How to Ice Your Knee

Ice

The use of icing for injuries has been documented in ancient Greece, using snow to treat injured areas to reduce swelling.  Today, icing is a first line treatment for many injuries and conditions.  I recommend it for all my patients after surgery.  

How does icing work?

Ice works by causing blood vessels to constrict and lessen blood flow and therefore limit swelling.  It also plays an important role to help prevent secondary damage to surrounding tissues.   When a traumatic injury occurs, blood flow inherently decreases to the area taking needed oxygen away from cells.  By slowing down the metabolic activity of these cells, we limit the amount of oxygen they need and help them survive.  It may be this secondary injury prevention that is most important with using ice after surgery or injury.  

Could Ice be bad for healing ?

There is an argument that the body’s natural inflammatory response is important and should be allowed to occur.  Researchers postulate that stopping this is a bad idea with ice.   The more popular view, however, is that avoiding the secondary injury associated with inflammation is potentially more important and avoiding a more severe injury.

Does compression help with ice ?

Most of you have heard of the idea of R.I.C.E = rest, ice, compression, elevation.  Adding a compressive wrap over the ice pack is always a good idea to also help reduce swelling.  Some ice wraps include this.  Using an ACE wrap can do the same thing, but they tend to bunch up and need to be re-done frequently. 

How to Ice

Applying ice should follow the rule of CBAN:  Cold, burn, ache then numb.  When ice is first applied, it should never touch the skin directly, but rather through a thin material.  It should feel cold.  That sensation of cold will last a few minutes until a mild burning sensation may take over.  This then typically tends to fade and the area will feel numb.  Once you have reached this level, its time to stop.  Continued exposure can lead to injury to your skin, possibly death of the skin.  This is KEY to stop icing.  Typically a 20 minute period of ice is enough to see beneficial effects.  Give yourself at least 30 minutes without any ice before putting it back on again.

Remember to frequently check your skin to be sure you are not over-doing it with ice.  This is EASY to do.  Before following any particular icing plan, consult with your doctor (my thoughts here are not advice specifically for all situations)

Ice for 20 Minutes every hour
0
Cold
Burn
Ache
Numb

Make your own ice pack

Making a gel/ice pack for your knee is easy. Use a freezer bag. Pour in 1 cup of rubbing alcohol and 2 cups of water. Seal the bag well and put it in the freezer for an hour
Cold Therapy / Ice Options
Click on any image to learn more

My favorite way to ice falls into the category of cold therapy machines.  These are essentially small ice chests with pumps that circulate cold water through a pad.  These allow continuously cool water to the desired area.  They stay very cold for a long time, and tend to use a lot of ice.  Because they last so long, these are perfect if its hard to get up to re-freeze a gel pack.  Total or partial knee replacement patients love these.  

Of this type of ice machine, the PolarCare Cold Therapy System is super easy to use.  For years, insurance companies used to pay for these, but now they consider them the same as an ice pack and will no longer pay.  Regardless, patients love these:

Post Op Recovery
PolarCare Cold Therapy

The next step down from this in cost is similar in appearance but does not have the motorized system.  You simply raise the cooler up to fill the pad on your knee, and after a while, lower it down to drain, then raise up again for a refresh of ice cold water.  The advantage is it will not stop working if the pump breaks.  

AirCast Cryo Therapy
Gravity-Fed 'CryoCuff'

The next option is to use a wrap-around ice pack that provides both cold and compression.  There are a lot of these available online and it can be hard to choose.  These all provide similar benefits and are simple to use.  

The ubertherm wrap is a nice balance of cold and compression, and allows for some movement when up and walking

This wrap provides both compression and cold.  Its a little hard to walk with it on as it is stiff, but provides a secure icing method.

The Ohuhu wrap is simple and inexpensive for the budget-minded.  It may not provide enough cold to the whole knee.

The polar ice knee wrap is simple to use and covers a large area.

The last option is to go for a large gel pack that you can secure wither with straps to your knee, or with an ACE wrap.  These come in many sizes, you can make your own as we discussed above, and are inexpensive.  Its hard to recommend just one best one.  Start by looking at one of these.  

Remember, never put it directly against your skin as it can cause frostbite.

A simple ice pack. hole it in place with an ACE wrap.

ACE Wrap.  Dont forget it.  The 6 inch version is  best!

Another simple flexible gel pack.  Comes in a variety of sizes and shapes.

Summary of Cold Therapy / Icing Options
Post Op Recovery

PolarCare Cold Therapy Machine

The most deluxe option

AirCast Cryo Therapy

CryoCuff Gravity

Advanced and easy to use

Ubertherm Compression Ice Pack

Ubertherm Wrap

Compression and ice

Shock Doctor Ice Compression Wrap

Shock Doctor

Compression, support and cold

Gel Ice Pack

Gel Pack

A simple gel pack

Gel Ice Pack

Flexible gel pack

A simple gel pack that conforms easily.