01/09/2020
Who doesn't like peace and love?
If you have ever rolled an ankle or sustained a minor injury you've probably heard of the acronym RICE. Rest, Ice, Compression, Elevation. RICE has long been accepted as the best way to manage injuries but it has always ignored the next steps in recovery from an injury.
With PEACE and LOVE it describes what to do immediately after an injury (1-3 days) and in the subacute phase (3+ days.)
P: Protect. Immediately after an injury it is still important to protect it from further damage. For the first couple days it is best to avoid any painful positions. This rest period should be minimised as prolonged rest compromises tissue strength and quality.
E: Elevate. This one still applies from RICE. Elevate the injury over the heart to promote interstitial fluid flow out of the tissue.
A: Avoid Anti Inflammatories: Inflammation actually plays an important role for proper recovery and soft tissue regeneration. Using pharmacological tools to reduce inflammation may impair tissue healing, especially when taken in high doses.
C: Compress: Compression may reduce swelling and help improve quality of life for an injured patient.
E: Educate: A therapist should play an imperative role in educating the patient about their next steps. Patients should be encourage to seek active care and rehab in order to help increase their recovery process.
Once the patient is out of the acute phase they should begin to use the acronym LOVE. We want to limit the amount of time in the PEACE phase.
L: Load: As soon as tolerable we want to begin loading the tissue little by little. Optimal loading with exacerbating pain promotes repair, remodelling and building tissue tolerance. This is one of the most important things you can do for a musculoskeletal injury.
O: Optimism: Psychological factors including catastrophization depression and fear can create barriers to recovery. Pessimistic expectations are associated with poor outcomes and a worse prognosis.
V: Vascularisation: Early mobilisation and aerobic exercise improve function, work status and reduce the need for pain medication.
E: Exercise: Exercise will help restore mobility, strength, and proprioception early after injury. Pain should be avoided to ensure optimal repair during the subacute phase of recovery.