The Effect of Elevation on Volumetric Measurements of the Lower Extremity

Background: The empirical evidence for the use of RICE (rest, ice, compression, elevation) has been questioned regarding its   clinical effectiveness. The component of RICE that has the least literature regarding its effectiveness is elevation. Objective: The objective of this study was to determine if various positions of elevation result in volumetric changes of the lower extremity. Methodology: A randomized crossover design was used to determine the effects of the four following conditions on volumetric changes of the lower extremity: seated at the end of a table (seated), lying supine (flat), lying supine with the foot elevated 12 inches off the table (elevated), and lying prone with the knees bent to 90 degrees (prone). The conditions were randomized using a Latin Square. Each subject completed all conditions with at least 24 hours between each session. Pre and post volumetric measurements were taken using a volumetric tank. The subject was placed in one of the four described testing positions for 30 minutes. The change in weight of the displaced water was the main outcome measure. The data was analyzed using an ANOVA of the pre and post measurements with a Bonferroni post hoc analysis. The level of significance was set at P <.05 for all analyses. Results: The only statistically significant difference was between the gravity dependent position (seated) and all other positions (p <.001). There was no significant difference between lying supine (flat), on a bolster (elevated), or prone with the knees flexed to 90 degrees (prone). Conclusions: From these results, the extent of elevation does not appear to have an effect on changes in low leg volume. Elevation above the heart did not significantly improve reduction in limb volume, but removing the limb from a gravity dependent position might be beneficial.