces the pull on the tendon attachment – this needs to be done for a minimum of 2 minutes a day.
  • Once underlying tension is taken out of the muscle, helping it to catch up in length with the bone, the attachment site seems to repair in double quick time.
  • Once the child feels no pain in stretch position, we replace massage with stretches, safe in the knowledge that it should be able to cope with the loading of stretches.
  • Massage is continued in parallel with stretches to speed up process of elongation.
  • Rest from aggravating activities is essential – for a minimum of 3 weeks we recommend nothing more strenuous than walking, otherwise this delays healing substantially!
  • An important aspect is the involvement of the parent / guardian as the protocol cannot be done without their help & cooperation, as it will be them that performs massage on daily basis.
  • This is followed by sport-specific rehab and addressing a biomechanical or technique issues as we guide you back to sport.

Does it work?

YES! It has a 95% success rate in 3 weeks when correctly adhered to!

How can goPhysio help?

If your son or daughter is suffering with knee pain (or pain at their heel), you may have been to see your GP who has advised you that there is nothing that can be done, your child just needs to rest. However, we have found that by using this treatment protocol we can effectively help children get back to what they should be – running round, doing sports and having fun!

What we can do to help you and your child is assess the problem thoroughly to make sure we’re confident with the diagnosis. We will then advise you on the best course of action. The great part is that the treatment is pretty simple, with our guidance you can carry out the programme at home – we’re here to provide extra support and advise on progress as and when you need it.

We also offer a specialist Young Rehab service, which provides guided specific rehab programmes for kids, you can read more about this here.