Swelling is a natural part of the inflammatory process after an injury. When the body needs to heal an injury, it creates swelling by sending blood, lymphatic fluid and special repair cells to the area. However, too much swelling, or swelling that lingers too long, can slow your recovery by making the injured area more painful and less mobile. In this article learn the tips that physical therapists use to decrease swelling after injury.
Who are these Tips for?
Go ahead: If your lymphatic, cardiovascular and nervous systems are intact. And, your swelling resulted from an injury.
Check with your physical therapist: If you have deficits in your lymphatic, cardiovascular or nervous systems. Examples include (not limited to): diabetes, peripheral vascular disease, active cancer, lymph nodes radiated or removed, venous insufficiency, congestive heart failure, paralysis or decreased sensation for any reason.
Visit your physician: If you experience unexplained new swelling, not related to an injury or previously diagnosed medical condition.
Tip #1 — Utilize the Muscle Pump
This is the physical therapist’s favorite way to get rid of swelling. Our veins, the vessels that bring blood BACK to the heart, rely on the pumping action of muscles to move blood “upstream” toward the heart. Veins have valves that prevent back-flow but the real action comes when we use our muscles. This is because veins don’t have smooth muscles in their walls like arteries (the vessels that push blood AWAY from the heart).
The lymphatic vessels also rely heavily on the muscle pump. There’s a slight pulse in the clusters of lymph nodes, but the tiny capillary-like vessels that transport lymphatic fluid right underneath your skin need muscle pumping action or some other form of compression to move excess fluid.
So, exercising the muscles around the swollen area is critical to getting rid of swelling!
Tip #2 — Compression
Compression is highly effective and can be achieved various ways. The most common way to compress a swollen limb is to wrap an ace bandage around it, making sure to “grade” the pressure (tighter at the end and looser toward the heart).
Another very effective form of compression is immersing in water. The deeper you go, the more compression is provided by hydrostatic pressure. No movement is required to receive this form of compression.
Finally, compression garments offer a convenient form of compression that can be worn throughout the day without adding bulk underneath clothing. Most running or athletic stores sell knee-high compression hose for athletic performance that can also be used to manage swelling. These are great if your swelling is in the ankles or lower legs.
Thigh-high and pantyhose styles are an option if the swelling is in the knee, thigh, hip or buttocks. Compression sleeves for the arms, typically used for lymphedema, are harder to find over-the-counter (without a prescription).
Tip #3 — Ice
Ice is great in the first 24-48 hours after an injury. The cold from ice causes vasoconstriction (narrowing vessels) which helps push swelling out. Another benefit of ice is it’s analgesic effect. If you have pain, swelling and heat, ice is a great option.
When you apply ice there are 4 stages that you experience. They are: very cold → burning → aching → numb. Hang in there through the burning and aching stages. To receive the therapeutic benefit from ice you need to get to the numb phase. Numb doesn’t mean frostbite, it means the ice no longer feels uncomfortable.
Ice Pack
- Duration: 15-20 minutes
- Types: Gel ice pack, ice from your freezer in a sealed bag with some water, bag of frozen peas or bag of frozen popcorn kernels
- Put one layer of pillowcase (or thin cotton) between the pack and your skin, wet the pillowcase for faster cooling
- Leave in place until you get to the numb phase
Ice Massage
- Duration: 1-7 minutes
- Types: Fill a paper cup with water and freeze, peel off the top lip of the cup, for little areas use an ice cube (hold with ice tongs or a washcloth)
- Massage in circular motions until you get to the numb phase
Tip #4 — Manual Lymphatic Drainage
This type of massage is usually done by a physical therapist or massage therapist who’ve been extensively trained. But, even without training, you can try this type of massage on your own. It can work well if your lymphatic system is intact, and definitely won’t hurt to try. We have larger clusters of lymph nodes at key places in the body. These are the neck, armpits, thoracic, abdominal and pelvic regions, groins and behind the knees.
First, locate the chain of lymph nodes closer to the heart than the area that’s swollen. Next, start by gently massaging that lymph node cluster. After 5-10 light strokes, begin to lightly (like petting a cat) massage the swelling toward those lymph nodes. Finally, continue like this until you notice a decrease in swelling.
Tip # 5 — Diaphragmatic Breathing
Remember the cluster of lymph nodes in the abdominal region? There’s a larger lymph duct, called the Cisterna Chyli located in the abdomen, under the diaphragm. It’s a dilated channel into which the intestinal and lumbar trunks of the lymphatic system drain. This means that if your swelling is located from the waist down, diaphragmatic breathing is essential.
When you breathe with your diaphragm, the Cisterna Chyli gets stimulated and assists transport of lymphatic fluid. When it’s all said and done, your old swelling has taken a long journey. It’s gone from your swollen limb, through the lymph vessels and nodes, into the Cisterna Chyli, transferred up the thoracic duct, through the rib cage, into the Subclavian Vein (under the left collar bone), pumped through the heart, filtered through your kidneys and eventually urinated out!
Tip # 6 — Hydration
Thinking about drinking more water might sound counter-intuitive. Why add more water to your body when there’s already swelling? Because fluid accumulates in our tissues when we’re dehydrated. It’s the body’s protective response against dehydration. Staying hydrated also makes the fluids in your body less viscous, and easier to transport.
Divide your body weight in half. This number is how many ounces you need to drink when you aren’t injured. While you’re injured, ensure you get at least that amount or a bit more.
Tip #7 — Elevation
Have you ever noticed that swelling improves first thing in the morning and worsens throughout the day? When you’re sleeping at night you’re in a gravity-neutral position, so it’s easier for your body to process the swelling. Throughout the day, gravity pulls the swelling back into your limbs.
Elevation is the least effective tip on this list. This is partly because elevation really only works if the swollen limb is ABOVE THE HEART. Plus, it’s passive, and now you know that the process of getting rid of swelling is extremely active!
Bottom – heart and limb at same level – INCORRECT
What about R.I.C.E after an Injury?
Many people suggest this acronym to decrease swelling after an injury (a.k.a. Rest, Ice, Compression, Elevation). Did you notice that Rest isn’t on our list? This is intentional. Injuries heal best, and swelling comes down faster, when you take a more proactive approach. When you do rest during the day, try to make it PRODUCTIVE REST (see below).
Combinations of Tips that Decrease Swelling after Injury even FASTER
It’s most effective to practice a combination of several of these tips. Here are some ideas:
- Cardiovascular Exercise: Utilize the muscle pump and diaphragmatic breathing while you exercise. Stay hydrated during exercise and afterward. If the injury is in the lower legs, wear compression hose while you exercise.
- Swim in cold water: While swimming you use your muscle pump and diaphragmatic breathing. The cold water acts like ice (vasoconstriction) while the water provides compression. Hydrate afterward.
- PRODUCTIVE REST: Elevate the limb above the heart while you apply ice. Perform manual lymphatic drainage to the lymph nodes above the injury. Isometrically contract your muscles around the injury (muscle pump), while you practice diaphragmatic breathing. Hydrate while you lay there.
We hope you learned something new from these tips to decrease swelling after an injury. When you engage in as many of these tips as you can, you’re sure to see your swelling come down as quickly as possible.
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