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What are good nonweightbearing stretches for AT and PTT?

Posted by Beverly on 8/01/01 at 14:15 (055101)

Hi docs,

My ankles that setback my PF stretching are continuing to show improvement thanks to a successful set of orthodics. (PF not making as much improvement, but that's another story...)

You may remember I had to back off from stretching when I got achilles tendonitis. For the past couple of months, I've been slowly reintroducing my nonweightbearing stretches... mostly FootFlex and holds, ankle circles, and moving foot side-to-side.

Is the towel stretch good for my AT or bad? I'm only holding it for a few seconds. I know the PF stretches well, but I'm not sure if my towel stretches I've just started doing again are good for the AT.

I still feel my ankle 'catch' when I do my morning stretches (even after applying heat) but I don't have the pain level in the ankle that I had a few months ago. I think if I could get back into my regular stretching routine, it would help my PF but I don't want to flair up the ankles in the process.

Thanks,
Beverly

Re: I mean foot flex stretches... not the product...

Beverly on 8/01/01 at 14:16 (055102)

eom...

Re: What are good nonweightbearing stretches for AT and PTT?

John E. on 8/01/01 at 14:45 (055103)

I only do towel stretches, three four five times a day. Get funny looks at my work. I think I'll do some now. I hold it for a few minutes, and I feel good for quite a while afterwards. They seem to work for me and they are non-weight bearing. Other traditional stretches hurt my knee and leg.

I do of course have PF problems, so I can't say if some other stretch would be more effective. I would also like any answer from someone else to this question.

Me - I think they are far better than other stretches though.

John E.

Re: What are good nonweightbearing stretches for AT and PTT?

Ed Davis, DPM on 8/01/01 at 15:44 (055109)

The stretches you describe are good for achilles tendinitis. The goal is to stretch with low intensity for a prolonged period of time--sounds like you may be rushing it a bit.
Ed

Re: Thanks... What does "low intensity/prolonged period of time" mean?

Beverly on 8/02/01 at 13:45 (055223)

Dr. Davis,
Thank you for your reply. I'm not sure if I understand what low intensity/prolonged period of time' means. I've had PF and been treating it for 1.5 years and PTT for almost that long. But the AT is relatively new... came on this past Spring. For several months any stretching hurt. I began slowly reintroducing my regular stretching in June... beginning with just a few stretches at a time 1x a day in water.

Now, I've worked up to doing six stretches each to the count of six of FootFlexes and pointing foot down & inward stretches (hard to describe what it looks like), and then six side-to-side stretches with no hold and six ankle circles. I'm now up to doing this routine 3x a day. This is much less than I did before the AT but at least it is something. I've been doing ok with this much.

It is the towel stretches that I'm still not sure about. I've just started doing three at a time. They still hurt a bit to do, but not like they did when I tried them a month or so ago.

So, am I doing too much... doing it the wrong way? I had many months of PT last year, and so I know alot of stretches, but now I'm on my own as to how to utilize them.
Thank you,
Beverly

Re: Thanks... What does "low intensity/prolonged period of time" mean?

Ed Davis, DPM on 8/02/01 at hrmin (055262)

Beverly:
If you look at a tendon under a microscope you will see that it is made up of many parallel fibers. Pull hard on the tendon and the fibers will contract and bunch up--shorten. This happens as a reflex, basically a defense mechanism, to prevent tearing of the tendon. Next, envision the parallel fibers with very light tension, light pull placed on them---nothing happens for a while, but as time goes by the fibers start to elongate and slide against each other, side to side. This is elongation of the tendon and it is desirable. So, in order to make a tendon longer it must be stretched but very gently. The longer the gentle stretch is kept up, the longer it will stretch.

This is one of the advantages of the night splint--it maintains gentle stretch on the achilles tendon for long periods of time allowing it to slowly elongate.
Ed

Re: I mean foot flex stretches... not the product...

Beverly on 8/01/01 at 14:16 (055102)

eom...

Re: What are good nonweightbearing stretches for AT and PTT?

John E. on 8/01/01 at 14:45 (055103)

I only do towel stretches, three four five times a day. Get funny looks at my work. I think I'll do some now. I hold it for a few minutes, and I feel good for quite a while afterwards. They seem to work for me and they are non-weight bearing. Other traditional stretches hurt my knee and leg.

I do of course have PF problems, so I can't say if some other stretch would be more effective. I would also like any answer from someone else to this question.

Me - I think they are far better than other stretches though.

John E.

Re: What are good nonweightbearing stretches for AT and PTT?

Ed Davis, DPM on 8/01/01 at 15:44 (055109)

The stretches you describe are good for achilles tendinitis. The goal is to stretch with low intensity for a prolonged period of time--sounds like you may be rushing it a bit.
Ed

Re: Thanks... What does "low intensity/prolonged period of time" mean?

Beverly on 8/02/01 at 13:45 (055223)

Dr. Davis,
Thank you for your reply. I'm not sure if I understand what low intensity/prolonged period of time' means. I've had PF and been treating it for 1.5 years and PTT for almost that long. But the AT is relatively new... came on this past Spring. For several months any stretching hurt. I began slowly reintroducing my regular stretching in June... beginning with just a few stretches at a time 1x a day in water.

Now, I've worked up to doing six stretches each to the count of six of FootFlexes and pointing foot down & inward stretches (hard to describe what it looks like), and then six side-to-side stretches with no hold and six ankle circles. I'm now up to doing this routine 3x a day. This is much less than I did before the AT but at least it is something. I've been doing ok with this much.

It is the towel stretches that I'm still not sure about. I've just started doing three at a time. They still hurt a bit to do, but not like they did when I tried them a month or so ago.

So, am I doing too much... doing it the wrong way? I had many months of PT last year, and so I know alot of stretches, but now I'm on my own as to how to utilize them.
Thank you,
Beverly

Re: Thanks... What does "low intensity/prolonged period of time" mean?

Ed Davis, DPM on 8/02/01 at hrmin (055262)

Beverly:
If you look at a tendon under a microscope you will see that it is made up of many parallel fibers. Pull hard on the tendon and the fibers will contract and bunch up--shorten. This happens as a reflex, basically a defense mechanism, to prevent tearing of the tendon. Next, envision the parallel fibers with very light tension, light pull placed on them---nothing happens for a while, but as time goes by the fibers start to elongate and slide against each other, side to side. This is elongation of the tendon and it is desirable. So, in order to make a tendon longer it must be stretched but very gently. The longer the gentle stretch is kept up, the longer it will stretch.

This is one of the advantages of the night splint--it maintains gentle stretch on the achilles tendon for long periods of time allowing it to slowly elongate.
Ed