Tight Achilles Tendons (aka Equinus) and its Consequences

Tight Achilles Tendons and their treatment is a common part of a podiatry practice. This extensive article highlights it's problems, although perhaps too much for my blog. If you know you have tight calves, or have been told that in the past, begin 2-3 times daily stretching as my video below reviews. For Equinus (yes, horses run on their toes), is a sometimes silent cause of many many lower extremity, even back, conditions. 

http://www.podiatrytoday.com/understanding-biomechanics-equinus

Monday's Image of the Week: Stretching a Very Tight Achilles

Patients whom have very tight achilles tendons can use this technique to stretch out very gently in a relatively short time. An exercise band (like this yoga strap) is used to place a continuous stretch on the achilles tendon. The strap is anchored around the waist so that the patient does not need to stand or hold the band during the prolonged stretch. A towel is placed under the foot to protect the foot. Then, heat is applied under the calf for 20 minutes, and then switched to a 10 minute ice pack. The secret is to hold the stretch consistently and painlessly for the entire 30 minutes. You need a friend/partner to help with set up and to change the heat pack to ice pack at the 20 minute time interval. Dramatic increases in flexibility are noted within several weeks. Typically this is done every third day, with normal stretching 3 times per day on the off days. It is important to protect the knee while holding this stretch by rolling a towel under the knee to keep it slightly bent. You must make sure your spine is stable as you rest against a firm supportive surface. Stop if any pain develops anywhere. Review with a physical therapist to make the exercise safer for you. 

Achilles Stretching: What if it hurts?

YouTube Viewer Asked:
What if your achilles gets irritated ?

Dr Blake's comment:

If you are doing achilles stretching exercises, and you feel that the tendon is getting irritated, you must back off. There are many ways to do this. You can try spending less time (say 20 seconds not 30 seconds). You can try going a little less deep into the stretch. You can use heat before (or massage) stretching. You can ice for 5 minutes after the stretch. Once you find the appropriate stretch that does not irritate, gradually increase the stretch over the next few months. Hope helps. Rich

Another YouTube Viewer Wrote:
I read that these stretches can be done with pain and can improve the pain.

Dr Blake's comment:

See my comment above. Pain is so subjective. Yes, pain between 0-2 on a scale of 10 is probably okay since you are stressing the tissue. However, your level 2 may be my level 5 and someone else a 0. We all have different pain levels. That being said it really boils down to you listening to your body and feeling what is good pain and what is bad pain. 25% of people are natural at this, the other 75% really do not get the idea so online advice has to be somewhat conservative. Hope this helps Rich

Prolonged Heat and Ice Stretching for Chronically Tight Achilles

This video for me introduces a very important stretching technique for the chronically tight muscle/tendon groups or the acutely tight post surgery, casting, burns, etc. The principle of Prolonged Heat Ice Stretching was first written up of post knee surgeries that left very tight quadriceps by the researchers at Temple University in Philadelphia. I have successfully used the technique to stretch out tight achilles/calf, hamstrings, and quads/patellar tendons.

The basic idea is to use heat to stretch the tendon, and while continuing to hold that stretch, ice is applied to physiologically freeze the tendon in this new position (resetting the golgi tendon organs within the muscle fibres). The art is to protect the other joints involved and find out how long each stretch should be held. The Temple Study used 30 minutes heat followed by 15 minutes ice (50% of the heat in terms of time), but even 10 minutes heat followed by 5 minutes of ice can be very useful. In fact, this is my starting point with patients when I introduce the technique.

The achilles/calf stretch demonstrated here can be done standing on a slant board for probably a deeper stretch (also ideal when stretching both sides at once), although getting the ice pack to stay in place can be a challenge. In the sitting position as the video demonstrates care must be taken to protect the back, elbows, shoulders, and knees. The patient is sitting with excellent back support, the towel must be long enough not to stress the shoulders and elbows, and a towel is rolled up and placed behind the knee to protect the knee from hyperextending. Listen to your body. If pain develops, stop immediately.

