Does Your Child Experience Heel Pain When They Run?

Running is supposed to be an enjoyable experience for children of all ages.  The thrill of running faster and faster is exhilarating and rewarding.  However, what happens when that joy of running is replaced with the pain of running?  Could it be Sever’s disease?

Are You Familiar With This Scenario?

Your child is hobbling, limping, and grimacing in pain during or after running.  And in some instances, they are reduced to tears during or after running.  To overstate the obvious, this should not happen.  Children should not experience heel pain when running or jumping.  Avoiding putting full body weight on one leg when walking, standing, or going up and down stairs are strong indicators that your child is experiencing symptoms which are not normal.

Sever's Disease

Heel pain can be used to describe a variety of different diagnoses (Sever’s disease, plantar fasciitis, stress fractures, Achilles tendonopathy, or retrocalcaneal bursitis)1.  The focus of this blog will be discussing Sever’s disease.

What Is Sever’s Disease?

Sever’s disease, also known as calcaneal apophysitis, is the result of repetitive micro trauma to the growth plate (apophysis) of the heel (calcaneus).  Because children are still growing the growth plate is considered “open”.  During running the Achilles tendon pulls at the growth plate. If the repetitive stress is too great from running, the area where the Achilles tendon attaches to the heel, as well as the growth plate become inflamed and painful.  The typical occurrence for Sever’s disease is with children between the ages of 7 to 15 years.

severs disease

First Steps

It is important to improve your understanding with the nature of the child’s symptoms.  These questions will help gather essential information:

  • Where is their pain?
    • Determine the location of their pain (back of the heel, bottom of the heel, arch of the foot)
  • Is there tenderness when the painful area is touched?
  • Does their pain worsen with activity?
  • Are they having difficulty walking / running?
  • Do you notice an usual pattern when walking / running (e.g., limp)?
  • When did their symptoms start?
  • Are their symptoms worsening?
  • Was there a recent growth spurt?
  • Was there a recent and dramatic increase in their activity (running and jumping)?
  • Has a new sport season begun?
  • Are their shoes older than 6 months?
  • Was there another recent (less than 2 months) injury to either leg?

If your child follows a pattern of symptoms based on pain location (heel), worsening symptoms, altered walking or running, new sport season, tenderness, recent growth spurt and increased activity there is concern for Sever’s disease.  This does not mean that a season is lost.  Early treatment is the key.  The earlier the treatment is initiated the sooner the symptoms will go away.

Initial Treatment

The most basic treatment options for Sever’s disease include:

  • Rest from activities that aggravate symptoms
  • Ice the painful area (wrapped in a towel) for 15 minutes or apply an ice massage for 5 minutes
  • Stretching – pain-free
  • Strengthening for the leg – pain-free
  • Balance exercises – pain-free


The above conservative initial treatment should be effective at decreasing symptoms within 7 to 10 days.  However, if the pain persists you should seek medical attention (medical professional).  Remember early treatment is essential to avoid the risk of missing an entire season. You need to avoid the “no pain, no gain” mindset – this will only make the problem worse.

A thorough evaluation by a medical professional includes a detailed patient history and a specific survey for the lower body.  The evaluation is crucial to determine what the actually cause of the injury is and helps develop the treatment plan. 


You should also expect an advanced evaluation to also include:

  • Comprehensive lower body flexibility testing
  • Comprehensive lower body strength testing
  • Hands-on assessment for range of motion and joint mobility
  • Hands-on assessment of the painful area(s)
  • Movement analysis with basic movements (squatting, stepping, walking)
    • If applicable – high speed video analysis with running
  • Discussion and recommendations for age appropriate training and avoiding / preventing overuse
  • Detailed home exercise program
  • Explanation of clinical findings
  • Anticipated recovery period based measurable goals

heel palpation


Successful recovery from injuries is criterion-based not time-based. If you are a sports fan you will appreciate the following example because you have heard it countless times.  An elite, professional athlete does not directly return from injury to competition based on a time frame.  They have to pass a collection of tests in order to be cleared for practice and light drills, then another collection of tests to increase the intensity of practice.  This pattern continues until they are able practice at near game conditions, then the athlete is cleared to return to play.

