Orange Bucket Therapy

Motivation

Orange Buckets, Achilles Tendinopathy therapy, water -- what??

The medical community mostly agrees that Achilles Tendinopathy is related to degeneration in the tendon. There does not seem to be consensus about exactly how or why that degeneration occurs. It may be related to overuse or ageing.

Irrespective of the causal mechanisms, decreased circulation is often suspected to inhibit the body's natural healing mechanisms. In my case, recent prevalence of aches and pains signals I'm not as young as I used to be. And commonly these days, "cold hands and feet" signal that circulation isn't what it was. To add injury to insult, the tendinopathy caused me to greatly curtail my physical activity. All these factors point to poor circulation in the Achilles vicinity -- something I need to combat.

One weapon in this war is Orange Bucket Therapy (OBT). I'm going to explain exactly how I do that.

Overview

The basic idea is immersing the lower leg alternately in hot and cold water. As hot as I can stand, and as I write this in springtime, the water is fairly cold too. In my case, one tendon is affected and the other stiff and hinting at problems, so I treat both left and right. I spend 20~30 minutes doing this, ideally every morning.

Equipment

Expensive medical equipment this is not !!! Here's what I use

• Two Orange Homer "LET'S DO THIS" 5-gallon buckets from Home Depot. These are just the right size for my feet, USA size 11, about 28 cm (11") long. It would be fine if my feet were smaller, and a problem if they were much longer
• A left-over washing machine supply hose with a standard 3/4" female threaded hose fitting such as this hose set at Home Depot. I find a right-angle fitting convenient but not essential. In fact, even a garden hose could work.
• A thermometer for measuring water temperature in the bucket. This non-contact infrared thermometer measures instantly without getting wet -- a big convenience.
• A few-minute timer -- I use my phone.
• Something to read, or spend time on the phone.
• A mop and towel for drying up small spills and drying off my feet afterwards

That's all I need!

Location

Luckily I have a very convenient place - a mud sink (having 3/4" male threaded hose fitting on the spout) located in a tiled area in doors. It's essential to have hot and cold water on tap, and a floor that won't be hurt by a little water. Of course a plastic mat could fix problems there. Where I live, it's too cold for outdoors in the winter, and I don't have hot water conveniently available. Otherwise, outdoors might be handy -- no need to worry about spills.

WARNINGS

• Small children or pets can get trapped and drown in only a few centimeters (a few inches) of water in a bucket -- I DON'T LEAVE UNATTENDED
• When on full, the water is HOT -- I WATCH OUT FOR BURNS
• I use common sense and good judgement to avoid other accidents, eg, slipping on wet tile floors

Bucket Filling

My goal is to have

• a hot water bucket almost full -- so when I stand one leg in it the water comes as high on my calf as possible, to warm and relax the calf, without overflowing the bucket
• a cold water bucket that will chill the foot and Achilles tendon, without cooling the calf too much.

Getting the right amount of water, at the right temperatures, can be tricky. If I mess it up and need to pour water back into the sink and fiddle around, it takes a lot of time. So I pay attention to what I'm doing, and I've come up with a repeatable recipe which saves a lot of time. It would need to be adjusted if the water temperatures were different, or feet or buckets different sizes. My recipe is

• my cold water at the tap after running for a while: 12 degrees Celsius (54 degrees Fahrenheit)
• my hot water at the tap after running for a while: 58 degrees Celsius (137 Fahrenheit). BURN WARNING! This is dangerously hot for feet or skin! Most homes' water heaters are NOT set this hot. I do NOT suggest anyone else should set their water heater temperature this hot.
• run full cold in the sink a while to get it good and cold
• fill the cold bucket to the middle of the "DO" letters on the bucket -- that is about 14 cm (5 1/2") deep
• switch to the hot bucket and continue running the full cold until it's at the bottom of the "DO" letters -- about 10 cm (4") deep
• turn the cold full off, and hot full on
• continue filling the hot bucket until it's at the middle of the three bucket flanges -- about 5 cm (2") below the top
• as the hot adds to the cold, the hot bucket temperature should climb to about 46 degrees Celsius (115 Fahrenheit) -- this is as hot as I can stand

Doing It

Heat is said to be unhelpful to tendon strength, so my sequence finishes each foot in the cold bucket to avoid leaving the tendon hot.

• I never put both feet in the same bucket
• Each step is 1 to 5 minutes in this sequence
  1. left foot in hot bucket, right on floor
  2. left in cold, right in hot
  3. right in cold, left in hot
  4. left in cold, right in hot
  5. left on floor, right in cold
• For a shorter sequence, eliminate steps 3 & 4
• For a longer sequence, repeat 3 & 4

Ideally I do Orange Bucket Therapy (OBT) prior to Alfredson Painful Heel Drops (PHDs). Just one small assult in the war against Achilles Tendinopathy ! I think it helps.