So, is it better to use hot or cold when you've got Achilles tendinopathy or tendinitis?
Well, the short answer is that cold is usually better, but it has some limitations, and there
are certain times when you shouldn't be using ice. So, in this video, we're going to look at:
What ice can do, what it can’t do, when you shouldn't be using it, and if you want to use it,
how to use it best. And then we're also going to look at why people think heat may be useful
and why it's not really recommended. So, for those of you who don't know me,
my name is Maryke. I'm one of the physiotherapists from my treatmyachilles.com,
where you can get online physiotherapy assessment as well as treatment for your
Achilles injuries. Have a look at the description of this video if you want a link to our website.
Ice can be a really useful tool to help decrease pain. So, if you've got a super painful Achilles
tendon, it may be something to use, and it works by numbing the nerve endings. Now, it's important
to understand that pain won't make your injury heal more quickly, so it's not going to speed up
the healing process if you ice it regularly. And in fact, icing it regularly, or too regularly,
is actually not that useful; I'll come to that in a bit. So, let's look at ice and pain. So,
you may think, ‘Well, it's just going to numb the pain, there's not really much use in using it.’
But, on the contrary, you've got to remember that there's actually a mismatch sometimes between pain
and injury. So, we used to think that the amount of pain or the intensity of the pain we feel
is directly related to the intensity or the degree of the injury. So, a bad injury really hurts
lots; an injury that's getting better doesn't really hurt. But now we understand that the body's
pain system can become sensitized. So, you can have a lot of pain and actually only a teeny tiny
little injury. And we often see this with Achilles tendons, that they can be super, super sensitive,
but when you look at a scan, the scan shows only a minor tendinopathy in there. So, ice is
useful because it can can help calm those nerve endings down and calm the pain system down. So,
if you have a super painful tendon, it's a useful tool to use. Now, it's not okay to just take your
foot and ‘Boom!’ leave it on the ice for hours on end, because if you cool the tissue too much,
you can actually also damage it. So, the best way to do this is, that you keep it on there for
max 10 minutes, but 7 minutes is likely enough, because there's not much between your Achilles
tendon and the ice pack. And you've got to put some protective layer in there, like a wet cloth
or something between the ice and your Achilles tendon. And you only leave it on there for,
like I said, 5 to 10 minutes. You take it off for 10 minutes - that's so that your skin can recover
and not get too cold - and then you can reapply for 10 minutes. And that's one session of icing.
Now, if your tendon is super painful at the moment or really flared up, you can do it more than once
a day. But like I mentioned before, don't think that you routinely need to ice it, because there's
actually research out there to show that if you routinely cool tissue after you've exercised,
you do not get the same strength adaptations in the tissue. Now, you've got to remember
that the main treatment that works for Achilles tendinopathy or tendinitis is to do a carefully
graded strength training programme, where you start low and you work with the exercises
over time, that it becomes more intense, with the idea that you strengthen that tendon up,
you make it more robust, you give it back its strength, and it allows you to do your sport. Now,
imagine if you routinely iced your tendon every time you've done your exercise or you've gone
out for some activities outside, then it may mean that you don't get the benefit from that
strength training. So, you don't want to lose out on that. So, only use ice when you need it
to calm down the excessive pain, but don't necessarily do it as a routine thing. The other
reason people tend to think ice works is because they think that it calms inflammation down. Now,
there isn't any inflammation in ongoing Achilles pain. So, what we used to think is,
anything that becomes painful and injured in the body has an inflammatory response. But now, again,
because they've done lots of research on this, and they can actually look at
what cells are involved there, is there inflammation, is there not inflammation?
They found that in ongoing pain – so, if you've had your pain in your Achilles for more than a
few weeks – there's actually no inflammation in that process; it's a different process. And I've
made a video about what happens in the Achilles tendon when you have a tendinopathy or tendinosis.
So, ice also … It's not worth putting it on there, thinking that you're helping the inflammation.
Now, let's get onto heat. So why do people think that heat is a …
could be useful for treating Achilles tendons? The main reason is that they have read on the Internet
somewhere, or somebody has told them that tendons don't have good blood supply, and that's why they
heal so slowly or that they get injured so easily. So, they think if they put the heat on the tendon,
it will improve the blood supply and there you go, it'll heal more quickly. The problem is,
yes, tendons do have a decreased blood supply compared to other tissues like bone or muscle,
but it is the perfect blood supply for a tendon; it has evolved to work with that blood supply.
So, if you heat the tissue, you may get a small increase in blood supply. But to be honest,
it's mostly to the skin, because the body will, at skin level, open the blood vessels up to try and
get rid of this extra heat, because it's always trying to keep the temperature inside the body
at the optimal heat for the cells to function. And as soon as you remove the heat, you will get that
the temperature just goes back to normal and the blood supply returns back to normal. So, you may
get a tiny bit of increase in blood supply, but it's not necessarily going to help your healing.
And if you heat it too much, you can actually delay your healing or interfere with the process.
So, our advice is, don't bother with heat, use ice if you really need it for pain management. But the
most important thing for Achilles tendinopathy or tendinitis, if you want to get it to be better,
is that you've got to use relative rest, which means you remove the aggravating activities
from your life. Which could mean that you have to cut down on what running you do or adjust
your running program, or perhaps just not walk as far for a little bit so that it can settle down.
Or perhaps just use something in your shoes to help you with that.
So, that's the first thing: Relative rest – taking out the really aggravating things
to allow it to settle down. And the second thing is, starting a rehab programme that starts at
the right level for you. So, don't just get something off the Internet that says, ‘Oh,
you've got to do high-load exercises,’ and jump in with that; it will likely just make it worse. It's
got to be set at the right level for you. And then, progress it over time, so that it gets to
the forces or that it equals the forces you want to use in your activity. So, if you're a walker,
your training programme won't be quite as heavy as if you're a runner or a jumper;
it just depends on what sports you do. Now, let us know if you've got any questions. And remember,
if you need more help with your Achilles injury, you're welcome to consult one of
the team via video call – a link to our website is in the description of this video. Take care!