Taking more than 10 to 14 days off from activity to rest while recovering from Sever’s disease requires a plan.  Immediately returning to the same level of training intensity following the period of rest is a recipe of disaster.  This accounts for the high rate of re-aggravation of symptoms and where a season is lost.  It is more safe and effective to determine return to play (running) through a systematic and gradual workout progression. 

what can i do


Youth athletes will be frustrated based on their inability to practice and compete.  In order to shorten the recovery period, it is importance that the youth athlete is active.  The crucial point is that the activity is PAIN-FREE.  Once the initial painful symptoms have decreased specific exercises need to be introduced to address their weakness, muscle tightness, coordination, etc.  After these exercise have been mastered (and pain-free) then onto the next phase of their recovery.  This is the basic principle of the criterion-based system.  Once the criteria has been met, the next phase is introduced.  Each individual navigates the phases at different speeds.  The rate of return to play from Sever’s disease varies based on the length of symptoms, severity of aggravation, strength, etc.

Sever's disease running

Properly managed Sever’s disease can be treated efficiently provided you are pro-active based on your newfound awareness and education related to this injury.  If you have concerns or questions talk to a coach or medical professional who has experience with youth athletes.

  1. Malanga GA, Ramirez-Del Toro JA. Common injuries of the foot and ankle in the child and adolescent athlete. Phys Med Rehabil Clin N Am. 2008; 19:347-371.

Matt Weissbach is originally from Canada, and graduated from Queen’s University (2002) and the University of St. Augustine (2017).  He has over 16 years of working as a physical therapist, coach, teacher, and consultant.  Currently, he is co-owner of Evolve Physical Therapy in Sherwood, Oregon.

Matt is a United States of America Track and Field (USATF) Level 1 Coach, and has spoken at track and field coaches clinics, universities, and international conferences on running, footwear, long-term athlete development, and ACL rehabilitation.

Your First Physical Therapy Visit For Knee Pain


If you are unsure if you will benefit from physical therapy for you knee you can follow these guidelines.

If you are experiencing:

  • Pain
  • Stiffness
  • Swelling
  • Weakness
  • Poor balance
  • Loss of muscle mass

If you have difficulty with:

  • Walking
  • Going up and down stairs or curbs
  • Running or jumping
  • Squatting
  • Getting into or out of a chair or car

If you answered YES to any of the above questions, you are a candidate for physical therapy.


Physical Therapy is essential for you to achieve your goals following an injection or surgical procedure, as well as with overuse injuries or degenerative changes (osteoarthritis). When you have knee pain, the body modifies how you move and is often referred to as compensation. This could mean that you are limping while walking, going up or down the stairs one leg at a time, shifting weight to the “good leg” when you are getting out of a chair, or when you are standing. This abnormal movement will not correct itself magically following a medical procedure or if you take time off from your sport. This is WHY you need physical therapy!

Our experience assisting people re-learn how to move pain-free is the combination of hands-on techniques for your knee, as well as the entire leg. Treatment will include strengthening and balance exercises to address weakness and poor joint stability. We will also spend time educating you on how treatment does not end once you leave the clinic. You will be given an individualized home exercise program to maximize your success of returning to the activities that you love.


Come Prepared:

Have a list of questions you would like to ask. Don’t be afraid to ask for more clarity with the answers you are provided.

Please bring a personal identification card with picture (your drivers license works best), your insurance card, and a detailed list of your medications.

In addition you filling out relevant medical history, you will also complete a functional outcome test for the legs, the Lower Extremity Functional Scale. The survey helps us determine your biggest limitations with your daily life. It also helps us objectively track your success in physical therapy.

Please wear or bring a pair of loose fitting shorts. We need to see the structure of your legs and how you move as you complete basic functional tasks such as: walking, standing, getting out of a chair, and negotiating stairs.

You should bring in your most common footwear choice, as well as your current workout shoes. This will provide insight with how your body moves and if footwear changes are needed.


A thorough initial physical therapy appointment will take 40 to 60 minutes. This involves us asking you questions for the most relevant information prior to the physical examination. Remember YOUR story is important because there is not a diagnosis, or treatment, which works best for everybody.

The Physical Therapy Knee Exam:

Once a detailed patient history has been given the next phase of the visit is the physical examination. We will address the symptoms, while performing additional tests to determine the cause(s) of your complaints in a thorough assessment.

