It used to be that everyone from weekend warriors to elite athletes treated their injuries with ICE (Ice, Compression, Elevation). Over time, treatment strategies evolved and acronyms expanded to include RICE (+ Rest), PRICE (+ Protect) and POLICE (+ Optimal Loading).
Two more acronyms — PEACE and LOVE — have recently found their way into the sports medicine lexicon. Created by two Canadian physiotherapists, they reflect a more updated and broad-based view of how to treat and manage acute soft tissue injuries, including strains, sprains and bruises.
“Our contemporary acronyms encompass the rehabilitation continuum from immediate care (PEACE) to subsequent management (LOVE),” said Blaise Dubois and Jean-François Esculier of the Running Clinic in a recent publication of the British Journal of Sports Medicine .
Dubois says the acronyms take into consideration the psychosocial aspects of recovering from an injury as well as the importance of an active, versus passive, path to recovery. The latest approach to healing suggests that resting an injured body part isn’t the best strategy for a speedy and optimal recovery.
“Passive recovery modalities like massage, electrical stimulation, manual manipulation and anti-inflammatory medication don’t speed healing,” said Dubois. “Lots of science now shows that moving earlier and loading (the injured body part) is a better approach to treatment.”
PEACE should be your guiding principle in those first few days post-injury, followed by several days of LOVE until the injured body part returns to its pain-free, fully functional state.
Dial back physical activity on Days 1 through 3 post-injury, to help minimize additional trauma and allow the physiological processes responsible for healing to kick in. But don’t go so far as absolute rest, which can cause an unnecessary reduction in strength and resiliency to the joint and surrounding soft tissue. Let pain be your guide as to how much regular function you can maintain, keeping in mind that some movement is better than no movement.
Reduce the pooling of fluid at the joint or around the injury by elevating the affected limb higher than the heart.
Avoid anti-inflammatory medications
Using anti-inflammatories designed to reduce swelling can actually impede healing, despite the popularity of advice that suggests otherwise. The same goes for the practice of applying ice to an injury, which Dubois and Esculier claim is a tradition that has very little science supporting its role in the healing process.
Wrap the affected body part with tape or a bandage as soon as possible to help reduce the discomfort and limitation to normal function caused by the buildup of fluid and internal bleeding that often accompany an injury.
Sports medicine specialists should inform injured exercisers that there is no magic bullet to recovery, including the type of therapies routinely employed by physiotherapists and athletic therapists. That’s not to say you shouldn’t seek professional counsel when it comes to treating an injury, but a therapeutic approach to repair doesn’t always yield better results than following the PEACE and LOVE method.
“Passive modalities, such as electrotherapy, manual therapy or acupuncture, early after injury have insignificant effects on pain and function compared to an active approach, and may even be counterproductive in the long term,” said Dubois and Esculier.
After PEACE, the next stage in injury repair is LOVE, which should begin after two consecutive days without pain. Don’t be worried if there’s still some discomfort as you guide your body toward a return to fully functional movement. Dubois says as long as any residual pain disappears when exercise or movement ceases, you’re not causing any further harm. So consider LOVE the final and most important part of your treatment plan.
Load refers to the active part of recovery, which involves moving and loading the injured tissues as soon as pain dissipates to the point where it is tolerable. In the case of a sprain or strain, that means limping is better than avoiding any weight-bearing, and range of motion should be tested early and often.
Athletes who are optimistic about their return to full function heal faster than those who dwell on discomfort and the disruption to their daily routine.
“Pain-free aerobic exercise should be started a few days after injury to boost motivation and increase blood flow to the injured structures,” said Dubois and Esculier.
Improving blood flow means more healing properties are delivered to the injured body part. Bike or swim if weight-bearing exercise is too painful, and walk or walk/run once pain and swelling have begun to abate.
Exercise is the key to restoring any injury-related loss in strength, agility and mobility. Use pain as a guide toward the appropriate exercise intensity and volume, and toward the gradual return to your regular exercise or training routine.