Prolonged Heat/Ice Stretching: Achilles Tendon Tightness

http://www.drblakeshealingsole.com/2011/07/prolonged-heat-and-ice-stretching-for.html

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.

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.