The following tests will be conducted:

  • Range of Motion (ROM) – the available movement for a joint
  • Hands-on joint mobility and soft tissue assessment
  • Muscle length, strength, and endurance
  • Balance assessment
  • Functional movement
  • Neurological screening

To perform these tests you will have to change your body position, for example lying on your back or front, sitting, and standing. If any positions make you feel unsafe or cause an increased level of pain, please let us know. Also, an informed patient is essential, which means we will explain what we are doing prior to testing. Your understanding of our intentions, interpretations, and the expectations of the test are vital to developing an effective treatment approach for you.

The Goals of the Initial Visit:

Based on the findings from the above tests an individualized treatment plan will be developed and discussed with you. We will work with you to develop strategies to help you improve how you walk, negotiate stairs and any other immediate limitations with your daily activities.

crutch knee

Findings of your clinical tests will be discussed and how those findings affect your functional independence. Your understanding of the WHY behind your pain and limitations is important to us. We believe the more you know and understand allows you to be more involved and successful with your physical therapy experience.


Your Commitment:

Ask questions to understand the goal of treatment
Perform the home exercises
Attend your appointments

Our Commitment:

We strive to clearly explain:

  • WHY physical therapy is needed
  • HOW physical therapy will help
  • WHAT treatment, both in the clinic and at home, is vital for your success

We will also provide you will resources for performing your exercises at home and the gym.

trust knee


To ensure our shared commitments, we will hold each other accountable to achieving the best possible results from physical therapy. We believe effective physical therapy is a partnership between individuals.

We will work together to




Matt is originally from Canada, and graduated from Queen’s University in 2002. His areas of clinical interest are pre and post-surgical rehabilitation, aquatic rehabilitation, and return to play testing. He has more than 15 years of experience working with active people across the lifespan, and athletes from grade school to professional level.

Are You Dizzy Or Do You Have Poor Balance? Here’s Why & What To Do – Part One

Remember as a child when being dizzy was fun? You probably recall hopping off a merry-go-round with your friends and trying to walk a straight line or attempting to stand still without falling down. It was all fun and games because you were able to recover quickly and run off to your next adventure.

But what if you have these symptoms without being on the merry-go-round and that feeling is actually causing you or a loved one to limit their activities? Maybe you see them walk nervously from one piece of furniture to another in their home. Or perhaps worse, that feeling contributes to you falling. Why are you feeling this way and what can you do about it?

Sometimes a medical condition such as an irregular heartbeat, excessively low blood pressure, or an intestinal bleed can cause these symptoms. In absence of a medical issue being the problem however, feelings of being off balance or dizzy are attributed to “aging”, “being out of shape” or “slowing down”. While these symptoms can certainly creep up on us as we age, aging alone does not explain the cause of these symptoms.

Our body maintains a stable and upright posture through the interactions of three primary systems – our visual system, our somatosensory system and our vestibular system. Let’s explore each of these.

Visual System

The visual system is quite obvious. It’s what we see in the world around us! Are we oriented to vertical? We determine this by comparing ourselves to objects around us such as a door, a light post or a building. This is a very powerful reference for us. When we can’t see a clear reference point, we are unsure of our position. Think of what you feel in an airplane that is banking left or right when while taking off. Our sense of vertical can become quite compromised without an accurate visual reference. The same can be felt in a dimly lit room or while being outside at night.

Somatosensory System

The second system that helps us is our somatosensory system. This system collects information through our skin and joint receptors by way of contact with our environment. If you are sitting right now you feel the surface of the floor under your feet, the chair contacting your legs and spine. If you’re standing, you feel the floor under you and perhaps your shoulder leaning against the wall. This is your somatosensory system doing it’s job.

Vestibular System

Finally, our vestibular systems acts as our internal gyroscope. Inside of each ear is a system of boney loops that hold fluid that moves with any slight motion of our head. If there is a problem in one of the loops themselves, as in the case of benign paroxysmal positional vertigo or BPPV, then one might feel very acute vertigo, such as the world spinning around, resulting in very poor balance. Remember the merry-go-round? That same sensation can now be quite scary as you contemplate a fall! There is one more important role that the vestibular system also performs. It coordinates all the information taken in from what we see (visual), what we feel (somatosensory) and the motions of the head and computes the information through the brainstem and prompts us to physically react in order to maintain an upright and secure position. Many times it is a problem with the coordination process that can lead one to feel insecure, imbalanced or prone to falling.

