Should You Use Ice or Heat for Knee Pain? Here’s How To Decide

Using ice and heat for knee pain can be one effective way to manage your discomfort, but “they are not miracle cures,” says Alec Martinez, PT, DPT, a physical therapist at Hinge Health. “Sometimes we treat them as a panacea, or medicine that will heal you, but that's not their job. They are a pain control method, and it's usually exercise and movement that’s the medicine.”

In other words, think of cold and heat therapy as a tool that gives you enough relief so you can do things like exercise or physical therapy to improve the underlying causes of your knee pain, such as muscle weakness, imbalance, or tightness. This is what will lead to longer-term relief. “When pain is overwhelming, it's hard to stay active,” says Dr. Martinez. “By taking away acute pain, you can focus more on movement, learning that it’s safe and won’t cause damage.”

So if you’re ready to use ice or heat for knee pain to kickstart your healing journey, you may be wondering if one is better than the other. Read on to find out, plus learn more strategies for lasting knee pain relief, including knee strengthening and stretching exercises recommended by Hinge Health physical therapists.

Ice Therapy for Knee Pain

Ice constricts or narrows blood vessels, decreasing blood flow to the treated area in order to reduce inflammation and swelling that can contribute to pain. It also numbs nerve endings to ease pain.

Ice is beneficial for acute knee injuries, like:

• Sprains

• Strains, or pulled muscles

• Ligament tears, like an ACL injury

• Meniscus tears

It can also be helpful for:

• Pain or soreness after a workout or strenuous activity. According to a study in the Journal of Strength and Conditioning Research, ice worked better than heat for post-exercise relief.

• A pain flare related to a chronic condition like arthritis or an overuse injury like runner’s knee.

• Swelling.

• Bruising.

• Redness.

• Warmth at the site of an injury.

While ice is a proven pain reliever, its effect on inflammation and swelling may actually impede the healing process, which is why some injury recommendations have changed. Inflammation is the body’s natural response to an injury and the first step in healing. Too much icing can prevent critical immune cells from getting to the injury site. 

“It’s not that ice is bad,” says Dr. Martinez. “But if you’re constricting your blood vessels too much with ice, it can prevent some of the body’s necessary nutrients and cells from getting to the area.” For optimal pain relief without compromising your recovery, ice carefully.

How to Use Ice for Knee Pain

An ice pack is the most common way to use ice for knee pain. You can buy a basic one that you lay on your knee or use an elastic bandage to secure it. There are also ice packs designed for the knee with straps to hold it in place. Or you can make your own by putting ice in a bag or using a bag of frozen veggies. Whichever method you use, make sure that you don’t put the ice directly on your skin. If the ice pack doesn’t have a cloth covering, use a paper towel, cloth napkin, or thin towel in between. Other options include chilling a wet towel in the freezer or taking an ice bath.

Apply ice for 10 minutes at a time every hour or so if you’re managing an acute flare-up. Otherwise, ice a few times throughout the day. “You want to allow enough time for the tissue to return to its normal temperature before applying ice again,” says Dr. Martinez. This balance provides pain relief while still allowing inflammation to do its job.

Heat Therapy for Knee Pain

Heat does the opposite of ice: It dilates blood vessels, increasing blood flow to the area. The increased circulation promotes muscle relaxation and can prevent stiffness. This can be helpful when preparing for activity or exercise. Heat also brings healing nutrients and immune cells to the area to start the recovery process, however, it can also increase inflammation and swelling. This is why heat isn’t typically recommended for acute injuries, especially ones with a lot of swelling.

Heat is beneficial for chronic knee conditions, like arthritis or pain lasting for more than six weeks. It can also be beneficial for: 

• Stiffness

• Sore muscles

• Improving range of motion

• Preparing for activity and exercise

“Heat tends to make you feel looser and more relaxed than ice, which can improve mobility,” says Dr. Martinez. This supports movement as medicine and the concept of movement optimism, which involves treating exercise, daily activities, and hobbies as primary solutions for joint pain rather than something to avoid for fear of making it worse.

