Jul 26 2011

Can I stretch my tendon ‘long’?

Published by mtbrider at 8:35 pm under Uncategorized

Hi all, just a quick question that popped into my head - I am in my moon boot (no surgery) at just over 7 weeks and have been taking it off 2-3 times a day to stretch my achilles (point my toes up and away from me) and do my ABC’s. Have been stretching for about 10 days. Things are developing very nicely with no pain, just the ‘tightness’. I know a concern of mine is the idea of healing ‘long’.

Am I right in thinking that at this stage I can stretch my tendon by bringing my toes towards me as long as I do not go past 90 degrees? Not that I can get there but am getting close. I am not using bands or anthing to stretch, just sitting on a couch with my ankle and calf resting on a coffee table.

Can you stretch your tendon too much at this stage and make it too long? Does anyone know how much of a stretch is too much? What about the rule ‘any stretch is great as long as there is no pain’? Should I take it easier? Argghhh so many questions!

6 Responses to “Can I stretch my tendon ‘long’?”

  1. bcurron 27 Jul 2011 at 1:20 am

    I thought that stretching long was done in the healing phase (first 6-8 weeks), after that its healed and its about getting your flexibility back?

    If you notice in the most cited protocol to follow, stretching is done in that from 6 weeks plus.

    http://achillesblog.com/normofthenorth/the-non-surgical-protocol-ive-been-following/

  2. univofpittbullon 27 Jul 2011 at 1:48 am

    I had this same question right at about the same stage in my recovery. I gained my ROM back very rapidly and could go past 90 in dorsiflexion at week 5 or 6. The possibility of overstretching was enough to keep me from even attempting it until i went to PT and they started stretching the hell out of my tendon. I figured if stretching that hard then I should be too and there went that fear. I’m at week 9 now and have been stretching fairly aggresively for 2 or 3 weeks now and things seem to be okay.

    Cheers

  3. drccdson 27 Jul 2011 at 5:04 am

    I am at week 9 (no surgery) and am wondering the same thing. I’m at zero on my VacoCast as of today, but wondering if I should go past that even in an attempt to rehab it.

  4. mtbrideron 27 Jul 2011 at 2:17 pm

    thanks for the replies so far -
    bcurr- cheers for that link which relaxes me a bit.
    univofpittbull and drccds- good to hear I am not the only person with this thought and question.

    I suppose I did not think that I could get some of my range of motion back so soon, so easily. Yes I sill have am still a long way off, not even at 0 degrees yet but I don’t want to stretch things too much and find there are consequences to what I have been doing.

  5. normofthenorthon 27 Jul 2011 at 6:06 pm

    I think it’s a great question, and I’m not sure any of us has an answer half as good! The consensus (right or wrong) seems to be that “active” dorsiflexion (with your own leg muscles) is much safer than “passive” dorsiflexion (with a towel or a theraband, etc.), which in turn is much safer than the kinds of stretches many athletes do pre-sports, with (any of ) your weight on the foot.

    The risk of re-rupture is said to drop off relatively sharply at around 12 weeks post-whatever (though we have several exceptions right here). It seems logical to me that if we can still tear it by pulling way too hard, we can also stretch or elongate it, by pulling less hard. Logic isn’t always right in this field, but it does seem logical.

    As I’ve posted once or twice, I haven’t noticed many people here who suffer from long-term shortages in dorsiflexion ROM — i.e., by the time we’re ready to use a lot of flexibility, most of us can get as much as we need. But I have noticed quite a few who suffered from long-term shortages in strength and a surplus of dorsiflexion ROM — i.e., healing long. To me, that suggests that patience in this regard may be a virtue.

    Also, the notion that it’s safe to stretch because a PT stretches you hard, may be a case of misplaced trust. My only serious setback in TWO ATR recoveries happened when I followed my PT’s advice, after I initially refused, because it seemed foolhardy (but she insisted, and I lost a month of recovery time)! In my case, my PT told me to do some 1-leg heel raises on the first day I could walk perfectly in bare feet, at ~17 weeks post-op. I told her it was too strenuous because I couldn’t do 8 “reps” (my rule-of-thumb for how much weight to lift, etc.). She said “just do as many as you can”, and I foolishly did, maybe 4 of ‘em. Didn’t hurt at all for another few hours, then it wouldn’t stop.

    And another Achilles blog site that’s listed on the Main Page here (with “family” in its name) did a survey of people who’d re-ruptured, and reported how they did it. As I recall, around 20% said “Physio”.

  6. mtbrideron 27 Jul 2011 at 7:27 pm

    Norm, the protocol from Brian Twaddle that I have posted from Bronny’s site said:

    “After 2 weeks up until 4 weeks from injury the patient can be placed in a removal orthosis set at 20deg of equinus. The patient is allowed to remove their foot from the boot for 5 minutes of every hour and move their ankle with dorsiflexion and plantar flexion, being careful not to come beyond a right angle, as the greatest risk is having a tendon that heals long. This should be repeated 5 minutes of every hour where possible.”

    So I will follow his right angle rule and hope all works out sweet!

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