Should You Use Heat or Ice for Arthritis Pain? Here’s How To Decide

Heat or ice for arthritis can often provide soothing pain relief, whether you’re dealing with an arthritic knee that leaves you hobbling up and down stairs, or stiff fingers that make it hard to button your shirt or tie your shoes. And if you’ve been wondering if one is better than the other to ease your swollen joints, you’ve come to the right place — our physical therapists often get asked if one remedy is better than the other when using heat or ice for arthritis. 

So…is heat or ice better? The short answer: both work. A 2021 study in the journal Clinical Nursing Research, for example, found that both helped to reduce pain and improve functioning in people with knee osteoarthritis. “Many people turn to heat or ice for arthritis because they find that it helps relieve pain and stiffness without having to take medication,” explains Jennifer Hayes, PT, DPT, a physical therapist at Hinge Health. 

That said, you may want to prioritize one over the other in certain situations. Ice may be best for a new arthritis flare up, while heat may be more soothing for more chronic stiffness and pain. Just remember that you’re the expert on you. “It may take a little trial and error, but you may find that one helps you more than the other, or that both provide relief,” says Dr. Hayes. And no matter which you choose, the goal is to achieve enough relief so you can do things like exercise or physical therapy to improve your everyday functioning. This is what will lead to longer-term relief.

Read on to learn more about when to choose heat or ice for arthritis pain, plus alternative strategies that help ease discomfort in your joints, including exercises recommended by Hinge Health physical therapists.

Ice Therapy for Arthritis

There’s good research to suggest that ice therapy can be helpful for improving pain, swelling, and range of motion and function in people with arthritis. One study, for example, found that doing an ice massage for 20 minutes, five days a week for two weeks, improved leg muscle strength, knee range of motion, and increased walking speed in people with knee osteoarthritis. 

Why does it help? Icing, also known as cryotherapy, shrinks your blood vessels. This limits blood flow to an area, which in turn will reduce swelling and inflammation. “This is very helpful if you have a flare up of your arthritis symptoms,” says Dr. Hayes. As the swelling goes down, your pain should get better. Ice may also temporarily relieve pain by simply numbing nerve endings.

You may especially benefit from ice for arthritis if you have:

• A new arthritic flare up

• Swelling

• Redness

• Warmth at the arthritic joint

• Pain following exercise

How to Use Ice for Arthritis

There are several different ways to apply ice that will be effective for temporarily relieving arthritis pain, including:

• Ice pack. Put ice in a plastic bag, add a little water to cover it, then wrap it in a wet towel.

• Ice towels. Wet a towel with cold water, squeeze it until damp, and then fold it and place it in a plastic bag. Freeze it for 15 minutes.

• Ice sponge. Wet a sponge with cold water, place it in a plastic bag, and freeze it for 15 minutes.

• A bag of frozen veggies. Wrap a bag of frozen peas or corn with a thin towel.

• DIY gel pack. Fill a zip-top bag with liquid detergent and freeze it.

• Instant ice packs. Keep these handy in a closet or first aid kit. When cracked, they become cold right away. Since they don’t need to be stored in the freezer, they’re a great option when you’re on the go. 

• Ice massage. Take a frozen water bottle and use it like a foam roller, rolling it up and down the affected joint, suggests Dr. Hayes. 

Whichever method you use, make sure that you don’t put the ice directly on your skin. If the ice pack doesn’t have a cloth covering, use a paper towel, cloth napkin, or thin towel in between to protect your skin, says Dr. Hayes.

How Often to Use Ice

If you’re experiencing an arthritic flare up, it’s fine to apply ice for 15 to 20 minutes two to three times a day. After about 48 hours, you’ll want to switch to heat, to increase blood flow to the area, says Dr. Hayes.

Heat Therapy for Arthritis 

“Many people prefer to use heat to manage arthritis symptoms because it improves circulation, reduces muscle tension, and soothes arthritic joints,” says Dr. Hayes. Groups like the American College of Rheumatology also recommend it as a treatment for arthritis. 

