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.

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.

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

There are no universally accepted guidelines for when to use heat or cold therapy on osteoarthritic joints, and recommendations are mixed.¹Oosterveid FG, Rasker JJ. Treating arthritis with locally applied heat or cold. Semin Arthritis Rheum. 1994;24(2):82–90. [PubMed]^,2Brosseau L, Yonge KA, Robinson V, et al. Thermotherapy for treatment of osteoarthritis. Cochrane Database Syst Rev. 2003;(4):CDO04522. [PubMed]^,3Porcheret M, Jordan K, Jinks C, Croft P. Primary care treatment of knee pain: a survey in older adults. Rheumatology. 2007;46:1694–1700. [PubMed ]^,4Hing WA, White SG, Bouaaphone A, Lee P. Contrast therapy – a systematic review. Phys Ther Sport. 2008;9:148–161. [PubMed]^,5Cameron MH. Physical Agents in Rehabilitation. 3rd ed. Vol. 257. St Louis: Saunders Elsevier; 2009. Hydrotherapy; pp. 269–270.^,6Denegar 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.⁷Denegar 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.⁸Welch 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.^,9Robinson 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.