Should You ICE Patellar Tendonitis?

One of the most common questions that people keep emailing me is “Do you recommend icing for patellar tendonitis?”

And to give you a precise answer: it depends.

Watch the video or read the transcript below to learn more.

Video Transcript:

To ice or not to ice?

Rest, ice, compression, and elevation is the standard approach for dealing with sports injuries and it’s also among the very first recommendations you’ll find if you start looking for advice on patellar tendonitis.

The research on icing for tendinopathy is still thin1 and even today, there’s no agreement on how exactly icing works (or does not work), but the common consensus among scientists and clinicians is that:

  • Icing is fantastic to deal with acute tendon pain after injury or a hard training session.
  • It’s also useful for getting pain flare-ups under control2
  • Icing reduces blood flow, swelling3, and it can reduce tendon inflammation4

Essentially, icing is an all-natural anti-inflammatory and painkiller. It’s not as strong as ibuprofen, but still a great alternative to try early in the game if your tendons are easily irritated. Here’s how you do it.

The Best Way

The fastest and cheapest way to ice tendons is to just use ice cubes from your cooler, because let’s face it, even if you have an ice wrap somewhere, it’s probably not in your freezer.

If you know you’re going to ice a larger area, you can also freeze water in a disposable plastic cup and use that instead.

Hold the ice with a towel and gently massage the tendon for up to three minutes or until you can no longer feel anything when touching the skin, whatever comes first. You then have to wait until the skin is warm again before icing another time, but aside from that you can ice as often as you like.

But sometimes ice makes a tendon feel worse. So if you have stiff tendons or if your tendonitis has already become chronic, you might want to try heat instead.

Ice vs. Heat

Heat increases blood circulation and it improves tissue elasticity. Back when I had tendonitis, I noticed that my pain was significantly worse after riding my bike in cold winter weather, so I decided to try the opposite.

I filled a warm water bottle with hot water, placed it on my knees, and then wrapped a towel around my legs to keep the heat in. Just five minutes would already make my knees feel soooo much better.

If you try this, please do not to burn yourself. Notice that the one side of the warm water bottle has this ribbed surface. Place that side against your pants and don’t use boiling water.

And don’t use heat if you’re going through a flare-up of pain or if you’ve only had tendonitis for a short time.

So the takeaway is: use ice to reduce inflammation and for pain management and try heat for stiff tendons and chronic tendon injuries.

References
[1] H. Horstmann et al., “Evidenzbasierte Therapie bei Tendinopathien am Kniegelenk,” Der Unfallchirurg 120, no. 3 (2017).

[2] Peter Malliaras, Lower Limb Tendinopathy Course (London, 31.10.2016), pp. M2.

[3] Gerard A. Malanga, Ning Yan, and Jill Stark, “Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury,” Postgraduate Medicine 127, no. 1 (2014).

[4] Jianying Zhang, Tiffany Pan, and James H.-C. Wang, “Cryotherapy suppresses tendon inflammation in an animal model,” Journal of Orthopaedic Translation 2, no. 2 (2014).

Martin Koban

About Martin Koban

I’m Martin Koban and I help people with knee pain get back to living a normal life. I’ve worked with professional athletes, recreational athletes, and regular people from all around the world.

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