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Most injuries can be managed with strength training and modifying aggravating activities. Some pain or discomfort during exercise is OK and safe. It is a good sign if your pain warms up as you exercise and doesn’t feel worse the next day. KEEP MOVING Resting too much can be more aggravating than staying active. Reduce your training volume enough to settle symptoms and ensure you don’t feel worse the next day. PLAN AHEAD Avoid consecutive days of impact exercise (like running and jumping) if you are sore. / S / - / T / - / T / - / S / MONITOR MORNING STIFFNESS & SYMPTOMS Low and stable symptoms are OK. A spike in stiffness, tightness, or pain, means you’ve probably overdone it the day before. You don’t need complete rest. Continue resistance training, do less impact training. BE PATIENT There’s no quick fix. GENERAL HEALTH We also need to consider general health variables that contribute to recovery:
A recently published article by Haroy et al, in the British Journal of Sports Medicine, described a simple exercise routine that decreased the number of groin injuries in male footballers by 41%. Groin injuries are very common in football. Research shows that weaker groin muscles are associated with an increased risk of groin muscle injury. So strengthening groin muscles can potentially prevent injury. The paper studied the Copenhagen Adduction exercise, which has previously been shown to strongly recruit adductor longus. Haroy et al, offered the Copenhagen at three levels of resistance, based of the players’ pain. Players started with Level 3. If the exercise gave them more than 3/10 pain, they were instructed to do the exercise level below instead: 3 > 2 > 1.
The training protocol is shown in the following table: Being only one, quick exercise, compliance was high. They found performing the Copenhagens decreased the risk of groin injury by 41%.
The full article is HERE. Copenhagens are definitely worth adding to your training. The concept is similar to strengthening hamstrings with the Nordic Hamstring Curl which has been shown to prevent 70%-85% of hamstring strain injuries. When the Achilles tendon begins to feel painful, two common questions people ask is “what should I do to make it feel better?” and “when should I see a healthcare provider for assistance?”. This infographic guides people with Achilles tendon pain on how they can self-manage their pain and symptoms, plus tips on when to seek professional advice for tendon pain.
J Orthop Sports Phys Ther 2024;54(1):95. doi:10.2519/jospt.2023.9001 HEEL PAIN IN CHILDREN
Sever’s is most common in 9 - 12 year olds. It’s sore to squeeze the bone at the base of the Achilles where it attaches onto the heel. It’s not something that can be seen - it never seems to look red or swollen. It’s worse after sprinting, jumping, and hopping. It settles with rest. It is an overuse injury so it’s common in pre-season, or anytime training loads increase too quickly. My kids get it when they do extra sessions in running spikes or footy boots, without the normal heel support of their running shoes. It’s an overuse injury from excessive loads.
OVERUSE INJURY
When we talk about excessive loads it can be “external” load such as:
I think the running pace is the more powerful multiplier in this list. Extra sprint sessions will do it. My kids got sore once when we did a boot-camp session with a novel plyometric exercise - split jumps. There are also “internal” variables that determine our ability to cope with the training load:
My kids definitely are more prone to Sever’s if they’ve had a couple of late nights that week. And, if they’re having a growth spurt, their bodies are busy spending resources on growing rather than recovering from the stress of a training session. NATURAL RECOVERY
Text books say that Sever’s disease is self-limiting because the growth plate eventually fuses by the age of 15 or 16. But I don’t think there’s anyone who would be happy to just let it run its course until then. It is usually sore enough to stop you participating in sport, so it needs treatment.
WHAT DO WE DO?
I used to put kids with heel pain in orthotics, until I read this research which confirms that a simple heel wedge is more effective than orthotics for Sever’s disease. Cheaper and easier, so that's a win.
I get them to do an isometric Achilles strengthening program which also helps with pain control. But ultimately recovery comes down to load management. Load management means reducing the excessive loads. So this could be:
And aid recovery with:
HAVE YOU HAD A CHILD WITH SEVER’S DISEASE?
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