Help my child’s heel pain

Sever’s Disease

What is it?

Sever’s disease is a painful bone disorder that results from inflammation of the growth plate in the heel. It is a common cause of heel pain in growing kids. It occurs during adolescence: Age 8-13 for female, 10-15 for males. It rarely occurs in older teens because the back of the heel usually finishes growing by the age of 15.


During the growth spurt of early puberty, the heel bone/calcaneus sometimes grows faster than the leg muscles and tendons. This can cause the muscles and tendons to become very tight and overstretched, making the heel less flexible and putting pressure on the growth plate. Over time, repeated stress on the already tight Achilles tendon damages the growth plate, causing the swelling, tenderness, and pain of Sever’s disease.

* A child is more at risk if they have pronated feet, flat or high arches, short leg syndrome, or if they are overweight.


Most common and most obvious is pain or tenderness in one or both heels-usually at the back. The pain might also radiate to the sides and bottom of the heel.

-swelling and redness in the heel

-difficulty walking

-discomfort in the feet in the morning

-discomfort when the heel is squeezed on both sides

-unusual gait- limping or on tiptoes to avoid putting pressure on the heel.


Most doctors are able to diagnose sever’s disease based on the symptoms. They may have an x-ray taken to rule out any fractures, but you cannot see sever’s disease on a x-ray.


Goal: pain relief!! Because the pain usually increases with activity, they will need to rest to relieve pressure on the heel bone, which will decrease pain.

-foot and leg exercises to stretch and strengthen the leg muscles and tendons

-ice to reduce swelling

-compression stocking for swelling


—Severe cases the doctor could place a cast from 2-12 weeks to immobilize the foot so that it can heal.

With proper care, it will go away within 2 weeks-2 months and doesn’t cause problems later on in life.

-Proper shoes(shock-absorbent soles, maybe shoes with open back to relieve pressure on the heel. No heavy or high heels

If your child is suffering from heel pain, call Rock and Armor at 208-917-2660 to get them headed in the right direction.


O’Brien, K. B. (Ed.). (2013, June). Sever’s Disease. Retrieved April 16, 2018, from

Carpal Tunnel Syndrome-Rock and Armor

Carpal Tunnel Syndrome

 By Mikayla Andersen, SPTA


Carpal tunnel syndrome is a peripheral nerve entrapment injury that occurs as a result of compression of the median nerve where it passes through the carpal tunnel. The carpal tunnel is created by the transverse carpal ligament, scaphoid tuberosity and trapezium, hook of the hamate and pisiform, and the volar radiocarpal ligament. The median nerve, FDP, FDS, FPL pass through the carpal tunnel.


Etiology: Unclear, however associated conditions that contribute to CTS include repetitive use, rheumatoid arthritis, pregnancy, diabetes, cumulative trauma disorders, tumor, hypothyroidism, and wrist sprain or fracture.

Signs and Symptoms: Sensory changes and paresthesia along the median nerve distribution in the hand. It can also radiate into the upper extremity, shoulder, and neck. Some symptoms you may have are: night pain, weakness of the hand, muscle

atrophy, decreased grip strength, clumsiness, and decreased wrist mobility. 

Diagnosis: Electromyography and electroneurographic studies can be used to diagnose a motor conduction delay along the median nerve within the carpal tunnel. MRI’s are also used to identify inflammation of the nerve, altered tendon or nerve positioning within the tunnel or thickening of the tendon sheath. Tinel’s sign, and phalen’s test can be used to assist when confirming the diagnosis.

Treatment: No universally accepted treatment, however, patients will initially receive conservative management including splinting, ergonomic measures, local corticosteroid injections, and physical therapy management.  In physical therapy, patients can expect to receive carpal mobilization, and gentle stretching. Severe cases may require surgical release of the carpal tunnel. Post surgical physical therapy intervention should include the use of moist heat with electrical stimulation, iontophoresis, cryotherapy, gentle massage, desensitization of the scar, tendon gliding exercises, and AROM. Patients should initially avoid wrist flexion and a forceful grasp. Patients should see improvement of symptoms within four to six weeks. If they have to do surgery, rehab may last six to eight weeks.

