Should You Use Ice or Heat to Treat Joint Pain and Swelling?

Sometimes old-fashioned home remedies are just what the doctor ordered. Take using ice or heat for joint pain, for example. When your knee or your shoulder feels stiff, sore, or has a burning sensation, cooling down or warming up the affected area (in conjunction with medications, physical therapy, and exercise) can help provide relief.

“It’s more of symptomatic relief,” says Nilanjana Bose, MD, a board-certified rheumatologist with the Rheumatology Center of Houston. “The pain may remain but because [the heat or ice therapy] gives symptomatic relief, over time that will help, in conjunction with other medicines, heal the area.”

But knowing when to use ice and when to use heat for pain relief can be confusing, especially if you’re dealing with an ache or issue that you’ve never dealt with before. Although you should see a health care provider if you’re experiencing consistent pain, it’s helpful to know what treatments can help provide immediate relief, especially if you aren’t able to see your doctor right away.

So, the question remains: when should you use ice versus heat to ease joint pain? Well, it mostly depends on the cause and type of joint pain you’re experiencing, though personal preferences matter, too. After all, nobody knows your own body like you do.

Below, we provide information on when to use heat or ice for joint pain relief, as well as some tips to make your treatment more effective.

What Are Heat and Ice Therapy?

Simply put, heat therapy and ice therapy — also known as ‘thermal therapy’ — mean applying something hot or cold to an affected area, which can affect how your body responds to pain, stiffness, and other arthritis symptoms.

Many arthritis patients swear by both heat and ice as part of their treatment plan — whether for osteoarthritis, which is “wear and tear” to a joint that occurs when the cartilage breaks down, or inflammatory types of arthritis, which is when inflammatory chemicals from an overactive immune attack the joint. (This category includes such conditions as rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis.)

For Eddie A., who has psoriatic arthritis, warm baths are a go-to part of his self-care routine. In fact, before he was diagnosed with PsA, he would find himself needing to sit in the tub for 30 to 45 minutes each morning before work “just to loosen up my hands,” he recalls.

“Heat and ice are everything for me,” Deanna K., who also has psoriatic arthritis, told CreakyJoints.

In its latest treatment guidelines for the management of osteoarthritis, the American College of Rheumatology “conditionally recommends” thermal interventions (aka, heat or ice therapy) for osteoarthritis in the knee, hip, or hand, for example. (Conditional means that the evidence is mixed or of lower quality.) In other words, there’s likely little harm in trying it, but it’s not a magic bullet.

Even though heat and cold are opposites, they can both reduce inflammation and ease pain and stiffness around the joints. They do so in different ways and may have different uses. That said, there is little scientific research on when to use one form over another.

“There’s really not much science to it as there is more intuition and experience,” Dr. Bose says. “Patients, for the most part, know what makes their joints or muscles feel good,” she says. Still, what evidence there is shows that patients experience pain relief from both methods.

When to Use Heat vs. Ice

Conventional wisdom (and googling) says this:

• Cold therapy reduces blood flow to the area, which can decrease swelling and inflammation. This can be especially soothing if you have an acute injury — say, your joints hurt worse than usual because you were gardening all weekend.
• Heat therapy increases blood flow to the area, which helps blood vessels dilate, drawing in more oxygen and nutrients. This can be especially soothing for stiff joints, especially for people who experience morning stiffness because of arthritis.

As this Cleveland Clinic article says, “for an acute injury, such as a pulled muscle or injured tendon, the usual recommendation is to start by applying ice to reduce inflammation and dull pain. Once inflammation has gone down, heat can be used to ease stiffness.”

“If you’re choosing between ice and heat, for the most part, it really just depends on what type of problem you’re dealing with,” says Brett Smith, DO, a rheumatologist at Blount Memorial Physicians Group in Alcoa, Tennessee. “You’re trying to get the opposite effect of what’s going on. If you’re physically swollen, you want to try and cool that [area] down to allow you to have less pain. If you’re not physically swollen, then you’re trying to heat it up to increase blood flow to help with the healing process.”

