Severs Week 1 - Pain Science, Foam Rolling And Calf isometrics

Pain Science, Foam Rolling And Calf isometrics

Welcome to Week 1 of the Severs Pain Elimination Program.

Now it’s time to get into the training, this week will include three components:

• The science of pain and heel rehabilitation
• A full body foam rolling routine
• Calf isometric holds

You will do the rolling and isometrics daily for this first week.

Week 1 Instructions & Resources

Keep Scrolling below to learn about this weeks exercises, routine and activities

The Science of Pain and Knee Rehabilitation

Being in pain is the worst. You can't play the sport you love, climbing stairs is a struggle and you can feel isolated, alone and frustrated. But pain doesn't define who we are, it's simply a hurdle that we have to overcome.

We will be asking you to report your knee pain levels throughout the next seven weeks of this program, so it's worth taking a little time to understand exactly what pain is and what is happening in our bodies and brains when we are injured.

Understanding Pain

This short video is a great starting place to better understand what is happening when we are injured and the mindset we should be focusing on as we aim to become pain free and go back to normal movement. We recommend you (and even coaches) watch this video, maybe even refer back to it throughout the program.

The Reality of Recovery

Recovery from knee pain rarely follows a straight line. You will have bad and good days, there will be setbacks (hopefully only small ones) in your rehab journey.

Think of it more like a rocky path up a mountain - some days you'll feel great and notice significant improvements, while other days might feel like steps backward. You may experience temporary setbacks, especially after more active days, but what matters most is the overall trend over weeks, not day-to-day changes. Throughout your recovery and this program what's important is:

• Staying patient with the process
• Being willing to adapt activities as needed
• Maintaining consistent effort with the rehab program
• Celebrating small improvements in both pain and movement quality

Managing Activity Levels

One of the most common causes of setbacks is sudden spikes in activity. Your body needs time to adapt to increased loads, so it's important to make gradual changes. When you start feeling better, resist the temptation to jump straight back into full training. Instead, plan your progression carefully and include regular rest days, especially after more demanding activities. Learning to listen to your body's signals and adjust accordingly will help you maintain steady progress.

Scoring Your Pain

This short video below explains how to best score your pain.

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We recommend doing one or two squats to a moderate depth and then scoring the amount of pain out of ten, where ten represents the worst pain you have ever experienced, and zero means you cannot feel anything. To keep this consistent, do the test squats to the same depth every time - using a chair or stool is a great way to control this.

Accurate Pain Reporting

The most reliable pain scores come from consistent measurement. Try to score your pain at the same time each day, using the same test movement (squats to chair height). It can be helpful to make note of any activities that might have influenced your pain level that day. Don't be discouraged by daily fluctuations - remember that improvement isn't always reflected in pain scores immediately, and the trend over weeks is more important than any single day's score.

Remember, recovery is a journey, not a race. Focus on consistent effort with your rehabilitation program and celebrate the small victories along the way.

Beyond pain: Movement Quality and Activity Guidelines

While tracking pain levels is important, it's not the only way to measure progress with Osgood-Schlatter's.

Pain reporting can be challenging, especially for younger athletes who might find it difficult to notice small improvements from day to day. This is why we encourage parents to also observe how your children are moving as a complementary way to track progress.

What Parents Should Watch For

Keep an eye on your child's everyday movements in life, sport and in-between. Look for these signs of improvement:

• Reduced limping during regular activities
• More natural walking patterns
• Return of "spring" in their step
• Improved confidence in movement
• Better stability when standing or changing direction

Sometimes these movement improvements appear before pain numbers start to decrease, making them valuable early indicators of progress.

The Importance of Staying Active

A common misconception is that complete rest is the best approach for Osgood-Schlatter's. However, current evidence shows that maintaining appropriate activity levels is crucial for several reasons:

1. Osgood-Schlatter's is primarily a strength and loading issue, not an inflammation problem
2. Complete rest can lead to weakness and deconditioning
3. Maintaining some activity helps preserve fitness and confidence
4. Regular movement helps prevent the stiffness that can come from too much sitting

Finding the Right Balance

The key is finding activities that your child can handle without causing significant flare-ups. Some guidelines:

• Daily walking is beneficial and should be encouraged
• Light activity on rest days can actually help reduce stiffness
• Participate in modified versions of regular activities when possible
• Listen to your body and adjust activity levels as needed

Foam Rolling

Foam Rolling for myofascial releasing and lengthening the muscles of the lower body, in particular the calves to take pressure off the painful calceneal tuberosity (achilles tendon insertion on the heel bone).

The first and most important thing to do when trying to fix Severs Disease is to create some length and flexibility in the calf to accommodate the rapid bone growth and take the pressure off the attachment site at the heel.

The problem is that by stretching the calf you are actually pulling on the sore bit and potentially making it worse. This is not fun, especially if your heels are sore and flared up.

This is what trips up most people. As their soreness increases, they stretch less and less which makes it harder and harder for the calves to stay loose.

Enter foam rolling

Foam rolling for self-myofascial release provides the perfect solution. Rolling allows you to create length in the calf and entire lower body without pulling directly on the sore tendon as you would with stretches.

‍WARNING: Foam rolling can be quite painful on the muscles when you first start. It is important that you persist and continue rolling as this is critical to curing Severs Disease. The good news is the more you roll the less it will hurt until eventually, it will even feel good! You just have to push through the first few days where it really hurts the tight and weak muscles.

The video below shows instructions for how to perform the foam rolling routine - pay close attention to the slow controlled motion and the alignment of James’ limbs in each position. For Sever's it's probably a wise idea to do a double round of foam rolling on the calves.

Standing calf isometrics

Isometric holds (or ‘Isos’) with the heel just slightly above the ground are amazing at helping settle down sore heels and strengthen the calf muscles that support it. They work in three ways.

1. They promote analgesia (pain relief) at the tendon, which will be incredibly beneficial in the weeks to come when we add the strength component of the program.
2. They activate and strengthen the calves and muscles of the foot to support, protect and deload the heel.
3. They take advantage of a phenomenon called mechanotransduction which in the case of Severs, is the tendons way of responding to isometric loading to heal the tendon tissue and stop the pain cycle. We have found three sets of 45 seconds (each leg) to be the perfect dosage.‍

WARNING: These might cause a slight amount of discomfort in the heels or calves during the hold or while lifting the weight into place. If this happens to you, swap to double leg holds, or try holding in a lower position. Some low level pain during these holds is normal, so do not be alarmed by this.

NOTE: If the pain is in a different location to your usual Severs pain, or feels different to the normal pain then stop immediately and get in touch with us so we can troubleshoot your specific situation.

NOTE 2: The most important factor to get right with the iso holds is how high are the heels off the ground? It should be that the heel is almost touching the ground, so you can just slide a sheet of paper under the heel

The video below shows instructions on how to perform the standing calf isometrics - pay close attention to the alignment of the foot.

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