To properly address the management of soft-tissue injuries through acute, sub-acute and chronic stages… all you need is PEACE & LOVE.
For years the RICE principle for managing soft-tissue injuries has been widely used. RICE – “REST”, “ICE”,“ELEVATION”AND “COMPESSION”- has been implemented in the acute or early phase of injury recovery. An article in the British Journal of Sports Medicine by Dubois and Esculier (2019) has suggested to supersede and replace this management technique with a new strategy with acronym “PEACE & LOVE”. Duboisand Esculier argue that the traditional “RICE” principle only addresses the acute phase (days 1-3) of the injury and doesn’t provide any information on further management through the sub-acute (day 4-3 weeks)and chronic phases (3 weeks onwards) of injury rehabilitation. They also suggest that applying ice for other than pain relieving purposes can in fact adversely impact 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 the first 1-3 days.
Benefits – reduction of bleeding, reduces risk of aggravating the injury, 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-term tissue healing and so avoiding them will stop this impact.
Avoid use of Ice:
Benefits – There is no strong evidence that ice assists with the healing 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, the things that will benefit their recovery, things they should modify or avoid, as well as realistic recovery timeframes will better equip the patient for a successful rehabilitation process.
LOVE
L – Load
Benefits – tissue repair benefits from active recovery – optimal loading without increasing pain.
O – Optimism
Benefits – the brain plays an important part in rehabilitation –staying realistic, but optimistic will provide the best chances of the best recovery.
V – Vascularisation
Benefits – early physical activity (within pain tolerance) has been linked with improved blood flow to injured structures, which helps with 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 should be implemented in clinic.
