Tendonitis, the irritation or inflammation of a tendon, is a common issue causing joint pain. Tendons are tough, fibrous cords that connect muscle to bone. When they become painful, people often wonder whether to use heat or ice. Successfully managing the discomfort depends entirely on the specific stage of the injury—whether it is a sudden, new injury or a long-standing, chronic issue.
Understanding Acute vs. Chronic Tendon Pain
Tendon issues are categorized into two types: acute and chronic, requiring different treatment approaches. Acute pain, often labeled true “tendonitis,” involves inflammation and arises suddenly from a recent injury or overload. This phase is characterized by symptoms like swelling, redness, and warmth.
Many long-standing cases referred to as tendonitis are actually tendinosis, a chronic condition. Tendinosis is degenerative, involving the breakdown of collagen fibers within the tendon tissue, rather than primarily inflammatory. This chronic phase presents as persistent aching, stiffness, and pain that often lasts for months or years, usually without the swelling seen in the acute phase.
When Heat Therapy is Effective
Heat therapy is effective for managing chronic tendon pain and the stiffness associated with tendinosis. This approach is beneficial only after the initial inflammatory period has passed, typically 48 to 72 hours after acute symptoms begin. Applying heat causes vasodilation, the widening of blood vessels in the treated area.
This increased circulation delivers oxygen and nutrients to the tendon tissue, assisting in the repair and remodeling process necessary for chronic degeneration. Heat also helps relax surrounding muscles, easing tightness and reducing mechanical force on the injured area. Furthermore, warmth improves the flexibility of collagen fibers, making the tendon less stiff and more receptive to movement. For chronic issues, heat should be used before physical activity or stretching to warm up stiff tissues.
Why Cold Therapy is Essential for Flare-Ups
Cold therapy, or cryotherapy, is the preferred treatment for acute tendon injuries and sudden, painful flare-ups. When a tendon becomes acutely inflamed, cold application causes vasoconstriction, the narrowing of blood vessels. This action immediately reduces blood flow to the injured area, minimizing swelling and inflammation.
By controlling fluid accumulation, ice alleviates pressure on nerve endings, providing a numbing effect that dulls pain. Cold application is important during the first 48 to 72 hours following an injury, or whenever the area feels hot, swollen, or sharply painful. Applying heat during this acute, inflammatory stage can worsen the condition by increasing blood flow and escalating swelling. If chronic tendinosis flares up intensely after activity, cold therapy should be used immediately to manage the resulting inflammation.
Safe Application and Complementary At-Home Care
Safe application of both heat and cold therapies is important to maximize benefits and avoid skin damage. Sessions should be limited to 15 to 20 minutes at a time. For acute injuries, cold therapy can be repeated every two to three hours, ensuring the skin returns to its normal temperature between applications.
A barrier, such as a thin towel, must be used between the skin and the ice pack or heating pad to prevent frostbite or burns. For chronic stiffness, heat can be applied two to three times per day, often using moist heat which penetrates tissue more effectively than dry heat.
R.I.C.E. Protocol
Initial home care for acute injuries should incorporate the Rest, Compression, and Elevation components of the R.I.C.E. protocol. Compression with a bandage helps limit swelling, and elevating the injured limb above the heart assists in draining excess fluid. Seek professional medical advice if the pain is persistent, if there is an inability to bear weight on the limb, or if symptoms do not improve after several days of home care.