For years we have all come to know the acronym “RICE” when it comes to managing an acute injury like a knock, sprain or strain.
With new research this advice has been recently updated, particularly with advice to avoid anti-inflammatories and ice. It also accounts for the higher complexity that often comes with the treatment of injuries throughout their stages to allow them to heal and return to their previous level of strength, or higher!
Instead we now use the two acronyms “PEACE” and “LOVE” which we use for acute (0-4 days) and subacute (4-14 days) respectively. We summarise this below and have included a PDF version for you to keep for future reference which you can download here.
PEACE
When you've had a sudden acute injury, like a knock, strain or sprain, we now use the acronym "PEACE" which replaces the previously used "RICE" to manage it.
P - Protect
Unload the injured part and avoid activities or movements that cause excessive pain during the first few (1-3) days after injury. This is to reduce the risk of bleeding and re-injury. Gentle, pain free movement without loading is generally ok.
E - Elevate
Elevate the injured limb higher than the heart. Elevation can reduce excessive swelling and promotes fluid flow out of he injured tissue.
A - Avoid anti-inflammatory modalities
Anti-inflammatories and can disrupt healing in the acute phase. Blood flow and inflammation drive the healing response and anti-inflammatories in particular can reduce this. The use of ice is also questionable, it can be helpful in reducing pain, however it should be used with caution as it may also disrupt the normal healing processes.
C - Compression
Compress injuries with elastic bandage or tape to help reduce excessive swelling and fluid build up, manage pain and improve circulation.
E - Education
Education is key! It’s important that you understand what is happening within your body and tissues during the healing process, and how an active approach to recovery, rather than a passive approach, can benefit. You'll need to have realistic expectations about what to expect and recovery times.
LOVE
Once your acute injury has settled down after the first few days, we then progress to "LOVE".
L - Load
Loading and mechanical stress promotes repair of your tissues and builds the capacity of muscles, tendons and ligaments. After a brief period of relative rest you need to return to gradual load as soon as possible, guided by pain and your individual advice.
O - Optimism
High levels of concern or stress can heighten sensitivity and cause us to adopt unhelpful coping strategies - such as avoiding movement. Know that your bodies are adaptable, focus on what you can do, plan out how to get back to what you want to do and celebrate progress.
V - Vascularisation
More research is needed on specific dosage, but pain free cardiovascular activity boosts motivation and improves blood flow to the area which can help with healing and recovery. Aerobic exercise is also a natural pain killer so can reduce the need for pain medication.
E - Exercise
Exercise helps to restore mobility, proprioception and strength, particularly specific and progressive exercise. It will also helps to reduce the risk of injuries reoccurring. Return to exercise and training as guided by your pain and any individual advice you have been given.
References
Dubois B, Esculier J. Soft-tissue injuries simply need PEACE and LOVE. British Journal of Sports Medicine 2020;54:72-73.
PEACE & LOVE
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PEACE & LOVE •
Your individual needs will differ and we always recommend an individual assessment to discern this.
Formotion Physio is a Physiotherapy practice based in West Perth, Joondalup & Osborne Park, Western Australia and we are available for individual appointments.