Quick answer: For arthritis, warmth usually suits joints that feel stiff and achy, and cold usually suits joints that feel hot, swollen or newly inflamed. Use either for around 10 to 20 minutes, wrapped in a cloth, and check your skin. Avoid both on numb or broken skin, and get urgent help for a suddenly hot, swollen joint with fever.
Heat and cold are two of the simplest, cheapest things you can use at home for arthritis pain. They will not change the course of your arthritis, but many people find they take the edge off pain and stiffness enough to move more comfortably. The trick is choosing the right one for how your joint feels at the time, and using it safely. This guide explains how.
The short rule: warm for stiff, cold for hot
| How the joint feels | Usually try | Why |
|---|---|---|
| Stiff, achy, tight, especially in the morning or after sitting | Warmth | Warmth relaxes surrounding muscles and many people find it eases stiffness |
| Hot, swollen, puffy or newly inflamed, for example during a flare | Cold | Cold can dull pain and many people find it calms a hot, swollen joint |
| Sore after activity or exercise | Either; many prefer cold | Try a short cold pack if it feels warm or puffy, warmth if it feels tight |
| Muscle spasm or tension around a joint (neck, back, shoulders) | Warmth | Warmth helps tense muscles relax |
| Not sure | Try one, then the other on another day | Personal preference matters; notice which helps you more |
Arthritis UK (formerly Versus Arthritis) gives similar advice: cold for joints that are hot and inflamed, warmth for stiffness and aching. There is no strong research showing one is better than the other for everyone. NICE's osteoarthritis guideline (NG226) does not single out heat or cold as treatments, but they are widely used as simple self-help alongside the treatments it does recommend, such as exercise.
How to use warmth safely
Good options at home
- A warm shower or bath, especially first thing in the morning for stiffness across several joints
- A microwavable wheat bag, heated exactly as the instructions say
- A hot water bottle filled with hot (not boiling) tap water, with a cover
- An electric heat pad with a timer or auto shut-off
- Warm-water exercise in a hydrotherapy or warm community pool, if one is available locally
- Paraffin wax baths for hands, which some physiotherapists and hand therapists use; follow the device's safety guidance carefully
Step by step
- Check the skin over the joint is not numb, broken or already red and hot.
- Warm the pack as instructed, then test it on the inside of your wrist. It should feel comfortably warm, never hot.
- Put a towel or cover between the pack and your skin.
- Use it for around 15 to 20 minutes.
- Check your skin every few minutes. Mild pinkness is normal. Stop if the skin becomes very red, blotchy, blistered or painful.
- Follow with a few gentle movements of the joint while it feels looser.
Warmth: what to avoid
- Do not sleep with a heat pad or hot water bottle against your skin. Burns can happen slowly at lower temperatures.
- Do not use boiling water in hot water bottles, and replace old or perished ones.
- Do not overheat wheat bags. Follow the timings exactly and let them rest before reheating.
- Do not put heat on a joint that is already hot and swollen.
- Do not use heat on areas with reduced feeling, for example from diabetes-related nerve damage, or over skin creams that contain heat-producing ingredients.
How to use cold safely
Good options at home
- A bag of frozen peas or sweetcorn, which moulds around the joint (label it and do not eat it after refreezing)
- A reusable gel cold pack kept in the freezer
- Ice cubes in a sealed bag with a little water
- A cold, damp flannel for a gentler option, especially for hands
Step by step
- Check the skin is not numb or broken.
- Wrap the cold pack in a damp or dry tea towel. Never put ice directly on skin.
- Rest the joint comfortably, raised if it is a knee or ankle and that feels better.
- Use it for around 10 to 15 minutes. The NHS advice for sprains is up to 20 minutes every 2 to 3 hours, which is a sensible upper limit.
- Check your skin during use. Stop if it becomes white, very red, blotchy or numb.
- Let the skin return to normal temperature before using it again.
Cold: what to avoid
- Do not use cold if you have Raynaud's phenomenon and cold brings on your symptoms. The NHS lists cold as a common trigger.
- Do not use cold on areas with poor circulation or reduced feeling.
- Do not leave cold packs on for long periods or fall asleep with them on.
- Be cautious if you are very frail, very thin-skinned or find it hard to feel temperature.
Heat or ice by type of arthritis
Osteoarthritis
Osteoarthritis often causes stiffness after rest and aching after use. Many people find warmth helpful before activity, for example a warm shower before a morning walk or a wheat bag on the knee before exercises. If a joint becomes puffy or warm after a busy day, a short cold pack may feel better. NICE recommends exercise as a core treatment for osteoarthritis, so heat or cold is most useful when it helps you keep moving.
Rheumatoid, psoriatic and other inflammatory arthritis
During a flare, inflamed joints are often hot, swollen and tender, and cold can be soothing. Between flares, warmth may help with morning stiffness, which often lasts longer in inflammatory arthritis. Heat and cold do not replace disease-modifying treatment, so if your joints are often hot and swollen, speak to your rheumatology team.
Gout
A gout attack usually causes a very painful, hot, swollen joint, often the big toe. The NHS suggests that keeping the joint cool, for example with a cold pack wrapped in a towel, and resting it raised can help during an attack. Avoid heat on a joint during a gout attack.
Back and neck pain from spinal arthritis
Warmth is often preferred for spinal stiffness and muscle tension. A heat pad on the lower back or a warm shower directed at the neck can make gentle movement easier.
