To properly address the management of soft-tissueinjuries through acute, sub-acute and chronic stages… all you need is PEACE & LOVE.
For years the RICE principle for managing soft-tissueinjuries has been widely used. RICE – “REST”, “ICE”,“ELEVATION”AND “COMPESSION”- has beenimplemented in the acute or early phase of injuryrecovery. An article in the British Journal of SportsMedicine by Dubois and Esculier (2019) has suggested tosupersede and replace this management technique witha new strategy with acronym “PEACE & LOVE”. Duboisand Esculier argue that the traditional “RICE” principleonly addresses the acute phase (days 1-3) of the injuryand doesn’t provide any information on furthermanagement through the sub-acute (day 4-3 weeks)and chronic phases (3 weeks onwards) of injuryrehabilitation. They also suggest that applying ice forother than pain relieving purposes can in fact adverselyimpact the body’s natural healing ability/process. “PEACE and LOVE” is outlined in more detail below.
PEACE
P – Protection Unload or limit activities that increase pain for thefirst 1-3 days.
Benefits – reduction of bleeding, reduces risk of aggravating theinjury, prevent distention of injured fibres.
E – Elevation Elevate the injured limb higher than the heart.
Benefits – improves flow of fluid out of the injured tissue
A – Avoid Anti-inflammatory Modalities.
Avoid Anti-inflammatory Medication:
Benefits – anti-inflammatory medication may affect long-termtissue healing and so avoiding them will stop this impact.
Avoid use of Ice:
Benefits – There is no strong evidence that ice assists with thehealing process and in fact it may have the reverse effects.
C – Compression
Benefits – The amount of tissue bleeding and swelling produced maybe reduced by using compressive garments.
E – Education
Benefits – Better patient understanding of their condition, thethings that will benefit their recovery, things they should modify oravoid, as well as realistic recovery timeframes will better equip thepatient for a successful rehabilitation process.
LOVE
L – Load
Benefits – tissue repair benefits from active recovery – optimalloading without increasing pain.
O – Optimism
Benefits – the brain plays an important part in rehabilitation –staying realistic, but optimistic will provide the best chances of thebest recovery.
V – Vascularisation
Benefits – early physical activity (within pain tolerance) has beenlinked with improved blood flow to injured structures, which helpswith repair, as well as improved mood and overall well-being.
E – Exercise
Benefits – restores strength, mobility and overall function.
In physiotherapy we take a holistic approach to the assessment,treatment and recovery from your injury. These values align with the“ Peace & Love” approach to soft-tissue injury management and shouldbe implemented in clinic.