There is a saying among some orthopedic surgeons to their patients that the surgery was the easy part it's the rehabilitation that is the hard part. Never have truer words been said. After either a knee, hip, or shoulder has been replaced keeping the pain and swelling to manageable levels is no doubt an art.
In physical therapy there are several hard and fast rules we tend to follow when preparing patients for rehabilitation. The use of heat and cold therapies are usually brought up somewhere in the overall discussion. Generally it's recommended that a patient will use heat on the surrounding tissue before exercise and ice or other type of cold therapy after the exercises. Now there are multiple ideas behind this theory with most prominent being, heat will relax the muscles around the joint making them more pliable and easier to stretch and cold will help reduce the swelling after the treatment and also reduce pain.
Heat and cold therapies have been around since the beginning of man and still promoted today. When I treat a patient which is in the home setting for instance, the joint that was replaced will not be quite as acute as it was in the hospital Therefore, one or both of these therapies may be discontinued by the patient but that is something I do not recommend. Before I get to the home I will recommend to the patient that a heating pad is placed around the surrounding joint not directly on it and also the proper toweling is to be used to prevent burning the soft tissue around the incision. this is usually applied 20-30 minutes before therapy is started. If it's a knee replacement for instance the patient is asked to also elevate the affected limb while getting the heat although this is not completely necessary.
The idea is by using the heat I can start by developing further range of motion in the knee or hip while the muscles are relaxed and easily manipulated. this can also of course be done by family members or yourself once properly trained to do so.
After the treatment or your exercise session is completed, this is the time to immediately apply a cold pack to the affected area for 20-30 minutes to help reduce the swelling and pain that was initiated after having the joint exercised. Also if it's a knee replacement it's advised to elevate the limb higher than your heart to help with the reduction of swelling. Again as with heat, do not place the cold pack directly on the skin, the pain during a joint replacement is hard enough to handle at times without having to deal with frostbite as well. Unlike heat you can place the cold pack over toweling directly on the knee or hip. The cold therapy will not promote further bleeding and swelling like heat will if placed directly over the joint.
Every individual has different tolerances to pain and swelling. You will meet people for instance that never used heat during their therapy and, will from time to time meet some patients who did not use cold therapy as well. I find that you can skip these modalities after a hip replacement if you choose, however, it is advised not to skip the cold therapy after a knee replacement as they seem to be more temperamental than the hip. Pain and swelling is more prominent in the knee thn in the hip.
Using heat and ice have their place in rehabilitation and can make your rehab experience tolerable.
Always check with your doctor or therapist if you have any questions regarding times or application of the above as there are many ways to use heat and ice with physical therapy and still be effective.