“It’s our ability to effectively collect and act on the information our systems detect that allows us to maintain good balance and avoid falls”, says Matt Whitaker, Physical Therapist. A physical therapist trained to assess and treat each of these systems can help you increase your confidence and get back to safely walking in the home and community and returning to the activities you want to do, or what we call being Active For Life! If you or someone you know has these type of problems, don’t wait for a fall and more potential problems that come with it, contact us today to schedule an appointment to get back on track to Move Better, Feel Better & Live Better.

Next week we’ll explore balance problems, how we treat them and what you can do to start helping yourself.

Matt Whitaker has treated the dizzy and imbalanced patient for over 19 years with certification in Vestibular Rehabilitation through the University of Miami School of Medicine Division of Physical Therapy.

Balance Therapy, Part Two – Plus 3 Balance Exercises

In Part One of this series, we discussed what systems our body uses to help us maintain our balance and remain stable. In this post, we’ll review how physical therapy can help address balance challenges and help you be more confident with your movements.

Vertigo, Dizziness or Imbalance?

These terms are often used interchangeably by people that have a vestibular or balance problem. The key to proper treatment is to determine if you have a sensation of spinning or if you are feeling unstable and off balance. If you have a spinning sensation called vertigo, then a complete assessment by a certified vestibular physical therapist is critical to correctly identifying your problem. “You want to ensure that you are being treated by someone who has extensive training in this area of care”, says Matt Whitaker, PT. “Proper identification of your problem is essential to successful treatment”.

If the problem you have is a feeling of poor balance and being insecure on your feet then your evaluation will focus on assessment of your strength, agility, muscle length or flexibility and the range of motion of your joints. A challenge with any one of these can create a sensation of poor balance and fear of falling.

What is Vestibular Rehabilitation?

Let’s take a closer look at what therapy entails. If you have vertigo or spinning, treatment is often referred to as vestibular rehabilitation. First we determine if the problem is peripheral or central in origin. Generally this means it may originate from a problem in the boney loops in the inner ear (peripheral) as in the case of BPPV or benign paroxysmal positional vertigo or your brain may have trouble coordinating the information received from your vision, what you feel and your head movements (central). For either problem you should see a physical therapist with experience working with neurologic conditions to receive very specific treatment to resolve your symptoms.

What is Balance Therapy?

If the problem is having poor balance without sensation of spinning you need balance therapy or retraining. Treatment will focus on your flexibility, leg, hip and core strength and your ability to control large or small movements of your body with and without foot movement. It’s how you control those movements that makes your balance effective or not. A complete balance therapy program will address all of these and potentially more.

Three Exercises for Balance

Matt Whitaker, PT states, “Not all balance problems are treated the same, but often they share a number of things in common that simple exercises can help.” Below are three balance exercises that you can perform to start improving your balance right away.

Stretch the lower leg muscles

The “runner’s stretch” is a great way to keep your ankle joints and surrounding muscles flexible to help your balance. You’ll feel the stretch in the gastroc or “calf” muscle of the back leg.

  • Assume the position below with your hands on the wall or perhaps a counter, only for a little support.
  • Apply pressure through the heel of the back foot as you push your hips toward the wall
  • Gently bend the front knee to increase the stretch.
  • Don’t let your back heel rise off the ground!
  • Gently hold for 30 seconds, alternating each foot and repeat 3 times on each leg.

Balance on One Leg

Just as it sounds, you want to practice standing on one leg so your foot can control your balance. Try to feel your toes and foot doing the work. If this seems too hard, don’t feel bad about holding on to a counter or the back of a sturdy chair. Over time gradually let up the pressure on your hand and control the balance through the leg only. Set a goal of 20 seconds on each leg. Repeat 5 times on each side.

Sit to stand transition

Finally, perform a sit to stand exercise from a medium height surface. Follow the sequence below and try not to use your hands to rise. If you need your hands, work from a higher surface. If this is easy, try a lower surface which will make you work a little harder. Also doing this a bit slower makes it more challenging! Repeat 10 times, rest 30 seconds and repeat it twice more.

If you perform each of the exercises above you will have completed a stretch, a balance and a strengthening exercise and be well on your way to Move Better, Feel Better and Live Better!

Matt Whitaker, PT has been providing vestibular rehabilitation and balance therapy patients for 19 years with 10 years exclusively treating neurologic patients. Call to schedule an appointment today for a balance evaluation and assessment.