Ice/cold therapy is often used for acute inflammation. However, patients with arthritis often report pain relief with warming of the joints, and exacerbation with cold conditions (E.g. cold weather). Is there a general principle regarding heat/cold therapy for inflammation in general, or in the case of arthritis specifically?
Generally during the winter or cold conditions we should use heat as the muscles get stiffness and nerves become contracted leading to the weak blood circulation and in the summer we should go other way round... This is my view .
Cold triggered arthralgia is due to reduced circulation to the peripheries as a defence mechanism, whereby vital organs are protected by re-routing of resources. There is a build-up of metabolic products in the peripheries as the clearing or wash-out of these that normally occurs with an intact circulation is absent. These products stimulate joint pain and inflammation by various mechanisms including stimulating the inflammatory cascade and direct toxic damage to the synovium, in the latter, the nociceptive response is responsible for pain generation. The nerves innervating the synovium run along with the blood vessels, and thus the vasospasm that occurs extends to the vasa nervorum, triggering an ischemic pain response. These are primarily defence responses gone wrong. There is a change in atmospheric pressure that accompanies weather change, and this triggers baroreceptor in the synovium. Studies have also shown variations in neuropeptides, glucosaminoglycans and cytokine reserves in pathological joints. The application of both heat and cold can be used to relieve arthralgia depending on the aetiology. Application of cold is useful in inflammatory conditions and acute trauma, where the inflammatory cascade is suppressed, whereas heat is beneficial when the pain is associated with stiff muscles and joints where it causes relief of the stiffness and promotes lubrication of the joint.
Greetings!!!!
Any arthritis-related aches and pains is symptomatically treated by applying heat or cold to the affected joints. However, people are often confused about when to use heat therapy and when to use cold therapy
Heat can relax muscles and help lubricate joints and relieve muscle and joint stiffness, help warm up joints before activity, or ease a muscle spasm.
Cold can reduce inflammation, swelling, and pain related to arthritis and activity. (It is also recommended to treat many acute injuries up to 72 hrs).
However, some people use alternate heat and cold therapy.
A patient may be encouraged to use heat therapy to warm up a joint(s) before physical therapy exercise and to use cold therapy after exercise.
A person can use heat therapy in the morning to loosen up an osteoarthritic knee and use cold therapy to reduce swelling a few hours later. This process can be repeated throughout the day.
Lt Col Bk Sharma Thank you very much for taking the time to write that extremely helpful response - it means a lot to me!
I generally agree with the preceding entry: heat is best for stiff muscles and cold is best for painful joints. That being said, it’s not black and white as there is a lot of subjectivity in patients’ preferences.
In theory, cold should be better for at least 2 reasons:
- first, the tissue destructive enzymes (e.g. metalloproteinases) are much less active at a cold temperature, even at a few degrees less than the normal body temperature;
- second, the joint temperature, (most evident by simple palpation of a normal knee, Ménard HA et al Can Med Ass. J ~1970s) is always lower than the body’s temperature. It would thus be logical for therapeutics purpose to use cold rather than heat to normalize joint temperature.
Lastly, given a very subjective experience with my OA knee, cold is best!
Hope that helps!
Dear Yosuf Saqib
This is an interestingly simplified article:
https://www.medicalnewstoday.com/articles/29108.php
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