If you think you may have carpal tunnel syndrome, or would like to try non-surgical treatment options for your symptoms, call Rock and Armor at 209-917-2660 or visit

Hip Impingement-Rock and Armor Physical Therapy and Sports Performance

Femoral Acetabular Impingement (FAI) occurs when bony aspects of the femur and acetabulum of the hip pinch together during certain movements of the leg. The acetabulum is the socket of the hip joint that the head (ball) of the femur sits inside.  FAI can be divided into either cam impingement or pincer impingement subtypes.  Cam impingement occurs with a thickening of the femoral neck.  Pincer impingement occurs with osteophyte growth on the acetabular rim.


FAI often causes hip pain during sitting and activities that involve hip flexion and internal rotation.  It can limit range in these motions and people often notice these limitations before they ever have pain.  FAI generally occurs in middle-aged adults with cam impingement much more likely in males (14:1), and pincer impingement more likely in females (3:1).  This condition can result in damage to articular cartilage and the labrum over time.  Physical therapy has been show to have similar results to surgical intervention in people with FAI.  Unfortunately, many people still report pain after surgical intervention.

Physical therapy program for FAI often includes a combination of much of the following:

  • Manual Therapy: Hip Extension in Standing MWM, Hip Distraction during Internal Rotation MWM, Loaded Lateral Hip Distraction MWM, Loaded Internal Rotation, Lateral Glide in External Rotation, Long Axis Hip Distraction
  • Motor Control Exercises: Reverse Lunge with Front Ball Tap, Isolateral Romanian Deadlift with Dowel, Lateral Step-Down with Heel Hover, Side Plank, Seated Isometric Hip Flexion, Supine Hip Flexion with Theraband.
  • Mobility Exercises: Kneeling Internal Rotation Self-Mobilization with Lateral Distraction, Half-Kneel FABER Self-Mobilization, Quadruped Rock Self-Mobilization with Lateral Distraction, Prone Figure-4 Self-Mobilization, ITB Soft Tissue Self-Mobilization on Foam Roll, Quadriceps Soft Tissue Self-Mobilization on Foam Roll, Piriformis/Glut Min Self Myofascial Release on Ball, Standing Figure-4 Stretch, Kneeling Tri-Planar Mobilizations

If you think you have Femoracetabular Impingement Syndrome and could benefit from treatment for this  condition, visit or call 208-917-2660 to schedule an appointment.

Mansell et al (2018)





Hip Mobility and Recruitment for an improved squat

I. Functional Assessment

• Perform non-cued squat

• Perform full deep squat


II. Functional Movement Presentation

• Knee Valgus

• Tibial External Rotation

• Lumbar flexion/posterior pelvic tilt

• Lumbar reversal fault (butt wink)

• Forward trunk

• Knees forward

• Decreased hip mobility

• Decreased ankle mobility


III. Problem List

• Weak/tight hip external rotators

• Tight hip adductors

• Weak Lumbar extensors

• Weak hip flexors

• Tight hamstrings


IV. Corrective Squat Biomechanics

• Feet placement: shoulder width apart/slightly outside

• Toe alignment: neutral/5-12 degrees ER if necessary

• Spinal alignment: braced in neutral (two-hand rule)

• Femoral ER torsion force

• Supinated/stable foot

• Knees outside of feet movement

• Upright/vertical trunk movement


V. Stretches

• ER Table stretch

• Pigeon stretch

• Warrior stretch

• Goalie stretch

• Hip opening band stretch (supine against wall)

• Executive hip stretch


VI. Exercises

• Squat rack barbell squat

• Wall squat

• Box squat

• ER theraband


I. Other Considerations

• Heel lift

• Load position

• Low-bar back, high-bar back, front, overhead

If you think you could improve your squat mechanics, visit or call 208-917-2660 to schedule an appointment with a skilled physical therapist today.


Starrett K. Cordoza G. Becoming a Supple Leopard: The Ultimate Guide to Resolving Pain, Preventing Injury, and Optimizing Athletic Performance. Victory Belt Publishing Inc. Las Vegas. 2015.

SCHOENFELD BJ. Squatting kinematics and kinetics and their application to exercise performance. Journal of Strength & Conditioning Research (Lippincott Williams & Wilkins). 2010;24(12):3497-3506.

Todoroff M. Dynamic deep squat: Lower-body kinematics and considerations regarding squat technique, load position, and heel height

Thoracic Outlet Syndrome

Thoracic Outlet Syndrome

Thoracic Outlet Syndrome (TOS) is a painful pathology that affects individuals with developed musculature and/or poor posture.  It can present as pain and numbness in the arm, hand, and fingers.


