In our last post, we talked about swelling after your TKA and why you get the swelling after an injury. We also talked about the circulatory system and the lymphatic system. How the lymphatic system takes the broken down, dead tissue, away and puts it back into the circulatory system to get excreted by the body.
This blog post the is practical aspects of reducing swelling in your knee. We left off with a list of things to do. Here is it and we are going to through each point, one-by-one, and do some explaining.
1) elevation
2) compression
3) knee, ankle, and foot movement
4) heat! (not what you were thinking, right!)
1) Elevation = most people of heard of this, elevate your injury, i.e. wrist, elbow, ankle, knee... but what I see missed a lot is this. They are not elevating the injured limb higher than the heart. They will sit in their lazyboy chair and put the foot rest up and feel that they are elevating the injured area appropriately. Not the case. The main pump in our body is the heart. We want the elevated leg to be above the heart because fluid/water flows downhill. You want to get the fluid in your lymphatic system draining down into the circulatory system to get eliminated by the body.
This is a great position to have the knee above the heart. Lying on your back on the floor with your feet elevated (and supported) by a chair or sofa. The hardest thing is to get into and out of this position. You can replicate it on your bed with pillows under the shins and the feet or resting your feet on the headboard of the bed with pillows under your knees. It is a very comfortable position. Some clients with TKAs have mentioned that the position is so comfortable that they will actually nap in this position.
I know there are very few things that are universal but this is one position that is universally relieving for back pain, as well. There are very few people that cannot tolerate this position and feel better while resting in this position. But I digress...
2) Compression = is a great thing to help you with the swelling in your knee. The compression gives the fluid a "squueze" to send it into the right direction (back towards the heart, when you are in the above mentioned position i.e. knee is above yoru heart). You want the compression to be firm but not restrictive, i.e. do you do not want to be cutting off the circulation to the rest of your leg. Compression socks might be useful. The most difficult thing with compression socks is getting them on and off. You will need help with this right after the TKA operation. The compressions socks are usually a graded compression meaning that there is more compression in the foot and less compression at the top of the sock, that way the sock pushes fluid up the leg, back towards your heart. If you are wearing compression socks, one thing you should be aware of is when the sock folds onto itself. If the sock folds onto itself, that small area you can get double or triple the normal compression of the sock. This will actually make the socks less effective as they will compress the small lymphatic vessels just under the skin and they will not be able to drain properly.
3) Knee, ankle, and foot movements = helping to get the fluids moving in your leg. Now you have elevated your leg, you put on your compression socks and now you lie back and relax, right? WRONG! Remember what I said in the past blog post, 3a, about the lymphatic system. It does not have a pump to pump the lymph fluid in the lymph vessels. Your muscles are the pump! While you are lying in that position, section 1), you want to wiggle your toes and feet, up/down and side-to-side, about 10 times every few minutes. In addition, you can try to straighten up your knee and do some foot/ankle movements with a straight leg. The wiggling of your foot/ankle/knee helps to get the lymphatic fluid moving and draining back into the circulatory system to get that fluid out of your body.
4) Heat! = this is still controversial. I know, I know. I get push back all the time about this topic but hear me out and see if makes sense. When you add ice to your body, the cold areas of your body constrict the blood and lymph vessels. That means that the vessels get smaller, like trying to drink a milkshake through a straw that you get with a juice box vs. a regular size straw. This makes the ability to drain the fluid from the area/knee to become slower and more difficult. In addition, the swelling is not just water, it is water with a bunch of chemicals dissolved in the water. The analogy I use is paint. Water based paint is basically water with a bunch of chemicals dissolved it in to get the correct colour. When you cool paint down, it becomes thicker and harder to pour/spread. However, if you heat paint up, it becomes much runnier, almost like warm maple syrup and it pours/spreads much easier. Very similar to our swelling.
When you put heat on the area, the blood vessels and the lymphatic vessels dialate. That means the vessels become larger in diameter and allow for more drainage out of the area. In addition, the swelling becomes thinner, more runny, and it flows easier.
I recommend that you do not put heat directly on your knee after surgery. Your knee will be hot enough. I recommend putting a hot pack on your inner thigh and lower part of your tummy on the same side of the TKA. This will help to dialate the lymphatic drainage vessels and veins in that area.
If, and a big, IF you are using the cold pack/cryocuff for pain control, you can continue to use it. Some clients I would get them having a cold pack on their knee for pain control and warm pack on their inner thigh and lower tummy.
That is the end of the this blog post/topic. Please if you have anything to add, stories to share please put them in the comments. Next topic on the TKA Survival kit, Part 4 is hydration!
If you are getting ready to have a knee or a hip replacement, have a plan in place and call New Leaf Physiotherapy for your at home physiotherapy needs. 250-826-7300 to talk with Lyndsey, a certified Rehabiliation Assistant, to help you book your assessment.
New Leaf Physiotherapy is a mobile physiotherapy service that sees clients in West Kelowna, Kelowna and Lake Country.
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