Does Using Ice Makes Knee Pain Worse? | 7 Reasons Why (And Their Solutions)

Written By on July 25, 2022 — Medically Reviewed By Mitch Torres (PT)

person using an ice pack on their reddened knee superimposed by a red circle

Cold therapy is a mainstay remedy in decreasing pain and swelling after an acute injury. But instead of making you feel better, what if using ice makes knee pain worse?

Well, although rare, this can happen if you don’t really need ice therapy. Or the cold pack is placed in the wrong area. Also, certain medical conditions may worsen your knee pain if you treat it with cryotherapy.

We’ll discuss those and other common reasons why ice increases your knee pain. But more importantly, what to do about it. Tap on any of the sections below to get started:

7 reasons why ice can worsen your knee pain

1) You just started

As you do your ice therapy, you may feel these four sensations (1):

  • Cold.
  • Burning.
  • Aching.
  • Numbness.

Between the 2-7 minute mark, it’s normal to feel a burning achy pain on your skin. (1)

Solution: Wait for a few more minutes

Let the ice stay still, as the pain will likely go away. In due course, the sensation would progress into numbness, which ultimately helps ease knee pain.

But if it gets too uncomfortable, use ice for shorter periods. Or, place a towel/napkin between the ice pack and your skin.

2) Left it on for too long

Ice should only be applied for 10 minutes at a time for maximum effect. (2) Leave it for too long and you risk developing frostbite.

Aside from pain, frostbite also causes redness, swelling, and blisters. (3) So if you happen to have such symptoms, please get your skin treated at your nearest emergency room.

Solution: Use a timer

As they say, prevention is better than cure. The next time you plan to use ice therapy, use a timer and set it at 10 minutes.

3) Mistakenly hitting a nerve

nerves in the knee, Mistakenly hitting a nerve

There are a bunch of nerves that pass through your knee joint, giving sensation to your leg. But accidentally covering one with an ice pack can potentially affect your nerve’s function and cause pain down to your calf and/or foot.

This can happen if you place the pack right on the knee pit, or on the sides of the joint. Those areas have many nerves that can become irritated if you place the cold pack on top of them for too long.

Solution: Use a towel

A towel will act as an additional layer of protection from the cold. You can place it on your knee or wrap your ice pack with it.

Pro tip: If you’re feeling numbness down your leg while doing cold therapy, stop for a few minutes. Then, start again but place the pack on another area of your joint.

4) Cold intolerance

Pain with the use of ice can also be a sign of cold intolerance. This means your body is sensitive to cold temperatures. Common signs of this include:

  • Feeling cold even though people around you are not.
  • Not even wearing more layers of clothing makes you feel better.

Solution: Consult your doctor

Cold intolerance might be a symptom of an underlying condition, such as vascular or thyroid disorders. (4, 5) Your doctor will likely request some tests and suggest the best treatment options according to your diagnosis.

5) Cold allergy

If your pain with ice therapy comes along with skin redness, hives, and itching, this can mean you have cold urticaria. (6) This is a rare condition that only affects 0.05% of the general population. (7)

Cold urticaria can trigger even just by walking in cold weather or bathing in cool water. (6)

Solution: Avoid using ice

Once your symptoms appear, stop using ice immediately. You can take antihistamine drugs to counteract your allergic reaction. (6)

If your symptoms persist even with medication, please consult your doctor immediately.

6) Wrong cold therapy method

Using an ice pack could potentially be too aggressive, thus causing pain. This is because cold absorbs a ton of heat as it melts. (8)

But, there are other options available that are equally effective as ice.

Solution: Use a cold gel compress instead

These are readily available online or over-the-counter. A cold gel compress is also versatile to use as it can conform to your knee’s contours and be used multiple times.

Also, there are compression sleeves that can provide ice and heat therapy as well. These are both effective and practical, as they combine the benefits of RICE therapy in a hassle-free way.

Learn more: Cocoon Knee Flex Pro – the only thermotherapy sleeve we recommend.

7) You don’t need cold therapy

Certain chronic pain issues like knee osteoarthritis or rheumatoid arthritis may benefit from both ice and heat therapy. (9)

Also, sometimes it’s just a personal preference – some people get more relief with hot than cold. So, if you’ve been trying ice for a while without success, give hot therapy a shot.

Solution: Try heat therapy instead

Place the heat pack on your knee for 20 minutes tops and check how you feel during that time and afterward. (10) If your symptoms improve, keep doing hot therapy for as long as needed.

Learn more: Ice versus heat – what’s best for arthritic knees?

