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Icing/heat for tendonitis?

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Looking for some advice on treating some tendon issues (de quervains in wrist and posterior tibialis in ankle)

I have had issues with both conditions for the last 12 months and have seen physios (for both) and a specialist doctor (for the wrist). Apart from a cortizone injection in the wrist, not much has worked in regards to stretching and strengthening exercises for my ankle and the wrist issue has come back since the steroid has worn off.

One thing I have never really done is iced the areas, or used heat. It seems to me ice is the most common approach. When should heat be used instead of ice ?(if at all) and how long and often should I ice/heat the areas for....and lastly , if done properly can I look forward to some good results? (million dollar question I know)
 Toerag 11 May 2017
In reply to Bjartur i Sumarhus:

I think Dave MacLeod has done a fair bit of research on 'heat treatment' for tendon injuries?
In reply to Toerag:

Has he? ok thx..I will do some digging
 SouthernSteve 11 May 2017
In reply to Bjartur i Sumarhus:

Have you considered an orthotic for the tib posterior dysfunction, I was quite prompt to get some after seeing horrible pictures of acquired flat foot on the internet and I definitely did my exercises!!

I found ice useful early on, but heat may be better at increasing blood flow. Shock wave therapy is another modality which is considered helpful by some, but I have no experience.

In addition, the following exercises are useful.

http://www.kinetic-revolution.com/tibialis-posterior-strengthening-exercise...
http://www.kinetic-revolution.com/tibialis-posterior-stretch-for-runners-tr...

HTH SS
 Pilo 11 May 2017
In reply to Bjartur i Sumarhus:

Dr.Pil prescription - Turmeric is superb as a tight press with some (old) cloths directly with heat on the area. Then include it as part of your diet in a big way. Regularly! It's certainly not going to harm you. Ice is better for immediate swelling issues.
 Jack 11 May 2017
In reply to Bjartur i Sumarhus:

If its been a problem for 12 months then it may be tendonosis rather than '..itis'. Worth a google as the treatment is different and if I recall correctly, ice or heat may not be the way to go.
 cathsullivan 12 May 2017
In reply to Bjartur i Sumarhus:

I developed de Quervain's early last year and it took about 10 months to get better. It's recently flared up again, which is a bit disappointing after I thought it was gone, but in my experience that's not unusual with tendon trouble.

Anyway, first you have my sympathies. Really makes you realise how much you need your thumbs for bl**dy everything. I've had various injuries of a similar nature and found this to be one of the worst and hardest to get rid of. Obviously, this is a bit anectodal but the things that worked for me were eccentric exercises (a *lot* of them) and wearing a specially designed wrist brace for computer work and at night. I also did some exercises to improve the movement in my shoulder as the physio thought that might be linked (and it needed fixing anyway). I also worked on the trigger points in my forearm a lot and I did very slow wrist rotations quite a lot (with the forearm held still so you know that you're moving the wrist and not other bits of the arm).

The way I did my eccentric exercises was with a theraband and I used various colours so that I could progressively increase the resistance. If you've done the Finkelstein test then the simplest way to describe how I did my exercises was that I basically repeated that movement while holding a theraband that I held up and back with the other hand. Eventually I progressed to using a very large hammer as you can move your hand position to increase the load and it is more advanced because you have to hold it level as well as moving your hand. Also as it got better I used a metolius gripsaver to try and strengthen my thumb and regain the movement in it. By the time I started that stage I couldn't do a 'thumbs up' on that hand at all, so I had a lot of work to do.

They also recommend that you work out what's causing it and stop doing that. But I found that very hard, partly because I wasn't entirely sure what caused it (although I think it was moving house and all the associated packing and cleaning that finally tipped my thumbs over the edge). Also, it's hard to avoid a lot of the things that hurt it (which was pretty much everything at one stage).

I didn't really use ice much because I think mine was a chronic over-use problem and the physio didn't seem to think it would help. I did sometimes use freeze gel when it was particularly sore (which was most of the time for several months).

I'd second the suggestion that you read up on what Dave MacLeod has to say about tendons. I have his book on injuries, which has lots of info in that will be relevant. He only briefly mentions de quervains but the general stuff on tendon health and healing is useful.

Good luck.
In reply to cathsullivan:

Very useful, many thx. I think mine was caused by years of picking up my small children using the thumb under their armpit technique, and I think my commute on a motorbike doesn't help the wrist heal either. Other than that it's a bit of a mystery what sets it off. Right now its inflamed so I won't be trying any strengthening exercises until it calms down.

I
 cathsullivan 12 May 2017
In reply to Bjartur i Sumarhus:

Have you heard that it's sometimes known as "mothers' thumb"?

It seems very counter-intuitive to do the eccentric exercises while it's sore, but it worked for me (usual disclaimer!).

Maybe try a splint for a while if it's really sore. This is the one I have: https://www.completecareshop.co.uk/physiotherapy-aids/wrist-brace-with-thum...

I got it from the physio at my GPs surgery for free but they're fairly cheap to buy.

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