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Ice to control pain and swelling

Josephine

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Please note that though this article mentions knees a fair bit, it's not exclusively about knees. It applies equally to hips, shoulders and other joints as well.

Using ice is an excellent means of controlling pain and swelling after joint replacement surgery. Following a knee replacement, it is very important to ice the BACK of your knee as well as the front and sides, as swelling can occur there as well as near the incision. Icing all around your knee will do a better job of keeping you comfortable.

Conflicting advice is often given to patients regarding the use of ice. Some doctors, nurses and therapists advise using it or 15-20 minutes 3 or 4 times a day. This is only appropriate when healing from an injury. Following joint replacement surgery, ice is a critical part of your pain management program and should be used on your joint and any other areas around it that are painful as much as you like. Just be sure to never 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.

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When using an ice pack, put a cloth between the ice source and your skin. A tea towel, kitchen towel or hand towel is perfect. Even if you are using an ice machine, you should have at least a thin cloth or your dressing between the cold surface and your skin.

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


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.

1. it's best not to use standard ice cube trays, they don't last long enough.
2. make super-sized ice bricks with 300mls plastic picnic cups
3. 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!
4. 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: Downside is that they thaw really quickly so you might be lucky to get more than about 30 minutes icing from them. And they make you wet!

If you have had bilateral knee replacements:
Most ice units work on a gravity basis so there is no need to worry about having a 'Y' junction tube to connect them both at the same time.

get two knee wraps
fill the bucket with water and ice as per directions
have a jug of cold water, about 2 pints standing by
fit both wraps on your knees
plug one wrap into the bucket and lift up the bucket so the wrap fills with water
when the wrap is full, disconnect it and top up the bucket with the spare water
plug in the second wrap and fill as before.
when either wrap needs replenishing, drain it into the bucket as per instructions and refill the wrap.
replenish ice as necessary
this is when it is a good idea to use small drinks bottles filled with water and frozen that way the bucket doesn't get overfilled with the melting ice

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.



There are various means of icing.

1. Gel packs

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

(Tim's icepack)

2a. Aircast Cryo-cuff gravity fed £165.5

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There are two types, gravity feed and motorised. Both are first charged with nice big block of ice (see above) and then filled with water to the level 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 motorised units, you 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. Or you can do this whilst leaving the cuff on your leg.

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

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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. (Not suitable for the UK)

Knee wraps
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Large or medium £72 each


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.

3. Breg PolarCare 300 $250.00 Each

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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

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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



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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