Thermotherapy or Cryotherapy for Osteoarthritis

Thermotherapy involves the application of heat to a painful joint affected by osteoarthritis. Cryotherapy involves the application of cold, each for the purpose of relieving pain, swelling, and other osteoarthritis symptoms. It may be used alongside medications, physical therapy, and other interventions.

According to the Centers for Disease Control and Prevention (CDC), osteoarthritis is the most common type of arthritis, affecting more than 32 million Americans. The stiffness, swelling, and joint pain can affect any joint but especially the knees, hips, and hands.

This article explains how heat and cold therapy may help, as well as switching between the two (contrast therapy).It offers insights you can discuss with your healthcare provider when choosing the best option for your needs.

Woman sitting with ice pack on knee
PhotoAlto / Odilon Dimier / PhotoAlto Agency RF Collections / Getty Images

What's Better for Osteoarthritis?

People living with osteoarthritis often try heat or cold applications to relieve symptoms. The treatment is easy and inexpensive compared to other treatment options, but people 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 constricts blood vessels, reduces joint inflammation and swelling, numbs pain, and slows or blocks nerve impulses to the affected joint.

Heat can be conveniently delivered by using heating pads, hot towels, paraffin wax, or warm baths. 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.

Deciding when to use heat vs. cold therapy is the key.

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 and 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.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Centers for Disease Control and Prevention. Osteoarthritis.

  2. National Institute for Health and Care Excellence. Osteoarthritis: Care and management [clinical guideline CG177].

  3. Fokmare PS Jr, Phansopkar P. A Review on Osteoarthritis Knee Management via Contrast Bath Therapy and Physical Therapy. Cureus. 2022 Jul 27;14(7):e27381. doi:10.7759/cureus.27381. 

  4. Algafly AA, George KP, Herrington L. The effect of cryotherapy on nerve conduction velocity, pain threshold and pain toleranceBritish Journal of Sports Medicine. 2007;41(6):365-369. doi:10.1136%2Fbjsm.2006.031237

  5. Brosseau L, Yonge K, Welch V, et al. Thermotherapy for treatment of osteoarthritis. Cochrane Database of Systematic Reviews. 2003;4(CD004522). doi:10.1002/14651858.CD004522

By Carol Eustice
Carol Eustice is a writer who covers arthritis and chronic illness. She is the author of "The Everything Health Guide to Arthritis."