Why is compression of an acute injury important

All online searches were updated through September and included only reports of randomized controlled trials. Articles were included in this literature review if the methods section indicated that at least one randomly-assigned treatment consisted of cryotherapy combined with compression. Treatment modalities could comprise dedicated cold compression devices or crushed ice and cold packs secured with elastic wraps or bandages providing concomitant mild to moderate compression.

Of 33 potential articles triaged, 21 were identified that met the selection criteria including two articles on ankle sprains, 20 , 21 eight on knee ligament repair, 8 , 10 , 22 — 27 seven on total knee arthroplasty, 2 , 28 — 33 and four on miscellaneous procedures including ankle fractures 34 , 35 and shoulder surgery.

Sloan et al 20 randomly assigned consecutive acute ankle injury patients to cold compression treatment or compression only. Continuous moderate compression was provided for all patients with an elastic support ProSport, Seton Ltd. Experimental patients received a single 30 minute application of cryotherapy with a freon-cooled anklet device Cryopac, Cryomed Corp.

The study was described as double-blind but the adequacy of blinded randomization and treatment allocation concealment were not reported. No differences were observed between groups in range of motion and pain relief. Patients in the compression only groups also received ice packs applied directly to the skin of the injured ankle for 20—30 minutes at least once per day during the acute phase of injury. Subjects who received focal compression recovered higher levels of ankle function earlier than those receiving uniform compression.

However, the addition of concurrent cryotherapy did not appear to offer supplementary benefit, although results are confounded by ice pack administration in the compression only groups and the small sample size of the study. Cohn et al 24 evaluated 54 consecutive patients having arthroscopically-assisted anterior cruciate ligament ACL reconstruction.

Cold compression patients, on average, also made the conversion from injectable to oral pain medications 1. The mean duration of hospitalization was the same for both study groups 3. Schroder and Passler 8 evaluated 44 patients undergoing ACL reconstruction with respect to post-operative swelling, range of motion, pain, analgesic requirements and return to function.

All patients were hospitalized for 14 days and had clinical assessment performed on days 1, 2, 3, 6, 14 and Standardized Noyes functional knee scores were also obtained after 12 weeks of follow-up. Visual analog scale VAS pain severity scores and analgesic requirements were recorded at multiple time points through 48 hours post-operatively.

Mean pain scores were consistently and significantly lower in the two groups using the CryoCuff device compared to the placebo group at all follow-up intervals.

The addition of the injectable narcotics intraoperatively provided additional pain relief at both 24 and 48 hours. Analgesic requirements also were significantly lower among patients using the CryoCuff device and, again, even more so in those receiving an intraoperative injection of narcotics.

All data in this study were collected prior to discharge. Despite significantly lower skin temperatures recorded with the cryotherapy pad and crushed ice, no significant differences were noted across treatment groups for length of hospitalization, range of motion, use of pain medications or drainage output.

Edwards et al 26 reported results similar to those of Konrath and coworkers. No significant differences were found 48 hours post-operatively across treatment groups for blood loss as measured from the intraarticular drain before removal, analgesic requirements, range of motion or VAS pain scores. Pain severity VAS and Likert scales was measured daily for one week postoperatively. A physical examination was performed at one week post-operatively.

The report concluded that compressive cryotherapy was beneficial in the reduction of pain medication use. Dervin et al 25 examined the effects of cold compression versus compression alone in 78 patients having endoscopic ACL surgery.

No significant differences were noted with regard to total wound drainage vs mL , VAS pain scores at 24 hours 3. Levy and Marmar 30 evaluated blood loss, pain relief and range of motion in 80 consecutive unilateral and 10 bilateral total knee arthroplasty patients. For bilateral cases, the second knee was selected for cold compression therapy in all patients. This was done to avoid contamination of the sterile field, because the second knee was opened while the first knee was being closed.

All measures of intra- and post-operative blood loss favored the experimental treatment. For the experimental and control groups, mean pain scores were 6. Healy et al 29 compared two different modes of cold compression in 76 patients knees undergoing primary total knee arthroplasty with respect to range of motion, swelling, wound drainage, and narcotic requirements.

