Give yourself some PEACE and LOVE…

A question I get almost daily is how to best manage an acute injury.  

For example, say, you sprain your ankle.  It’s warm, swollen, painful, and difficult to walk on.  So, what do you do next?  Is it best to apply ice or heat?  Should you elevate it?  Should you walk on it even though it’s sore? Should you take an Advil or a Tylenol?

Our approach to some of these questions has changed over the past few years with new research.  It will also depend on your state of healing at the time (ie. if your injury is within the first few days of healing vs the first few weeks).

You have likely heard the acronym RICE, which stands for Rest, Ice, Compression and Elevation (or it’s variations).  This has been the standard advice given for an acute injury (ie. your first few days after an ankle sprain).

However, it doesn’t address what to do after that first few days and recent research challenges some of this philosophy.

The current recommendations are to follow a PEACE and LOVE approach, a more holistic approach which incorporates all phases of healing.

Immediately after an injury, let PEACE be your guide and do no harm.

P = Protect.  Restrict/limit movement or unload the area for 1-3 days to minimize bleeding and reduce the risk of aggravating the injured tissue.  Rest should be minimized, as prolonged rest can compromise tissue strength.

E = Elevate.  Elevate the limb higher than the heart to promote fluid flow out of the injured area.

A = Avoid anti-inflammatory modalities.  Inflammation is a normal immune response.  It helps to repair damaged soft tissues.  Strategies which decrease inflammation may actually negatively affect long term tissue healing.  The use of ice is also questioned, even thought it’s commonly recommended for acute injuries.  Ice can potentially disrupt healing by decreasing inflammation and formation of new blood vessels, thereby impairing tissue repair.

C = Compress.  Taping or bandaging techniques can limit joint and tissue swelling and also limit hemorrhage.

E = Educate.  Education should be provided about what to expect from therapy, when you can return to your usual activities and the benefits of active rehab. Passive treatment is not overly effective here and may be counterproductive long term. 

After the first few days, soft tissue injuries need LOVE.

L = Load.  Increasing movement and activity level at this phase encourages further healing.  Normal activities should be resumed as soon as possible within pain limits to promote tissue repair and build resilience in tendon, muscle and ligament tissue.  Movement is medicine!

O = Optimism.  Positive thinking is associated with better rehab results and overall outcomes.  Factors such as fear, depression and ‘thinking the worst’ can hinder recovery.

V = Vascularisation.  Pain-free aerobic exercise should begin a few days after injury to increase blood flow to the injured area.  Exercise improves physical function, so you can return to your usual activities sooner.  It also can decrease the need for pain medication by encouraging endorphin release.

E = Exercise.  There is strong research to support that exercise is helpful in restoring mobility strength and balance after injury, as well as decreasing the risk of recurrent injury.  Exercise should be pain-free, progressed based on ability and stage of recovery and specific to your own goals!

This new approach to soft tissue healing is more all encompassing and includes recommendations for beyond the initial few days of injury.

If you have questions about your specific injury and how to properly manage your symptoms we are happy to help!

Lindsay Pleasance, Registered Physiotherapist

South Simcoe Physiotherapy

References:

https://therunningclinic.com/
https://www.physio-pedia.com/Peace_and_Love_Principle

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