Is Cold or Heat Better for Tendonitis or Sore Muscles?

There is no strong consensus on the benefits of heat versus cold

Know that the topic of whether to apply heat or cold to a recent injury or pain is the subject of much debate, both in scientific publications and among healthcare professionals.

There have been hundreds of academic publications on the subject for several decades: thermotherapy.

And there is not a strong consensus in favor of heat or cold [Malanga 2015].

Here are the arguments put forward for applying heat rather than cold to tendon-related pain, and vice versa.

Arguments for applying cold 🧊

It’s more often suggested to apply cold to a tendonitis or to a recently injured or operated painful area.

And this for two theoretical reasons:

• Inflammation reduction: Cold can help reduce inflammation by constricting blood vessels and thus limiting blood flow to the affected area, which can reduce swelling often causing pain;
• Local anesthesia: Cold numbs the affected area, thus reducing the sensation of pain.

🚨 It’s always recommended not to apply cold directly to the skin to avoid the risk of burns. Instead, use a light fabric between your skin and the cold pack if that’s the method you’re using.

Arguments for applying heat ♨️

In contrast to cold, applying heat can worsen inflammation by dilating blood vessels and increasing blood flow to the affected area. And therefore increasing heat and swelling.

However:

• There isn’t always inflammation in the case of tendonitis;
• It’s not certain that the effect of heat is sufficient to significantly increase inflammation, especially if applied for only a few tens of minutes per day.

Moreover, heat can have theoretical advantages over cold.

• Improved blood circulation: Heat can dilate blood vessels, promoting better blood circulation to the affected area, which can help speed up the healing process. Because it’s through the blood that the substances necessary for healing are brought to the injured area.
• Reduction of muscle stiffness: Heat can help relax muscles and soft tissues around the affected area, thus reducing stiffness and discomfort.
• Pain relief: Some people describe feeling more relieved of their pain with heat than with cold, even with tendonitis.

What do clinical studies say about heat and cold?

Here are some summaries of recent studies that I find interesting to empirically document these stories of heat or cold on muscle or tendon pain.

🔺 Regarding tendinopathies, international recommendations do not cite heat or cold as effective strategies for relieving pain [Irby 2020].

🔺 In a randomized controlled trial conducted on 44 individuals with rotator cuff tendinopathy, in the short term, cold application was as effective as a program of progressive reloading exercises in improving functional level and reducing symptoms [Dupuis 2018].

However, heat application was not tested.

🔺 In another study involving 20 adults without any particular pathology, a research team evaluated whether heat increased the extensibility of the anterior and posterior cruciate ligaments of the knee and reduced the force required to flex the knee.

Their results showed that the flexibility of the anterior and posterior cruciate ligaments increased and the force required to move the knee decreased with heat by about 25% compared to cold application for 20 minutes [Petrofsky 2013].

🔺 A Chinese research team synthesized the results of 59 clinical studies involving 1367 individuals suffering from muscle soreness [Wang 2022].

Their conclusions:

• Within 48 hours following exercise, the use of warm compresses was superior to other interventions;
• More than 48 hours after exercise, cryotherapy (cold) was the optimal intervention for pain relief;
• The level of evidence remains low.

Conclusion: Should You Use Heat or Cold?

How do you decide between using heat or cold? Here’s my advice for those who ask me this question.

If it’s for an inflammatory issue (recent injury or surgery) or a burning sensation associated with tendonitis/tendinopathy, try cold therapy first.

✅ If you feel relief immediately: continue with cold therapy.

❌ If you don’t feel relief or very little: try heat therapy.

If you find that heat provides more relief, simply stick with heat!

Remember: whether you use heat or cold for your muscle and tendon pain, you’re not exposing yourself to a risk of complications!