Should inflammation be supported or suppressed to heal a lateral epicondylitis?

I have read and heard contradictory statements, see examples below.


Once these burdens are identified and lifted, provoking primary inflammation is often the best way to facilitate healing in these chronic problems. This means we get to support the body's natural pathway of healing. In my experience, supporting, rather than suppressing primary inflammation, will foster healing of tissues, even when they have been chronically inflamed and painful for years.


  • Apply ice or cold packs as soon as you notice pain and tenderness in your muscles or near a joint. Apply ice 10 to 15 minutes at a time, as often as twice an hour, for 72 hours. Continue applying ice (15 to 20 minutes at a time, 3 times a day) as long as it relieves pain. Although heating pads may feel good, ice will relieve pain and inflammation.
  • Take pain relievers if needed. Use acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, as directed for pain relief. NSAIDs also reduce any inflammation you might have in or around the tendon (tendinitis). NSAIDs come in pills and in a cream that you rub over the sore area. Do not rely on medicine to relieve pain in order to continue overusing a joint.


Suppressing inflammation relieves pain and encourages a tendon strain to heal.


It should be remembered that inflammation is part of the healing process. Sometimes reducing inflammation is necessary, but not always.

http://physical-therapy.advanceweb.com/Features/Articles/Tendinitis-or-Tendinosis.aspx indicates that icing should only be used for tendonitis (i.e., when an inflammation is present) but not for tendinosis (i.e., when no inflammation is present, only micro-tears/degeneration):

Treatments for tendonitis are vastly different from those of tendinosis, and there is no room for overlap. In fact, tendonitis treatments can worsen the condition of a patient who actually has tendinosis.

"It could worsen the condition if you're talking using anti-inflammatories, icing and resting with no physical activity," said Bishop. "The most important thing is to understand the mechanism of tendonitis and tendinosis, and the pathomechanics happening in the tendon. Rest and modification of activity and increasing inflammation is the opposite of what you want to do in a tendinosis condition

  • These are two completely separate articles. The suppressing inflammation is taken out of context from the section on when first noticing symptoms of tendinitis, not after a lengthy period. The first article is written in support of PRP, which is a mechanically induced state of inflammation. They aren't related.
    – JohnP
    Commented Oct 12, 2015 at 14:50
  • @JohnP For suppressing inflammation, I've added a WebMD reference. What's the issue with the TheHuffingtonPost article? PRP is just one way amongst others to induce inflammation, and is mentionned as an example. Commented Oct 12, 2015 at 19:17
  • I'm just pointing out that you are using two different sources that describe treatments for different phases of injury to "be at odds". PRP is used to treat chronic (As I understand it), while the ice/suppressing inflammation is used when the injury/stress is still in the acute stage. They aren't really contradictory statements.
    – JohnP
    Commented Oct 12, 2015 at 19:25
  • @JohnP Good point, I agree, my understanding is the same, I guess the answer would distinguish early phase from the rest of the recovery, and ideally give some criteria to define approximately when the early phase ends. (and I also guess my comment will be deleted since it contains some elements of answer…) Commented Oct 13, 2015 at 15:36


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