  • Compression or irritation of brachial plexus roots (scalences, costoclavicular equal frequency)
  • Compression of subclavian artery (costoclavicular most frequent)
  • Compression of subclavian vein

3 potential locations of neurovascular compression: between scalene muscles, costoclavicular space (clavicle and 1st rib), pectoralis minor muscle

Causes: trauma, posture, repetitive stresses/overuse, anatomical alignment



Neurogenic: women

Venous: men

Arterial: equal distribution



Neurogenic thoracic outlet syndrome (90%)

  • dermatomal pain (usually in the ulnar region)
  • paresthesias
  • weakness/loss of dexterity
  • neck pain
  • occipital headaches


Arterial thoracic outlet syndrome (1%)

  • pain in hand (but rarely in shoulder or neck)
  • finger ischemia
  • paresthesias
  • coolness/pallor
  • weakness/loss of dexterity
  • early fatigue


Venous thoracic outlet syndrome (3%)

  • pain increases along course of axillary vein
  • feeling of heaviness in the affected extremity
  • arm swelling and cyanosis
  • stiffness in fingers
  • paresthesias


Provocative Maneuvers

Adson Test

Allen Test

Costoclavicular Test

Roos Test

Upper Limb Tension Test (neurogenic)


Physical Therapy

Postural reeducation/ergonomics

Stretching -scalenes, pectoralis minor

Strengthening – scapular muscles

Manual therapy – 1st rib manipulations, joint mobilization, taping

To schedule an appointment for this condition call 208-917-2660 or visit

DynaMed Plus [Internet]. Ipswich (MA): EBSCO Information Services. 1995 – . Record No. 115626, Thoracic outlet syndrome; [updated 2014 Dec 23, cite; [about 7 screens]. Available from Registration and login required.



Surgery: First rib resection and scalenectomy (FRRS)

The most frequent sports conducted by this group were baseball and softball, volleyball, and cheerleading and gymnastics, ranging from high-school to professional levels. The survey results revealed that 96% were improved in pain medication use, 75% would undergo FRRS on the contralateral side if needed, 82% had resolution of symptoms, and 94% were able to perform activities of daily living without limitation; 70% returned to the same or better level of athletic activity after FRRS, and this occurred within 1 year in 50%.


Shutze W, Richardson B, Shutze R, et al. Midterm and long-term follow-up in competitive athletes undergoing thoracic outlet decompression for neurogenic thoracic outlet syndrome. Journal of Vascular Surgery. 2017;66(6):1798-1805. doi:


Drop Shoulder Condition – scapular depression at rest, late insufficient upward rotation, general weakness upper and middle trapezius seen in people with TOS.  Physical therapy includes retraining of scapular muscles for proper recruitment with upper extremity motions

Watson LA, Pizzari T, Balster S. Thoracic outlet syndrome part 2: Conservative management of thoracic outlet. Manual Therapy. 2010;15(4):305-314. doi:


Nichols AW. Diagnosis and management of thoracic outlet syndrome. Current Sports Medicine Reports (American College of Sports Medicine). 2009;8(5):240-249.,url,uid,cookie&db=sph&AN=44304683&site=ehost-live.


Astym therapy vs. IASTM: What’s the difference?
       Astym therapy resulted from a groundbreaking research endeavor undertaken by a multidisciplinary research team including well-known scientists, therapists, and physicians, with support from major universities and hospitals.  In this Astym Research Project, the team had the unique advantage of being able to combine knowledge of physiology, cellular biology, and emerging scientific discoveries into the development of a whole new approach in the treatment of soft tissue dysfunction.  Astym therapy continues to forge new ground in the treatment of injuries and also expand the boundaries of physical therapy into new patient populations.  The Astym Research Project developed entirely unique new theories on how to engage soft tissue healing, and changed the actual paradigm on how to treat soft tissue dysfunction.
       Astym therapy, evidenced to engage the regenerative mechanisms of the body and promote the healing of soft tissues, has repeatedly been shown safe and effective in controlled clinical trials, clinical study, and large population outcomes studies.
       Astym treatment is different in goals and application from the Instrument-Assisted Soft Tissue Mobilization (IASTM) techniques.  IASTM uses tooled friction massage to mechanically break apart tissue, whereas Astym therapy’s aim is to engage the regenerative mechanisms of the body to repair damaged tissue and resorb scar tissue.  IASTM’s role in the treatment of soft tissue dysfunction is unclear, as IASTM has been shown to (a) not improve treatment results for ankle injury, (b) be comparable to no treatment being provided in elbow tendinopathy, and (c) result in a significant increase in pain and a significant decrease in the perception of function, where the ability to perform activities of daily living (ADL) decreased following IASTM.  There have been case studies suggesting IASTM may have a role in treatment, however, those studies have largely been multimodal, so conclusions from those are difficult or impossible to draw.  The research that has isolated IASTM for study suggests that clinical use may not be beneficial.
      For a fully referenced summary of research on Astym therapy and IASTM, please read this Research Overview.
Rock and Armor is proud to be an ASTYM Certified provider and happy to discuss if this mode of treatment is appropriate for your condition.  Call us at 208-917-2660.

