Maybe you sprained your ankle playing pickleball, developed tendonitis in your shoulder from raking leaves, or suffered muscle spasms in your back after shoveling snow. All of these injuries can vary in the degree of their severity and pain level. The bottom line is you want relief!
You may have heard of the acronym RICE, which stands for Rest, Ice, Compression, and Elevation, to treat these types of soft tissue and muscle damage. This treatment for injuries has been the standard for many years.
In 2020, an article in the British Journal of Sports Medicine proposed the PEACE and LOVE model as an alternative to RICE. This model emphasizes avoiding anti-inflammatory drugs, early mobilization, optimism, and exercise to promote healing. The new protocol was termed by Dubois and Esculier, who compiled the latest research on musculoskeletal injury recovery.
What Does PEACE and LOVE Stand For?
During the first few days immediately following an injury, practice PEACE.
- PROTECT: Restricting movement for 1-3 days after an injury reduces the risk of aggravating the injury.
- ELEVATE: If possible, place the injured area above the heart to improve fluid circulation away from the injury.
- AVOID anti-inflammatory methods such as ibuprofen or ice. The newer thought process is that using anti-inflammatories slows the healing process of the injured area. The healing process consists of inflammation, angiogenesis (new blood vessels forming from existing blood vessels), and restoring blood flow.
- COMPRESS: Use compression bandages or taping to help limit the amount of swelling in the injured area.
- EDUCATE: An active approach (movement, gentle resistance, or weight bearing) has more of a positive benefit to recovery versus a passive approach [ice, medicine, massage, transcutaneous electrical nerve stimulation (TENS)].
Soft tissues need LOVE after the first few days following the injury.
- LOAD: Begin gentle movement and exercise, such as riding a stationary bike or walking. Gradual use of resistance or weight bearing through the injury site without increasing pain will help with repair and remodeling and building tissue tolerance.
- OPTIMISM: Stay realistic but optimistic to achieve optimal recovery. Fear of movement or a pessimistic outlook will affect the prognosis of an injury. Practice self-care, such as deep breathing, meditation, or other activities that help you relax and stay grounded.
- VASCULARIZATION: Pain-free cardiovascular activity, such as stretching/yoga, biking, walking, or swimming, increases blood flow to injured structures, thus improving function and reducing the need for pain medication.
- EXERCISE: There is evidence that supports the use of exercise therapy in recovery from sprains to reduce the risk of recurring injury. Exercise will restore mobility, strength, and balance. Use your pain level as a guide to gradually progress exercises.
Should I Avoid Using Heat and Ice?
Heat and ice are not the enemies but are meant to be used sparingly.
Heat - Chronic injuries that continue to cause stiffness and achiness would benefit from heat to improve circulation and help you tolerate active movement of the injured area. Arthritic joint pain tends to respond better to heat because it helps with joint mobility. Above using a passive modality such as heat or ice, gentle active mobility of the body part will help improve symptoms. Even if it hurts, movement is typically the best thing for arthritis symptoms.
Ice - Ice can help prevent delayed onset muscle soreness after exercises if used within the first 24 hours. Is ice after surgery still recommended? Yes! Ice continues to show a reduction in pain, swelling, and reduced need for pain medication following an orthopedic surgery (total joint replacement, tendon repair, arthroscopy).
If you are struggling to recover from a soft tissue injury (sprain, strain, muscle spasm), contact your primary care provider for further assessment and physical therapy referral.
