Healing Soft Tissue Injuries with PEACE & LOVE

Written by UVM EXMS student, Rebecca McNally

Many different acronyms have guided our management of acute soft tissue injuries over the years.  Initially, ICE (ice, compression, elevation) was the basic principle for early treatment.  Soon, ICE became RICE (rest, ice, compression, elevation), and then PRICE (protection, rest, ice, compression, elevation) and POLICE (protection, optimal loading, ice, compression, elevation).1  The latest update is the first to address not only acute but subacute and chronic stages of soft-tissue injury healing, emphasizing rehabilitation as a continuum.  This new model suggests that PEACE should guide your approach in the first days immediately following an injury, and LOVE will guide subsequent management after the acute stage of healing has passed.2

 
Protect

For the first 1-3 days following an injury, try to unload or restrict movement in the injured area, and avoid any activities or movements that increase pain.  This will help minimize bleeding, reduce the risk of aggravating the injury.  Keep in mind that prolonged rest can actually compromise the strength of the healing tissue, so use pain as a guide for when you are ready to introduce movement again.

Elevate

Raising the affected area higher than the heart will promote the flow of fluid out of the injured tissues and reduce swelling.

Avoid anti-inflammatory modalities

The phases of inflammation are important for tissue repair.  Inhibiting the acute inflammation process with medications may affect long-term tissue healing and muscle growth, especially when medication is taken at higher doses.3-5  A common anti-inflammatory modality is ice, which may suppress the natural healing process and disrupt tissue repair during the acute stage of healing.  While evidence for the efficacy of ice in treating soft tissue injuries is limited, many find it helpful as an analgesic.

Compression

Despite some conflicting research, external compression using bandages or taping may help reduce swelling in the affected area.3

Education

This one is really for the physical therapists, athletic trainers, and other providers treating people who have the injuries.  Providers should educate patients on an active approach to recovery, where the patient is in control.  In addition to educating patients on the specific condition, setting realistic expectations about the recovery timeline will help avoid unnecessary passive treatments and medical interventions.

 

After the first few days have passed, use LOVE as a guide for subsequent management.

Load

Optimal loading during the early stages of healing promotes tissue repair.  Return to normal activities as soon as pain will allow.3,6

Optimism

Confidence and positive thoughts can have a significant impact on outcomes and prognosis.   It is important to set realistic and optimistic expectations when it comes to your recovery.

Vascularization

Cardiovascular activity should be resumed as soon as pain will allow.  This type of exercise will increase blood flow to the repairing tissues and improve physical function.

Exercise

Finally, there is strong evidence supporting the use of exercise for the treatment of injuries as well as the prevention of re-injury.6  Still using pain as a guide, exercise should be continued early to rebuild strength, balance, mobility, and function.

 

 

 

References

 

  1. Bleakley CM, Glasgow P, MacAuley DC. PRICE needs updating, should we call the POLICE? British Journal of Sports Medicine 2012;46:220-221
  2. Dubois B, Esculier J-F. Soft-tissue injuries simply need PEACE and LOVE. British Journal of Sports Medicine. 2019. doi:10.1136/bjsports-2019-101253.
  3. Vuurberg G, Hoorntje A, Wink LM, et al. Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. British Journal of Sports Medicine 2018;52:956
  4. Duchesne E, Dufresne SS, Dumont NA. Impact of Inflammation and Anti-inflammatory Modalities on Skeletal Muscle Healing: From Fundamental Research to the Clinic. Physical Therapy. 2017;97(8):807-817. doi:10.1093/ptj/pzx056.
  5. Singh DP, Barani Lonbani Z, Woodruff MA, Parker TJ, Steck R, Peake JM. Effects of Topical Icing on Inflammation, Angiogenesis, Revascularization, and Myofiber Regeneration in Skeletal Muscle Following Contusion Injury. Front Physiol. 2017;8:93. Published 2017 Mar 7. doi:10.3389/fphys.2017.00093
  6. Khan KM, Scott A. Mechanotherapy: how physical therapists’ prescription of exercise promotes tissue repair. British Journal of Sports Medicine. 2009;43:247-252

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