Stretching exercises for Sever’s disease – What to do and what to avoid

One would think that calf muscle stretches should be one of the most obvious Sever’s disease stretches, but they can actually worsen your child’s symptoms if done too early or aggressively. Learn why this is and what alternative stretches are more useful – with instructions and video demos.

Remember, if you need help with an Achilles injury, you're welcome to consult one of our team via video call.

The terms tendinitis, tendonitis, tendinosis, and tendinopathy mean the same thing for all practical purposes, and we use these interchangeably in most of our articles.

In this article:

1. When NOT to stretch the calf muscles

2. Calf stretch alternatives

3. Stretches for the posterior chain

4. Calf stretches for Sever’s (when appropriate)

5. Where calf stretching fits in with Sever’s treatment

6. How we can help

We’ve also made a video about this:

If you’re unsure of what Sever’s disease is or whether your child indeed has Sever’s, I would suggest reading our article on its causes before moving on to this one.

When NOT to stretch the calf muscles

A calf stretch is any movement where the top of the foot moves closer to your shin.

In the early, painful, or highly irritable phase of Sever’s disease, calf stretching is often not recommended.

Sever’s is a “traction apophysitis”, which means the growth plate in the heel is irritated because the Achilles tendon has been pulling excessively on it. When you stretch your calf muscles, they pull on the Achilles tendon, which then pulls on the already irritated growth plate which can further irritate it.

Calf stretches also cause your Achilles tendon to move closer to and compress against the heel bone which, similar to pressing on a bruise, has the potential to increase pain. This might not cause damage, but it can make symptoms worse or slow recovery.

👉 For this reason, sustained or repeated calf stretches are usually avoided when:

• the heel pain is sharp or severe,

• pain limits normal walking,

• stretching clearly aggravates symptoms.

This does not mean your child must avoid normal movements that take the foot into that position altogether. Everyday activities such as pulling the foot back to put on shoes or moving freely while playing are fine. The concern is more about long, held stretches or activities that stretch the calf muscles strongly and repeatedly.

Calf stretches might be introduced later, once pain has settled and the heel is less irritable, depending on how your child responds. We cover these later in the article.

Calf stretch alternatives

When calf stretching is not appropriate, there are still ways to address tightness in the calf area without aggravating the heel.

Massage

Massage of the calf muscles can help to reduce tension without placing extra stress on the heel. This includes:

• self-massage by the child,

• massage by a parent,

• massage from a physiotherapist or other healthcare professional.

Maryke demonstrates self-massage techniques for when you have Achilles pain in this video. The same approach applies for Sever's:

Dry needling

This is another option for relieving tightness in the calf muscles – when done correctly by a qualified professional. In this article of ours on dry needling for Achilles tendonitis, there’s a section on how dry needling helps tight calf muscles to relax.

Stretches for the posterior chain

The muscles in the backs of our legs (glutes, hamstrings, calves) are all connected through thick fascia layers – they form part of what is referred to as the posterior (muscle) chain in the body. This is why stretching areas above the calf can often be helpful. These stretches are also less likely to irritate the heel, which makes them a suitable place to start

Remember that a stretching programme should always be tailored to what the specific child needs. What works well for one child may not be suitable for another, especially during various stages of recovery.

If you are unsure which stretches are appropriate, or when to introduce them, professional guidance from a physiotherapist can help ensure your child is doing the right things at the right time. This is something we can assess and provide via Video Consultation.

For all the stretches below:

• Hold each stretch for 30–40 seconds

• Repeat 2–3 times per side

• Do them daily.

🚨 Stretching should never cause pain.

These can be done during quiet times, such as watching TV or before bed, or as part of a warm-up or cool-down – provided they remain comfortable.

Glute (bottom) stretches

One option is done lying on the back:

1. Bend both knees

2. Cross one leg over the other so that its ankle rests on its thigh

3. Let the crossed leg’s knee fall out to the side

4. The foot stays relaxed (not pulled back or pointed)

5. Grab the back of the thigh of the other (non-crossed) leg with both hands and pull it towards you until a stretch is felt in the glute muscle of the crossed leg.

Glute stretch demo 1: Figure 4 stretch

An alternative seated version can be used if lying down is uncomfortable. Both versions aim to stretch the same area.

Demo 2: Seated glute stretch

If your child experiences pain, discomfort, or cannot get into the position easily, the stretch should not be done. Your physiotherapist can provide you with a different option.

Hamstring (back of thigh) stretches

A common option is:

1. Lie on your back

2. One leg stays straight on the floor

3. The other leg is lifted and held behind the thigh

4. The foot stays relaxed (not pulled back or pointed)

5. The leg is straightened until a stretch is felt along the back of the thigh.

Hamstring stretch demo:

Calf stretches for Sever’s (when appropriate)

Once the painful symptoms have settled and your physio has advised that it is safe to do so, calf stretches can be introduced.

🚨 Any calf stretch should feel like a mild pull in the muscle, not pain in the heel.

Classic calf stretch

This is the typical “runner’s stretch” for the calf muscles.

1. Stand with one foot out in front of you, one behind you, both feet facing forward.

2. The back leg is straight, and the front one is bent.

3. Lean forwards until you feel a stretch in the calf muscles of the back leg.

To target the soleus calf muscle (the one that sits slightly lower than the gastrocnemius), bring your feet closer together, bend both knees, and then lean forwards.

Standing calf stretch demo:

Gentler calf stretch options

If the classic calf stretch causes pain or discomfort, this option might work:

1. Sit on the floor with the leg to be stretched straight out in front of you.

2. Hook something like a scarf or belt around the ball of the foot.

3. Pull the foot back gently until you feel a stretch in the calf muscles.

Gentler calf stretch demo:

Where stretching fits in with Sever’s treatment

There are many factors that can contribute to a child developing Sever’s and for some, tight muscles might not be the main or only issue. So, while stretches can form an important part of the treatment plan, they are not essential for every child with Sever’s, and some children might not need to stretch at all.

In practice, stretching decisions should be based on:

• how irritable and painful the heel currently is,

• whether stretching increases symptoms,

• how your child moves overall, not just what feels “tight”, because the cause of the sensation of tightness might come from a different source (like the nerves).

Stretching is usually considered alongside other strategies such as pain relief, activity modification, footwear support, taping, strength work, and movement control. It is not a standalone fix for Sever’s disease.

We will soon publish an article with a detailed exploration of how to treat Sever’s – in the meantime, here is our video that discusses various treatment options, among other things.

How we can help

Need help with your child's Sever's or with any Achilles or related injury? You’re welcome to consult one of the team at TMA online via video call for an assessment of your injury and a tailored treatment plan.

We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine or at least 10 years' experience in the field. All of us have a wealth of experience working with athletes across a broad variety of sports and ranging from recreationally active people to professional athletes. You can meet the team here.

About the Author

Alison Gould is a chartered physiotherapist and holds an MSc in Sports and Exercise Medicine. You can follow her on LinkedIn, Facebook, Instagram, and Twitter.