Thermotherapy plays a critical role in the management of musculoskeletal pain and stiffness. Two widely practiced methods Ushna Lepa, rooted in Ayurvedic tradition, and paraffin wax therapy, a standard in modern physiotherapy utilize heat to alleviate discomfort, improve circulation, and promote healing. Although both therapies employ heat as the central mechanism, they differ significantly in their methodology, therapeutic philosophy, materials used, and broader physiological effects. Ushna Lepa1 involves the application of warm herbal pastes composed of medicinal ingredients like Nirgundi, Dashamoola, or Eranda, chosen based on the individual's Dosha imbalances. The heat from the paste, in combination with the pharmacological effects of the herbs, helps to pacify Vata and Kapha doshas, improve local circulation, and reduce Ama (toxins). It is particularly beneficial in conditions like Amavata (rheumatoid arthritis), Sandhivata (osteoarthritis), and localized muscular pain 2. Paraffin wax therapy3, on the other hand, is a modern heat therapy modality commonly used in physiotherapy settings. It involves immersing or coating a body part with molten paraffin wax maintained at a safe and controlled temperature. The wax retains heat and delivers it evenly to the target area, aiding in tissue relaxation, increasing joint mobility, and reducing stiffness. It is frequently employed in the management of arthritis, soft tissue injuries, and post-traumatic rehabilitation. This study presents a detailed comparison between the two therapies, analyzing procedural techniques, thermal profiles, indications, physiological mechanisms, contraindications, advantages, and clinical outcomes. The findings suggest that while both therapies are effective in relieving musculoskeletal discomfort, Ushna Lepa offers the added benefit of herbal pharmacology, making it a holistic approach, especially within an Ayurvedic framework. In contrast, wax therapy is more suitable for standardized, repeatable clinical applications due to its simplicity, safety, and controlled thermal delivery. This comparative study highlights the potential for integrative approaches in clinical practice, encouraging further research to combine the strengths of traditional and modern modalities for enhanced patient care.