Both ice and heat therapy may decrease the transmission of pain signals to the brain, which can also help with pain relief.

Keep in mind there are no hard-and-fast rules about when to use ice or heat therapy for arthritis-related pain. If you prefer one over another, use what feels best for you.

Using Ice and Cold Therapy for Joint Pain

When to Use Ice for Joint Pain

For the most part, ice is appropriate to use within 48 hours of an acute injury or a flare-up of joint pain that comes with inflammation, experts explain. Examples include tendinitis, bursitis, soft tissue injuries, and inflamed joints, Dr. Bose says.

How to Use Ice for Joint Pain

The rule of thumb for icing down an inflamed area is up to 10 minutes on, followed by about 10 minutes off, several times if needed. Don’t put ice or a cold pack directly on the skin, unless the cold pack has a built-in barrier, to prevent skin damage. (This also prevents a wet mess, Dr. Smith notes.) Pay attention to how your body is responding to the cold. “Listen to your body,” Dr. Bose says. “I tell my patients: Use an ice pack, put it on the knee, and once it starts getting uncomfortable, give it a break.”

Types of Ice Therapy

You have a lot of options when it comes to icing a joint. At-home solutions like filling a plastic bag with ice cubes and a little water, using a bag of frozen vegetables, or putting a damp towel in the freezer are time-tested for a reason. You can purchase gel packs and other types of cold packs at drugstores or supermarkets. Whatever method you choose, use something large enough to cover the whole area where the pain is located, Dr. Smith says.

Safety with Ice Therapy

Most people’s bodies will tell them when they’re too cold, says Rosa Elena Torres-Panchame, PT, DPT, a doctor of physical therapy and professor at St. John’s University in Jamaica, New York. People who have neuropathy or another condition that makes them less sensitive to temperature changes should take extra care because leaving the ice in place for too long can cause frostbite, she says.

When to Use Heat for Joint Pain

Heat tends to be more beneficial for the types of everyday joint pain, such as stiffness, that  people with arthritis experience. You can use dry heat, like from a heating pad, or moist heat, like from a moist towel warmed up in the microwave for 20 to 60 seconds. Moist heat tends to transfer through the skin more quickly and efficiently, Dr. Torres-Panchame says.

How to Use Heat for Joint Pain

As a guideline, don’t apply heat to an area of your body for more than 20 minutes at a time or you could risk burning your skin. As with ice, don’t put a heated object on your skin without some kind of protective barrier, like a cloth or towel. Heat also can follow ice therapy once the cold brings down swelling and inflammation, Dr. Torres-Panchame says.

As with ice, being careful and attentive is important to prevent injury. “If something feels too warm, then probably it’s too warm,” Dr. Bose says. “So the temperature needs to be comfortable, ideally, not too hot, because it can burn your skin.”

Types of Heat Therapy

Simple, do-it-yourself methods, like using a microwaved moist towel or taking a warm bath or shower, work well. Hot water bottles and reusable and disposable heating pads are easily purchased, and some are specially designed for moist heat. If you have pain in your hands or wrists, paraffin wax baths may be especially soothing. Eddie A. swears by his paraffin wax machine. “It’s a great way keep heat on you for a little while — and then your hands are lovely and smooth afterward,” he says.

Safety with Heat Therapy

Check your skin after five minutes to make sure there are no signs of burns and check again a few times while using heat, Dr. Torres-Panchame says. “If you start seeing blisters forming, that is too hot. You need to remove the heat or else you can cause skin damage,” she said.

This is especially important for people who have neuropathy or any other condition that makes them less sensitive to touch and temperature.

Patients who don’t respond to heat therapy may want to talk to a doctor about seeing a physical therapist, who can use professional-grade devices to deliver higher levels of heat in a supervised setting, she says.

How Often Should I Use Ice or Heat for Joint Pain?

As long as you’re being smart about which therapy you use and careful about how to use it, Dr. Torres-Panchame says they are “okay to use repetitively throughout the day.”

