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Frequently, I’m asked by patients, “What’s the initial treatment as far as non-operative?” As I
had said in a prior interview, I am very conservative as far as treatment options, and we usually
progress from the non-operative to the operative. The patients’ non-operative treatments most
frequently incorporate the acronym R.I.C.E., or rest, ice, compression, and elevation. After the
initial injury, a patient should press through this particular treatment option for the first few
days to allow the inflammation and the edema to start to settle down. The resting is obviously
pretty straight-forward; it’s elevating the limb. Usually, we like to have that higher -- if it’s a
knee, higher than the hip; if it’s a limb, try to have at least higher than the heart. This helps to
allow the soft tissue fluid accumulation to decrease. When a limb is hanging down, gravity
frequently causes what’s called the tendon edema, and this particular edema causes increasing
pain and also further soft tissue compromise. By elevating the limb, gravity works for you to
help drain any excessive fluid that’s accumulating in the tissues. The next treatment option is
ice. Ice -- cold therapy -- that is basically to help decrease the blood supply to the particular
area to try to decrease the inflammatory response. Cold causes blood vessels to constrict; and
therefore, the swelling and the edematous changes that occur with an injury help to be
diminished. The ice itself should be put on for 20 minutes at a time and rested for 20 minutes
at a time. Frequently, there should be some soft clothing or a towel between the ice and the
patient’s skin. This helps to reduce the chance of any ice injury to the actual skin itself. The
anti-inflammatory medication -- it is very common over-the-counter medications, such as
Advil, Motrin, Aleve. These particular medications can be found in your drug store, and they
also work chemically to help decrease the inflammatory response to the particular area. So the
patient’s actually getting a response from two separate locations: one is from a chemical which
is the medication and also from the chemical which is the cold, and then the final one is from
mechanical, compressing it with an Ace Wrap and elevating it to allow gravity to take the fluid
in the proper direction to decrease the inflammation and help with the healing.