I have been routinely icing my knee for patellofemoral pain syndrome. I do the icing as prescribed by my physician before and after my knee exercises. But sometimes I forget and I really don't notice any difference if I do (or don't) use the ice. Can I just quit using it?

It's always best to check with the prescribing physician when changing something in the way a home or exercise program is carried out. In the case of ice therapy, there are different reasons why this might be used. In some cases, the cold constricts (closes) blood vessels in the area in order to keep swelling down. For other patients, it's meant as an analgesic (pain reliever) as it freezes the skin and temporarily halts pain messages to the brain. Patellofemoral pain syndrome is often marked by pain across the front of the knee whenever the patella (knee cap) moves up and down over the front of the leg. Symptoms are especially pronounced when this motion is combined with compression through the knee (e.g., squatting, going up and down stairs, jumping, running long distances). Studies comparing the use of ice alone against other modalities such as heat, biofeedback, or electrical stimulation have not shown a difference with any of these modalities. That was true whether the heat, cold, or electrical modality was used alone or in combination with others. In the end, there simply isn't enough scientific evidence to support the solo or combination use of modalities mentioned.There's no doubt that sorting out which modalities might be useful and in combination with what other treatment options (in terms of modality use) is a challenge. But if there is no added benefit of using such modalities, then they should be discontinued. With so many variables yet to study, it's clear that future research in this area is needed. In the meantime, check with your physician and find out if you should still use the ice and perhaps what the intended benefit may be for you. This may help you understand why you should continue using ice. Or perhaps you will find your physician agrees with you and recommends dropping it or using something else.

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