It doesn’t need to be a formal “sit-on-the-couch-with-your-leg-up” type of treatment. You may find you’re already benefitting from thermal therapy without even realizing it. If taking a hot shower or bath every morning is very soothing to your joints, then you’re already reaping the benefits of heat therapy.

Other patients say that washing their hands with hotter-than-usual water is a quick way to sooth their hands throughout the day. Some people report that they actually like washing dishes after meals because it’s an easy way to use heat therapy.

When Should I Seek Medical Attention?

While ice and heat therapy are a good way to give yourself some regular low-effort pain relief — and can be a regular and important part of your self-care toolkit — it’s a good idea to call your doctor if you experience new or worsening joint pain.

This includes situations in which ice or heat previously worked well enough to relive your symptoms but doesn’t anymore, Dr. Bose says. “If you’re not getting relief, it should trigger a warning bell,” she says. “Maybe there’s something deeper inside, or this might need more systemic treatment rather than topical.”

These symptoms might mean your medications and other therapies aren’t working as well as they’re supposed to. It could indicate that your arthritis is progressing, Dr. Bose says. Either way, it’s better to know.

Track Your Symptoms with ArthritisPower.

Join CreakyJoints’ patient-centered research registry and track symptoms like fatigue and pain. Learn more and sign up here.

Applying Heat vs. Cold to an Arthritic Joint

An inexpensive and easy way to treat arthritis-related aches and pains is by applying heat or cold to the affected joints. However, people are often confused about when to use heat therapy and when to use cold therapy.

Using heat and/or cold therapies on an arthritic joint is a simple, inexpensive alternative treatment that can help to alleviate pain, stiffness and swelling. Read: Alternative Treatments

Heat can relax muscles and help lubricate joints. Heat therapy may be used to relieve muscle and joint stiffness, help warm up joints before activity, or ease a muscle spasm.

Learn more: When and Why to Apply Heat to an Arthritic Joint

Cold can reduce inflammation, swelling, and pain related to arthritis and activity. (It is also recommended to treat many acute injuries.)

Learn more: When and Why to Apply Cold to an Arthritic Joint

Alternating heat and cold. Some people alternate between heat and cold therapy. For example:

• A patient may be encouraged to use heat therapy to warm up a joint(s) before physical therapy exercise and to use cold therapy after exercise.
• A person can use heat therapy in the morning to loosen up an osteoarthritic knee and use cold therapy to reduce swelling a few hours later. This process can be repeated throughout the day.

advertisement

In This Article:

• Applying Heat vs. Cold to an Arthritic Joint

• When and Why to Apply Heat to an Arthritic Joint

• 9 Easy Ways to Apply Heat to an Arthritic Joint

• When and Why to Apply Cold to an Arthritic Joint

• 3 Types of Cold Packs for Arthritis

• Video: How to Make a Gel Ice Pack

• Video: How to Make an Ice Massage Applicator

• Video: How to Make a Homemade Heat Pack

Cold therapy is recommended for certain types of arthritis that cause painful inflammation flares, such as gout and pseudogout. People with other types of arthritis—including but not limited to osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis—may benefit from both heat and cold therapy.

Learn more:

• Ankylosing Spondylitis Treatment
• Osteoarthritis Treatment
• Rheumatoid Arthritis (RA) Treatment

advertisement

There are no universally accepted guidelines for when to use heat or cold therapy on osteoarthritic joints, and recommendations are mixed.

¹
Oosterveid FG, Rasker JJ. Treating arthritis with locally applied heat or cold. Semin Arthritis Rheum. 1994;24(2):82–90. [PubMed]
^,
2
Brosseau L, Yonge KA, Robinson V, et al. Thermotherapy for treatment of osteoarthritis. Cochrane Database Syst Rev. 2003;(4):CDO04522. [PubMed]
^,
3
Porcheret M, Jordan K, Jinks C, Croft P. Primary care treatment of knee pain: a survey in older adults. Rheumatology. 2007;46:1694–1700. [PubMed ]
^,
4
Hing WA, White SG, Bouaaphone A, Lee P. Contrast therapy – a systematic review. Phys Ther Sport. 2008;9:148–161. [PubMed]
^,
5
Cameron MH. Physical Agents in Rehabilitation. 3rd ed. Vol. 257. St Louis: Saunders Elsevier; 2009. Hydrotherapy; pp. 269–270.
^,
6
Denegar CR, Saliba E, Saliba S. Therapeutic Modalities for Musculoskeletal Injuries. Champaign IL: Human Kinetics; 2010. Cold and superficial heat; pp. 122–123.
People with osteoarthritis are advised to experiment with both heat and cold therapy to find what works best for them.

