Last week I had a patient that came into the clinic with complaints of knee pain. The pain started for no apparent reason and was causing him a lot of pain and swelling. His wife told me that over the weekend his knee swelled up even more. After I realized I needed to have something I could hand out with instructions, so I decided to write today’s article so I would always have something
to hand out.
These are my general recommendations for someone with a swollen and/or painful knee.
The popular expression R. I. C. E. is no longer the best advice!!
Back in 1978, in The Sports Medicine Book, Dr. Gabe Mirkin coined the term RICE (Rest, Ice, Compression, Elevation). Since then, icing has been the standard treatment for injuries and sore muscles due to its ability to relieve pain immediately in a cost-effective manner. Ice is still a great way to relieve pain, but to reduce swelling there are better options.
Complete “rest” is no longer recommended. There are some occasions where I recommend resting but it is very rare and specific to the individual. I recommend stopping if something is making you worse, but advising it is OK to try again the following day.
I also recommend patient use common sense, for example, if you sprained your ankle would you go for a run right after? If you have a big swollen knee, it is NOT a good idea to jump on it. These are “common sense” recommendations.
Instead of resting it is important to mobilize your injured area. Mobilization, when possible, is crucial to the recovery process. If you have sprains, strains, pulls, bumps and bruises try to keep the region as mobile as possible by taking the nearest joint(s) through its full range of motion to the best of your ability. For the knee the heel slides and stationary bicycling are great ways to move the knee without aggravating it.
When Mobility is too painful or simply impossible, “activation” is a great next step. Activation can be manual (i.e. massage) where the muscle around the joint is massaged by hand to promote activation/blood flow. This is best performed by a physical therapist or massage therapist and can be taught to someone able to help at home.
If that is too painful, try another activation technique in Physical Therapy like the electrical stimulation and in some cases ultrasound, which stimulates/activates surrounding muscles without causing direct pain.
It is also important to begin using the knee, foot and ankle as normal as possible as soon as possible and making sure no new issues come from walking with a limp.
Compression, is here to stay.
Ideally, you want to compress the area and mobilize it while it is compressed. A simple knee wrap or ace bandage will make a big difference in recovery.
I also recommend elevation...but elevation as high as you can lift the foot...just prop it up as high as you can. On the back of the couch or exercise ball works.
Water is essential for nearly every function of the human body. Dehydration can increase joint pain, muscle soreness and slow down the lymphatic process. Staying hydrated will ensure that everything is functioning properly.
Make sure you are getting water when you’re injured, I recommend adding to your typical amount by 12-24 ounces per day.
Observation is the last (but not least) step. Your body gives you continual feedback during the recovery process. It’s your job to observe and react to it. Having a physical therapist monitor you through the process can be helpful. If you are interested in asking questions about your knee, please feel free to email me at This email address is being protected from spambots. You need JavaScript enabled to view it. or call for an assessment at 518-306-6894.
In summary the priorities are:
1. Reduce/prevent swelling
2. Restore any lost motion
3. Restore function
Matthew Goodemote can be contacted by calling 518- 306-6894. Goodemote Physical Therapy PLLC is located at 3 Maple Dell in Saratoga Springs.