Other treatment options for knee pain

Pain relief does not stop at the use of ice. There are other options you can try as well, such as:

Home exercises

Going for a regular exercise routine improves the strength and mobility of your knee. This could make your joint more adaptable to different activities and boost your pain tolerance.

Try it: 6 knee strengthening exercises you can do at home.

Take medications for joint pain relief

Some medications for knee pain can give you instant joint relief. Although they may not cure the cause of your pain, they can buy you time to exercise or rehabilitate your knee pain-free.

Acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) are a few over-the-counter options.

Use a knee brace or tape

There are several types of knee braces out there that may help your symptoms.

Some limit your knee’s range of motion, which can lessen the pain while you recover. Others provide compression, which can also help with muscle pain and decrease swelling.

This can help: How to choose the right knee brace for you?

Consult your physical therapist

A physical therapist can give you personalized treatment strategies to help you recover, such as:

  • Using other thermotherapies for pain like a heating pad.
  • Manual therapy to recover your mobility.
  • Therapeutic exercises to regain your ankle function.
  • Teach you do-it-yourself remedies and exercises to continue your recovery at home.
  • Prevent you from developing chronic knee pain.

Visit your doctor

There are a ton of tissues that may have caused your knee pain. Your doctor can refer you to proper diagnostic tests to cover all possible causes and give professional medical advice accordingly.

This may help: What kind of doctor treats knee pain?

FAQs

Is it supposed to hurt when you ice your knee?

It’s normal to feel a bit of a burning, achy feeling a few minutes after using ice therapy. This should subside after a few minutes.

Can ice make joint pain worse?

Normally it doesn’t. But improper use of ice, like wrong placement and timing, might cause more harm than good.

Can ice make inflammation worse?

Not in general. Ice is known to decrease blood flow, which can reduce swelling and inflammation. (11)

Conclusion: Why does ice make my knee pain worse?

There are different situations where ice can make your knee pain worse. These can be from unforeseen health complications or even simple honest mistakes.

Regardless of what it may be, you can address them on your own or by consulting your doctor. You can also use other treatments like pain medications and physical therapy to relieve your pain.

Resources

  1. Johnson, Norma. THE EFFECTS OF THREE DIFFERENT ICE BATH IMMERSION TIMES ON NUMBNESS (SENSATION OF PRESSURE), SURFACE TEMPERATURE, AND PERCEIVED PAIN. 2004. Brigham Young University. Masters Dissertation. https://scholarsarchive.byu.edu/cgi/viewcontent.cgi?article=1180&context=etd
  2. Kuo, Chia-Chi et al. “Comparing the antiswelling and analgesic effects of three different ice pack therapy durations: a randomized controlled trial on cases with soft tissue injuries.” The journal of nursing research : JNR vol. 21,3 (2013): 186-94. DOI: 10.1097/jnr.0b013e3182a0af12
  3. Basit H, Wallen TJ, Dudley C. Frostbite. [Updated 2021 Nov 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK536914/
  4. Patil N, Rehman A, Jialal I. Hypothyroidism. [Updated 2022 Feb 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519536/
  5. Musa R, Qurie A. Raynaud Disease. [Updated 2021 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499833/
  6. “Urticaria, Cold.” National Organization for Rare Disorders. 2004. https://rarediseases.org/rare-diseases/urticaria-cold/
  7. Möller, A et al. “Epidemiologie und Klinik der Kälteurtikaria” [Epidemiology and clinical aspects of cold urticaria]. Der Hautarzt; Zeitschrift fur Dermatologie, Venerologie, und verwandte Gebiete vol. 47,7 (1996): 510-4. DOI: 10.1007/s001050050461
  8. Breslin, Matthew et al. “Acute effects of cold therapy on knee skin surface temperature: gel pack versus ice bag.” BMJ open sport & exercise medicine vol. 1,1 e000037. 7 Dec. 2015, DOI: 10.1136/bmjsem-2015-000037
  9. 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
  10. 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
  11. Wang, Zi-Ru, and Guo-Xin Ni. “Is it time to put traditional cold therapy in rehabilitation of soft-tissue injuries out to pasture?.” World journal of clinical cases vol. 9,17 (2021): 4116-4122. DOI: 10.12998/wjcc.v9.i17.4116

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Author
Paolo Sarmiento (PT)
Paolo is a physical therapist, educator and fitness enthusiast. He shares his knowledge and experience in helping people deal with health issues, especially with the knee. As health-conscious as he can be, he enjoys long bicycle rides, early morning runs, and a good slice of pizza with extra pepperoni.

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