RICE to Control Swelling

How do I best control swelling after a knee surgery?

Physical therapists often use the acronym RICE to educate patients in the principles of controlling the inflammatory response to injury or surgical trauma:

R: rest- Resting the leg after surgery allows the traumatized tissue structures to relax. Surgical procedures involving a bony repair require eight weeks of non-weight bearing status to allow the bone to heal. After a ligament repair, gentle weight-bearing exercises are allowed under the supervision of a physical therapist. Although an individualized home program is encouraged, excessive exercise is not advised.

I: ice- Cold modalities affect blood vessels through the process of vasoconstriction to decrease joint effusion. Choices include an ice pack, an ice water circulating cooler, or an ice cube massage. An ice bag works best over large, general areas and should be administered 15-20 minutes, 2-3x/day. Ice cooler units circulate cold water for a 15 minute treatment. An ice massage takes only 5-7 minutes and works best over bony prominences.

C: compression- Using an Ace bandage or a surgical sleeve to provide constant pressure around the knee joint prevents inflammatory by-products from collecting in the knee joint or draining into the lower leg during weight-bearing activities. The Ace wrap should be applied from top to bottom encompassing the entire knee joint.

E: elevation- Positioning several pillows under the heel prompts the inflammatory fluid to return to the bloodstream and flush back towards the heart to reenter the circulatory system. The key to elevation is to ensure the leg is above the level of the heart (lay flat on back with leg up). Combining the four RICE principles and resting the leg while compressing the joint with an ice bag in an elevated position for 20 minutes after exercise is the ideal situation to control swelling after a knee surgery.

-Rebecca L. Deal, MSPT

Rotator Cuff Surgery and Repair

How long does it take a rotator cuff tendon to heal after a surgical repair?

A surgical rotator cuff repair requires a tendon reattachment into a bony anchor in the shoulder. The bone site of tendon reinsertion requires eight weeks to heal. Physical therapy, although specifics depend on the surgeon’s rehab protocol, usually begins three-five days after the surgery and continues for up to twelve weeks in three distinct phases until all prior shoulder function returns.

During phase one, the first eight weeks of physical therapy, while the bone is still healing, rehab is focused on symptom control and the return of symmetrical range of motion (ROM). Educating the patient to ice, encouraging the use of an arm support to rest the irritated tendons, and introducing the Codman pendulum exercises are all common strategies for controlling shoulder symptoms. ROM activities are limited in phase one to passive stretching (the patient must keep the muscles relaxed while the therapist stretches the rotator cuff muscles).

After the surgical repair site has healed and the patient has full ROM, emphasis shifts in phase two to shoulder strengthening. Strength work focuses on both rotator cuff muscles and the interscapular muscles to promote the return of normal shoulder biomechanics. Rotator cuff strengthening begins with isometric contractions and progresses to eventual strengthening with weight or Theraband resistance.

Phase three involves proprioceptive training for the upper extremity to ensure proper reaction time and future injury prevention. During week twelve of physical therapy the patient performs final assessment to determine if they can safely return to all activities of daily living before formal discharge from physical therapy. Once discharged, the patient is encouraged to maintain shoulder flexibility and strength with an independent exercise program.

-Rebecca L. Deal, MSPT