PEACE and LOVE for Soft Tissue Injury  

We are familiar with RICE for handling soft tissue injury. Rest, Ice, Compression, and Elevation are suggested as the first treatment of injuries. Over time other acronyms have been suggested and added: PRICE, POLICE, MICE, including ‘Avoid HARM’ (Heat, Alcohol, Reinjury, Massage).

A 2012 review study found that there is Insufficient evidence is available from randomized controlled trials to determine the relative effectiveness of RICE therapy for acute ankle sprains in adults. Note that insufficient evidence does not mean it is ineffective.

Dr Gabe Mirkin who first proposed RICE in 1978 wrote recently that “now it appears that both Ice and complete Rest may delay healing, instead of helping.”

Ice or cooling when used directly after an injury, is thought to slow down the metabolism of injured tissues with may prevent secondary injuries to cells that are not injured.  However cooling may have other cellular effects. Some studies suggest that applying ice on injured soft tissue is not only ineffective but might interfere with the body’s ability to heal. Ice could potentially disrupt inflammation, angiogenesis and revascularisation, delay neutrophil and macrophage infiltration as well as increase immature myofibers. This may lead to impaired tissue regeneration and redundant collagen synthesis.

Blaise Dubois and Jean-Francois Esculier from Canada mentioned that RICE and other similar treatments only focus on acute management, but ignore chronic stages of tissue healing. They proposed two new acronyms for the rehabilitation of soft tissue injury. PEACE for immediate care and subsequent management (LOVE).  The following is from

https://blogs.bmj.com/bjsm/2019/04/26/soft-tissue-injuries-simply-need-peace-love/

P for Protect

Avoid activities that can increase pain during the first few days after injury. Rest should be minimised as prolonged rest can compromise tissue strength and quality.

E for Elevate

Elevate the limb higher than the heart to promote interstitial fluid flow out of the tissue.

A for Avoid anti-inflammatory modalities

Anti-inflammatory medications may potentially be detrimental for long-term tissue healing.

C for Compress

External mechanical pressure using taping or bandages helps to limit intra-articular edema and tissue hemorrhage.

E for Educate

Therapists should educate patients on the benefits of an active approach to recovery.

After the first days have passed, soft tissues need LOVE

L for Load

An active approach with movement and exercise benefits most patients with musculoskeletal disorders. Mechanical stress should be added early, and normal activities resumed as soon as symptoms allow. Optimal loading without exacerbating pain promotes repair, remodeling and building tissue tolerance and capacity of tendons, muscles, and ligaments through mechanotransduction.

O for Optimism

The brain plays a key role in rehabilitation interventions. Psychological factors such as catastrophisation, depression, and fear can represent barriers to recovery. While staying realistic, practitioners should encourage optimism to enhance the likelihood of  optimal recovery.

V for Vascularisation

Pain-free physical activity that includes cardiovascular components should be started a few days after injury to boost motivation and increase blood flow to the injured structures.

E for Exercise

Exercises will help to restore mobility, strength, and proprioception early after injury.