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