Cold or Heat? Therapy for Chronic Joint Pain

Chronic joint pain can be a debilitating condition, especially when it persists for longer periods of time. Luckily, the use of cold and heat therapy are effective ways to heal sore and inflamed joints while also promoting immune health.

Heat and cold therapy are two common treatments for chronic joint pain. Heat therapy can reduce stiffness, relax muscles, and increase circulation to the area. Cold therapy can help relieve inflammation and reduce swelling. It is important to understand the different effects of each type of therapy so that you can determine which one is best for your individual needs.

Cold Therapy, What is it?

Cold therapy, also known as cold compression therapy or cryotherapy, is a treatment option used to reduce inflammation and chronic joint pain. Cold therapy works by decreasing inflammation in the affected area while simultaneously constricting blood vessels to reduce swelling and prevent further damage. This cold compress effect helps to speed up healing as well as reduce chronic joint pain. Cold temperatures help decrease blood flow and reduce muscle spasms which can cause pain and discomfort. Cold exposure also reduces oxidative stress which helps reduce inflammation.

Cold triggers thermogenesis, a process where heat energy is produced as an adaptation to cold temperatures. This stimulates muscles near the affected areas helping them heal. Besides these benefits, cold treatment has been associated with an increase in brown fat production. This type of fat is known to improve metabolism and general well-being.

Brown fat is so-called “good” fat because it provides our bodies with energy rather than storing excess calories as white fat does. Weight and excess white fat is often an issue for many chronic joint pain sufferers. Cold therapy helps stimulate the production of brown fat through thermogenesis – a process in which the body creates heat to generate energy. The cold temperature activates brown fat cells and helps to break down white fat which can help reduce overall body weight when combined with a healthy lifestyle.

A recent study examined the use of cold therapy in gout patients. Cold-water immersion decreased pain, stress, anxiety, and depression, and increased joint mobility, physical activity, and quality of life. It also provided significant pain relief as well as improved quality of life. While this study examined just the effects of cold therapy, research is also focusing on the benefits of using heat and cold as contrast therapy.

How to Use Cold Therapy

Cold therapy can be applied in various ways depending on the severity of the injury or condition being treated. Commonly used techniques include cold packs, cold baths or showers, cold compresses, or ice massages. It is important to note that cold therapy for extended periods can lead to skin damage and tissue damage. So, it is important to consult your healthcare provider before starting cold therapy in order to ensure that it is appropriate for your condition.

Cold therapy is often used at the beginning of a joint flare or when the joint is red and hot. Cold is typically used within the first 48 hours of a joint flare. Take care not to apply ice compresses for more than 10 minutes at a time. Don’t apply ice directly on the skin unless you use a cold pack that has a built-in barrier to prevent skin damage. An ice massage may be a better alternative; here, an individual applies pressure with an ice cube directly to the affected area while moving it in circles over the area for approximately five minutes.

Cold therapy can be used either as a standalone approach or in combination with other treatment methods such as heat therapy, physical therapy, natural therapies, and medication. Contrast hydrotherapy is an effective therapy used to treat chronic joint pain conditions. It involves alternating cold and warm water treatments, usually several times over the course of one session.

Heat Therapy, What is it?

Heat can often provide great relief by increasing blood flow and circulation to the joint. It alleviates joint stiffness through relaxing the muscles and is typically used to manage tingling and numbness, muscle tightness, aches, and pains. Some of the best ways to apply heat therapy at home include taking hot baths, using a heating pad or moist heating pack, soaking in a hot tub or sauna, getting a professional massage with hot stones and heated oils, and using a hot water bottle. If done properly, heat therapy can help prevent pain and reduce inflammation in the joint or muscle.

How to Use Heat Therapy

Heat wraps, warm baths, and hot compresses are all examples of ways that heat therapy can be applied at home. It is important to be mindful of the temperature you are exposing yourself to and not leave heated objects on your skin for too long as this may cause burns. Generally, 20 minutes at a time is a guideline as long as the temperature is not so high as to burn your skin. When using a heating pad or hot compress, it is important not to leave it on for too long as this could further aggravate the affected area and cause more harm than good. It is also important to note that heat therapy is not appropriate for everyone, so it is best to consult with your healthcare provider before using any heat therapy modalities.

Contrast Therapy, What is it?

In Contrast hydrotherapy, the cold treatment helps reduce inflammation while the warm treatment improves circulation and relaxes the area. This combination of hot and cold temperatures allows for a more effective healing process by encouraging blood flow throughout the affected area, which helps in relieving pain symptoms. Over time, this type of cold therapy can help increase muscle strength and flexibility around the affected joints, reducing the risk of further injury or discomfort.

Patients with chronic joint pain often report that Contrast hydrotherapy can provide nearly instantaneous relief from their discomfort. A study of knee osteoarthritis patients found that contrast hydrotherapy worked better than cold therapy, alone. The contrast group displayed remarkable improvement in physical, psychological, and social areas as well their overall quality of life.

contrast hydrotherapy for chronic joint pain

In conclusion, cold and heat therapy have both been found to be beneficial in treating chronic joint pain. While cold therapy may decrease inflammation and stimulate the production of brown fat, heat therapy can increase blood flow and relaxation of muscles in the affected area. Ultimately, it is important to consult with your healthcare professional before beginning cold or heat treatment so that they can help you decide which approach would be best for you and ensure that you are using these therapies safely and effectively.


–Kurniasari MD, Monsen KA, Weng SF, Yang CY, Tsai HT. Cold Water Immersion Directly and Mediated by Alleviated Pain to Promote Quality of Life in Indonesian with Gout Arthritis: A Community-based Randomized Controlled Trial. Biological Research For Nursing. 2022;24(2):245-258. doi:10.1177/10998004211063547

-Manal Ibrahem Abd elFatah, Soheir Mohammed Weheida, Mimi Mohammed Mekkawy. Effect of Cold Application Versus Contrast Hydrotherapy on Patients Knee Osteoarthritis Outcomes. American Journal of Nursing Science. Vol. 8, No. 4, 2019, pp. 151-158. doi: 10.11648/j.ajns.20190804.14 

-Wang X, Han T, Wang L, et al. Whole-Body Cryotherapy in the Treatment of Joint Pain: A Review and Meta-Analysis. Medicine. 2018;97(31):e11528. doi:10.1097/md.0000000000011528.

-Li S, Ma X, Li Y, Gao H., Liu J., & Zhang W.. The effect of cold therapy for chronic joint pain relief: a systematic review and meta-analysis. BMC Musculoskeletal Disorders. 2021;22(1):464. doi:10 1086/713314 .

-American College of Rheumatology (ACR) guidelines on cold therapy for chronic joint pain. ACR Clinical Practice Guideline on cold therapy for chronic joint pain. Accessed April 10, 2021. -Practice-Guidelines /ColdTherapyForChronicJointPain.

-Irish Society of Rheumatology (ISR) cold therapy guidelines for patients with chronic joint pain. ISR cold therapy guidelines for the management of chronic joint pain in Ireland. Accessed April 10, 2021. https://www.irishsocietyofrheumatology .ie/guidelines/cold_therapy_guidelines_for _the_management_of_chronic _joint_pain_in _ireland .aspx.

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