Give your injuries some PEACE and LOVE
It has always been common practice after an injury - muscle or ligament sprain or strain- to follow the principles of RICE (rest, ice, compression, elevation) or PRICE (protection, rest, ice, compression, elevation). The question is, do these practices really support the natural healing and recovery process?
The principles of RICE and PRICE may support the initial acute stage of recovery but after just a few days our bodies move in to a more sub-acute and then chronic stages of healing. These stages require a different approach to ensure optimal healing and restoration of strength and function.
Canadian researchers reported on new knowledge about injury recovery in the British Journal of Sports Medicine, 2020 based on recent research. The new acronym PEACE and LOVE provides a more supportive approach to injury management.
The first few days after an injury your body needs PEACE (protection, elevation, avoid anti-inflammatories, compression, education). Once those first few days have passed, your soft tissues need LOVE (load, optimism, vascularization, exercise) to maximize their recovery
Acute Injury Management
In the first few days after injury give your body some PEACE.
Protection:
Avoid activities and movements that increase pain for 1-3 days after an injury. Be mindful that complete rest and restriction of activity for too long can have a detrimental affect on the strength and quality of tissues as they are healing.
Elevate
Elevate the injured limb higher than the heart as much as possible. The purpose of this is to help the flow of fluid from the injured tissues. There is not strong evidence for this practice but there is also very little risk.
Avoid anti-inflammatories and icing
The various phases of inflammation are a natural part of healing and necessary for recovery. Anti-inflammatories and icing disrupt the natural course of inflammation and may affect long term healing.
Compress
External pressure/compression such as taping or bandages can help to limit intra-articular swelling or bleeding within the tissues. Research is conflicting, but evidence does suggest that compression after an injury such as for an ankle sprain can decrease swelling and improve comfort.
Educate
Your body knows best how to heal. Learn to understand your body and how to manage your recovery. Work with a physiotherapist who keeps up to date with current literature and understands that an active approach to recovery will serve you more than a focus on passive modalities
Sub-Acute and Chronic Injury Management
A few days after an injury, the injured tissues are in the sub-acute phase of inflammation and recovery. Now we need to give our tissues some LOVE
Load
At this stage of recovery an active approach to treatment is crucial. To promote tissue healing, repair and remodelling of the tissues is needed to build resiliency and capacity of the muscles/tendons/ligaments, To achieve this, there needs to be appropriate loading of the muscles and tendons through movement. Movement should be added early. Finding the optimal level of load will be guided by pain as activity increases. It can sometimes be difficult to find that fine line of how much movement is appropriate. Too little loading of the tissues will not support building sufficient strength and too much movement can over stress the tissues. Working with a physiotherapist can help you to find that optimal level of activity and loading of the healing tissues.
Optimism
Be optimistic about your recovery and expected results. Fear and negative beliefs about your recovery and injury can be just as detrimental to your recovery as the pathophysiology of the injury itself.
Vascularization
Cardiovascular exercise is important to recovery and should be included early on in your recovery. Pain free aerobic exercise will help to improve blood flow to the injured tissues. More research is needed to determine the most appropriate amount of cardiovascular exercise. Working with a physiotherapist will help you understand what you are feeling and can provide guidance on appropriate exercise for your recovery, with education on how know if you are doing too much or ready to do more.
Exercise
There is strong evidence for exercise in the management of soft tissue injuries. That doesn’t mean that you should just keep pushing through with whatever program you are currently on…..Your exercise program needs to be graded according to you - your stage of recovery and level of strength. In the early stages, pain is the guide to exercise progression.
What is important to remember is that your recovery is not just about short term damage and pain control. Pain may resolve within days or weeks after an injury but to achieve favourable long term recovery, ongoing exercise progression to strengthen the tissues is crucial. Work with your physiotherapist to establish exercise progression that improves the resiliency and strength of our bodies as we return to our sport or life activities.