Is Heat Or Cold Better For Arthritic Knees? | It Depends, Here’s Why

If I got a nickel every time a patient asked me, “is heat or cold better for arthritic knees?” I would be rich. See, it depends on the type of arthritis and your preferences.

Heat tends to be better for tight muscles and knee osteoarthritis. (1) While cold therapy may be best for fresh injuries, gout, and rheumatoid arthritis. (2)

This isn’t set in stone, though. You may want to test both of them to discover which one works best for YOUR arthritis symptoms. (3)

Keep reading to learn how and when to use heat and cold to help knee arthritis symptoms. Here’s what I’ll cover, tap on any bullet to go straight to the section:

• Best thermotherapy according to your knee arthritis
• Heat therapy: how to use it for pain relief
• Cold therapy: how to use it for pain relief
• What about contrast therapy?
• What if they aren’t enough?
• FAQs

Best thermotherapy according to your knee arthritis

Let’s clarify something first – there are over 100 types of arthritis! (4)

See, the word “arthritis” only means “inflammation of the joint.” It’s a medical term to say the joint is swollen, but it doesn’t tell us why.

Now, these are the most common types of arthritis (4):

• Osteoarthritis. Due to wear and tear. Ironically, it’s NOT inflammatory.
• Gout. Here, uric acid crystals accumulate in the joints, causing inflammation.
• Rheumatoid arthritis. An autoimmune disease that affects the joints.

And, the truth is that anyone with these chronic diseases can benefit from cold and hot therapies. (3, 5)

But, research shows one thermotherapy may provide more benefits than the other, depending on the condition:

Heat therapy may be superior for knee osteoarthritis pain

If you have knee osteoarthritis, using heat therapy can be a life-saver.

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It can help relax your tight muscles, reduce stiffness, and prepare your joints for physical activity.

In people with this condition, studies recommend using moist heat every other day for 20 minutes at a time, for 4 weeks at least. It may help decrease pain while improving your knee function. (1)

You can maximize these results by pairing this protocol with the medication your doctor prescribed and doing a rehabilitation program. (1)

Cold therapy may be superior for gout and rheumatoid arthritis pain

These conditions often cause flare-ups – acute episodes of pain, where the joint gets more swollen than usual. Applying ice packs 2-3 times per day will reduce that inflammation in no time.

Yet, research suggests that applying a cold pack twice a day may reduce the levels of inflammatory chemicals within the knee joint fluid. (2)

In the long term, this could mean less pain and swelling in people with gout, pseudogout, and rheumatoid arthritis. (2)

Try it: Learn how to ice your knee in 7 steps.

But regardless of your type of arthritis, I’d recommend trying both.

See, each body reacts differently to temperatures, so there are no right or wrong answers here.

Someone with rheumatoid arthritis may feel better after using heat. Whereas someone with severe knee osteoarthritis may be able to go through their day after 15 minutes of ice. (3, 5)

This is why I recommend trying each therapy for 1-2 weeks to see where your body responds best. (But, if you’re treating a fresh injury, use ice.)

Now, here’s how to use each therapy for pain management:

Heat therapy: How to use it for knee pain relief?

Heat increases blood flow in the targeted area. This makes it very effective at relaxing stiff joints and muscle spasms. It also helps warm up your knee joint before exercise.

I recommend doing heat therapy for:

• Easing morning knee joint stiffness.
• Preparing your knee joint for physical activity.
• Promoting relaxation at the end of the day.

When not to use heat therapy?

In scenarios where the body is already increasing the blood flow in the area. Applying heat therapy will draw even more blood to the tissues, which can worsen pain and swelling.

Common examples include:

• Open wounds.
• The presence of infection.
• Right after a workout.
• The first 3-5 days after an injury.

Instructions to do heat therapy at home

If you’re going to use a heating pad, moist heat pads, or hot water bottles:

• Make sure you don’t burn your skin. The heat should feel nice, otherwise, it won’t promote relaxation.
• Do it for 15-30 minutes, up to 3 times per day.

Another option is taking a hot shower or a warm bath. I recommend doing this at the end of the day, as it can help you sleep better.

Cold therapy: How to use it for knee pain relief?

Cold treatments do the opposite effect – they constrict the blood vessels, thus lowering the amount of blood entering the area. As a result, this can reduce inflammation.

Ice has a numbing effect too, making it an ideal tool for soothing arthritis pain. It can be extremely helpful in some situations where heat is counterproductive, such as:

• The first days after an acute injury.
• Right after a workout.
• After a long day where you overexerted yourself.
• For flare-ups in chronic knee joint conditions.

Cold therapies can also help reduce the pain from an infection – as long as it’s not an open wound and you’re taking antibiotics.

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Instructions to do ice therapy at home

You can use cold packs, a bag of frozen vegetables, or frozen peas for this.

If it’s not uncomfortable, you could apply the cold pack directly to your skin. But if it is, place a thin towel or pillowcase between the ice pack and your skin to prevent burns.

In fresh injuries, it’s best to do this for 10 minutes, three times per day tops. Studies suggest that more than that may suppress the proper healing of the tissues.

For chronic conditions like gout or rheumatoid arthritis, you can leave the ice for longer.

Related: Knee Swelling Reduction in 4 Steps

Try contrast therapy

This therapy consists of combining heat and cold. This could ease joint pain and swelling for some people. The usual protocol is (3):

• 4 minutes of heat,
• Followed by 2 minutes of cold,
• Repeated 3 times.

Contrast therapies aren’t better or worse than heat or cold therapy. However, they can be effective at relieving pain, too – it’s definitely worth a try.

What if you need more pain relief?

If heat and cold therapy aren’t enough for your painful joints, it may be time to go to a physical therapist to manage your knee OA.

This health care provider will design an individualized treatment plan to help you overcome knee pain. Also, she/he may suggest other treatment options to make sure you recover successfully, such as:

• Other home treatments for pain management.
• Some exercises to strengthen your joints.
• Depending on your symptoms, refer you to a doctor to treat your knee pain.

FAQs:

Conclusion: Is ice or heat better for knee arthritis?

Now you know both can be equally effective for your sore joint. They’re staples in joint pain treatment for a reason.

Regardless of which one suits you better, maximize their results by pairing them with other treatments for arthritis pain – like physical therapy, medications, and exercise.

Resources

1. Yildirim, Nurcan et al. “The effect of heat application on pain, stiffness, physical function and quality of life in patients with knee osteoarthritis.” Journal of clinical nursing vol. 19,7-8 (2010): 1113-20. DOI: 10.1111/j.1365-2702.2009.03070.x
2. Guillot, X et al. “Local ice cryotherapy decreases synovial interleukin 6, interleukin 1β, vascular endothelial growth factor, prostaglandin-E2, and nuclear factor kappa B p65 in human knee arthritis: a controlled study.” Arthritis research & therapy vol. 21,1 180. 30 Jul. 2019, DOI: 10.1186/s13075-019-1965-0
3. Denegar, Craig R et al. “Preferences for heat, cold, or contrast in patients with knee osteoarthritis affect treatment response.” Clinical interventions in aging vol. 5 199-206. 9 Aug. 2010, DOI: 10.2147/cia.s11431
4. Senthelal S, Li J, Goyal A, et al. Arthritis. [Updated 2021 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK518992/
5. Robinson, V et al. “Thermotherapy for treating rheumatoid arthritis.” The Cochrane database of systematic reviews, 2 (2002): CD002826. DOI: 10.1002/14651858.CD002826