Managing a soft tissue injury through PEACE & LOVE
Rehabilitation of soft tissue injuries can be complex. You might be familiar with the old acronym RICE (rest, ice, compression, elevation) for treating soft-tissue injuries. ICE/RICE/PRICE focus on acute management, unfortunately ignoring sub-acute and chronic stages of tissue healing.
For this reason, research published in the British Journal of Sports Medicine puts forward a new up-to-date evidence-based rehabilitation continuum in the acronym of PEACE (immediate care) & LOVE (subsequent management).The management plan is as follows:
P for Protect
Avoid activities and movements that increase pain during the first few days after injury However, prolonged rest can compromise tissue strength and quality, so this should be minimised. Use pain to guide what the appropriate time and degree of loading will be
E for Elevate
Elevate the limb higher than the heart to reduce swelling in the injured area.
A for Avoid anti-inflammatory modalities
While anti-inflammatory may be effective for pain relief, the various phases of inflammation are vital to protect and heal the injured area. Inhibiting such an important process through pharmaceuticals is not recommended as it could impair tissue healing, especially when a higher dosage is taken.
Additionally the pain that is associated with the injury is a signal from your body to PROTECT the injured area.
C for Compress
External mechanical pressure using taping or bandages helps limit intra-articular edema and tissue haemorrhage and improve quality of life.
E for Educate
Passive modalities such as electrotherapy, manual therapy or acupuncture, early after injury has a trivial effect on pain and function compared with an active approach; and it may even be counter-productive in the long term. Better education on the condition and load management will help set realistic treatment guidelines, optimise self management while avoiding over-treatment.
After the first days have passed, soft tissues need LOVE
L for Load
As previously mentioned an active approach where the injured site is optimally loaded through graded exercise benefits most patients with musculoskeletal disorders. The goal of this phase is to load without exacerbating pain to promote repair, remodelling and tissue tolerance and capacity of tendons, muscles and ligaments.
O for Optimism
The brain plays a key role in rehabilitation interventions. Psychological factors such as catastrophization, depression and fear can represent barriers to recovery. They are even thought to explain more of the variation in symptoms and limitations following an ankle sprain than the degree of sprain. It's easy to be pessimistic or down then you injure yourself but try to be positive and trust in the treatment plan that you and your practitioner have in place. This enhances the likelihood of an optimal recovery, and reduces the chance of you falling into the boom and bust cycle.
V for Vascularisation
Physical activity that includes cardiovascular components represents a cornerstone in the management of musculoskeletal injuries. Pain-free cardiovascular activity should be started a few days after injury to boost motivation and increase blood flow to the injured structures.
E for Exercise
This is the most important one, especially if you want to reduce the chance of another injury happening further down the line. Exercises will 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 progressing exercises to greater levels of difficulty.
Dubois, B. and Esculier, J., 2020. Soft Tissue Injuries Simply Need PEACE & LOVE | BJSM Blog - Social Media's Leading SEM Voice. [online] BJSM blog - social media's leading SEM voice. Available at: <https://blogs.bmj.com/bjsm/2019/04/26/soft-tissue-injuries-simply-need-peace-love/> [Accessed 23 June 2020].
Bleakley CM, Glasgow PD, Phillips N, et al. Guidelines on the management of acute soft tissue injury using protection rest ice compression and elevation. London: ACPSM, 2011
Duchesne E, Dufresne SS, Dumont NA. Impact of inflammation and anti-inflammatory modalities on skeletal muscle healing: From fundamental research to the clinic. Phys Ther Sport 2017;97: 807-17.
Hansrani V, Khanbhai M, Bhandari S, et al. The role of compression in the management of soft tissue ankle injuries: A systematic review. Eur J Orthop Surg Traumatol 2015;25: 987-95.
Briet JP, Houwert RM, Hageman MGJS, et al. Factors associated with pain intensity and physical limitations after lateral ankle sprains. Injury2016;47: 2565-9.