Traditionally, the appropriate advice following a soft tissue injury was R.I.C.E (Rest, Ice, Compression, Elevation). However, a new synonym has been appropriately developed to help return to normal, quickly and more effectively. P.E.A.C.E & L.O.V.E is now seen as the gold standard in recovering from injury and stands for:
P – Protect
Unload or restrict movement for 1 to 3 days to minimise bleeding. Rest should be minimised as prolonged rest can compromise tissue strength and quality.
E - Elevate
Elevate the limb higher than the heart to promote interstitial fluid flow out of tissue.
A - Avoid anti-inflammatory modalities
Anti-inflammatory medications may potentially be detrimental for long-term tissue healing, particularly in the first 72 hours, post injury.
C - Compress
Using taping or bandages helps limiting edema and tissue hemorrhage.
E - Educate
Educate patients on the benefits of an active approach to recovery. Better education on the condition and load management will help avoid over treatment which has been suggested to increase the likelihood of injections or surgery and higher costs to healthcare systems because of disability compensation.
After the first four days have passed, soft tissues need LOVE
L - Load
An active approach with movement and exercise benefits most patients with musculoskeletal disorders. Graded loading should be added early and normal activities resumed as soon as pain allows.
O - Optimism
The brain plays a key role in rehabilitation interventions. Psychological factors such as catastrophizing, depression and fear can represent barriers to recovery. Pessimistic patient expectations are also associated with sub-optimal outcomes and worse prognosis. While staying realistic, practitioners should encourage optimism to enhance the likelihood of an optimal recovery.
V - Vascularisation
Physical activity that includes cardiovascular components represents a cornerstone in the management of musculoskeletal injuries and should be commenced a few days after injury to optimise recovery.
E - Exercise
There is a strong level of evidence supporting the use of exercises for treatment of injuries and for reducing chance of recurring injuries. Exercises will help to restore mobility, strength and proprioception early after injury. Pain should be avoided to ensure optimal repair and should be used as a guide to progress rehab/exercises.
Although PEACE & LOVE is for soft tissues primarily, similar expectations could be applied for joint, bone and nerve injuries – however, the healing times for these may vary. Setting clear and honest expectations from the outset are important to manage the recovery process. Having a dialogue with the patient at the initial consultation is important to help them process their injury and set clear goals to help them achieve a full and effective recovery in a timely manner.
Reference:
Dubois and Escullier (2019). Soft tissue injuries simply need PEACE and LOVE. BJSM Blog.
www.therunningclinic.com - photo credit