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.
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:
With these type of overuse injuries, I interpret "soreness" as essentially the same thing as "tiredness". If they've been training more, sleeping less, or growing more, we would expect some "tiredness". If they were tired what would be the treatment?... Sleep more and train a bit less.
Netball Australia has developed a great program to help prevent knee and other lower limb injuries in netball.
Knee and ankle injuries are common in netball, making up three quarters of all injuries. Devastating ACL injuries are unfortunately common, making up 25% of serious injuries. The KNEE program offers a range of warm-up exercises that help prevent injury. There are a range of age and experience appropriate exercises for junior through to elite netballers. They are easily understood by players and coaches, with a number of options offering variability and progression. It would be great to see this program widely adopted by Australia's largest participation sport for females.
Ankle sprains are the most common sports injury.
After an initial ankle sprain, athletes are prone to re-injury of the same ankle. The risk of suffering an ankle sprain is doubled in the year following initial injury. Common interventions aimed at preventing ankle sprains include taping, bracing, muscle strengthening, and balance training. Taping and bracing have shown to be effective prevention for ankle sprains, however disadvantages include hindering performance, loosening with activity, and skin irritation. A 2015 systematic review and meta-analysis from La Trobe University has concluded that balance training programmes are effective at reducing the rate of ankle sprains in sporting participants, particularly those with a history of ankle sprains. Approximately 17 sporting participants, or 13 participants with a history of ankle sprain need to undergo balance training in order to prevent one future ankle sprain. |
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