If you have ever done a first aid course, you are undoubtedly aware of the acronym RICE for managing soft tissue injuries.
But have you heard of PEACE & LOVE?
PEACE & LOVE was proposed in 2019 and endorsed by the British Journal of Sports Medicine (BJSM) as best practice for soft tissue injuries. It gives guidance for acute and subacute injury management in line with current evidence-based medicine.
PEACE is for the management of acute injuries.
P- PROTECT- Rather than recommending Rest, Protect is to avoid harm and aggravating movements to; 1) minimise the risk of further injury and 2) optimise tissue healing. Total rest/absence of activity should be minimised, but activities should be modified to reduce load for a few days. Practically, this may mean exercising in ways that don't impact your injury (training lower body if you have an upper-body injury), reducing the load of your regular training ( consider weight, reps, sets, range, frequency, complexity, ect), or even using braces, taping, slings or crutches, particularly if they improve movement quality. While movement doesn't have to be pain-free, use pain to guide your activity level.
E- ELEVATION- Continue resting injured limbs above your heart intermittently for the first few days. Elevation assists in pain management, circulation and minimises swelling.
A- AVOID ANTI-INFLAMMATORIES & ICE- This is probably the most significant change between RICE and PEACE. Both ice and anti-inflammatories slow tissue healing in the acute phase. Its the inflammation and blood flow to an injured area that actually drives the healing response. By reducing either, you may slow your recovery. While both ice and anti-inflammatories can help manage pain, try to avoid their use in the first few days.
C- COMPRESSION- Continue compressing injured limbs where possible. As with elevation, compression can help reduce swelling, manage pain and improve circulation.
E- EDUCATION- Learn about your injury and the recovery process. An appropriate health care professional should be able to talk you through a path to resolution that includes;
-Managing pain and symptoms in the short term,
-Things you can do to optimise your recovery,
-Things that may put you at risk of further injury or poor recovery,
-Surgical vs conservative options,
-What rehabilitation will look like for you,
-The anticipated outcome of the process, &
-An estimated timeline-based upon your unique situation.
PEACE replaces RICE, so what's LOVE got to do with it?
LOVE relates to the subacute phase or rehabilitation after an injury. Most injuries will benefit from dedicated rehabilitation, ideally until the area is more robust than before the injury. After a short period of protecting, its time to get back to moving sensibly, in ways that are important to you.
L- LOAD- All tissues heal through movement and loading. While it's ok to rest for a short period, no one recovers fully without loading. The sooner you get back to usual activities, with modifications, the better. Returning to training early and gradually increasing the load is the best way.
O-OPTIMISM- High levels of worry and concern about an injury increase pain sensitivity. People are more likely to adopt behaviours that reduce healing, such as avoiding movement, socially isolating, and abusing alcohol and other drugs. Focusing on abilities, recognising progress and developing a plan to minimise symptoms whilst training will encourage a positive outlook. Adaptive coping strategies such as healthy pain management (heat, walking, gentle stretching, massage), prioritising self-care, managing stress, spending time with friends and family, and doing pleasurable activities will help promote optimism.
V- VASCULARISATION- General movement that increases the heart rate and blood flow to the injured area will reduce sensitivity, increase tissue healing, is great for general health, and can help you feel more positive about your situation.
E- EXERCISE- Movement, in general, is great, but training is even better. Studies have shown that planned and purposeful movement conveys more positive benefits than the same amount of incidental activity.