Ankylosing Spondylitis-Rock and Armor Physical Therapy, Meridian, ID

Ankylosing Spondylitis

 Ankylosing Spondylitis (AS) is a chronic inflammatory rheumatic disease affecting primarily the sacroiliac joints (pelvis) and the spine. Age of onset usually begins between 15-30 years old with 80% of symptoms beginning before the age of 30 years old. AS is more common in men than women. The exact cause of the disease is unknown, but there is a combination of genetic and environmental factors seen with individuals with the disease. There is a gene called HLA-B27 that has been noted to be present in 90% of people with the diagnosis. However, only about 5% of people with this gene develop ankylosing spondylitis. The environmental factors that contribute to AS are less known but include mechanical stress to the entheses and pathological infections. Entheses is the attachment point of a tendon or ligament to the bone. Stresses occurring at this site are linked to the inflammatory response that occurs with AS.  

The chief complaint of a person with ankylosing spondylitis will be back pain worse upon waking up or after rest which lasts greater than 30 minutes. The back pain will also improve with movement. A person will have spinal stiffness and loss of mobility in the spine due to the bony fusion that occurs at the joints. Other common symptoms are fever, generalized fatigue, loss of appetite, difficultly breathing, and uveitis which is swelling of the eye. 

A diagnosis criteria for ankylosing spondylitis is called the Modified New York criteria. This includes the following: 1) Presence of either bilateral sacroiliitis greater than grade 2 or unilateral sacroiliitis greater than grade 3 on an x-ray. 2) Plus greater than one of the following: inflammatory low back pain for greater than 3 months that improves with exercise and does not improve with rest, limited lumbar spine motion in sagittal and frontal planes, and/or decreased chest expansion for age and sex. The Modified New York criteria for classification of grades include: grade 0 – normal sacroiliac joint, grade 1 – suspicious changes, grade 2 -minimal abnormality with erosions or sclerosis but normal joint width, grade 3 – unequivocal abnormality with erosion, sclerosis, widening, narrowing, or partial ankylosis, grade 4 – total ankylosis.  

The American College of Rheumatology developed evidenced based 2015 guidelines and recommendation for the treatment of ankylosing spondylitis. The guidelines strongly recommend the use of nonsteriodal anti-inflammatory drugs (NSAIDs). Some common NSAIDs include ibuprofen, Advil, and aspirin. Other medications strongly recommended are tumor necrosis factor (TNF) inhibitors. Both these medications are used to decrease pain and inflammation. In addition, it is strongly recommended for treatment with physical therapy. Physical therapy interventions may improve pain and function in ankylosing spondylitis. Interventions include posture training, strengthening, stretching, and flexibility exercises, deep breathing exercises, and pain management techniques. Evidence based research has concluded that physical therapy with mobilization treatment for 8 weeks may improve chest expansion, posture, and spine mobility in patients with ankylosing spondylitis. Rehabilitation programs may reduce fatigue and increase spinal mobility following treatment with tumor necrosis factor inhibitors in patients with ankylosing spondylitis. Also addition of cardiovascular training to flexibility training may improve cardiovascular fitness and peripheral joint pain in patients with ankylosing spondylitis. In conclusion, a combination of medication and physical therapy is important for managing ankylosing spondylitis. 

Hunter Huberty, SPT, University of North Dakota Physical Therapy Department, 2018

Ward MM, Deodhar A, Akl EA, et al. American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network 2015 Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis. Arthritis & rheumatology (Hoboken, NJ). 2016;68(2):282-298. doi:10.1002/art.39298. 


DynaMed Plus [Internet]. Ipswich (MA): EBSCO Information Services. 1995 – . Record No. 143424, Ankylosing spondylitis; [updated 2017 Aug 28; [about 32 screens]. Available from Registration and login required.