Is cryotherapy effective for tendon health? A systematic review of evidence and methodological limitations

Cryotherapy is widely used in managing soft tissue injuries, but its scientific foundation and clinical application remain inconsistent. Human evidence-especially concerning tendinopathy-is limited and heterogeneous. Understanding the effects of cold exposure on tendon structure and function is essential for safer and more effective clinical practice.

To systematically review the clinical, mechanical, and physiological effects of cryotherapy on human tendons, both healthy and affected by tendinopathy.

Comprehensive searches were conducted in CENTRAL, MEDLINE, EMBASE, CINAHL, and PEDro. Studies including human participants exposed to cryotherapy and assessing tendon-related outcomes were eligible. From 1075 records screened, 12 studies met inclusion criteria.

Among the 12 included studies, seven (58.3 %) were randomized or quasi-randomized, four (33.3 %) experimental, and one (8.3 %) observational. Nine studies (75 %) used ice and three (25 %) used cold- or ice-water immersion. Cryotherapy was applied either as a standalone treatment (five studies, 41.7 %) or combined with other therapies (seven, 58.3 %) such as exercise, ultrasound, compression, or taping. Short-term improvements were reported in pain and microcirculatory parameters, suggesting potential benefits when used as an adjunct. However, methodological limitations-small samples, limited follow-up, and heterogeneous outcomes-restrict the strength and generalizability of findings.

Current evidence does not support cryotherapy as a standalone or standard treatment for tendinopathy. It may serve as an adjunctive strategy for short-term symptom relief, but its long-term structural or functional benefits remain uncertain. High-quality randomized controlled trials are required to clarify its therapeutic role.