What You NEED to Know about Eliminating Your Athlete’s Heel Pain

What Is Sever’s Disease (Heel Pain) in Gymnasts?

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This article is for any and every athlete dealing with Sever’s Diseaseheel pain in gymnasts 2

Heel pain in gymnasts (and other young athletes) is a real, sometimes mysterious (for parents and providers), and serious problem. Because of heel pain, I’ve seen young gymnasts sit-out more than a year in order to reduce the pain in their heels. Their parents and medical providers felt there was no other choice but to quit gymnastics to reduce the pain and allow their heels to heal.

To understand heel pain in gymnasts, you first have to understand gymnastics and its interaction with the leg and foot. Heel pain is a direct result of participation in athletics, particularly landings and take-offs. Young athletes have growth plates that are very active and when combined with intense work, they are usually the weak areas taking the brunt of their long hours during practice.

Heel pain in the child and adolescent gymnast is a condition referred to as Sever’s Disease. The gymnast’s skeleton is made of bones and long bones. Bone growth occurs at the ends of bones, or in regions that are well defined, called “growth plates.”

Growth plates, because they are active areas of change, are weaker than surrounding mature bone that has completed growth. Sever’s Disease is an irritation and an inflammation of the growth plate in the heel.

In gymnastics, we produce the “perfect storm” for Sever’s.

How Does The Growth Plate Become Irritated and Inflamed?

Overpronation of The Arch and Foot

There are multiple reasons why the growth plate in the back of the heel becomes irritated. In athletes of soccer, lacrosse, and football, it usually stems from running on a foot that overpronates. Over-pronation refers to a natural foot position where the foot tilts toward the big-toe side. Over-pronation also puts pressure on the growth plate in the heel by a gait that is altered. Overpronation of the foot can put undue pressure on the heel and achilles tendon.

Many gymnasts that experience heel pain are overpronated in the feet or have flat feet, and sometimes it is made worse because they are running around barefoot with absolutely no support of their arches.

Interaction of The Foot/Heel with The Springs in The Floor and Vault

The Achilles tendon attaches just above the growth plate in the heel. This growth plate can be aggravated by the constant and rapid contraction of the muscles of the calf. The tensile forces applied by the calf muscles through the Achilles tendon to the calcaneus (heel bone) can be so large that the weaker growth plate is irritated.

Bone is a strong material, but bone is strongest when the forces are applied via compression. Bone is considerably weaker when the applied forces come from tension, bending, or shear. From below, the growth plate can be irritated by running around the gym in bare feet, and from above, the force that occurs during a “punch” on floor can create incredible amounts of tension and shear to the growth plate.

There is so much force created for our gymnast’s achilles tendons and growth plates, that one of the major injuries occurring in college gymnasts is achilles tendon ruptures. It’s the same mechanism occurring in both the Sever’s inflicted gymnast and the ruptured achilles gymnast. The difference is that the weak point for the younger gymnast is the growth plate. The older, mature gymnast has no other outlet for the stress occurring during the “punch”. The achilles tendon takes the brunt of the stress.

Does Rest Help to Relieve The Symptoms?

We’ve found that long term rest does not affect heel pain at all. As soon as the athlete returns to the gym after rest, the symptoms return. Of course, it’s very important that you listen to your medical providers recommendation, but most of your providers have never seen a gymnast with Sever’s disease. Rest is their default recommendation for any musculoskeletal injury. Sometimes rest is the best advice, but with Sever’s, it doesn’t work.

What does work is getting at the root of the issue when it comes to Sever’s disease. What are the root issues that we have to address? Here they are:

  • Remove the inflammation/irritation of the growth plate in the heel
  • Increase the plasticity of the achilles tendon
  • Reduce the overly tight (hypertonic) calf muscles
  • Support the arches to help reduce overpronation of the feet

Now let’s get into the nuts and bolts of the Gymnast Care Sever’s Disease Protocol, designed and tested with thousands of gymnasts and other athletes.

The Gymnast Care Sever’s Disease Protocol

To Download a FREE Heel Pain Protocol Quick Tip Sheet from Gymnast Care, Click Here! We’ll send the protocol right to your inbox so you can have a quick reference for at home or in the gym!

The following is the Sever’s Disease protocol used with thousands of young gymnasts. If you don’t think you can follow through with the following protocol, give this protocol to your physical therapist, athletic trainer, massage therapist or chiropractor to allow your gymnast to get maximum benefits from the protocol.

