Say goodbye to RICE – acute injuries need PEACE and LOVE

To manage soft tissue injuries such as ankle sprains or muscle strains, most would be familiar with the acronym RICE (rest, ice, compression and elevation). The latest evidence suggests a new acronym PEACE and LOVE, PEACE for initial injury management and LOVE for ongoing management, an important step not identified using RICE.

For the first few days after an acute soft tissue injury think ‘PEACE’ to guide management.

P: Protect
Unload and restrict movement for 1-3 days following injury to minimise bleeding and reduce the risk of reinjury. Minimise rest as prolonged rest can lead to longer recovery times by compromising tissue quality and strength.

E: Elevate
Elevate your limb higher than your heart, this promotes fluid flow out of the injured area.

A: Avoid anti-inflammatory modalities

It is recommended to avoid taking anti-inflammatories for the first few days. The various phases of the inflammatory process are important to aid soft tissue repair, anti-inflammatories such as Nurofen, ibuprofen and Voltaren may inhibit this process and affect tissue healing in the long term. Ice may also potentially disrupt the inflammatory process. Ice can be used as needed to help manage pain, but is no longer recommended to reduce swelling or inflammation. Heat can also be used for pain management.

C: Compress
Compression using bandages or taping assist in limiting swelling and bleeding within the tissues.

E: Educate
Come and see your osteopath to get the latest advice. This will provide you with a better understanding of your injury, realistic recovery expectations and to avoid any confusion about what to do or not do.

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

L: Load
If your pain and symptoms allow it, resume normal activities. Your body will tell you when it is safe to increase load. Early mechanical loading by using the injured body part is recommended as it promotes repair, remodeling and build tissue tolerance. Make sure you listen to your body and don’t push too hard too early.

O: Optimism
Be optimistic about your recovery! Evidence shows better outcomes for patients who are optimistic. The brain plays an important role in rehabilitation with barriers to recovery including fear and avoidance behaviour. Working with your osteopath can give you confidence in moving your body after injury resulting in a more positive outlook on your recovery.

V: Vascularisation
Return to pain free cardiovascular exercise,as this helps increase blood flow to injured structures. Cardiovascular exercise combined with rehabilitation exercises improve physical function, assist in your return back to work or normal activities and can reduce the need for pain medication. You might find a stationary bike, walking or swimming work for you.

E: Exercise
Your osteopath will provide you with exercises specific to rehabilitate your injury. Benefits include restored mobility, strength and proprioception (your body’s ability to know where it is in space) which contribute to more favourable long-term outcomes.

Dubois, B., & Esculier, J. F. (2020). Soft-tissue injuries simply need PEACE and LOVE. British journal of sports medicine, 54(2), 72-73.

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