Fifty knees were randomly allocated to treatment with the CryoCuff device and 55 knees were treated with an ACE compression wrap and crushed ice pack. Post-operative follow-up evaluations were undertaken at three intervals: 2 to 4 days, 7 to 14 days, and 4 to 6 weeks. Both groups showed similar levels of improvement over baseline, but there were no notable or statistically significant differences between treatment groups for any outcome evaluated at any interval through six weeks of postoperative follow-up.

However, the potential for meaningful comparisons of functional endpoints as measured in this study may have been compromised by the wide time window in which measurements were taken eg, day seven evaluation could be quite different if taken on day 14, instead. Scarcella and Cohn 32 studied 24 total knee arthroplasty patients mean age: 67 years treated in the immediate postoperative period with the ThermoTemp thermal blanket device providing cold therapy and mild concomitant static compression.

Patients were blinded to treatment group assignment and had cryotherapy applied to the operative site until discharge. The post-operative hospital stay was 1. However, range of motion was only measured at discharge, a time point too early to be meaningful in this setting.

Additionally, because of the relatively small sample size, this study was likely underpowered to demonstrate significant differences even though trends favored cold compression therapy. Webb et al 33 enrolled 31 patients undergoing unilateral and 9 patients having bilateral total knee arthroplasty procedures to evaluate the effectiveness of cold compression therapy post-operatively on blood loss, pain, swelling and range of motion.

Random treatment allocation consisted of application of the CryoCuff cold compression device or a wool and crepe dressing. Measurements were taken at three post-operative intervals: day five, six weeks, and three months. Swelling was assessed by the same examiner throughout and measured at a point 2 cm proximal to the patella.

Mean opiate requirements also were lower among experimental patients 0. Mean post-operative VAS pain severity scores favored cold compression treatment 5. There were no significant differences detected between treatment groups for swelling or range of motion through three months of follow-up. All patients were followed for 10 days post-operatively. Blood loss was recorded by the drainage in the suction tube.

Some movement, however, is beneficial. Gentle, pain-free, range-of-motion and basic isometric contractions of the joints and muscles surrounding an injury have been shown to speed recovery. I: Ice refers to the use of cold treatments, also known as cryotherapy, to treat acute injuries.

Ice is recommended with the intent to minimize and reduce swelling as well as to decrease pain. There are many ways to employ cryotherapy at home. The most common and most convenient is a simple plastic bag of crushed ice placed over a paper towel on the affected area. It is important to protect the skin and limit the cold exposure to 10 to 15 minutes.

Cycles of 10 to 15 minutes on and 1 to 2 hours off are generally agreed upon as effective and safer than longer periods of continuous ice application. Skin sensitivity or allergy to cold exposure can occur. It may manifest as skin that becomes mottled, red and raised where the ice contacted the skin. If this is experienced, the ice treatments should be discontinued. Healthwise, Incorporated, disclaims any warranty or liability for your use of this information.

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Updated visitor guidelines. Top of the page. Topic Overview As soon as possible after an injury, such as a knee or ankle sprain, you can relieve pain and swelling and promote healing and flexibility with RICE—Rest, Ice, Compression, and Elevation. Rest and protect the injured or sore area. Unconsciousness can be caused by nearly any major illness or injury. It can also be caused by substance drug and alcohol use. Choking on an object can result in unconsciousness as well.

Brief unconsciousness or fainting is often a result from dehydration, low blood sugar, or temporary low blood pressure. Can you elevate an injury too much? Elevation With leg injuries, it's important to keep the legs elevated while seated or reclining so that excess fluid is not allowed to collect around the injury.

Following a leg injury, the risk of a dangerous blood clot increases if you don't elevate the injury, especially if you spend a lot of time sitting or in bed. Is swelling good for healing? Swelling isn't good for us all the time. It initially helps by recruiting healing factors that accelerate how quickly cells migrate to the site of injury - but swelling is also bad because it destructs and distends the tissues, and distorts the anatomy.

Why icing an injury is bad? The most confusing anti-ice claim is that ice impedes the healing process, particularly the inflammatory phase, potentially leading to an increase in swelling.

Some claim ice delays healing because it does not allow the body to go through the textbook phases of healing: injury, inflammation, repair, and remodeling. Why do you elevate an injury above your heart?