P.E.A.C.E & L.O.V.E
Evidence-based management of acute and subacute soft tissue injuries
Management and rehabilitation of soft tissue injuries can be complex. Some people swear by applying ice and compression straight away, others prefer to go for a dip in cold water and do gentle range of motion exercises. But what is the ‘right’ way to address an injury, if you want to get on track towards a fast recovery?
The widely known RICE/ PRICE / POLICE principles have long been the focus for acute injury management, however we now know that these methods are outdated. The most up to date evidence now suggests we use PEACE & LOVE to provide guidance for soft tissue injury management. These principles not only focus on acute care for injuries, but also give direction on subacute care to optimise long term recovery.
Immediately after an injury has occurred we want to focus on avoiding subsequent harm to the tissues and approaching the injury with PEACE.
P: Protect
Restrict movement of the injured body part for 1-3 days to minimise bleeding and reduce the risk of further aggravating the injured tissue. Although important, this stage should be as short as possible, as prolonged rest can negatively impact tissue strength. Allow pain to guide the end of the protection phase.
E: Elevate
Elevate the injured body part higher than the heart to promote lymphatic drainage.
A: Avoid Anti-inflammatories
Much to contrary belief of the general public, inflammation helps repair damaged tissue. If we therefore inhibit inflammation of an injured area, we are actually negatively affecting the long term ability of that tissue to heal.
This means avoid anti-inflammatory medications such as ibruprofen and voltaren in the week following an injury. It also means we should avoid applying ice as it can disrupt inflammation, new blood vessel formation, and delay healing factors from entering the injured tissue.
C: Compress
Compression using tape or bandages helps to limit excess fluid from entering the joints and tissue haemorrhage.
E: Educate
This point is targeted at therapists, and tells of the importance of educating patients on the benefits of an active approach to recovery. In immediate days following an acute injury, passive modalities such as electrotherapy, acupuncture & manual therapy should be avoided as their effectiveness on pain and function has not shown to be more beneficial than an active approach. This is where the therapist must advocate for realistic expectations for recovery and encourage the above principles and gentle movement.
After the first few days have passed, the injured tissues require LOVE. This method of sub-acute care will aid in optimising recovery.
L: Load
Mechanical stress should be placed on the injured tissues as early as pain allows. Appropriate loading will promote repair and remodelling of the tissue, whilst building tolerance and increasing the capacity of tendons, muscles and ligaments.
O: Optimism
Optimistic patient expectations are associated with better outcomes and prognoses. Addressing psychological barriers such as catastrophisation, depression & fear can greatly benefit recovery.
V: Vascularisation
Pain-free aerobic exercise should be implemented in a rehab program a few days post injury. This form of exercise boosts blood flow to the injured structures and will also help to improve overall mood.
E: Exercise
Commencing an injury specific exercise program as early as possible helps to restore mobility, strength and proprioception. There is very strong level evidence to suggest this form of treatment greatly improves injury recovery and reduces the prevalence of recurrent injury.
Applying PEACE & LOVE principles to the management of soft tissue injury not only addresses the acute stage, but also the sub-acute stage and will aid in achieving more favourable outcomes in the long term.
REFERENCES
Dubois B, Esculier J. Soft-tissue injuries simply need PEACE and LOVE. British Journal of Sports Medicine 2020;54:72-73.