Achilles Stretch Weight Bearing with Ice in Place

Side View Achilles Stretch with Ice in Place on Slant Board
Patients arms are resting comfortably on a platform on table

Many doctors recommend surgically releasing tight tendons. This may be an excellent way to rehab and lengthen the tendon without surgery. It is important for the physician or therapist involved to measure the tendons periodically to see if the stretch is helpful. I usually supplement this stretch done 2 or 3 times per week with 3 times daily normal weight bearing achilles stretches with can be done in other posts on this blog.

Dangerous Achilles Strengthening Exercise

The video above has two basic parts to it. The first part is the stretching part. As long as the heel is on the ground, the stretch is safe and should produce excellent flexibility. The second part however is the strengthening part. This is very risky since a Negative Heel Effect is created when the heel comes off the ground. Negative heel is when the front of the foot is higher than the heel. This is a very unnatural position and definitely the cause of many injuries. Avoid at all costs. The same exercise starting with the heel and front of the foot at the same level is much safer.

Stretching: Contract Relax Technique Introduced

     The basic principles of Contract Relax Stretching are introduced in the above video. A specific demonstration of partnered hamstring stetching is shown. Contract Relax stretching technique can be used on any tight muscle/tendon group. The muscle is fatigued by alternating contractions against some resistance allowing for better stretching. This is the same basic principle of stretching that warming up a muscle/tendon will allow for a deeper stretch. In the partnered hamstring stretch demonstrated, the patient contracts the hamstring against the resistance of the partner's shoulder. Isometrics are normally done to a slow count of 6 with increasing strength as the count continues. During the stretch part, the partner gently and gradually stretches the hamstring to its endpoint. The same basic stretching principles as in the video link and text link below are followed including deep breathing, no pain while stretching, alternating sides, no bouncing, etc. Contract Relax Stretching can also be done solo to achieve better flexibility by creating a contraction followed by a stretch alternating program. For example, solo or unpartnered contract relax for the achilles can be an alternating program of 5 one-sided toe raises, followed by a 30 second stretch, repeated 5 times. I hope this introduces this powerful stretching technique to you, especially used in hard to stretch muscle/tendon groups.

http://www.drblakeshealingsole.com/2010/07/video-7-generalizations-for-stretching.html

http://www.drblakeshealingsole.com/2010/04/generalizations-for-stretching.html

Plantar Fasciitis/Achilles Tendinitis: Stretches To Do and Not To Do

This short video demonstrates the 4 common weight bearing stretches for plantar fasciitis and achilles tendinitis. The Gastroc Stretch, the Soleus Stretch, and the Plantar Fascial Wall Stretch are all safe and can be done multiple times throughout the day to improve flexibility. The final stretch demonstrated called the Negative Heel Calf Stretch is potentially dangerous and places too much abnormal stress on the plantar fascia, heel, achilles tendon, and midfoot areas. The first 3 safe stretches have one major safety valve. That is that the stretch is done with the heel on the ground in a stable position. Please see the links below for other posts on these important exercises.

http://www.drblakeshealingsole.com/2010/08/plantar-fasciitis-all-important-wall.html

http://www.drblakeshealingsole.com/2010/08/video-plantar-fascial-am-stretches-for.html

http://www.drblakeshealingsole.com/2010/08/video-on-plantar-fasciitis-big-3-weight.html

http://www.drblakeshealingsole.com/2010/05/quick-tip-6achilles-stretch-to-avoid.html

http://www.drblakeshealingsole.com/2010/05/quick-tip-7-rolling-ice-stretch-for.html

http://www.drblakeshealingsole.com/2010/08/video-plantar-fasciitisachilles.html

http://www.drblakeshealingsole.com/2010/07/video-7-generalizations-for-stretching.html

I sure hope these help!! Dr Blake