Peace and love – something we all need. And our injuries do too. We have all heard of “RICE”
and later “PRICE” in regards to soft tissue injuries like ankle sprains (if you haven’t PRICE =
protect, rest, ice, compression, elevate). These older acronyms tend to focus on the immediate phase – right when the injury occurs and the first couple days after – and neglect the phases that come after. The new acronyms “PEACE” and “LOVE” cover the immediate phase and then the management that comes after these injuries have occurred.
The first acronym is PEACE. We want to do these things during the first few days following an injury.
P = Protection
E = Elevation
A = Avoid Anti-inflammatories
C = Compression
E = Education
The first 1-3 days after an injury, we want to protect the area by avoiding activities and
movements that are aggravating to it. This doesn’t mean we have to rest entirely, but simply work around the injury we are experiencing. We also want to elevate the area higher than our heart (if possible) for any extended rest time (like sitting for a few hours or sleeping) and avoid anti-inflammatories like ice and NSAIDs. Yes, avoid ice! Inflammation is actually what we need when we get injured, and it has been shown to increase healing times when we try to decrease our body’s normal inflammatory response. We want to compress the area instead using elastic = bandages or taping, which has been shown to help with any swelling that occurs. The last part of this is education. You can trust your body to heal any minor injuries on its own. Research has been shown that unnecessary imaging or treatment for minor soft tissue injuries can delay healing and actually lead to issues down the road compared to an active approach. LOVE is the acronym that covers the active approach to healing monitor soft tissue injuries.
L = Load
O = Optimism
V = Vascularization
E = Exercise
We should be loading minor soft tissue injuries as soon as we are able. This looks like stressing those injured tissues as much as we are able to without worsening pain which then helps with repair of those injured tissues and helping them become build capacity for day to day stressors again. We should do our best to remain optimistic about the healing of our injuries. Beliefs and emotions about our injuries have been shown to have more of an impact than the degree of damage to the tissues (which is not saying pain is all in our heads). A favorite saying of mine is “Pain is always 100% mental AND 100% physical” (Thank you Dr. Zoffness). Vascularization is a big word for promoting blood flow to the injured area. The sooner the better – starting pain free mobility and aerobic activity (like walking, biking, running) early has been shown to decrease overall healing times and reduce the need for pain medications. Exercise is the final piece of the puzzle. Performing exercises to regain mobility and increase strength have been shown to decrease return times to normal day to day activities and reduce the chances of some types of injuries occurring again. Using pain as a guide is key during these early phases (1st day to 4+ weeks) is key for performing exercise. Working with a rehabilitation professional
during the Exercise portion of PEACE & LOVE can be helpful for those who have uncertainties about managing their injury healing progression. So the next time you roll your ankle, pull a hamstring, or tweak your shoulder – remember that we all need more peace & love in our lives.
With Peace and Love,
Dr. Halley
doi:10.1136/bjsports-2019-101253