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Ice (Cryotherapy) to control pain and swelling

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Updated 22 November 2020

Please note that though this article primarily talks about knees and hips, the information applies equally to shoulders and other joints as well.

Using ice (cryotherapy) is an excellent means of controlling pain and swelling after joint replacement surgery and it should be part of every patient's pain management program. Ice can be applied to the incision or other painful areas around your joint as much as you like during the day and night.

Conflicting advice is often given to patients regarding the use of ice. Some doctors, nurses, and therapists advise using it for no more than 20 minutes at a time. This recommendation might be appropriate for treatment of an injury, but not for joint replacement surgery. It's given as a means to protect patients from accidentally over-chilling their skin and causing tissue damage, a serious condition that can easily be avoided by not allowing the ice source to be too close to bare skin. Especially in the first couple of weeks following surgery, keeping your joint area cooler helps to minimize inflammation and swelling. The goal is to prevent pain before it even starts, so begin cryotherapy as soon as you can and continue it as long as it's comfortable, even if you're not experiencing pain or swelling.

Be sure not to place the ice source directly on your skin. This can cause severe burns as well as potentially reduce the flow of the blood and lymph circulation. Placing a towel between you and the ice source should permit adequate cooling without the danger of freezer burn.

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Even if you are using an ice machine, you should have at least a cloth or your dressing between the cold surface and your skin. If you've had bi-lateral surgery (both joints replaced at the same time), you can purchase a "Y" connector for your ice machine so that both can be iced at the same time.

Note: Fresh ice in an ice or gel pack is always a bit colder than the chilled water in an ice machine or an ice pack once it's started to melt. Be sure you have adequate protection between you and the ice source when you are using new ice.


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

If you're using an ice machine, you're going to need a lot of ice:
You can buy bagged ice, but that gets expensive and difficult to do for weeks at a time. Bagged ice or ice from your home refrigerator/freezer can melt fairly quickly and it's not recommended. It's better to make your own ice to use in the machine's water reservoir. To make your own ice, you can freeze water in containers such as large plastic drink cups, margarine tubs, or other containers. But most people freeze bottled water, as it's easy to reuse. Use whatever size bottle fits best in your reservoir. Figure out how many bottles your water reservoir can hold and freeze twice that many. That way you always have some frozen ones on hand.


Remember:
* Elevate while you are icing. It maximizes the calming effect and helps get swelling under control.
* Don't use ice instead of pain medications, but as an adjunct to it.
* PREVENT pain instead of TREATING pain. Don't wait until you hurt to apply ice.

It's a triple approach: pain meds, elevation and icing.



Suggestions for icing

1. Gel packs ($)


These can purchased online through Amazon or in most grocery or drug stores in the First Aid Section. Larger gel packs are better than the smaller ones. A rectangular shape is preferable for knees or shoulders as it can be wrapped around the joint better. Square ones are better for the hip. You should get several, so you always have a frozen one ready for use. This is an effective and relatively inexpensive option. Depending on the size and way a gel pack is constructed, they may need to be changed out fairly frequently.

Here are some options available through Amazon. Or scroll down in this article to find out how you can make your own "gel" packs for icing.

FlexiKold Gel Pack, 2-pack, 10 1/2 x 14 1/2 in, $27.99

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Tester's Choice Gel Pack, 2-pack, 11 x 5 1/2 in, $10.95

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2. Combination ice and compression wraps ($$)
These wraps combine the benefits of cooling and compression to combat pain and swelling. Having both can be very effective against pain and swelling. But because they use frozen gel packs that must be changed fairly frequently, they are not as convenient as a motorized ice machine.

Corflex Cryo Pneumatic Knee Wrap, $52.00

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Unit combines cooling ice gel packs and compression delivered with a manual air pump.

ActiveWrap Ice Wrap for hips, $50.00

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Wrap uses gel pack inserts and allows for mild compression. Can be used on either hip.


3. Gravity feed or motorized feed ice machines ($$$)
There are two types of ice machines, gravity feed and motorized. Both use iced water in a reservoir that is delivered to a cooling pad via tubing. Obviously the motorized units are a bit more expensive, but they are more convenient, as you don't have to "recharge" the cooling pad every 30-45 minutes by lifting the water reservoir.

Gravity fed unit:
Place the cooling pad on your knee. Connect the filled ice water reservoir to it and then hold it up high above the knee. Gravity will cause the pad to fill. 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 benefit of a gravity unit is that the patient can walk around with the cuff on, which is not possible with a motorized unit. When the cooling pad needs to be refreshed, take it off your joint, plug it back into the bucket and hold the cuff up high to drain the water back into the reservoir. Give the reservoir bucket a good shake to mix up the warm and cold water. Then put the cooling pad back in place and refill as before. The first fill of the cooling pad can last up to 2 hours. Each subsequent refill will be somewhat shorter as the ice in the reservoir melts.

Motorized ice machine:
Unit is similar to gravity models, but a motor is added to the ice/water reservoir to allow for a continuous flow of cold water through the tubes and cooling pad. Some models have varying controls for the water flow, timers, and other features. Most feature "quick release" fittings so you can detach yourself easily from the machine when needed.

Aircast Cryo-Cuff Ice Machine, gravity fed, $104.00 - $135.00

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Some units can add mild compression to the cooling effect.


CoolMan Motorized Ice Machine, universal pad, $188.00

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The unit has variable settings and a relatively quiet motor, which is important if you plan to ice while you're sleeping or trying to watch television. Clear reservoir allows you to see when ice needs to be replaced.










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!

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Home made ice packs using Isopropyl Rubbing Alcohol

Here is a step by step with pictures:

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


2. The mixture is 1 to 4; so 1 cup of rubbing alcohol to 4 cups of water
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3. Into the freezer bag pour in 8 cups of tap water - size according to your choice but a 500ml/one (UK) pint/20 fluid oz size should be adequate, much the same as the ice packs shown above

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4. Next pour in 2 cups of rubbing alcohol
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5. For a total of 10 cups of fluid
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6. Then make sure to get as much of the air out of the bag as possible while you seal it
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7. Then to stop any chances for leaks and for durability, slip the sealed first
bag into another gallon sized Ziploc freezer bag.
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8. Then seal the second one as air tight as possible
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9. 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
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10. 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.
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11. See? Still pliable
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12. Bendable and floppy
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13. Perfect!
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