Switching between heat and cold
Some people like contrast treatment: warmth, then cold, then warmth, each for a few minutes. There is little evidence it works better than either alone, but it is reasonable to try if you find it helpful, as long as you follow the safety rules for both. Keep sessions short and always protect your skin.
Practical tips for specific joints
Hands and fingers
Warm water is often the easiest option. Many people soak their hands in a bowl of warm water for a few minutes in the morning, then gently open and close the fingers. Washing up in warm water can do the same job. For a hot, swollen knuckle, a cold damp flannel is gentler than an ice pack.
Knees
A wheat bag or heat pad wraps well around the knee. A bag of frozen peas moulds around it when it is puffy. Rest the leg out straight on a footstool, rather than with the knee bent, while you use either.
Hips
The hip joint is deep, so heat and cold mainly affect the muscles around it. A heat pad on the buttock or outer hip while lying on your side, with a pillow between your knees, is a common comfortable position.
Shoulders and neck
Wheat bags designed to drape around the neck and shoulders are widely available. A warm shower directed at the neck and shoulders before gentle shoulder rolls is another easy option.
Feet and ankles
For stiff feet, a warm foot bath followed by ankle circles and toe curls can help. For a hot, swollen ankle or big toe, rest it raised on a cushion with a wrapped cold pack. If you have diabetes or reduced feeling in your feet, check with your GP or podiatrist before using heat or cold.
Getting the most from heat and cold
- Pair it with movement. Use warmth before gentle exercises or a walk, and cold afterwards if a joint feels puffy.
- Time it. Warmth before getting dressed or before a morning routine; cold after a busy afternoon.
- Keep kit handy. A wheat bag by the kettle, a cold pack in the freezer door, and a cover nearby.
- Track what helps. Note which you used and your pain score before and after for a week or two. Patterns can surprise you.
- Do not rely on it alone. Heat and cold work best alongside exercise, pacing, a healthy weight and the medicines your clinicians recommend.
Extra care: who should check first
Ask your GP, physiotherapist or pharmacist before using heat or cold if you:
- Have diabetes or another cause of reduced feeling in your skin
- Have poor circulation, peripheral arterial disease or Raynaud's phenomenon
- Have very fragile skin, for example from long-term steroid use or older age
- Have had recent surgery on the joint, such as a joint replacement, and have not had advice about heat or cold
- Have any skin condition over the area
- Care for someone with dementia or who cannot easily tell you if something is too hot or cold
Our guide to heat versus ice for frail adults covers extra safety steps for older people and carers.
When to get medical help
- Call NHS 111 or go to A&E if a joint suddenly becomes hot, red, swollen and very painful, especially with a fever or feeling unwell. This can be a joint infection, which needs urgent treatment rather than an ice pack.
- Get urgent advice if you burn your skin and the burn is large, deep, blistering badly or on the face, hands, feet or genitals.
- Call 999 for chest pain, severe breathlessness, signs of a stroke or collapse.
- See your GP if joint pain or swelling has not been diagnosed, keeps coming back, or heat and cold are no longer helping. You may benefit from a review of treatment or a physiotherapy referral; in many areas you can self-refer to NHS physiotherapy.
Is heat or ice better for arthritis in the knee?
It depends on how the knee feels. Warmth usually suits a stiff, achy knee, for example before exercises or a walk. Cold usually suits a knee that feels warm and puffy after a busy day or during a flare. Use either for around 10 to 20 minutes, wrapped in a cloth.
How long should I leave an ice pack on an arthritic joint?
Around 10 to 15 minutes is enough for most people. The NHS suggests up to 20 minutes every 2 to 3 hours for sprains, which is a sensible upper limit. Always wrap the pack in a towel and stop if the skin becomes numb, white or blotchy.
Can heat make arthritis worse?
Heat can make a joint that is already hot and swollen feel worse, so use cold instead during a hot, inflamed flare. Too much heat can also burn the skin. Used comfortably warm for 15 to 20 minutes on a stiff joint, heat rarely makes arthritis worse.
Is it safe to sleep with a heat pad on?
It is safer not to. Burns can develop slowly even at lower temperatures, especially if your skin feeling is reduced. Warm the joint before bed instead, and use an electric blanket only as the manufacturer advises, usually to warm the bed before you get in.
Should I use heat or ice for rheumatoid arthritis?
Many people with rheumatoid arthritis use cold on hot, swollen joints during a flare and warmth for morning stiffness. Both are self-help only. If your joints are often hot and swollen, contact your rheumatology team, as your treatment may need reviewing.
Are heat creams and gels the same as using heat?
Not quite. Warming rubs create a feeling of heat on the skin rather than warming the joint. Some people find them soothing. Do not use them with a heat pack, on broken skin or straight after a hot bath, and check with a pharmacist if you take other medicines.
Sources and further reading
- Arthritis UK: Managing arthritis flare-ups
- NHS: Sprains and strains
- NHS: Osteoarthritis
- NHS: Raynaud's
- NHS: Septic arthritis
- NICE NG226: Osteoarthritis in over 16s
Educational information for people in the United Kingdom — not a diagnosis or personal medical advice. Charity no. 1218461. Pending clinical review. Everyone's situation is different, so always follow the advice of your own GP, pharmacist or rheumatology team. If you feel very unwell, call 999 or go to A&E. For urgent advice, contact NHS 111.
Continue with related help
- Heat versus ice for frail adults — extra safety for older or frail skin
- Using heat packs safely — choosing and using heat packs
- First 24 hours of a flare — what to do on day one
- Flare action plan — free printable plan
- Pain relief — medicines and other options
- Exercise hub — movement that helps joints