04/04/2026
Just published 🔥
𝗣𝗥𝗜𝗖𝗘 (𝗣𝗿𝗼𝘁𝗲𝗰𝘁𝗶𝗼𝗻, 𝗥𝗲𝘀𝘁, 𝗜𝗰𝗲, 𝗖𝗼𝗺𝗽𝗿𝗲𝘀𝘀𝗶𝗼𝗻, 𝗘𝗹𝗲𝘃𝗮𝘁𝗶𝗼𝗻) 𝘃𝘀 𝗣𝗘𝗔𝗖𝗘 𝗮𝗻𝗱 𝗟𝗢𝗩𝗘 (𝗣𝗿𝗼𝘁𝗲𝗰𝘁𝗶𝗼𝗻, 𝗘𝗹𝗲𝘃𝗮𝘁𝗶𝗼𝗻, 𝗔𝘃𝗼𝗶𝗱 𝗮𝗻𝘁𝗶-𝗶𝗻𝗳𝗹𝗮𝗺𝗺𝗮𝘁𝗼𝗿𝗶𝗲𝘀, 𝗖𝗼𝗺𝗽𝗿𝗲𝘀𝘀𝗶𝗼𝗻, 𝗘𝗱𝘂𝗰𝗮𝘁𝗶𝗼𝗻 𝗮𝗻𝗱 𝗟𝗼𝗮𝗱, 𝗢𝗽𝘁𝗶𝗺𝗶𝘀𝗺, 𝗩𝗮𝘀𝗰𝘂𝗹𝗮𝗿𝗶𝘇𝗮𝘁𝗶𝗼𝗻, 𝗘𝘅𝗲𝗿𝗰𝗶𝘀𝗲) 𝗶𝗻 𝗮𝗱𝗼𝗹𝗲𝘀𝗰𝗲𝗻𝘁 𝗹𝗮𝘁𝗲𝗿𝗮𝗹 𝗮𝗻𝗸𝗹𝗲 𝘀𝗽𝗿𝗮𝗶𝗻 𝗿𝗲𝗵𝗮𝗯𝗶𝗹𝗶𝘁𝗮𝘁𝗶𝗼𝗻: 𝗮 𝗿𝗮𝗻𝗱𝗼𝗺𝗶𝘇𝗲𝗱 𝗽𝗿𝗼𝘀𝗽𝗲𝗰𝘁𝗶𝘃𝗲 𝗰𝗼𝗺𝗽𝗮𝗿𝗮𝘁𝗶𝘃𝗲 𝘀𝘁𝘂𝗱𝘆 𝗼𝗳 𝗺𝘂𝘀𝗰𝗹𝗲 𝘀𝘁𝗿𝗲𝗻𝗴𝘁𝗵 𝗮𝗻𝗱 𝗱𝘆𝗻𝗮𝗺𝗶𝗰 𝗯𝗮𝗹𝗮𝗻𝗰𝗲
🦶 Lateral ankle sprain (LAS) is one of the most frequent musculoskeletal injuries in active adolescents, yet wide variability persists in diagnostic methods and treatment pathways (https://pubmed.ncbi.nlm.nih.gov/29514819/, https://pubmed.ncbi.nlm.nih.gov/29886432/).
📋 For more than 20 years, acute care has relied on the PRICE (Protection, Rest, Ice, Compression, Elevation) approach, combined with non-steroidal anti-inflammatory drugs (NSAIDs). However, guideline authors note a lack of high-quality evidence supporting PRICE as a universal strategy and warn that excessive rest and prolonged NSAID use may impair optimal tissue repair (https://pubmed.ncbi.nlm.nih.gov/29514819/). On the contrary, contemporary rehabilitation enhances early loading, progressive exercise, and patient education. A 2019 systematic review and meta-analysis reported that exercise-based rehabilitation reduces recurrent sprains risk compared with usual care, though optimal content and dosage remain unclear (https://pubmed.ncbi.nlm.nih.gov/30612980/).
In order to avoid drawbacks of traditional treatment algorithm, PEACE and LOVE was suggested as a two-phase protocol covering immediate care (Protection, Elevation, Avoid anti-inflammatories, Compression, Education) and subacute recovery (Load, Optimism, Vascularization, Exercise), paying attention to education, early optimal loading, and graded activity (https://pubmed.ncbi.nlm.nih.gov/31377722/).
❤️ ☮️ Traditional PRICE + NSAIDs and the PEACE and LOVE frameworks differ not only in clinical management but also in underlying physiological basis. PRICE concentrates primarily on early symptom control by reducing pain and swelling; however, prolonged rest and routine use of anti-inflammatory strategies may impair beneficial inflammatory cascades, macrophage activation, angiogenesis, and collagen remodeling required for optimal tissue healing (https://pubmed.ncbi.nlm.nih.gov/22889660/).
Conversely, PEACE and LOVE supports early, gradual mechanical loading and patient education to stimulate mechanotransduction, maintain neuromuscular function, and support collagen fiber alignment. This protocol aims to optimize tissue regeneration and functional recovery rather than simply controlling symptoms (https://pubmed.ncbi.nlm.nih.gov/31377722/).
📘 In a brand-new randomized prospective comparative study, Meškauskas and colleagues (https://pubmed.ncbi.nlm.nih.gov/41840451/) enrolled 76 adolescents (12–17 years) with first-time LAS, allocated to PRICE + NSAIDs or PEACE and LOVE treatment group (s. comments). Functional performance was assessed at 1–2, 5–7, and 12–15 weeks using Biodex isokinetic dynamometry and the Y-Balance Test composite score (YBT-CS).
📊 Significant improvements over time were observed for strength, range of motion, and dynamic balance in both groups. However, no statistically significant group effects or Group × Time interactions were detected, indicating similar recovery trajectories between rehabilitation approaches during the 12–15-week follow-up period.
💡Clinical relevance
The PEACE and LOVE framework may represent a biologically informed and patient-friendly approach to LAS management in adolescents, emphasizing education, early optimal loading, and functional rehabilitation. Despite being a more recently proposed rehabilitation framework, PEACE and LOVE demonstrated short-term functional outcomes comparable to those observed with the traditional PRICE + NSAIDs approach. In the present study, both rehabilitation protocols were associated with comparable short-term improvements in strength, ROM, and dynamic balance. No statistically significant between-group differences were detected.
⭕The magnitude of these changes was modest, and their clinical relevance should be interpreted cautiously. Future studies incorporating minimal clinically important difference thresholds, patient-reported outcomes, and longer follow-up are needed to determine practical impact. Given the single-center design, application of these findings should be considered in the context of local clinical resources and expertise
Infographic: https://pubmed.ncbi.nlm.nih.gov/31377722/
