What can be given to reduce swelling?

Treatment for Swelling Reduction

For acute soft tissue injuries, apply ice wrapped in a damp cloth for 10-20 minutes at a time, 3-4 times daily during the first 48-72 hours, combined with NSAIDs for pain control and early mobilization with functional support—avoid relying on ice alone without active rehabilitation. 1, 2

Immediate Management (First 48-72 Hours)

Cryotherapy Application

• Apply ice and water mixture surrounded by a damp cloth for 10-20 minute intervals, repeated 3-4 times daily 1, 2
• Never place ice directly on skin to prevent cold injury 1
• Ice wrapped in a wet towel achieves the most effective tissue cooling compared to gel packs or ice alone 1, 3
• Target temperature reduction of 10-15°C in the tissue 3
• Ice provides short-term pain relief but does not reduce swelling or improve function when used alone 1, 4

Critical Limitation of Ice Therapy

• Ice alone has no proven benefit for reducing swelling, improving function, or accelerating recovery 1, 4
• The traditional RICE protocol (Rest, Ice, Compression, Elevation) lacks evidence supporting its effectiveness as a standalone treatment 1, 4
• Ice is only effective for swelling reduction when combined with exercise therapy 1

Pharmacological Management

NSAIDs for Swelling and Pain

• Oral or topical NSAIDs (ibuprofen, diclofenac, naproxen) effectively reduce pain in the short term (<14 days) without significantly increasing adverse events 1
• Topical NSAIDs eliminate gastrointestinal hemorrhage risk associated with oral NSAIDs 1
• Diclofenac shows superior results at days 1-2 compared to piroxicam and ibuprofen for reducing pain during motion 1
• Acetaminophen is equally effective as NSAIDs for pain and swelling reduction 1
• NSAIDs may delay natural healing by suppressing necessary inflammatory responses 1

NSAID Precautions (FDA Label)

• Use lowest effective dose for shortest duration needed 5
• Increased cardiovascular risk (heart attack, stroke) with higher doses and longer use 5
• Increased risk of GI bleeding, ulcers, and perforation—especially in elderly, those with prior ulcer history, or concurrent use of corticosteroids/anticoagulants 5
• Monitor blood pressure as NSAIDs can cause new or worsening hypertension 5
• Avoid in pregnancy after 30 weeks gestation; use cautiously between 20-30 weeks with monitoring 5

Compression Therapy

Evidence-Based Application

• Apply compression wrap after acute ankle sprain for comfort, but do not overtighten to avoid compromising circulation 1
• Compression wraps do not reduce swelling or pain during recovery, nor do they improve joint function, range of motion, or time to recovery 1
• Compression may provide short-term comfort in the acute phase only 1

Essential Active Rehabilitation

Why Ice Alone Fails

• Relying on RICE alone without active rehabilitation delays recovery and provides no proven benefit 4
• Ice combined with exercise therapy shows greater swelling reduction compared to heat application 1
• The combination of cryotherapy and exercise significantly improves ankle function in the short term, allowing increased weight-bearing 1

Recommended Treatment Algorithm

• Begin supervised exercise therapy within 48-72 hours post-injury focusing on proprioception, strength, coordination, and function 4
• Continue semirigid ankle brace for 4-6 weeks 4
• Avoid prolonged immobilization which leads to muscle atrophy and worse outcomes 1, 4, 2
• Patients return to sports 4.6 days sooner and work 7.1 days sooner with functional treatment versus immobilization 4

Common Pitfalls to Avoid

• Do not use ice as the sole treatment modality—it provides no benefit for swelling reduction without exercise 1, 4
• Do not apply ice for longer than 20-30 minutes per session—this increases risk of cold injury without additional benefit 1, 3
• Do not delay active rehabilitation—prolonged rest without early mobilization is inferior to functional treatment 4, 2
• Do not use corticosteroid injections into tendon substance—they may inhibit healing and reduce tensile strength, predisposing to spontaneous rupture 1
• Be aware that reflex activity and motor function are impaired for up to 30 minutes following ice treatment, increasing susceptibility to reinjury 3

Special Considerations

When to Seek Medical Attention

• Any painful extremity injury that limits use requires medical evaluation 1
• Uncertainty about whether injury is sprain, strain, or fracture necessitates limiting use and seeking professional assessment 1

Contraindications for Ice

• In patients with hemophilia or coagulation disorders, ice application may increase hemorrhage morbidity by further impairing coagulation and hemostasis 6
• Ice has not been shown to stop bleeding or swelling from hemarthrosis 6