The stretching and icing should be done every hour on the hour the gymnast is at home or inactive at the gym. Stretching and icing hourly is a critical step to reducing inflammation.

The massage should be done every other day by the parents or a professional and compression as much as possible, and definitely overnight.

When doing the full protocol on the same day, massage, stretch, and ice in that order, then repeat the stretch and cold water soak every hour on the hour.

1. Soft Tissue Therapy (Massage)

massaging the calves

Massage the calves from the knees to the heel, concentrating on the achilles tendon and where the muscles meet the tendon. Utilizing instrument assisted soft tissue therapy works amazingly well, even though it is a bit intense for the athlete.

At home, you can use your hands, and knuckles work great to work the Achilles tendon as long as you’re not too rough. We recommend every other day with massage, making sure to give 72 hours rest before competition.

Massage should be firm, but not so firm as to cause injury.

Remember, the calves, and especially the Achilles tendon region will be extremely tender. Your athlete will experience discomfort when doing this.

Use your knuckles when nearing the Achilles tendon. The space between your knuckles is the perfect width to contain the Achilles tendon and this allows for a great massage of this structure.

Make sure to move the foot from flexion into extension (flex and point) during the entire massage. This pumping motion is extremely important and KEY to increasing range of motion and increasing pliability of the achilles tendon.

2. Stretch

stretching

Stretch both calf muscles in each leg for 30 seconds. Stand with both feet on the stairs, and allow one heel to drop off the stair. Keep the ball of your foot on the edge of the stair. Keeping your knee straight, let gravity gently pull you into a nice stretch for 30 seconds. At the end of 30 seconds, bend your knee and once again letting gravity pull your heel down, stretch for 30 seconds. This stretch will be felt at the bottom of the leg and even around the ankle.

Repeat both stretches on the other leg.

3. Cold Water Soak

cold water soak

Ice using a cold water bath that covers both the foot and the calf. This will help to decrease the inflammation throughout the leg and foot.

To make a cold water bath, fill bucket or trash can with cold water that is 50-55 degrees F. Add ice if needed to reduce temperature to this range.

An ice bath with temperatures below this is unnecessary and can injure your young athlete!

4. Support the Arches

Keep supporting the arches using The X Brace (click here to find them on Amazon) or the low dye taping technique (click here to watch the video) any time barefoot and when you feel you need the extra support.

Supporting the arches has been shown to instantly reduce pain in young athletes by up to 5 points on a scale of 1-10.

5. Compress The Heel and Calves

Utilize compression for at least 3 hours after each practice, and if possible, at night when you’re sleeping. You can start with a compression sock or use an ace bandage as pictured.

compression of the heel and calvesCompression has been shown to increase oxygen supply to damaged tissue and decrease inflammation by supporting athletes lymph systems. You want to use compression with most injured areas of your athletes body.

How To Prevent Sever’s Disease and Achilles Tendon Stress

If you’re reading this but your gymnast does not have Sever’s or you’ve completed the initial protocol and you want to prevent Sever’s from returning, this is my recommendation for this. It’s also a great way to prevent achilles tendon stress.

After your gymnast’s initial pain is gone, it is important to maintain the flexibility and increased pliability you’ve created in their calves. Here is an example plan for your gymnast and you to stick with:

  • Massage: 2-3 times per week
  • Stretch: every night and after each practice
  • Cold water soak: after every massage
  • Compression: for 3 hours after practice/competition, and overnight if possible
  • Arch support: any time in the gym

Sever’s disease does not have to cause your gymnast immense amounts of pain and it definitely doesn’t need to end your gymnast’s career.

Stick with the protocol and see amazing results.

The Gymnast Care Book on Injuries

Did you like this post? All of the information found here is from the Gymnast Care Book on Injuries. The protocols found in the Book on Injuries are just like the ones found in this post. The protocols are practical, easy to use, and proven to protect your gymnast.

You can find the hard copy on Amazon.com (just click the amazon.com logo) or the digital copy with videos at the Gymnast Care Book on Injuries site (click here).

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If you have any questions about our Sever’s disease protocol, leave them in the comments below. We’d love to hear from you!

Dr. Joshua Eldridge

About Dr. Joshua Eldridge

Dr. Joshua Eldridge has specialized in protecting gymnasts from injury. He is the inventor of The X Brace, and has developed a treatment protocol for Sever's disease and heel pain that has helped thousands of gymnasts throughout the world. Dr. Eldridge brings practical, easy injury care and prevention that can be done at home.

