Heat Versus Ice: What's Really Best for Your Knee Arthritis?

Medically Reviewed By William C. Lloyd III, MD, FACS
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If you are among the tens of millions of people who live with knee osteoarthritis, you know your pain tends to worsen with and after activity. You also probably know that regular exercise is one of the best things you can do to improve your range of motion and flexibility as well as strengthen the muscles that surround your knee.

Enter heat and ice.

Both of these modalities can be effective pain relievers when used correctly. Other pluses: They are relatively inexpensive and mainly free of side effects. The trick is knowing when and how to use heat or cold to treat your knee pain.

The following sections comprise a cheat sheet on the use of heat versus ice for knee pain.

How and when to use heat

Heating pads, warm baths, and other heat-based treatments tend to be best before activity. Applying heat to your knee before you hop on the treadmill or head out on a shopping excursion will improve blood flow, relax your muscles, and prime your joints for action.

Wrap a moist heating pad in a towel and place it over your knee or knees for 15 - 20 minutes before exercise. For a do-it-yourself heating pad, place a wet washcloth in a freezer bag and heat it in the microwave for 1 minute. Electric heating pads are another option for treating knee pain, provided they are not too hot.

Other ways to tap into the healing effects of heat include:

  • Warming your clothes in the dryer before getting dressed.
  • Turning your electric blanket up for a few minutes before getting out of bed. (Remember to turn it off when you get out of bed.)

There is one caveat to keep in mind when using heat therapy: Do not burn yourself. Avoid this by using heating pads for less than 20 minutes at a time and filling heating bottles with hot—not boiling—water.

How and when to use ice

Actual ice, ice packs and other cold therapies can help reduce knee pain and muscle spasms. Conventional medical wisdom suggests using ice to treat an acute injury or pain that occurs after activity. Put another way: Apply heat before your activity and cold after you return home. Cold can numb pain, decrease swelling, and block nerve impulses to the joint.

A review article summarizing six studies suggests cold therapy can be an effective way to relieve knee pain. One study showed that ice massage performed for 20 minutes, 5 days per week, for 2 weeks improved range of motion, function and knee strength among individuals with knee osteoarthritis.

To prepare to perform an ice massage, fill a Styrofoam cup with water and freeze it. When removed, that rounded block of ice fits your hand perfectly for performing knee massage.

Another study found that ice packs used for 3 days per week for 3 weeks improved pain just as well as no treatment. Importantly, there were no side effects seen with cold therapy in any of these studies.

To explore the benefits of cold therapy for knee osteoarthritis:

  • Apply a bag of ice wrapped in a towel or a gel-filled cold pack to the painful area for about 10 minutes.
  • Wrap a towel around a bag of frozen vegetables and place it on sore joints for pain relief. Tip: Frozen peas or other vegetables mold to your body, making them ideally suited for treating knee pain.

Remember, if your pain does not improve or seems to worsen, visit your doctor to find out what else you can do for your knee arthritis.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 May 1
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
  1. Head-cold for pain relief, Arthritis Foundation. http://www.arthritistoday.org/arthritis-treatment/natural-and-alternative-treatments/remedies-and-th...
  2. Bhatia D, et al. Current interventions in the management of knee osteoarthritis. Journal of Pharmacy And Bioallied Sciences. 2013 Jan-Mar; 5(1): 30–38. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3612336/)
  3. Thermotherapy (heat treatment) for treating osteoarthritis of the knee. Cochrane Database of Systematic Reviews. 2011. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0012852/
  4. Patient information: Osteoarthritis treatment (Beyond the Basics). UpToDate. http://www.uptodate.com/contents/osteoarthritis-treatment-beyond-the-basics