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Managing injury with PEACE & LOVE

Updated: Jun 20, 2023

​For many years, ice has been the go-to for acute injuries and if someone were to roll their ankle, most of us would reach for the pack of frozen peas…but what does the latest research tell us about this ingrained way of managing injury?


For many years, RICE (Rest, Ice, Compress and Elevate) was the standard approach to dealing with the initial stages of injuries, such as strains & sprains. Ice is a great pain numbing agent and most would agree that the effect of ice does make injuries ‘feel better’, at least in the short term. In 2014 the scientist that was responsible for initiating the RICE approach, retracted ice from his initial protocol having established that both ice and rest may in fact delay healing and that the approach, whilst useful for the initial (acute) stages of an injury, it ignored sub-acute (day 4 – 21 post injury) & chronic (3 weeks+) stages of soft tissue healing.


'PEACE & LOVE' is now considered a more comprehensive approach to management of injury. It eliminates the ice & rest elements and takes into consideration the importance of education, as well as active recovery and psychosocial factors.


PEACE is a guide for the immediate few days after an injury


P- Protection

Protection is a more sophisticated approach than the previous term “rest”. We now understand the importance of early movement to promote healing, but want to protect against any activity, exercise or movement which will increase levels of pain or may make the injury worse. In the first 1-3 days after an injury therefore, movement is encouraged, but only within tolerable pain limits.

E – Elevation

Excessive swelling and congestion in the area of injury can have a negative effect, so elevation of the injured limb (higher than the heart if possible) may help to promote lymphatic drainage and reduce fluid from settling.

A – Avoid Anti-Inflammatories

Avoid the use of anti-inflammatories in the first few days where possible. Inflammation is an essential component of the natural healing process and taking anti-inflammatories could slow or halt the initial phase of healing.

C – Compression

Compression over the injured area can help reduce excessive swelling which prevents movement or may contribute to damage of surrounding tissues. An elastic bandage or specialised taping can be effective.

E – Education

Understanding the injury and the healing process will help you to make better decisions during your immediate and long-term recovery. Get advice from a soft tissue/physical therapist and choose treatments that emphasise movement and muscle contraction over passive modalities and total rest.

After the first few days have passed, soft tissues need LOVE….


L – Load

Tissues need load in order to heal properly and as pain decreases and tolerance increases, begin to move, apply load or weight and strengthen the injured area. Optimal Performance can provide rehab advice on appropriate and optimal loading, so that steady healing takes place without further tissue damage.

O – Optimism

Psychosocial barriers and negativity can impede healing and lead to a much longer recovery time. Managing your mental health & remaining positive after an injury can be challenging but is essential to a successful (and speedier) outcome.

V – Vascularisation

Increasing blood flow to injured tissues will contribute to healing, reduce pain and can improve function. Massage therapy will increase blood flow & circulation, as will heat. E – Exercise

Exercise is essential to restore mobility, strength, and balance and to prevent future injuries. With advice from a therapist, gradually increase intensity, load or difficulty to promote full recovery and to reduce the risk of re-injury.


So I should avoid icing an injury?


Without the evidence to support the use of ice as a effective way of managing an injury the answer is “probably yes”……BUT personally I would caveat this with two things:

1. Ice can be a great way of temporarily numbing pain and can be helpful in the immediate aftermath of an injury, especially if anti-inflammatory painkillers, such as Ibuprofen, are to be avoided.


2. While some inflammation is useful for recovery, too much or prolonged swelling is bad news. Excessive swelling can place unwanted pressure on the tissues, restrict movement, increase pain and decrease muscle function. In these circumstances ice may be a viable option, not to necessarily prevent all swelling, but to limit the extent of it.


To summarise, ice is less important than we once thought but poses benefits such as reducing inflammation & numbing the injured or affected area when injuries are severe and in circumstances where swelling will likely be the limiting factor for recovery.


What about heat?


Heat is an effective and safe treatment for most aches and pains and may aid recovery or repair of damaged tissues.


Heat causes the blood vessels to dilate which brings more blood into the area, thought to stimulate healing of damaged tissues. It can relax the muscles, helping to relieve pain and can ease stiffness by making the tissues more supple.


Heat should not be used on a new injury, as it will increase bleeding under the skin around the injured area and may make the problem worse. The exception to this is lower back strains, where a lot of the pain in this case is caused by muscle spasms rather than tissue damage, so heat is often helpful.


References
  1. Dubois, B. & Esculier, J-F. (2020). Soft-tissue injuries simply need PEACE and LOVE. British Journal of Sports Medicine. 54, 72-73.

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