You should apply RICE (rest, ice, compression, elevation) in the instance of a soft tissue injury right?
Maybe not!
More and more RICE is being replaced with PEACE and LOVE (protection, elevation, avoid anti-inflammatories, compression, education, load, optimism, vascularisation, exercise) (Dubois & Esculier, 2020).
There is evidence to suggest that ice along with anti-inflammatories can slow the body's natural healing process, part of which is inflammation.
PEACE and LOVE includes physical and psychological components of injury rehabilitation, the latter having previously been disregarded.
PEACE describes the suggested care in the short-term (couple of days) after the injury and LOVE suggests the long-term care (Dubois & Esculier, 2020).
So let's drill down to the nitty gritty of the PEACE & LOVE acronym!
P for Protect:
This may seem like an obvious one. Protect the injury site to avoid further harm for a couple of days.
It is important to note however that you don’t want to rest too much as this can impact the healing process (Bleakley, Glasgow, & MacAuley, 2012)! Use pain as a guide of what you can and can’t do (Dubois & Esculier, 2020b).
E for Elevation:
You might be familiar with this one from RICE. Raise the injury above the height of your heart. This is to assist in moving blood and lymphatic fluid away from the injury site to reduce excessive swelling (Dubois & Esculier, 2020b; Tsang, Hertel, & Denegar, 2003).
A for Avoid Anti-Inflammatories:
Along with Ice, Anti-Inflammatories may inhibit the healing process (Dubois & Esculier, 2020a; Vuurberg et al., 2018).
C for Compression:
Compression should be applied to reduce swelling (Dubois & Esculier, 2020b; Hansrani, Khanbhai, Bhandari, Pillai, & McCollum, 2015).
E for Educate!!!
It’s important to understand what PEACE & LOVE means, and how it can be used to rehabilitate your injury. You don’t want to waste money and time on different treatment methods you don’t need, or be too cautious, or not cautious enough in the rehabilitation process (Dubois & Esculier, 2020b).
After you’ve made PEACE for the initial days after the injury, it’s time to move on to LOVE.
L for Load:
This is all about progressively getting you back to normal activities and exercise. This process should be guided by any pain felt during or after the activity (Bleakley, Glasgow, & MacAuley, 2012; Dubois & Esculier, 2020b).
O for Optimism:
Interestingly, being optimistic can have profound effects on the rehabilitation process and injury outcomes! Believing you can and will get through injury rehabilitation has been demonstrated in the literature to have a positive effect on recovery in ankle sprains (Briet et al., 2016; Dubois & Esculier, 2020b).
V for Vascularisation:
Movement in the absence of pain is important for injury recovery. This is recommended to increase blood flow to the injury site (get rid of rubbish around the injury site and deliver nutrients to assist with healing) (Dubois & Esculier, 2020b).
E for Exercise!!! Our specialty! Exercise without pain is important for getting back to the activities you love, and making the injury site stronger to avoid re-injury (Vuurberg et al., 2018). It is also as important as ever for your physical and psychological health. As stated many times in this blog post, it’s important to let pain guide what you can and can’t do (Dubois & Esculier, 2020b).
Do you have a recent injury? Do you have an old injury that flares up or has changed your movement ability? Does it stop you or make you weary of training?
At The Gym, we take on new members with an array of different old and new injuries. We provide individual warm-ups & rehab/prehab programs designed specifically to cater to each member's needs. When assisting members with injury management, we also design an individualised training program to ensure training continues whilst the injury is being rehabilitated. Continued movement during an injury is a non negotiable at The Gym to ensure the continued physical and psychological benefits that our training provides.
Any questions?
Feel free to shoot us a message at: train@thegymsydney.com.au
Coaches Sam & Missy
References:
Bleakley, C., Glasgow, P., & MacAuley, D. (2012). PRICE needs updating, should we call the POLICE? In: BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine.
Briet, J. P., Houwert, R. M., Hageman, M. G., Hietbrink, F., Ring, D. C., & Verleisdonk, E. J. J. (2016). Factors associated with pain intensity and physical limitations after lateral ankle sprains. Injury, 47(11), 2565-2569.
Dubois, B., & Esculier, J.-F. (Producer). (2020a). PEACE and LOVE acronyms. [Image] Retrieved from https://bjsm.bmj.com/content/54/2/72
Dubois, B., & Esculier, J.-F. (2020b). Soft-tissue injuries simply need PEACE and LOVE. In: BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine.
Hansrani, V., Khanbhai, M., Bhandari, S., Pillai, A., & McCollum, C. N. (2015). The role of compression in the management of soft tissue ankle injuries: a systematic review. European Journal of Orthopaedic Surgery & Traumatology, 25(6), 987-995.
Tsang, K. K., Hertel, J., & Denegar, C. R. (2003). Volume decreases after elevation and intermittent compression of postacute ankle sprains are negated by gravity-dependent positioning. Journal of Athletic Training, 38(4), 320.
Vuurberg, G., Hoorntje, A., Wink, L. M., Van Der Doelen, B. F., Van Den Bekerom, M. P., Dekker, R., . . . Ridderikhof, M. L. (2018). Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. British journal of sports medicine, 52(15), 956-956.