WAG Skipping Levels and Severs?

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tpMom

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Hi Everyone, I was wondering what your experiences with increased training and Severs Disease? As some background. My DD started Rec classes at age 6, when she turned 7 she started complaining of heel and ankle pain which we kind of ignored (I know, I feel horrible) for a while. She also has juvenile arthritis so regular joint/bone pain is pretty normal. Within a few months she could not walk on her left foot at all. She ended up having to drop out of gymnastics, wear a hard cast for 6 weeks, and spent almost 8 weeks on crutches. The final diagnosis was severe Severs Disease. After she felt better she BEGGED us to get back into gymnastics. The rec coach spent an hour with her and asked us to put her on the pre-team. She practiced with level 2 for a week, got moved up to level 3, and has spent the year competing level 3 very successfully She has been the top scorer on bars for all age groups for each of her last 5 meets, she's also scored in the top 2 of her age group and the top 4 of all age groups in the AA at every meet. She's ALSO been dealing with Severs on top of everything. She spent 4 weeks on crutches this November and the orthopedist is considering another 4 weeks in a hard cast for her latest flare up. (State is this weekend - she is dealing with an arthritis flare up as well as Severs in both feet and we are just trying to support her at this point. My suggestion that she skip state was met with the same reaction as if I had suggested we remove her arms.) Now the coaches are wanting her to score out of level 4 at a mobility meet this summer and compete Level 5 this year. My question is, have any of you had any experience with this in a child with such severe Severs? At level 3 she practices 7 hours a week. Level 5 practices 14 hours per week. I'm concerned that increasing her training would ultimately just increase her injury problems and ultimately keep her out of the gym. Or is Severs just Severs regardless of how often they train?
 
Severs is severs.....it is around as long as your child is growing.
The calf muscles and the hamstrings need special attention.....
My dd has been dealing with severs for one year. Sometimes it's really bad and she needs to ice bath 2-3 times a day. Otherwise, some stretching and limiting certain things helps.....good sneakers.....cheetah heel cups.
If it is really bad, we use PT which really seems to help.
I'm no doctor, but this is what I have been doing. I don't like casting since it just comes right back. The best way to keep the inflammation at bay is icing and stretching......
It is definitely worse the more they train.....its all about overuse...
Hang in there! It can get pretty bad, but she will get through it!
 
If it were just severs, she might be able to wait it out and push through it but you have to consider the arthritis as well, which can cause permanent damage to injured joints. This isn't so much an issue now but injuries are very common in the upper levels so you have to take this into consideration. Her body is already showing signs of distress with low hours in the gym. It will only get worse with increased hours. And while she may be able to "keep up" now even though she is taking extended breaks, this will be more difficult as she goes higher in the levels.

I commend your dd's determination to fight through all the pain and the time out of the gym but at some point, you have to look at what is best for her both now and in the future. I grew up with JRA, from 3 years old. No other way to say it other than "it sucks". Not just the pain but also the knowledge that I couldn't do everything I wanted to and that I had to make decisions based on my current status as well as what my actions would mean for the future. This included not being able to do gymnastics, which I wanted to try so badly! My doctor wouldn't even entertain the thought. That was a long time ago. Now doctors are more encouraging, wanting children to stay active. However, you still have to be "smart" about the types and level of sports. The goal is to keep them active while protecting their joints. High level gymnastics is opposite of that goal. If I were in this position with my daughter, I would do one of 2 things, based on how much she "lives for gymnastics". 1 - Find a good xcel or AAU program that allows for her to continue to compete in the sport with much lower training hours and less conditioning/reps. and generally will limit the skills level so she is not pounding as hard on her joints or 2- (preferable) help her to find another sport that does not have the heavy physical loads of gymnastics. My niece also has JRA and she found gymnastics to be too physically stressful. She did better with swimming and basketball. She is now cheering, but no heavy tumbling or flying.

As a side note, is she seeing a pediatric rheumatologist? I ask because long term immobilization of joints in arthritis patients is not recommended, even if she is not yet showing signs of arthritis in those particular joints. Obviously sometimes it is a must like for fractures, but casting for severs in general remains controversial. Add in the arthritis, I am just surprised.
 
If it were just severs, she might be able to wait it out and push through it but you have to consider the arthritis as well, which can cause permanent damage to injured joints. This isn't so much an issue now but injuries are very common in the upper levels so you have to take this into consideration. Her body is already showing signs of distress with low hours in the gym. It will only get worse with increased hours. And while she may be able to "keep up" now even though she is taking extended breaks, this will be more difficult as she goes higher in the levels.

