Very Tight Tendons: Consider Heat Ice Prolonged Stretching

This patient has a very tight achilles tendon. The prolonged heat ice routine is based on a study done at Temple University years ago. The goal is to 3 times per week hold a stretch throughout a 30 or even 45 minute period. Heat is utilized here in the form of a heat pack for 30 minutes and this is followed by an ice pack for the last 15 minutes. Therefore, it is a 2:1 ratio of heat to ice, so 20 minutes of heat followed by 10 minutes of ice, or 15 minutes of heat and 7.5 minutes of ice. You can see it is a two man job! I get great results within a few weeks (probably near the 10th time landmark). The days the patient is not doing this they still need to stretch 3 times normally. 

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.