PEACE AND LOVE for SOFT TISSUE INJURIES
The world is full of acronyms, and it’s a job to keep up with them because they are often changing, especially in the world of medicine which is continuously evolving as new research is published.
Most people are familiar with ICE – Ice, Compression, Elevation – for acute soft tissue injuries. This evolved to RICE (adding Rest), then PRICE (adding Protection).
But now we have PEACE and LOVE, evolved following new research that suggests that ice is no longer crucial in soft tissue recovery and can actually slow the healing process.
The new acronym is designed to encompass rehabilitation, stressing the importance of education and addressing psychosocial factors.
PEACE
Immediately after injury – PEACE
P for protect
Unload or restrict movement for 1–3 days to minimise bleeding, prevent distension of injured fibres and reduce the risk of aggravating the injury. Rest should be minimised as prolonged rest can compromise tissue strength and quality. Pain signals should guide the cessation of protection.
E for elevate
Elevate the limb higher than the heart to promote interstitial fluid flow out of tissues. Despite weak evidence supporting its use, elevation shows a low risk-to-benefit ratio.
A for avoid anti-inflammatory modalities
The various phases of inflammation help repair damaged soft tissues. Thus, inhibiting inflammation using medications may negatively affect long-term tissue healing, especially when higher dosages are used. Standard care for soft-tissue injuries should not include anti-inflammatory medications.
Whilst the use of ice, or cryotherapy has been recommended for many years, recent studies have questioned this recommendation. Ice could potentially disrupt inflammation and may lead to impaired tissue repair. Ice does however have analgesic effects so can be used for pain relief.
C for compress
External mechanical pressure using taping or bandages helps limit swelling and bleeding into the tissues. Despite conflicting studies, compression after an ankle sprain seems to reduce swelling and improve quality of life.
E for educate
Therapists should educate patients on the benefits of an active approach to recovery. Early diagnosis and education on the condition and load management will help recovery and empower the patient to help themselves. Setting realistic expectations with patients about recovery times is important too.
LOVE
After the first days have passed, soft tissues need LOVE.
L for load
An active approach with movement and exercise benefits most patients with musculoskeletal disorders. Mechanical stress should be added early and normal activities resumed as soon as symptoms allow. Optimal loading without exacerbating pain promotes repair, remodelling and builds tissue tolerance and the capacity of tendons, muscles and ligaments.
O for optimism
Optimistic patient expectations are associated with better outcomes and prognosis. Psychological factors such as catastrophisation, depression and fear can represent barriers to recovery. Beliefs and emotions are thought to explain more of the variation in symptoms following an ankle sprain than the degree of pathophysiology.
V for vascularisation
Cardiovascular activity represents a cornerstone in the management of musculoskeletal injuries. While research is needed on dosage, pain-free aerobic exercise should be started a few days after injury to boost motivation and increase blood flow to the injured structures. Early mobilisation and aerobic exercise improve physical function, supporting return to work and reduce the need for pain medication in individuals with musculoskeletal conditions.
E for exercise
There is a strong level of evidence supporting the use of exercise for the treatment of ankle sprains and for reducing the prevalence of recurrent injuries. Exercises help to restore mobility, strength and proprioception early after injury. Pain should be avoided to ensure optimal repair during the subacute phase of recovery, and should be used as a guide for exercise progressions.
Managing soft-tissue injuries is more than short-term damage control. We need to think of long-term outcomes.
Getting some advice from a professional as to what damage may have been done and the best way to move forward is advisable for a full recovery. Often it is possible to actually get yourself into a better condition than before the injury, and that will reduce the chance of it happening again!
https://www.vineyhallphysio.co.uk/services/physiotherapy-in-forest-of-dean
https://bjsm.bmj.com/content/54/2/72
https://thesportjournal.org/article/the-r-i-c-e-protocol-is-a-myth-a-review-and-recommendations/
