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Heat vs. Cold Therapy for Joint Pain

Applying heat or cold can offer an inexpensive and easy way to relieve arthritis-related aches and pains. However, there can be confusion about when to use heat versus cold therapy. Heat can relax muscles and improve joint lubrication. Heat therapy is typically used to relieve muscle and joint stiffness, help warm-up joints prior to activity, and/or relieve muscle spasm. Cold therapy can help reduce the inflammation, swelling, and pain related to joint arthritis. Cold application is also often recommended for acute bone and joint injuries.

Heat and Cold therapy can potentially provide arthritis relief, so therapy must be individualized.

Some patients may even get best results by alternating between heat and cold therapy. For example, heat may be utilized in the morning to ‘loosen-up’ stiff arthritic joints and cold application subsequently used later in the day to reduce swelling. This alternating process can be repeated throughout the day for pain relief.

Most often, cold therapy is recommended with certain types of painful arthritis inflammation flares, such as seen with gout and pseudogout. Other types of arthritis, including osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis, may benefit from both heat and cold therapy. No specific universal guidelines exist for when to use heat or cold therapy for joint pain, and a quick web search will yield varying recommendations. People with arthritis joint pain are advised to experiment with both heat and cold therapy to find which works best for their individual symptoms.

Research does show that heat and/or cold application does not affect rheumatoid arthritis disease activity but it can assist some rheumatoid arthritis patients with comfort.

Heat Therapy Benefits

Heat therapy can:

  • Help promote healing of damaged tissue. Warmth increases blood flow to an area, which increases the flow of oxygen and nutrients to the tissues.
  • Decrease joint stiffness. Heat therapy increases the pliability of the connective and muscle tissues, which often improves joint flexibility and movement. Increased joint movement, in response, can stimulate joint fluid (synovial fluid) production to increase joint lubrication and the delivery of nutrients to tissues.
  • Distract the brain from the pain. Heat therapy can stimulate sensory receptors on the skin and decrease the transmissions of pain signals to the brain.

For many patients, heat therapy works best when combined with other treatment options, including exercise, physical therapy and anti-inflammatories.

CAUTION: Heat therapy should be warm, not hot and should never be painful or burn the skin. The most effective heat therapy provides a constant temperature for an extended period of time. Time of heat application may depend the pain location, severity or depth. Heat must penetrate into the affected joint and tissues to be most effective.

Minor to moderate pain in joints close to the skin surface (ankle, elbow) may only require 15 to 20 minutes of heat therapy for relief. Deeper discomfort, such as moderate to severe arthritis of the hip or lower back, may benefit from longer heat therapy sessions (up to 30 minutes at a time).

When to Avoid Heat Therapy

Heat is not recommended for every patient or situation. Avoid or use extreme caution with:

  • Acute injury with swelling/bruising
  • Dermatitis
  • Deep vein thrombosis
  • Diabetes
  • Peripheral vascular disease
  • An open wound
  • Severe cognitive impairment
  • Patients with heart disease and/or hypertension should consult their doctor before using heat therapy

How to Make a Homemade Heat Pack

Cold Therapy Benefits

Cold therapy can:

  • Decrease inflammation. Cold therapy reduces blood flow to tissues and helps reduce inflammation.
  • Slow the production of joint fluid. Excessive synovial joint fluid can contribute to swelling and discomfort. Applying a cold compress to a swollen joint can slow the production of joint fluid.
  • Distract the brain from the inflammation. Like heat, cold therapy triggers sensory receptors in the skin and reduces the transmissions of pain signals to the brain.

CAUTION: There have been reported cases of frostbite caused by application of cold packs. A cold pack should be applied for no more than 20 minutes at a time, and can be repeated every couple hours through the day.

Additional precautions to avoid skin damage:

  • Avoid applying ice directly to the skin. Use a towel or other protective barrier between the ice and skin. Cold therapy should never be painful to the skin.
  • People with certain conditions may be advised to avoid ice application, such as people who have Raynaud’s Syndrome, cold allergic conditions, or paralysis or areas of decreased sensation

How to Make a Homemade Cold Pack

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Cory Calendine, MD is an Orthopaedic Surgeon and founding partner of the Bone and Joint Institute of Tennessee at Williamson County Hospital in Franklin, TN. Dr. Calendine is an expert in Joint Replacement, specializing in Hip and Knee Surgery. From diagnosis through treatment, the Orthopaedic Surgical experts at the Bone and Joint Institute use the latest techniques and technology to improve care for people with musculoskeletal problems. For more information, please contact our office or schedule your appointment today.  
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