As a follow up to my last blog post on Achilles flexibility Issues, we all know that if we find Achilles tightness (aka Equinus) we should begin the patient on a flexibility program. So, let us review the common principles governing stretching in general, and the Achilles tendon specifically. Please feel free to add your own general rules that you have found useful.
These include (as this list is not every general rule):
- It is better to stretch a tendon if warmed up some, even following a short walk in the morning to loosen up)
- Never stretch a tendon through pain, or if the tendon hurts afterwards for more than a few seconds
- Never stretch and balance at the same time. The patient should be advised to hold on to something, like a wall, while stretching
- Typically 20-30 seconds per stretch is adequate.
- 20-30 seconds is better obtained with 5-8 deep breathes to get oxygen into the tissues being stretched
- Maintaining flexibility is done with daily stretching
- Improving flexibility is done with 2 to 3 times of stretching daily
- If the patient does not feel the stretch in the calf area for the achilles, they are probably stretched adequately
- Stretch the 2 calf muscles separately with the gastrocnemius stretch having the knee straight and the soleus having the knee bent at least 20-30 degrees
- When the patient is in pain, or overflexible, avoid the deep negative heel stretch with dropping the heel off a stair
- Don’t bounce while stretching
- Don’t stretch at all if you have been told you have over flexible tendons
The following is a simple video explaining to patients achilles stretching with the plantar fascial wall stretch.
How To Stretch for Plantar Fasciitis and Achilles Tendinitis
Next week we will discuss the strengthening exercises used in a daily program for improving Achilles health, and in the hypermobile patients that need strength over flexibility. I will use a case report of a patient with 3 years of Achilles tendonitis to bring home my point.