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  • Abby Mosher

    Hi, my son is a gymnast and has Sever’s. I bought the xbraces, but his sports med physician is telling me he should use Tuli’s Cheetah ankle brace with heel cups instead for heel absorption during gymnastics instead of the xbraces for arches. She was quite impressed with the xbraces and had never seen/heard of them before and said she would recommend them for arch support. I have been following your protocol and he has been doing pretty well. Any thoughts about this?
    Thank you!!!

  • Dr. Joshua Eldridge

    Thanks Abby for the question….the mechanism of injury in gymnastics is not compression, especially when it comes to floor…you could make an argument for compression on vault, but if he is running correctly (on his forefoot, rather than his heels) this shouldn’t be as much of an issue.
    The proprioceptive feedback that you get from The X Brace is what makes it so powerful…it gives your son a better knowledge of where his feet are in space, which allows him to move better!
    Usually, when you stick with the protocol, wear The X Brace, and don’t push through the pain, the heel pain will go away pretty quickly.

    Hope this helps!

  • Sarah Roberson

    Thank you so much for this information. My daughter just started having Sever’s pain about two and a half weeks ago. We’ve starting using this protocol, and our final piece we are trying to implement is the taping or X-brace. Does she use the low-dye tape or Xbrace everyday that she is at the gym, or only at certain times such as when it’s most painful? She trains 3 days a week for 3 hours. Her coaches told her to get the Tuli’s ankle brace, but that is not helping at all. I’m so glad I found your site and they you share this information. It’s been great for us and some other girls on her team.

  • Dr. Joshua Eldridge

    Everyday at the gym while she is having pain, but she might love to use The X Brace even after that. I would use the low dye tape job with Elastikon (Click here to see more info
    ) if The X Brace isn’t available…hope this helps

  • Kevin

    My nephew is not in gymnastics, but he has Severs. He has been playing basketball since he was 5 (2 hour daily workouts pretty much), and Severs has been affecting him/causing him much pain for the past 3 years I think. He does everything in the book (custom inserts in shoes, has taped his feet, taken a pill (forgot the name), thorough stretching, ices afterwards. He turns 13, and it is just disappointing him greatly now because he has been dealing with this for about 3 years. He has to sit out of PE, his basketball workouts are always cut short (many times they miss a workout because his feet bothered him at school), other kids are passing him because he is unable to practice, and he will have to miss this spring/summer’s AAU tournaments. He is just a very sad kiddo lately because of Severs. Is there anything else you can recommend? Nothing seems to help. Thanks in advance!

  • Dr. Joshua Eldridge

    Hey Kevin…I would get started ASAP with the Gymnast Care Heel Pain protocol and follow it to a T…if you follow it, it works!

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  • Anita

    Hi Dr. Josh,
    My daughter is a level 10 gymnasts and has intermittent problems with heel pain. Where can I purchase the X Brace?

  • Dr. Joshua Eldridge

    Anita,
    Because I’m no longer involved with The X Brace, the only location I know to purchase one is thexbrace.com. I hope this helps!

  • Agnes

    Hello Dr. Joshua , my daughter has been having hill pain in her right foot for a month. I just found your protocol so we are starting with the it today. Do I understand correctly that every hour when my daughter is at home first she should stretch and then water soak her leg? Should she do any warming up on her calf muscles before stretching? As I understand stretching is to be avoided on a cold muscle. She is also suffering from hamstring pain right at the sit bone on the same leg as her hill pain. What recommendation might you have for the hamstring pain. Thank you for all you do and for your advice.

  • Dr. Joshua Eldridge

    Hello Agnes…yes, she should stretch then cold water soak. As long as she’s been walking around, that should give enough of a warm-up that she should be able to gently stretch without injuring herself.

    Her hamstring pain needs to be examined by a sports doc and most likely imagined to make sure there is not an avulsion fracture of the hamstring…not likely but possible and needs to be ruled out.

  • Amy Crist

    My daughter is 9 and has been struggling with this condition for almost 2 years now. Just now found this article and am starting the protocol ASAP. When following the protocol what type of compression sock do you recommend? I see some are 15-20mmHg and others are 20-30mmHg. Thanks!

  • Dr. Joshua Eldridge

    Amy, Some of it will be your daughters preference. There have not been (to my knowledge) studies done on compression recovery for 9 year olds. Find ones that fit snug, that allow her to sleep in without any numbness in the feet, and that she wakes up feeling good in.

    Hope this helps…let us know how the protocol goes for you.