Is a hot or cold compress more effective for relieving knee pain (patellofemoral pain syndrome)?

From the Guidelines

For relieving knee pain due to patellofemoral pain syndrome, a cold compress is more effective, particularly in the acute phase, as it can acutely decrease pain and swelling, as demonstrated in a recent study 1. When considering the management of knee pain, it's essential to differentiate between acute and chronic phases.

• In the acute phase (within the first 48-72 hours), cold therapy is recommended as it has been shown to improve pain scores and reduce edema compared to heat therapy 1.
• The most effective method of cold application is using a bag filled with ice and water surrounded by a damp cloth, with the duration limited to 20 to 30 minutes, applied 3 to 4 times daily 1.
• It's crucial to avoid direct contact between ice and skin to prevent cold injury.
• After the acute phase, or for chronic knee pain, heat therapy may be considered to increase blood flow, relax muscles, and improve tissue elasticity.
• However, the current evidence from the 2024 American Heart Association and American Red Cross guidelines for first aid 1 prioritizes cold therapy for acute injuries, making it the preferred initial treatment for knee pain associated with patellofemoral pain syndrome. Key considerations include:
• Always placing a barrier, like a thin towel, between the compress and the skin.
• Monitoring for increased pain, numbness, or skin changes, and stopping the therapy if any of these occur.
• Individuals with circulatory problems, diabetes, or decreased sensation should consult a healthcare provider before initiating temperature therapy.

From the Research

Effectiveness of Hot and Cold Compress for Relieving Knee Pain

• The effectiveness of hot and cold compress for relieving knee pain, specifically patellofemoral pain syndrome, can be evaluated based on existing studies 2, 3, 4, 5, 6.
• A study published in 2010 found that cold and compression therapy can provide better outcomes, such as pain relief, than alternative interventions for patients with knee arthroplasty 2.
• Another study published in 2023 discussed the evaluation and treatment of knee pain, including patellofemoral pain syndrome, but did not specifically compare the effectiveness of hot and cold compress 3.
• A 2022 study found that contrast therapy, which involves alternating between hot and cold temperatures, can be effective in reducing knee joint pain, swelling, and stiffness in active patients and young injured athletes 4.
• A 2001 systematic review found that ice therapy can be effective in reducing pain and inflammation, but the optimal duration and frequency of application are not well established 5.
• A 2010 study found that patient preferences for heat, cold, or contrast therapy can affect treatment response, and that patients who received their preferred treatment had greater pain reduction and improvements in functional outcomes 6.

Comparison of Hot and Cold Compress

• The studies suggest that both hot and cold compress can be effective in relieving knee pain, but the optimal choice may depend on individual patient preferences and needs 4, 6.
• Contrast therapy, which involves alternating between hot and cold temperatures, may be a viable option for patients who do not respond to either hot or cold compress alone 4.
• Further research is needed to determine the optimal duration and frequency of hot and cold compress application, as well as the potential benefits and drawbacks of each approach 2, 5.