When to use heat or ice for arthritis

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According to Creaky Joints, heat therapy may help soothe stiff joints, particularly if arthritis causes morning stiffness. Heat therapy may help by increasing blood flow, causing the blood vessels to dilate and pull in more oxygen and nutrients to the joints and muscles.

Cold therapy works in the opposite way, constricting blood vessels and reducing blood flow to the area. This can help reduce swelling and inflammation and assist in soothing aching joints after physical activity.

Cold therapy may also help a person manage pain symptoms, as it slows down pain signals traveling to the brain.

Learn about other home remedies for arthritis.

People can choose a method of heat therapy that works for them. Different ways to use heat include:

• Warm shower: Taking a long, warm shower may help ease the joints, increase range of motion, and reduce stiffness. A person can aim for a shower temperature of 92–100°F (33.3–37.7°C).
• Damp, warm compress: A person can dampen a clean towel and heat it in a microwave, so the temperature feels comfortable to apply to affected areas.
• Warm bath: Individuals can soak in a warm bath for around 20 minutes. They can also try adding magnesium sulfate crystals, or Epsom salts, to increase magnesium levels. Magnesium is an important mineral for bone and heart health.
• Heating pads or hot water bottle: Someone can use a moist heating pad or fill a hot water bottle and leave it on the affected area while resting or sitting down.
• Paraffin wax: A person can melt paraffin wax, and after checking it is not too hot, dip the hands, feet, or any aching joint into the wax. They should wait for the wax to cool and harden before peeling off.
• Warm pool: People can swim or exercise in a warm pool 2–3 times per week to increase flexibility and range of motion.

Heat therapy needs to be warm rather than too hot. The Arthritis Foundation (AF) recommends the following tips for using different types of heat therapy:

• Take a hot shower or bath in the morning or before exercising to help reduce stiffness, warm up the body, prepare the joints, and help reduce the likelihood of injury.
• Take a warm bath at the end of the day to ease the joints after a day of activity.
• Avoid using heat on any injury or during a flare-up.
• If any redness, swelling, or bruising is present, use cold therapy instead for a few days until it subsides.
• If people have neuropathy or another condition that makes them less sensitive to temperature changes, they should check their skin every 5 minutes to check that it is not burning or blistering.

People may also be incorporating heat therapy into their day without realizing it. Taking a hot shower in the morning, washing their hands in moderately hot water, or washing up can all be ways to soothe the joints throughout the day.

Different methods of cold therapy include:

• A bag of frozen vegetables: Wrap a bag of frozen peas or something similar in a thin, damp cloth or towel and apply it to the affected area. A bag of ice cubes can also be effective.
• A frozen towel: Take a damp sponge or dampen and fold a towel and place it in the freezer for around 15 minutes. Remove it from the freezer, place it in a plastic bag or thin cloth and apply it to the affected area.
• Reusable DIY cold packs: Fill a clean, spare sock with rice and place it in the freezer, or fill a resealable plastic bag with liquid washing-up detergent. Take out of the freezer when necessary.
• Ice or gel cold pack: Buy an ice pack or gel pack to freeze. Choose the shape and size suitable for the affected areas.
• Ice massage: Take a paper cup, fill it with water, and place it in the freezer. Once frozen, peel away the top part of the cup, leaving a small section at the bottom to hold onto. Rub the exposed ice in small circles over the sore area, avoiding any part where the bone is close to the skin, such as the elbow point or kneecap.
• Instant ice packs: People can buy single-use ice packs that they snap to activate. These may be useful when other options are unavailable.

Cold therapy will not affect the body’s internal temperature, as it targets the tissues and muscles close to the surface of the skin. Tips for using cold therapy include the following:

• Use cold therapy for around 8 minutes at a time.
• Use items that have reached freezing point but wrap any frozen or very cold object in a towel or cloth before applying it to the skin.
• Stop using any cold therapy if the skin starts to feel numb or if a person feels increased pain or discomfort.
• Avoid cold therapy for too long, as it may damage tissue or result in frostbite.
• Avoid cold therapy if people have neuropathy or another condition that makes them less sensitive to temperature changes.
• Use cold therapy during flare-ups to reduce inflammation and swelling.
• Avoid using cold therapy on broken skin.
• Choose heat therapy instead if a person wants to improve flexibility, reduce pain, and ease stiffness.

People may choose to alternate between heat or cold therapy throughout the day. Repetitive use of heat and cold therapy is safe to do as long as individuals are careful about their methods.

The AF advises leaving a couple of hours between heat and cold therapy when alternating between both.

People with arthritis may find that heat and cold therapy helps ease joint pain and stiffness.

According to studies that the AF cites, people with arthritis who took part in exercise classes in a warm pool 2–3 times a week had increased range of motion and up to 40% reduction in pain.

The 2019 guidelines from the American College of Rheumatology and AF conditionally recommend heat and cold therapy for people with osteoarthritis of the knee, hip, or hand. However, there is insufficient reliable evidence of the benefits of heat and cold therapy to recommend it unconditionally.

Heat and cold therapy may help ease arthritis symptoms.

Heat therapy increases blood flow and may help to soothe stiff joints. In contrast, cold therapy constricts blood vessels and may be useful in reducing stiffness and inflammation.

People can alternate between heat and cold as necessary.

A person can discuss the types of heat or cold therapy with a healthcare professional to check whether it is safe to use and which methods may be best for their type of arthritis.