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Ice to control pain and swelling

Discussion in 'Post-surgery information (knees)' started by Josephine, Jan 19, 2010.

  1. Josephine

    Josephine NURSE DIRECTOR, BONESMART Administrator

    Member Since:
    Jun 8, 2007
    North East
    United Kingdom United Kingdom
    Using ice is an excellent means of controlling pain and swelling after knee surgery both of which can be significant problems.

    There is some conflicting advice given patients regarding the use of ice: some doctors, nurses and therapists say use it all the time whilst others say only use it 15 mins for 3 or 4 times a day.

    The reason there is caution recommended is for the hazard of putting fresh ice directly onto the limb. This can cause burns to the skin as well as potentially reducing the flow of the blood and lymph circulation. The way to counter this is simple: when using a fresh icepack, put a cloth on your knee first and the ice pack on top. A tea towel would be perfect. When the fierceness of the ice has diminished, the cloth can then be removed and the pack applied directly to the skin.

    Ice can be used like this as often and for as long as you desire.

    There are various means of icing.

    1. Gel packs

    These can often be bought in discount chemists and pound-shops in the first-aid section. Oblong ones are preferable as they can be wrapped around the knee better. You should get several, 4 or even 6, then you will always have some in the freezer ready for use.

    2a. Aircast Cryo-cuff (gravity fed) £104.86


    There are two types, gravity feed and motorised. Both are first charged with nice big block of ice (use plastic 20oz picnic tumblers) and then filled with water to the line indicated. Firmly screw the lid back on. Both types have have non-return tubes.

    Gravity fed unit:
    You put the empty cuff on your knee, connect the filled ice bucket to it and then hold it up high above the knee. Gravity will cause the cuff to fill and when it is a comfortable pressure, put the bucket on the floor and disconnect the tube from the cuff. It can then be fixed on the handle with the small wrap of velcro. The plus of this unit is that the patient can walk around with the cuff on whilst with the other two units, they cannot.

    When the cuff needs to be refreshed, take it off the knee, plug it back into the bucket and hold the cuff up high. The water will drain back into the bucket. Give the bucket a good shake to mix up the warm and cold water. Then put the cuff back on the knee and refill as before. Each refill will last about 2-4 hours.

    2b. Cryo/Cuff™ IC Cooler with Integral Pump £150.00


    This a unit comes with a pump in the lid which simply works by pumping air into the bucket thus forcing the water into the cuff. After a few seconds, it switches off and the water drains back into the bucket again. This reputedly gives a phased compression to the knee which helps control the swelling as well. The bucket needs to be kept at a specific height for this to work properly.

    Personal note
    My Cryo-Cuff was my very best friend during my recovery! Putting on the cuff and feeling it fill up with that chilled water was like hugging a hot water bottle on a cold day - in reverse! Every time I would just breath a great big sigh of relief and settle back to enjoy the comfortable freedom from the pain, the heat and the tightness!

    My take on that as opposed to gel packs is that when gel packs loose their edge, you have to go to the kitchen to replace them. With a Cryo-Cuff, you plug the hose into the cuff and drain out the water, give the canister a shake to mix it with the ice and then lift the cannister to let the water back into the cuff and it's all nice and chilled again. You can do that quite a few times with one fill - several hour's worth.

    Tips: don't use regular ice cubes, they melt far too quickly. I got big plastic picnic cups and made big ice blocks. I could get three in the cannister. Others have used small drinking bottles which is pretty much the same idea. Saves on water as you can just toss them back into the freezer! By comparison I suppose it was a bit of a hassle refilling the cups and having to carefully transfer them into the freezer! Hard not to have some spills.

    I did get one with a little pump on it (off Ebay!) but it was an American version and the pump didn't like the lower UK voltage so it was much too weak to do anything. The idea with that is that the pump (much like an aquarium pump) will empty and refill the cuff on a regular cycle so you never have to go through the hassle of lowering and raising cannister to empty and refill the cuff!

    3. Breg PolarCare 300 $250.00 Each

    This is similar to the CryoCuff except that has a pump, a cooling unit and uses a pump for continuous flow of chilled water for 6-8 hours. This unit maintains a constant pad pressure as well.

    4. DonJoy Iceman Cold Therapy Unit $149


    The DonJoy Iceman® Cold Therapy Unit is a motorized device integrating a patented semi-closed loop system. The DonJoy Iceman provides up to 7 hours of continuous cold therapy for a variety of indications. Using a patented semi-closed loop system, the Iceman maintains a more constant and accurate temperature

    Finally you can always use bags of frozen peas! Just make sure you get big bags, 2kgs, and remember not to let the peas get used for dinner! :heehee:

    Instant Ice Packs
    If you need to get around, go out or visit, you can take your ice with you using these - the kind of thing coaches have in their kit when players have an incident on the pitch. Very neat and easy to use. You just crush the capsule inside the pack so it mixes with the contents and a chemical reaction makes it go really cold. They're dead cheap and last for a couple hours!


    Making ice.
    You can, of course, buy in packs of ice but you would get through quite a lot during the course of your recovery so it's best to make it.

