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Pain and swelling control: elevation is the key

Discussion in 'If You’re In Pain…' started by Josephine, Aug 15, 2010.

  1. Josephine

    Josephine NURSE DIRECTOR, BONESMART Administrator

    Member Since:
    Jun 8, 2007
    The North
    United Kingdom United Kingdom
    This is applicable to both hips and knees.

    Please note, these illustrations are not meaning to imply that you need the devices shown.
    The proper positions can be as easily achieved using pillows, cushions or rolled up blankets.

    It's not enough to just put your foot on a foot stool like these

    foot stool 2.jpg foot stool 1.jpg
    and the leg flap on some recliners only comes up to about 30 or 40 degrees before the back rest starts to go down and maybe even stays below seat level after that which isn't much good either.

    foot stool recliner.jpg

    For TKRs, it's also not a great idea to try and elevate with your leg totally straight like this as it stresses the muscles at the back of your knee tremendously, causing quite severe pain - and you already have enough of that anyway!

    elevating angles.jpg

    Yes, I know PTs get very upset and say "NO BENDING ZE KNEES"! but that's not altogether correct either. In a swollen, painful leg, it's positively torture! Besides which a little bend is perfectly okay.

    elevate cushion.jpg

    But don't EVER use a wedge that keeps your knee bent, either - like this, it really is a nonofinger.gif

    elevate 4.jpg

    The correct way to elevate

    The foot should be above the hip (not the heart!) and the higher the better in order to get good drainage for the lymph and tissue fluid that is the primary cause of swelling. This also helps with the pain levels.

    Another rule often quoted is "toes above nose" though this more appropriate in cases of extreme swelling.

    Below are the best positions but do remember:
    - if you are a hip patient, to observe the 90 degree rule if applied
    - if you are a knee patient, never have a bundle of pillows or a cushion hard behind the knee or belly of the calf as it causes compression which might assist the development of blood clots, especially in the early days post-op
    - also note how the heels are not in a position to take weight or pressure as this can lead to sore heels and in extreme cases, maybe even the risk of pressure sores.

    Some examples of good elevation:

    1. in or on the bed

    elevate 1.jpg

    2. on the settee - though preferably not with your back twisted like the model's!

    elevate 2.jpg

    3. sitting up on a chair but again, preferably one with a higher back than is illustrated to support the spine, neck and head.

    elevate 3.jpg

    4. using a pillow stack

    pillow stack.jpg
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