Thank you for your question. When dealing with chronic tendinosis, knowing the appropriate treatment methods is key to recovery. In this post, we’ll answer some common questions about using heat versus ice, the role of stretching and strengthening, and when it is safe to begin exercises after immobilization.
Heat vs. ice for chronic tendinosis
Ice is more appropriate for acute tendon injuries such as tendinitis. Tendinitis is an acute short-term inflammation of the tendon that can occur anywhere in the body. It can be caused by sudden injury by either lifting something heavy or repetitively causing micro -tears in the tendon.
In contrast, tendinosis is a chronic condition that occurs when the collagen fibers in the tendon break down. It is often caused by tendon overuse or can be the result of an injury that hasn’t healed completely.
Heat can better help improve or decrease chronic pain, such as in the case of tendinosis, by increasing blood flow to areas which provided nutrients essential for tissue healing. It also allows for muscle relaxation which can help decrease pain and stiffness around the affected tendon or joint.
Stretching vs. strengthening for tendinosis
Both stretching and strengthening are important in treating tendinosis.
Light stretching helps improve the length of the tendon and overall mobility of the muscle-tendon unit. Additionally, light strengthening exercises can help manage pain, particularly when the tendon is irritated.
One of the most effective approaches used in physical therapy to treat tendinosis is eccentric strengthening, which combines stretching and loading the tendon through its full range of motion. This method not only improves symptoms but can also reverse the degenerative effects of tendinosis. Eccentric training is often combined with other techniques like deep cross-friction massage, taping, and isometric holds to enhance recovery. You can learn more about the benefits of eccentric training in this article from Healthline.
When to begin stretching and strengthening with tendinosis
You can typically start gentle stretching and strengthening exercises early in your recovery, as long as you avoid movements that increase pain. This is a good place to start if you are immobilized in a boot. Gentle range of motion exercises without the boot in a non-weight position is a good way to normalize the range of motion necessary for functional activities. Once the boot is removed, progressing to more weight bearing activities would be appropriate and again, we would recommend staying within pain-free ranges of motion and slowly progressing to larger ranges of motion.
Since we are unable to perform a full physical examination, we recommend making an appointment with your local PT for an appropriate exercise prescription geared to better address your specific injury.
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