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Monday, April 1, 2013

Prolonged Heat/Ice Stretching: Achilles Tendon Tightness

Several years ago I introduced a wonderful method of stretching out a very tight muscle/tendon. As a podiatrist, I use it the most on tight achilles tendons, but it was first introduced as a method to stretch out the quadriceps post knee surgery (Temple University study). So many podiatrists, knowing the dangerous effects of a tight achilles tendon, opt for surgery to lengthen the tendon. This causes a 2 year rehabilitation program due to the scarring, and severe weakness following the surgery, and not counting the dramatic changes in gait. A more gradual process to lengthen the tendon is with prolonged heat/ice stretching. I measure my patients before and after both gastrocnemius (knee extended) and soleus (knee bent). The typical program is 45 minutes of straight stretching where you change the hot pack (30 minutes) for a cold pack (last 15 minutes) without the patient stopping the stretch. I will make sure the knee does not hyperextend during the stretch. I will start with 10 minutes heat and 5 minute ice the first time making sure the patient can tolerate this. If you can develop a stretch like this 2 to 3 times a week, along with their normal achilles stretches, you should see great results. 

Here a sports cord is wrapped around the waist of the patient and then the foot and tightened.  The patient should feel that the achilles tendon is maximally stretched. 

The initial heat pack can be seen under the leg. It is the calf muscle, not the achilles tendon, that you are heating up.

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.