PEACE and LOVE Injury Management

RICE or PRICE is OUT. The medical community advocate a more science based and holistic approach to injury management and treatment:

PEACE

P for protect
Unload or restrict movement for 1–3 days to minimise bleeding and reduce the risk of aggravating the injury. Prolonged rest will compromise tissue strength and quality so minimise immobilisation and use pain as a guide to gradually increase activity.

E for elevate
Elevate the an injured limb higher than the heart whenever possible to promote blood and waste product flow out of injured tissues. Despite weak evidence supporting its use, elevation shows a low risk-to-benefit ratio.

A for avoid anti-inflammatory medications
Moderate inflammation helps repair damaged soft tissue. Therefore, using anti-inflammation medications to inhibit inflammation may negatively affect long-term tissue healing, especially over the long-term or when higher dosages are used. Minimise the use anti-inflammatory medications, especially 48/72hrs post injury. There is no high-quality evidence on the efficacy of ice for treating soft-tissue injuries despite widespread use. The use of ice (short term) should be restricted to the acute phase of injury.

C for compress
External mechanical pressure using taping or bandages helps limit intra-articular oedema (swelling) and tissue haemorrhage. Despite conflicting studies, compression after an ankle sprain seems to reduce swelling and improve quality of life.

E for educate
Therapists should educate patients on the benefits of an active approach to recovery. Better education on the condition and load management will help avoid over-treatment. This in turn reduces the likelihood of unnecessary injections or surgery. In an era of hi-tech therapeutic options, we strongly advocate for setting realistic expectations with patients about recovery times.

LOVE

After the first days have passed, soft tissues need LOVE:
L for load
An active approach with movement and exercise benefits most patients with musculoskeletal disorders. Mechanical stress (exercise) should be added early and normal activities resumed as soon as symptoms allow. Optimal loading without exacerbating pain promotes repair, remodelling and builds tissue tolerance and the strength of tendons, muscles and ligaments through mechanotransduction.

V for vascularisation
Pain-free aerobic exercise should be started as soon as possible after injury. This will boost motivation and increase blood flow to the injured structures. Early mobilisation and aerobic exercise improves physical function, supporting return to work and reduce the need for pain medication in individuals with musculoskeletal conditions.

O for optimism
Optimistic patient expectations are associated with better outcomes. Psychological factors such as catastrophisation, depression and fear can represent barriers to recovery. Beliefs are thought to explain more variation in symptoms following injury than the degree of pathophysiology.

E for exercise
There is strong evidence supporting the use of exercise for injury treatment and for reducing the prevalence of recurrent injuries. Exercises help to restore mobility, strength and proprioception after injury. Pain should be avoided during the early phase of recovery to ensure optimal repair, and should be used as a guide for exercise progression. Managing soft-tissue injuries is more than short-term damage control. And always treat the person with the injury rather than the injury of the person.

Adapted from: Dubois B, Esculier J-F. Br J Sports Med 2020; 54:72–73