Should You Compress and Elevate After an Injury?

By djpope

July 14, 2020

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So you just hurt yourself.  The question is now, what do I do?  The old adage RICE comes to mind:

  • Rest
  • Ice 
  • Compress
  • Elevate

We want to throw some ice on there, elevate the injured area above the heart, wrap it tight and take it easy.  Sounds sensible right?  Well, is it really?  

Fortunately for us we have some very smart researchers out there to help us answer these questions.  Chris Bleakley is one of those smart folks and he answered this question very well in his presentation at Sports Kongres you can check out HERE:  In case you missed last week's article we summarized Chri's talk on whether or not we should be icing after an injury.  Click HERE to check it out:

 In today's article we tackle whether or not we should be compressing and elevating after an injury.  Before we can come to a conclusion on whether these practices are effective, it's important to understand a few other assumptions about compression and elevation:

  1. Compression and elevation can reduce swelling
  2. Excessive swelling can cause more tissue damage
  3. This reduction in swelling can help the area heal faster by reducing swelling and subsequent damage

So let's dive into these assumptions and see if they carry any substance.  First let's talk about what happens during swelling after an injury.

After a soft tissue injury the capillary bed is disrupted.  More fluid is pushed out of the blood vessels and into the interstitial space (space between capillaries and cells).  More cells are also brought to the injury site.  This creates edema or swelling in the injured area.  

Swelling separates the capillary bed from the cells which in essence starves the cells of their food source and potentially can cause cell death (not good).  So the thought is that if we can decrease the swelling this may reduce tissue damage.

So here's the scoop...

1: Compression and elevation can reduce swelling (probably)

Compression has been shown to shunt blood flow from the superficial to deep veinous system.  This helps to get swelling away from the injury site.  Elevation is similar in effects.  Gravity helps move fluid away from the injury site (although we need more research to validate this concept).  

We do have some research to show that compression does both reduce swelling and help improve quality of life after soft tissue ankle injuries.  However, we also have some studies to show certain forms of compression (like compression tubing) have no effect on swelling.  

2: The effects of elevation are immediately lost as soon as the injured limb is no longer elevated

Now, the concept of elevation makes total sense.  Elevate the leg and then get the swelling out.  This would be great however there is another concept known as the "rebound effect".  Basically as soon as you put the injured arm or leg back down the swelling reappears immediately.  So any benefit we had is immediately lost as soon as we aren't elevating anymore.

3: We don't know if the positives of compression and elevation offset the negatives of compression and elevation

What's interesting about compression is that it will decrease fluid in the interstitial space (which is beneficial for bringing the cells closer to their food supply to potentially decrease cell death).  The problem is that compression also can negatively affect lymphatic drainage by compressing those structures.  We don't know if the positives of reducing interstitial fluid is outweighed by the negatives of disrupting lymphatic function.  The jury is still out here.

Next, elevation by itself is only effective when actually elevating the injured area.  This is a sneak peak to the next article, but movement is generally the best medicine for injury.  If we're lounging all day just to reduce swelling we may be recovering more poorly simply because we're not being active.  With compression the same rule applies.  If the compression allows us to move a bit more following an injury it is probably beneficial for recovery by allowing extra motion. 

4: We don't have good research on what types of compression work best and in what doses 

There are so many different types of compression out there.  There are socks, stockings and compression tubes all with varying degrees of compression.  You've also got intermittent compression machines out there as well.  We don't necessarily know what the optimal dosage of compression really is.

On top of this we also don't have many studies comparing compression after injury vs. no compression at all.  You'd think there would be a plethora of high quality research out there on the topic but there isn't much. 

The other problem is that most studies actually just compare different types of compression against one another (eg: intermittent compression vs. compression sleeves).  What we do seem to know at this point is that intermittent compression works better then wearing a compression tube.

In conclusion compression and elevation both seem to help reduce swelling after an injury.  Just keep in mind that conflicting evidence on the topic exists.  Elevating is effective but only for as long as the elevation occurs.  On top of this we don't know fully if the benefits of compression outweigh the negatives of compression or what the best dosage of compression is following injury.  Lastly, if either of these interventions allow more movement following an injury, then they're beneficial from that perspective.

If you want some specific guidance on how to get out of pain after an injury and how to get back to weight training in the gym then click on one of the links below to get started:

Big fan of rice and chicken,