Soft tissue injuries are an inevitable part of life and can affect anyone. Soft tissue injuries include sprains, strains, tendonitis, contusions and bursitis. After sustaining an acute injury, damaged cells release inflammatory signals leading to local vasodilation. Blood flow then increases to the area, resulting in redness and heat. The injured body part will typically swell which will stimulate pain receptors as a warning sign letting you know that you have injured yourself. Swelling acts as a rudimentary brace for your injury while the inflammatory process lets the body know to send additional specialized cells to the area to assist with the recovery. Nobody likes a setback, but the first few steps after an injury can quickly influence your outcome.
So, what should you do about it?
Since 1978, one of the best-known acronyms coined by Gabe Mirkin to manage acute injuries was RICE (Rest, Ice, Compression, Elevation)2,4. The RICE approach was based on the best available evidence at the time, however since then, new research has led to improved evidence-based practice and treatment approaches.
In 2019, after evaluating the current body of evidence, Dubois & Esculier wrote a scientific paper in the British Journal of Sports Medicine titled “Soft-tissue injuries simply need PEACE and LOVE” where they proposed modifying the RICE method with two new acronyms called PEACE and LOVE to optimize soft tissue recovery.1,3
How do you PEACE and LOVE you acute injury?
“Immediately after injury, do no harm and let PEACE guide your approach” 1
PEACE
P = Protection – Avoid aggravating activities that increase pain during the first few days after injury
E = Elevation – Elevate the injured limb higher than the heart to promote blood flow out of the tissue as much as possible
A = Avoid Anti-Inflammatories – Avoid taking anti-inflammatories as they can reduce tissue healing
C = Compression – Use elastic bandage or taping to help reduce swelling
E = Education – Your body knows best. Avoid unnecessary passive treatments and medical investigations. Let nature play its role.
“After the first days have passed, soft tissues need LOVE” 1
LOVE
L = Load – Pain is your best guide to know when you can return to normal activities. Your body will tell you when it’s safe to increase the load
O = Optimism – Remain confident and positive in your recovery
V = Vascularization – Increase blood flow to the healing tissue by choosing pain free cardiovascular activities
E = Exercise – Adopt an active approach in recovery by restoring mobility, strength and proprioception
Bottom Line
As stated by Dubois & Esculier “PEACE and LOVE outlines the importance of educating patients and addressing psychosocial factors to enhance recovery”1. The physiotherapist’s management of soft tissue injuries should focus on both short-term damage control as well as long-term recovery while considering the person as a whole to promote their return to everyday function.
NOTE: Information provided in this blog post is for educational purposes and does not constitute treatment recommendations.
References
1. Dubois, B., & Esculier, J.-F. (2019). Soft-tissue injuries simply need PEACE and LOVE. British Journal of Sports Medicine.
2. Physiopedia. (2021). Retrieved from RICE: https://www.physio-pedia.com/RICE
3. Physiopedia. (2021). Retrieved from Peace and Love Principle: https://www.physio-pedia.com/Peace_and_Love_Principle
4. Robinson, D. J. (2017, October 18). This Changed My Practice (UBC CPD). Retrieved from The University of British Columbia: https://thischangedmypractice.com/move-an-injury-not-rice/