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Is ice or heat better for Achilles tendonitis?

Updated: Mar 13

It is usually better to use ice (cold) rather than heat when you have a painful Achilles tendon, but it has its limitations. There are very specific things to keep in mind when using ice for Achilles tendonitis/tendinopathy. In this article, we’ll look at the various reasons why someone may want to use ice or heat and whether this is good, bad, or just a waste of time. Remember, if you need more help with an Achilles injury, you're welcome to consult one of our team via video call.


Should you use hot or cold for Achilles tendonitis?

In this article:

  1. Can ice help for Achilles tendonitis?

  2. Can heat help for Achilles tendonitis?

  3. How we can help

We also made a video about this:



Can ice help for Achilles tendonitis?


Icing your injured tendon for short periods during the day can be a useful way to reduce your pain and make you more comfortable, because it numbs the nerve endings. However, it won’t speed up your tendon’s healing process. For the tendon to recover and rebuild itself, you have to reduce the aggravating activities (this allows it to calm down) and follow a carefully graded strength training programme (this rebuilds the tendon).


It’s usually best to apply the ice for 10 minutes or less at a time, with breaks of 10 minutes or more, and to use it only when needed. Overcooling tissue can actually hinder repair and may even cause additional injuries. So, don’t just stick the ice on your Achilles tendon and then forget about it.



Also, don’t ice your tendon just for the sake of icing it, as it can decrease the positive effects of your strength training exercises. Research has found that if you routinely cool tissue after doing strength training, it blunts the training response. In other words, you don’t gain as much from a training session as when you don’t cool the tissue. If we consider that the whole aim of the strength training is to strengthen the tendon, you can see why this is not an ideal outcome.


I’ve discussed this in detail in this video.



Can heat help for Achilles tendonitis?


No. One of the reasons that patients mention for wanting to apply heat to their tendons is that they’ve read that a tendon has poor blood supply, and they hope that the heat will improve the blood flow.


Yes, a tendon does have poorer blood supply than other types of tissue (muscles, for instance), but its blood supply is exactly right for a tendon; it is meant to work with that blood supply. Applying heat to the tendon area may provide a mild increase in blood flow (mostly only in the skin) as the body tries to get rid of the extra heat, but your cells are designed to work at their best at a very specific temperature. So, the body will always strive to keep your temperature constant.


If you overheat the tissue, you may cause damage. Our advice is not to apply heat when you have Achilles tendinopathy or tendonitis.


How we can help


Need more help with your Achilles injury? You’re welcome to consult one of the team at TMA online via video call for an assessment of your injury and a tailored treatment plan.

We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.

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About the Author

Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Master's Degree in Sports Injury Management. Follow her on LinkedIn or ResearchGate.



References:

  1. Cook JL, Rio E, Purdam CR, et al. “Revisiting the continuum model of tendon pathology: what is its merit in clinical practice and research?” British Journal of Sports Medicine 2016;50:1187-1191

  2. Khan, KM et al. “Time to abandon the ‘tendinitis’ myth.” BMJ (Clinical Research Ed.) vol. 324,7338 (2002): 626-7. doi:10.1136/bmj.324.7338.626

  3. Yamane M, Teruya H, Nakano M, Ogai R, Ohnishi N, Kosaka M. Post-exercise leg and forearm flexor muscle cooling in humans attenuates endurance and resistance training effects on muscle performance and on circulatory adaptation. Eur J Appl Physiol 2006;96(5):572-80

  4. Roberts LA, Raastad T, Markworth JF, et al. Post-exercise cold water immersion attenuates acute anabolic signalling and long-term adaptations in muscle to strength training. J Physiol 2015;593(18):4285-301 doi: 10.1113/JP270570