    ~ it's best not to use little ice cube trays, they don't last long enough.
    ~ make super-sized ice bricks with 300mls plastic picnic cups
    ~ get 300ml drink bottles and fill them with water, leaving about an inch or two of space in the top. These can be frozen and dropped into the bucket. They have the advantage that you can reuse them and just toss them into the freezer!

    Safety first
    When you are using fresh ice, always remember that ice can burn the skin. It's called frost bite! With a gel pack or ice machine cuff, you should have a thinnish cloth between your skin and the ice pack for a few minutes. Eventually, it will cool up (!) a bit and not be so fierce at which point you can apply the pack or cuff directly to the skin.

    Elevate while you are icing. It maximises the calming effect and help to get the swelling under control.

    Don't use ice instead of pain meds but as an adjunct to it.
    It's a triple approach: pain meds, elevation and icing.


    The following explanation of pain and swelling is also useful:
    PFPS (Patello-Femoral Pain Syndrome) can be exaggerated with running and climbing up and down stairs. This mechanism of injury is simply due to overuse or excessive force. Such activities as climbing stairs can produce forces 3 times one's body weight. A loss of Tissue Homeostasis occurs and now the joint’s synovial lining becomes inflamed (#1). This concept is a pretty easy one to understand.

    However, how does one explain the movie sign (Pain in the knee with a prolonged period of sitting)?

    One does not put excessive force through the knee as they sit. There are two leading theories for the movie sign. While sitting we may predispose our knee to change normal position and now structures may impinge a once swollen inflamed synovial lining.

    The second theory is that as we sit our knee's intra articular pressure increases and thus creates pain. Studies have shown that the knee is an extremely fibrotic and capsular entity. When put in prolonged flexion we may impede venous outflow and increase arterial blood flow to and from the knee. This change in blood flow can increase the pressure within our knee as we sit. (The complexity and fullness of the arterial blood supply to the knee can be seen in this image)

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  2. Jamie

    Jamie Administrator

    Member Since:
    Mar 24, 2008
    United States United States
    Re: Using ice

    Ice is soooo important to recovery itself and to your comfort during the process. One additional thing to remember following a knee replacement is to ice the BACK of your knee as well as the front and sides. Swelling can occur back there too and the icing all around will do a more complete job of reducing pain and swelling.
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  3. goodasnew

    goodasnew Graduate

    Member Since:
    Feb 20, 2011
    After my first TKR I had a cryocuff machine and by the time I'd finished with it the velcro straps on the cuff had pretty much worn out. Also the bucket wouldn't seal anymore so it was no good for TKR No. 2. So the hospital gave me a new unit and my husband has managed to get 2 cuffs working off the new ice bucket. He put a Y connector on the water outlet so 2 cuffs could be attached and now I can wrap my whole knee with the cuffs and get constant cooling and compression. It feels wonderful!

    Just thought I'd post in case anyone else has spare parts from their ice machine you might be able to do something similar. It has certainly helped the swelling in the back of my knee.:dancy:
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  4. lonewolf121

    lonewolf121 Member

    Member Since:
    Feb 23, 2012
    Pacific Northwest-US
    I hope I'm putting this thread in the right place. I just wanted to pass on a really amazing icing solution that I learned from my physical therapist. This is, by far, the best method I've ever used for at home icing! To be effective you probably should make two of these so I'm going to write these instructions as if you are making two.

    What you will need: 1 bottle of
    70% Isopropyl Rubbing Alcohol (enough for 4 cups), 4-1 gallon sized Ziploc freezer bags and tap water.

    The basic steps are
    : take a gallon sized Ziploc freezer bag and into it pour 8 cups of tap water and 2 cups of rubbing alcohol. Try to get all the air out of it then seal it. Then place the filled and sealed bag inside another gallon sized freezer bag and seal that one, just in case it leaks. Then repeat these steps once more, so that you have two made. Then stick them in the freezer. It takes about 8 hours or so to fully get mushy. The brilliance of this is that it never fully freezes (Like a Margarita). So it makes them extremely easy to wrap around your knee; or anything else for that matter. I like to use two; that way I can have one under my knee and one on top.

    Here is a step by step with pictures:

    For making two (2) ice packs you'll need 4 Ziploc freezer bags and approximately 4 cups of
    70% Isopropyl Rubbing Alcohol

    The mixture is 1 to 4; so 1 cup of rubbing alcohol to 4 cups of water

    Into the gallon sized freezer bag pour in 8 cups of tap water

    Next pour in 2 cups of rubbing alcohol

    For a total of 10 cups of fluid

    Then make sure to get as much of the air out of the bag as possible while you seal it

    Then to stop any chances for leaks and for durability, slip the sealed first bag into another gallon sized Ziploc freezer bag.

    Then seal the second one as air tight as possible

    This is what is looks like after 8 hours in the freezer. The one in my left hand is the before and the white one is after

    Now on to trying them out. Don't put these directly on your skin! I've found that the best barrier for these are old pillow cases. If you are wearing sweats then the pants leg of the sweats should be adequate.

    See? Still pliable

    Bendable and floppy

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