By Dr. Emily Jones, Osteopath
Injuries can be complex to manage, with ever changing acronyms guiding how we treat and manage the initial stages of the injury. Soft tissue injuries are characterised by a strain to a muscle or a sprain to a joint or ligament and can be quite painful to manage.
I’m sure many of us have heard of acronyms such as RICE, PRICE or POLICE, and may have even used these to manage a rolled and ankle or strained hamstring.
Well now, a new acronym is in town and it provides us with an evidence-based guide for what we can do immediately after a soft tissue injury, and how to manage it once the first few days have passed. We call this acronym PEACE and LOVE:
P = protect
Unload or restrict movement for 1–3 days to minimise bleeding and reduce the risk of aggravating the injury.
Rest should be minimised as it can be counter intuitive to healing.
E = elevate
Elevate the limb higher than the heart to promote fluid drainage out of tissues.
A = avoid anti-inflammatory modalities
The various stages of swelling and inflammation are beneficial to repairing damaged soft tissues, therefore taking anti-inflammatory medications can impair the inflammatory process and may negatively affect long-term tissue healing.
* While anti-inflammatories can help benefit short term pain and function, these are only recommended on a case-by-case basis *
Additionally, avoid ice packs as they can potentially disrupt inflammation and increase healing time.
C = compress
External pressure using taping or bandages helps limit fluid in the joint and bruising.
E = educate
Individuals should be educated on the benefits of an active approach to recovery, as well being provided realistic expectations about recovery times.
Once the first few days have passed, soft tissues need LOVE.
L = load
An active approach with movement and exercise should be resumed as soon as symptoms allow.
Optimal loading promotes tissue repair and remodelling, and builds tissue tolerance and the capacity of tendons, muscles and ligaments.
O = optimism
Optimistic patient expectations are associated with better outcomes and prognosis.
Sometimes, your own negative beliefs and emotions can act as a barrier to recovery and can amplify your pain experience more than the severity of the actual injury.
V = vascularisation
Pain-free aerobic exercise should be started a few days after injury to boost motivation and increase blood flow to the injured structures, to improve physical function.
E = exercise
Exercises help to restore mobility, strength and proprioception early after injury.
Pain should be avoided to ensure optimal repair during the subacute phase of recovery and should be used as a guide for exercise progressions.
Managing soft-tissue injuries is more than a just a short-term fix. In order to maximise long term outcomes, is important to treat and manage each injury specific to the individual and their own goals.
So remember: Immediately after injury let PEACE guide your approach … After the first days have passed, soft tissues need LOVE.
Dubois, B., & Esculier, J. F. (2020). Soft-tissue injuries simply need PEACE and LOVE. British journal of sports medicine, 54(2), 72–73. https://doi.org/10.1136/bjsports-2019-101253