⁷
Denegar CR, Dougherty DR, Friedman JE, Schimizzi ME, Clark JE, Comstock BA, Kraemer WJ. Preferences for heat, cold, or contrast in patients with knee osteoarthritis affect treatment response. Clin Interv Aging. 2010 Aug 9;5:199-206. PubMed PMID: 20711439; PubMed Central PMCID: PMC2920200

Likewise, evidence shows that heat and cold therapies do not affect rheumatoid arthritis disease activity but can make some RA patients more comfortable.

⁸
Welch V, Brosseau L, Shea B, McGowan J, Wells G, Tugwell P. Thermotherapy for treating rheumatoid arthritis. Cochrane Database Syst Rev. 2001;(2):CD002826. Review. Update in: Cochrane Database Syst Rev. 2002;(1):CD002826. PubMed PMID: 11406046.
^,
9
Robinson V, Brosseau L, Casimiro L, Judd M, Shea B, Wells G, Tugwell P. Thermotherapy for treating rheumatoid arthritis. Cochrane Database Syst Rev. 2002;(1):CD002826. Review. Update in: Cochrane Database Syst Rev. 2002;(2):CD002826. PubMed PMID: 11869637.

Dr. Brandon Kambach is an orthopedic surgeon who specializes in adult and pediatric spine surgery. He practices in Jacksonville, FL. Dr. Kambach has several years of experience evaluating and treating conditions of the spine and joints, and he has participated in clinical research studies for cervical spine disorders.

• Share on Facebook
• Share on Pinterest
• Share on Twitter
• Subscribe to our newsletter

• Email this article

advertisement

Editor’s Top Picks

• Understanding Joint Pain

• How Arthritis Causes Joint Pain

• Joint Pain Caused by Arthritis Video

• Video: How to Make a Homemade Heat Pack

• Video: How to Make an Ice Massage Applicator

Heat or cold: which is better for pain relief in each case?

Rus. Delfi.lv | January 26, 2016 15:13

Foto: F64

Both cold and heat relieve pain well and cost little or nothing – everyone knows that. However, in what case should one remedy be used, and in which case another? This simple help will give you the answer!

What is better for heat and warmth?

Arthritis. Any chronic pain in the joints and muscles, because heat increases blood flow.

Headache. Only if it is accompanied by spasms in the neck, heat relaxes the muscles.

Stretching of muscles and ligaments. Works well for numbness, but heat compresses and heating pads should only be used after the body and medications have dealt with the inflammation, otherwise it can make things worse.

Tendinosis is a chronic feeling of stiffness in the tendons near the ligaments. The heat does well with it.

Conclusion: fever is good in all cases where the pain or injury is old and at least one and a half months old. The heat increases the intensity of blood flow, and this relaxes the muscles and ligaments.

What helps cold better?

Attacks of gout. Cold reduces pain and reduces the intensity of the attack.

Headache. A cold compress relieves pain in the upper part of the head.

Stretching of muscles and ligaments. A cold compress is good for relieving pain immediately after an injury and reducing the symptoms of inflammation (but does not cure it!).

Tendinitis – inflammation of the tendon tissue. Cold relieves pain and helps fight inflammation.

Conclusion: cold is good for all sudden injuries and recent wounds because it constricts blood vessels – it relieves pain, reduces inflammation and prevents bruising.

How to use heat or cold therapy correctly?