I commend your dd's determination to fight through all the pain and the time out of the gym but at some point, you have to look at what is best for her both now and in the future. I grew up with JRA, from 3 years old. No other way to say it other than "it sucks". Not just the pain but also the knowledge that I couldn't do everything I wanted to and that I had to make decisions based on my current status as well as what my actions would mean for the future. This included not being able to do gymnastics, which I wanted to try so badly! My doctor wouldn't even entertain the thought. That was a long time ago. Now doctors are more encouraging, wanting children to stay active. However, you still have to be "smart" about the types and level of sports. The goal is to keep them active while protecting their joints. High level gymnastics is opposite of that goal. If I were in this position with my daughter, I would do one of 2 things, based on how much she "lives for gymnastics". 1 - Find a good xcel or AAU program that allows for her to continue to compete in the sport with much lower training hours and less conditioning/reps. and generally will limit the skills level so she is not pounding as hard on her joints or 2- (preferable) help her to find another sport that does not have the heavy physical loads of gymnastics. My niece also has JRA and she found gymnastics to be too physically stressful. She did better with swimming and basketball. She is now cheering, but no heavy tumbling or flying.

As a side note, is she seeing a pediatric rheumatologist? I ask because long term immobilization of joints in arthritis patients is not recommended, even if she is not yet showing signs of arthritis in those particular joints. Obviously sometimes it is a must like for fractures, but casting for severs in general remains controversial. Add in the arthritis, I am just surprised
.

Thank you for the reply, I honestly hadn't even thought about her keeping up in higher levels, I just worried about increased training time. Her arthritis is very minor - she has only had flare ups in her finger joints, hips, and toes at this point. We were worried when we restarted gymnastics but it really seemed like the best possible thing for her. Being active and strong has seemed to help a LOT - she hasn't had a flare up of any arthritis pain at all since August until the past few weeks. During her worst flare up of arthritis (which was still pretty minor) she saw a rheumatologist but her lab work was pretty good and he was located about 8 hours away, out of state, so he recommended that we stick with her pediatrician unless her flare ups get worse. There's obviously some kind of autoimmune process working against her but it's very minor and she has been very lucky. They casted her Severs originally because while we were waiting to see if it would pass on it's own she was holding her foot in a mildly pointed position. By the time she refused to walk on it her Achilles tendon had become so tight that she could no longer flex her foot, so we had to use a graduated cast system where they casted first with her toes slightly pointed (flexed as far as possible) and then 3 weeks later removed the cast, moved the foot to a flexed position and recasted. I had no idea using a cast for Severs was controversial. It sounds like I need to do more research and possibly get a second opinion about this. It sounds like we have a lot to discuss as a family. I honestly can't imagine asking her to step away from gymnastics. She has worked SO hard at it, and she loves it so much. She would live at the gym if we let her. It's heartbreaking just thinking about it. Sounds like skipping level 4 at the very least is a bad idea...
 
I don't know anything about arthritis, but my daughter has Sever's. We chose a boot over a cast for the initial flare-up (ortho suggested both options) and it worked well. She was able to remove the boot for stretching and conditioning, and came out of it with improved range of motion. We have been able to head off subsequent flare-ups with the Gymnast Care protocol of stretching, massage, and ice. I am not posting the link to the protocol because for some reason my browser thinks it's not safe--perhaps the site needs some security updates.

Re. States, my daughter had a negative experience competing at her state meet last year when she wasn't fully prepared as a result of another injury, and it ended up being a huge blow to her confidence that set her back considerably during summer training. I now wish I had insisted on keeping her out of that meet. I would consider your daughter's personality and preparedness very carefully before letting her compete. For some kids having to sit out the meet would be devastating, but for others it would be even more devastating to compete in pain or unprepared and end the season with a less-than-personal-best performance.
 
tpmom- I have had amazing results with PT- they loosen up the tendon, muscle and fascia.......It is truly amazing to see the difference before and after pt.
It is painful. The stretching hurts a lot but they get immediate relief.
Similar protocol that mommyof1 states above the only difference for me is that the PT gets much better results and if I do it, I will end up fighting with my DD.
 
Coaches perspective: but when a gymnast is dealing with a lot of pain, I think it's better to slow down their progression so they can train less hours and feel less pressure to "train through the pain" especially if it means they do a level that they can safely compete with less reps.

This year one of our girls could have gone level 8, but she's been having a Osgoods and other growth related issues. We said, that's okay, no need to push, let's do 7 again. She's been rocking it! And when she has to take some days off or some light weeks, that's okay, because she has her skills securely enough.
 

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