In general, heat is best to:

• Relieve stiffness

• Boost blood flow to the affected joint

• Relax tight muscles

• Prepare you for activity and exercise

The way heat works is pretty simple, says Dr. Hayes. When you warm up a sore joint, the surrounding blood vessels get bigger. As a result, more blood, oxygen, and nutrients can be delivered to the area, promoting healing and relief from joint stiffness.

How to Use Heat for Arthritis

Just like with icing, there are many different ways to apply heat. Choose the one that’s most soothing and comfortable for you. 

• A warm shower. Make sure it’s not too hot — between 92 and 100 degrees Fahrenheit is best, according to the Arthritis Foundation. 

• A warm dip. Research shows that people with arthritis who swam in a warm water pool two to three times a week reduced joint pain by about 40%. 

• Electric heating pad. Just remember to unplug it when you’re done and never fall asleep with it on. 

• Moist heating pad. Warm a wet washcloth in the microwave for a minute. 

• Warm tub. Dr. Hayes recommends that you add in some Epsom salts — they’re rich in magnesium, which can help to boost your bone health, too.

How Often to Use Heat

There’s no hard-and-fast rule as to how often you should use heat, says Dr. Hayes. It’s good to use it before activity, as well as before bed, but you can heat as often as every few hours. Just don’t apply heat for more than 15 to 20 minutes at a time (this holds true whether you are using a heating pad or soaking in a warm bath), as too much heat can injure skin. Never fall asleep with heat applied to your body, either, as it could lead to a burn.

When Not to Use Heat or Ice for Arthritis 

While both heat and ice can help with arthritis symptoms, there are certain times when you shouldn’t use them. Avoid ice if you have:

• An open wound

• Diabetic neuropathy

• Problems with your circulation

• Peripheral vascular disease

• Hives

Avoid heat if you have:

• An open wound

• Diabetic neuropathy

• An active infection, like the flu or COVID-19

If you’re unsure if heat or cold therapy is safe for you, you can always talk to your primary care doctor or physical therapist first.

Ice and heat can help reduce arthritis symptoms enough so you can get back to the best treatment for arthritis: exercise. The moves above are recommended by Hinge Health physical therapists for general arthritis pain relief. Working with a physical therapist (PT) can help you develop a more targeted exercise program for your specific form of arthritis. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

PT Tip: Alternate Ice and Heat 

It’s perfectly okay to opt for a cold pack or reach for a heating pad if you feel one seems to work best for your arthritis self-care. You can also rotate between heat and ice. For example, apply heat before exercise, and then apply ice while you cool down, advises Dr. Hayes. But don’t go from hot to cold immediately — try to space them out by at least an hour or two. 

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program. 

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. 

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you. 

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

1. Ariana, M., Afrasiabifar, A., Najafi Doulatabad, S., Mosavi, A., & Behnammoghadam, M. (2021). The Effect of Local Heat Therapy versus Cold Rub Gel on Pain and Joint Functions in Patients with Knee Osteoarthritis. Clinical Nursing Research, 31(6), 105477382110355. doi:10.1177/10547738211035502

2. Brosseau, L., Yonge, K., Welch, V., Marchand, S., Judd, M., Wells, G. A., & Tugwell, P. (2003). Thermotherapy for treatment of osteoarthritis. Cochrane Database of Systematic Reviews, 4. doi:10.1002/14651858.cd004522

3. Kolasinski, S. L., Neogi, T., Hochberg, M. C., Oatis, C., Guyatt, G., Block, J., Callahan, L., Copenhaver, C., Dodge, C., Felson, D., Gellar, K., Harvey, W. F., Hawker, G., Herzig, E., Kwoh, C. K., Nelson, A. E., Samuels, J., Scanzello, C., White, D., & Wise, B. (2020). 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care & Research, 72(2), 149–162. doi:10.1002/acr.24131

4. Sayre, C. (2024). Heat Therapy Helps Relax Stiff Joints. Arthritis Foundation. https://www.arthritis.org/health-wellness/healthy-living/managing-pain/pain-relief-solutions/heat-therapy-helps-relax-stiff-joints