Photo: Shutterstock

Basic rule for heat or cold therapy: 20 minutes on, 20 minutes off. Whatever you apply or use – take a 20-minute break after a 20-minute session. And you can apply and use:

• Ice packs: cheap and cheerful. Usually they are used immediately after injury, but can be practiced even after a few days – until the inflammation subsides.
• Ice massage: freeze water in a disposable cup and then “massage” (stroke) the affected area. Works best for “spot” therapy like a broken eyebrow, for example – where an ice pack is inconvenient.
• Ice masks: is sometimes sold in pharmacies, but even a towel soaked in ice water and placed on the forehead or over the eyes can pass for one to relieve a headache.
• Damp heat: bath, shower, whirlpool, anything with very warm but not scalding hot water.
• “Heat” bandages: again, even a towel can come off if you pour hot water on it and, for example, wrap it around your neck.
• Heating pads: a great variety of them – use any. All you need to know about the heating pad is that it should be removed and set aside (reduce the temperature if possible) if it gets too hot. This is not a mustard plaster!

Safety

Yes, ice can be used to relieve high temperatures, but heat compresses are dangerous for people with reduced skin sensitivity! Therefore, before applying a heating pad, always ask if the person has diabetes or some other disease that can reduce sensitivity (it can come to burns).

The most common mistake most people make is trying to build a “warm nest” for their sports injury. Any injuries “on impact” or “stretching” should be treated only with ice, even if it is unpleasant! You can strictly undead a stretched leg in warmth only after the inflammation has passed, otherwise you simply delay the healing process. Physiology, nothing personal.

Noticed an error?
Select the text and press Ctrl + Enter!

Use of ice to relieve inflammation. In which situations it is worth using ice, and in which it is not

The Australian researchers added to this a study where they studied two groups of rats with deep thigh muscle injuries. The first group, the affected areas were immersed in ice for more than 5 minutes. The other group did not receive the “ice” treatment. When the researchers tested the rats three days later, the “on ice” group did have less inflammation, but the problem was different, they also had lower levels of important markers that indicate blood vessel formation and muscle regeneration. than in the “no ice” group. A similar study questioned the use of non-steroidal anti-inflammatory drugs like ibuprofen for the same reason. Inflammation is a necessary part of the healing process. Eliminate it and you risk slowing down your recovery.

This does not mean at all that you should allow each bruise to inflate like a balloon. Physicians do not recommend ice for general muscle recovery . But not all swelling is productive. If you’ve injured your knee or hit your knee in a fall, ice can not only help relieve pain, but also reduce some of the initial swelling. If the ice allows you to move, it makes sense.

How to understand in which situations it is worth using ice, and in which not? Here is a general guide:

Injuries: muscle pain during exercise. You’ve had a tough race or training ride and are worried about your condition tomorrow.

What to do : Do not use ice. Pay attention to proper recovery and nutrition. Light massage, stretching. Perform moderate, light aerobic activity the next day to improve blood flow and restore muscles. If available, use an electrical muscle stimulation device.

Injuries: consequences. You fell off your bike.

What to do: Apply ice to the affected area to prevent unnecessary swelling and bruising in the first place. Arriving home, you need to raise the bruised limb as high as possible to reduce blood flow and swelling.

Injuries: sprain. The leg jumped off and you sprained your ankle.

What to do: ice will initially prevent significant swelling – but more importantly, the limb must be elevated to avoid increasing swelling. Apply a tight fixing bandage with an elastic bandage or improvised means.

Injuries: adductor sprain (groin). They didn’t calculate the load, didn’t warm up well, and the sprint left unpleasant consequences.

What to do: Ice only when needed to relieve pain. The main thing is to apply a fixing bandage to the damaged muscles. Rest of the affected area.

Summing up.

Ice is used as a short term treatment to help injured athletes get back on track. Cooling down (no more than 5 minutes) can help relieve pain and swelling, but it affects the athlete’s strength, speed, endurance, and coordination.

When you damage tissue from an injury or experience muscle pain from intense training, you are repaired with the help of your immune system. When muscles and other tissues are damaged, your immune system sends the same inflammatory cells to the damaged tissue to speed up healing. Cold, in turn, does not allow “healing” cells to enter damaged tissues and slows down healing.