How to Use Heat for Knee Pain

The easiest way to apply heat to your knee is with an electrical heating pad or a microwaveable one — both provide similar levels of relief. Microwaveable heating pads, however, don’t offer as precise temperature control, which may increase your risk of a burn, so make sure you test the temperature first. A hot shower or soaking in a warm bath are also options.

Similar to the use of ice, it’s best to apply heat for short periods of time — about 10 to 15 minutes — and then wait about an hour to let your skin temperature return to normal before reapplying. “A big concern with heat is that it can be numbing to the skin, so you may not notice your skin reacting to the heat,” says Dr. Martinez. To monitor this, press your finger onto your skin where you’ve applied heat. The spot should appear white when you remove your finger. If you see prolonged redness that doesn’t blanch, you may be starting to burn and should stop applying heat.

How to Use Ice and Heat Together for Knee Pain

Sometimes, a combination of ice and heat for knee pain is the best choice. For example, if arthritis is causing your knee to hurt, heat may be helpful to increase mobility before a workout, hike, or day of shopping. And after, you may find ice helpful in easing any achiness or pain from the activity.

You can even try alternating them in a single session.

• Ice for 10 minutes.

• Wait an hour.

• Heat for 10 to 15 minutes.

• Wait an hour.

• Repeat as needed.

Remember, you’re the expert on you. Experiment with both ice and heat to find the most effective method for you based on your situation and personal preferences.

When Not to Use Ice or Heat for Knee Pain

If ice or heat is causing more knee pain than relief, stop using it and talk to your physical therapist or doctor. Here are some other instances when ice or heat for knee pain may not be appropriate.

• Your pain suddenly worsens. Stop any treatment that is suddenly making your pain worse.

• You have an open wound. Applying ice or heat for knee pain could increase your risk of an infection.

• You have a lot of swelling. Ice is better in this circumstance because heat may worsen swelling.

• You have multiple sclerosis or another condition that affects the protective covering of nerve fibers, the myelin sheath. These conditions make you more sensitive to temperature changes.

• You have a sensation issue, like neuropathy or Raynaud’s syndrome. You may be less sensitive to temperature changes, which could damage your skin.

This exercise strengthens the hamstring muscles in the back of your thigh. Imbalances between the hamstrings and quads can contribute to knee pain, so you want to keep both groups of muscles strong.

As ice or heat lessens your pain and improves your mobility, begin doing the above exercises to strengthen and stretch the muscles around your knee, which can further ease pain and prevent future problems. When you use ice or heat to your advantage, you can turn down the volume of your pain enough to focus more on treating the underlying issues that are the main contributors to your knee pain.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

PT Tip: Don’t Overdo It

“While ice and heat can provide temporary relief, relying too heavily on them can prevent you from tuning into your body’s natural signals. Instead of masking discomfort, it’s important to gradually reduce dependence on these methods and focus on strengthening your body’s resilience through movement. “If you feel the need to numb an area to get through an activity like a long run or strenuous workout, it might be your body’s way of telling you it’s not ready for that level of intensity yet,” says Dr. Martinez. “The key is to find your movement sweet spot, which requires zeroing in on the right type and amount of movement and exercise that challenges your body and pain system, while also strengthening your muscles and reducing pain.”

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References 

1. Malanga, G. A., Yan, N., & Stark, J. (2014). Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgraduate Medicine, 127(1), 57–65. doi:10.1080/00325481.2015.992719

2. Petrofsky, J. S., Khowailed, I. A., Lee, H., Berk, L., Bains, G. S., Akerkar, S., Shah, J., Al-Dabbak, F., & Laymon, M. S. (2015). Cold Vs. Heat After Exercise—Is There a Clear Winner for Muscle Soreness. Journal of Strength and Conditioning Research, 29(11), 3245–3252. doi:10.1519/jsc.0000000000001127

3. Wang, Z.-R., & Ni, G.-X. (2021). Is It Time to Put Traditional Cold Therapy in Rehabilitation of Soft-Tissue Injuries Out to Pasture? World Journal of Clinical Cases, 9(17), 4116–4122. doi:10.12998/wjcc.v9.i17.4116