Thermotherapy or Cryotherapy for Osteoarthritis

Heat or cold for your joints? Thermotherapy involves the application of heat, and cryotherapy involves the application of cold. The target is a joint affected by osteoarthritis for the purpose of relieving osteoarthritis symptoms.

Osteoarthritis is the most common type of arthritis, affecting more than 21 million Americans. The disease can affect any joint but it is most common and especially disabling in the knees, hips, and hands. Stiffness, swelling, and joint pain are among the symptoms associated with osteoarthritis. While medications are usually prescribed, non-drug treatments are also popular for the relief of osteoarthritis symptoms.

Woman sitting with ice pack on knee
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What's Better for Osteoarthritis?

Osteoarthritis patients often try heat or cold applications to relieve symptoms. The treatment is easy and inexpensive compared to other treatment options, but patients want to know:

  • Which works better — heat or cold?
  • How should heat or cold be used for the best results?
  • How do thermotherapy and cryotherapy work to relieve osteoarthritis?

Thermotherapy is thought to work by improving circulation and relaxing muscles. Cryotherapy numbs pain, reduces joint swelling, constricts blood vessels, and block nerve impulses to the affected joint.

Heat can be conveniently delivered by using heating pads, hot towels, or paraffin wax. Cold can be applied by using cold compresses, crushed ice in a plastic bag wrapped in a towel, frozen gel packs, or some people get creative and use a bag of frozen vegetables that work well by conforming to the joint.

Cochrane Review: Thermotherapy Versus Cryotherapy

A Cochrane Review assessed three randomized, controlled clinical trials involving 179 patients with knee osteoarthritis. Patients were allowed to continue taking their medications but also used hot, cold, or ice packs and towels, with or without massage. They were compared to a control group receiving no treatment. Reviewers looked for outcomes of pain relief, reduction of edema/swelling, and improvement of knee flexion (bending), range of motion, and function. Here are the results of the Cochrane Review:

  • The first of the three studies revealed that massaging with ice for 20 minutes a day, five days a week, for two weeks improved muscle strength in the leg, improved range of motion in the knee, and resulted in less time needed to walk 50 feet, compared to the control group.
  • The second study showed that knee osteoarthritis patients using ice packs for three days a week for three weeks had no significant improvement in pain compared to patients receiving no treatment.
  • The third study indicated that cold packs applied to the knee for 20 minutes, ten times, resulted in decreased swelling compared to the control group who received no treatment. Hot packs used for the same amount of time had the same effect on swelling as the control group who received no treatment.

Points to Remember

To summarize, ice massage appeared to be beneficial for knee strength, range of motion, and function. Ice packs had no significant effect on knee pain. Cold packs were useful for reducing knee swelling. Hot packs did not reduce swelling.

If you wish to try cold or heat, discuss it with your healthcare provider. Discuss which you should try and have your healthcare provider give you specific directions for how long and how often to use cold or heat. Some patients have individual preferences for heat or cold based on what has worked best for them in the past. But, start with your healthcare provider for advice specific to your situation.

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  • Thermotherapy for treatment of osteoarthritis. The Cochrane Collaboration. Cochrane Reviews. Brosseau L., Yonge KA., Robinson V., Marchand S., Judd M., Wells G., Tugwell P. August 24, 2003.