PEACE and LOVE; the NEW acronym for the management of acute soft tissue injuries.
For as long as anyone can remember, acute soft tissues injuries have been treated and managed using the old ‘RICE’ method. Rest, ice, compression and elevation. While the acronym is constantly changing to adapt to the latest research, PEACE and LOVE is what the research is telling us now!
During the first few days, soft tissue injuries need PEACE.
P – Protect
Unload or restrict movement for the first 1-3days. This reduces bleeding and the risk of aggravating the injury. You don’t want to completely stop moving though, as prolonged rest compromises tissue strength and quality. Keep it moving without loading it (eg: gentle pain free movement for an ankle sprain).
E – Elevate
Elevate the injured limb, ideally above the level of the heart. This promotes fluid flow out of the injured tissue. There is poor evidence for elevation, however it is still recommended due to its low risk-benefit ratio.
A – Avoid anti-inflammatories
The inflammatory process in the early stages of an acute soft tissue injury is an important part of the healing process. Anti-inflammatory medication can negatively affect long-term tissue healing and impair the healing process.
It is also now recommended to avoid ice. The use of ice is mostly analgesic and using ice may potentially disrupt inflammation and other processes that are required for tissue healing.
C – Compress
Intra-articular edema and tissue hemorrhage may be limited by external mechanical compression such as taping, bandages and compression garments.
E – Educate
Education is key! It’s important the patient understands what is happening within their body and tissues during the healing process and how an active approach to recovery, rather than a passive approach, can benefit the patient. The patient needs to have realistic expectations about what to expect and recovery times.
After the first few days of PEACE, our soft tissue injuries require LOVE.
L – Load
Soft tissue injuries benefit from an active approach with movement and exercise. Normal activities should continue as soon as symptoms allow for it. Early mechanical stress with optimal loading without increasing pain promotes repair and remodelling and builds soft tissue tolerance.
O – Optimism
The brain plays a significant part in rehabilitation and some barriers include catastrophization, depression and fear. Staying realistic and encouraging optimism helps improve the chances of an optimal recovery.
V – Vascularisation
Musculoskeletal injury management needs to include cardiovascular physical activity. Pain-free cardiovascular exercise is a motivation booster and increases blood flow to injured structures.
E – Exercise
Evidence supports the use of exercise therapy in the treatment of soft tissue injuries. Benefits include restoring mobility, strength and proprioception. It is important to avoid pain in the early phases and then use pain as a guide to progress exercises gradually.
While the treatment and management of soft tissue injuries is forever changing, it is important to follow the most up to date evidence to ensure you have the best chance of a full recovery. Our Osteopaths at Berwick Family Osteopathy can help you!