Swelling: The Body's Reaction to Injury

You step in a hole and turn your ankle or your knee. You throw too much and feel a twinge in your shoulder. You try to break your fall with your wrist. Acute injuries are easy to recognize: first comes the pain, and then comes the swelling. Chronic or long-term injuries take weeks, sometimes even months, to develop, but it is the same story: first comes the pain, then swelling.

Swelling is a normal reaction of the body to an injury. Sometimes the body goes overboard and the swelling response is excessive. When this happens it can actually begin to cause more harm than good.

What is swelling?

Swelling is any abnormal enlargement of a body part. It is typically the result of inflammation or a buildup of fluid. Edema describes swelling in the tissue outside of the joint. Effusion describes swelling that is inside a joint, such as a swollen ankle or knee. Hemarthrosis is a condition where there is blood and swelling within a joint. This indicates either a ligament injury, such as an ACL tear or a fracture. Hemarthrosis is determined by removing some fluid from the joint with a needle. Acute refers to swelling that occurs within 24 hours of injury. If the swelling occurs within the first 2 hours, it is probably associated with hemarthrosis and should be checked out by a physician. Chronic refers to swelling that occurs over a long period of time and can be difficult for an athlete to detect, but is very harmful if left untreated.

Why can swelling be a bad thing?

The body always responds to an injury with a predictable inflammatory response, as the first step towards healing. Redness, heat, swelling and pain are associated with this first stage. Redness and heat are caused by increased blood flow. Swelling is the result of the increased movement of fluid and white blood cells into the injured area. The release of chemicals and the compression of nerves in the area of injury cause pain. The pain and swelling can keep the athlete from using the injured part, serving to protect it from further injury. However, often times, the body's response is excessive.

"Prolonged inflammation and pain can lead to atrophy of the muscles surrounding the joint and a decreased ability to activate the muscles," states Lisa Kluchurosky, ATC, service line administrator for the Sports Medicine Department at Nationwide Children's Hospital. "If not treated appropriately, the swelling can become chronic, or long term. Chronic swelling leads to tissues becoming more rigid and less pliable than their healthy counterpart. Less pliable tissues are more susceptible to further injury."

What to do about swelling?

In the early phase, remember PRICE:

  • P = Protection from further damage
  • R = Rest to avoid prolonging irritation
  • I = Ice (cold) for controlling pain, bleeding, and edema
  • C = Compression for support and controlling swelling
  • E = Elevation for decreasing bleeding and edema
  • Protection can mean immobilization with a brace, or a wrap, or even just staying off the body part.
  • Rest means not moving the body part in a painful way. Movement is good, and can increase healing, but it should be pain free at this stage.
  • Ice for the first 72 hours, 20 minutes out of every hour. Leaving ice on longer actually reverses the effect it has, and may increase swelling. Chemical icepacks should never be applied directly to the skin, or frostbite can occur. Do not use heat for the first 72 hours; heat will increase the swelling.
  • Compression, with an ace wrap. Your athletic trainer or doctor can show you how to wrap the body part to minimize swelling.
  • Elevation, or resting with the injury above heart level, to encourage swelling to return towards the body, instead of collecting in the extremities where it is difficult to get rid of.

If your swelling is chronic, or lasts longer than 2-3 weeks, you should see your doctor. Your doctor will be able to recommend medication, exercise or therapy to resolve the swelling. Remember, swelling is the body's reaction to an injury; if the swelling is still present, so is the injury.

Returning to Play

You are not ready to return to play until all the swelling is gone.

Kluchurosky says, "You should be able to perform multiple repetitions of the activities your sport requires (jumps, sprints, kicks, etc) without an increase in swelling or pain in the injured area before attempting to return to competition."

Nationwide Children’s Hospital Sports Medicine specializes in diagnosing and treating sports-related injuries in youth, adolescent, and collegiate athletes. Services are available in multiple locations throughout central Ohio. To make an appointment, call 614-355-6000 or request an appointment online.