Ice or Heat for Arthritis? Reasons to Alternate

When it comes to arthritis pain, some people prefer ice, others prefer heat, and some choose to alternate these. Each of these approaches may help ease the symptoms of arthritis.

Arthritis is a group of diseases characterized by joint inflammation. These include rheumatoid arthritis, gout, and osteoarthritis, which is the most common type of arthritis and is a known as wear-and-tear arthritis. Arthritis affects about 1 in 4 adults in the United States.

Life with arthritis isn’t easy, but learning to manage symptoms can help you enjoy the fullest life possible. What works best for you may depend on factors such as the type of arthritis you have and which joints hurt at the moment.

This article explores the potential benefits of using ice or heat for arthritis pain, how to do it safely, and when alternating may be best.

Why Ice and Heat Work as Pain Relief for Arthritis

They work differently, but ice and heat can each relieve arthritis joint pain.

Cold works by reducing blood flow to the muscles and joints. It helps control inflammation and numb acute pain.

Heat works by expanding (dilating) blood vessels and improving circulation. It helps oxygen and nutrients get where they're needed. Stiff muscles and joints relax, which improves flexibility and helps reduce the pain of chronic conditions such as arthritis.

In short, cold may temporarily relieve pain and swelling, while heat may relax and soothe stiff muscles and joints. When done properly, there's little risk of harm.

There's no proof that one method is better than the other at relieving arthritis pain. According to the American College of Rheumatology and the Arthritis Foundation, treatment for osteoarthritis requires a multipronged approach in which providers and patients share decision-making.

Ice vs. Heat: Compared 

Optimal Temperatures and Safety

While ice can help ease arthritis pain, prolonged direct contact with your skin can lead to frostbite or "ice burn." Ice can cause permanent damage to delicate tissues. So, be sure to place a thin towel between the ice or gel pack and your skin. Check your skin periodically and stop immediately if it's discolored, numb, or tingly.

When using a heating pad, start on the lowest setting and increase heat gradually to see what you can tolerate. To avoid burns, check your skin after five minutes. If your skin is red or you can see the beginning of blisters, stop immediately.

Don't keep heat on your skin for more than 20 minutes at a time. A good temperature for a warm shower or bath is between 92 and 100 degrees F. Hold off on using heat during an acute flare-up or after an injury.

Keep in mind that medicated arthritis creams and heat shouldn't be used together because the combination can burn your skin. And never go to sleep while using an electric heating pad.

Avoid both ice and heat on skin with cuts or sores.

Types 

For cold therapy, ice the affected area for up to 20 minutes. You can use:

• Cold pack: Cold packs are ready-to-use straight from the freezer and are reusable. You can also stock up on single-use ice packs.
• Ice bag: As long as you have ice, an ice bag is convenient and durable.
• DIY: Fill a plastic bag with ice cubes, then wrap it in a towel. In a pinch, even a bag of frozen vegetables will do the trick.

Heat therapy can be applied for up to 20 minutes as well. For localized heat therapy, you can use:

• Heating pad or hot water bottle: One great feature of an electric heating pad is that once you choose your heat level, it'll maintain it. A hot water bottle can stay warm for about 20 minutes or so.
• Warm compress: Dampen a towel and heat it in the microwave. Be sure to test the temperature before applying it to your skin.

For full-body heat therapy:

• Shower or bath: A warm shower in the morning can help loosen stiff muscles and joints and improve range of motion. It can also help to take a warm shower just before you exercise.
• Heated pool: If you have access to a heated pool, about 20 minutes should help loosen up those achy muscles and joints. Whether you swim or do other water exercises, you'll find that water supports and helps take pressure off joints.
• Hot tub: A hot tub can be incredibly soothing. But soaking in a hot tub can lower blood pressure and increase heart rate. If you have heart disease or any other chronic illness, ask your healthcare provider if it's safe for you to use a hot tub.

Arthritis Location

Arthritis can affect joints throughout the body, including:

• Hands, wrists, and fingers
• Knees
• Feet, ankles, and toes
• Neck
• Shoulders
• Lower back
• Hips

Fortunately, ice and heat can help just about any joint. When choosing your method of ice or heat, think about where you'll use it.

For example, if you have pain in your hand or knee, you might want to choose something small and flexible so you can easily wrap the area. For pain in your lower back, choose something that can cover a large area. And for pain in your shoulder or neck, a large, flexible product would work best.

Before, During, or After a Flare

Arthritis is a chronic condition, but you can also have periodic flare-ups. An arthritis flare is a period of intense disease activity in which you have more severe symptoms. You can use ice and heat before, during, or after a flare. However, you should avoid putting heat on joints that are swollen or inflamed.

What you choose to use depends on what helps you feel better.

When to Alternate Therapy 

Alternating ice and heat may be the most effective strategy when you've overused a joint. But it bears repeating that everyone's reaction to ice and heat is different. You can alternate ice and heat to suit your own needs.

For example, if you tend to wake up in pain during the night, try icing the joint just before bed. If you frequently wake up with a stiff shoulder, consider applying heat in the morning. Heat before exercise or when you feel stiff; cold when your joint swells or pain intensifies.

When alternating therapies, it's important to leave time for your skin to return to its normal temperature between applications. The Arthritis Foundation suggests allowing two hours between sessions.

Summary

Ice and heat can each relieve arthritis pain. Ice restricts blood flow, which alleviates pain and swelling. Heat increases blood flow, which relaxes stiff, achy joints.

Cold may work better for acute symptoms, while heat can give joints and muscles more flexibility. There's no scientific evidence that one method is better than the other for treating arthritis.

For some people, alternating between the two provides the most relief. When used in conjunction with a total treatment plan, ice and heat may help you manage symptoms and improve overall quality of life.