When was the last time you or someone you know had a soft tissue (tendon, muscle, ligament) injury? Something like rolling your ankle during a run or twisting your knee during sport. And how was the injury managed?
The RICE principal
In the late 1970’s, the RICE principal was introduced and became the standard treatment for sporting injuries. Since then it has been used for decades by coaches, trainers and health professionals. This acronym that you may have heard of incorporates:
While the consensus and research on this area has been quite mixed, in general there is limited evidence that supports the use of ice with soft tissue injuries, which is traditionally believed to cool down the injured site to delay swelling and improve recovery. More recently, it is suggested that both complete rest and ice, can result in worse clinical outcomes, and delay recovery.
Tissue usually likes to be loaded, to stimulate the repair process and stay healthy. Therefore, complete rest can actually cause tissue wastage, and become weaker.
When soft tissues injuries occur, special cells in the body initiates inflammation at the site of injury to bring in particular hormones to start the healing process. Similar to when inflammation brings in what's necessary to help fight off an infection. Ice is known to cause the blood vessels to constrict, reducing swelling and blood flow to the area, which can potentially last up to a few hours following application. As such, it can disrupt the healing process, and lead to more tissue damage.
PEACE and LOVE
It is now widely accepted to replace the RICE principal with the new acronyms, PEACE and LOVE. This approach is more centered around the person as a whole rather than just the site of injury, and removes absolute rest and icing due to reasons mentioned above.
Immediately following injury, it is important to cease some activity in order to cause no more harm to the body. The PEACE principal can then be followed:
For days 1-3, it is important to restrict some movements to minimise bleeding, and especially ones that may aggravate the injury. Minimise long periods of rest, and use pain as a guide on when to protect the injury and stop an activity.
Raising the injury above the heart, to direct excessive fluid to flow out of tissues
- Avoid anti-inflammatory modalities
As previously mentioned, inflammation actually helps with the repair of soft tissues. Therefore medications and other modalities that disrupts this process can actually negatively affect the long term healing of tissue.
Using tape or bandages to compress the site of injury can help control excessive swelling and bleeding in the area.
Health professionals should be offering education about the injury, setting realistic expectations, and choosing suitable active treatments to help with recovery.
After the first days of injury has passed, soft tissues are then treated with LOVE:
By taking an active approach, optimal loading can promote repair, build tissue tolerance and capacity of the soft tissues. This means returning to normal activities as soon as pain and symptoms allow.
Research shows that being optimistic with recovery can lead to better injury outcomes. Whereas psychological factors such as catastrophising, depression and fear can actually impede recovery.
Pain-free aerobic exercise a few days after injury can help with motivation and increase blood flow to the injured site. Research shows this can improve physical function, return to activity sooner and reduce the pain medication needed by individuals.
Research strongly supports the use of exercise with soft tissue injuries. It can help reduce the chance of re-injury, but also restore joint range, strength and function to the area. Pain can be used as a guide to ensure optimal repair during the early stages of recovery.
The PEACE and LOVE principals offers a new way to help guide the initial management of injuries, and reduce the chance of further damage. For best outcomes, and especially for severe injuries, it is still important to seek help from suitable health professionals, to establish a thorough treatment plan to get your back to your favourite activities and sport sooner.
Bleakley, C., McDonough, S., & MacAuley, D. (2004). The use of ice in the treatment of acute soft-tissue injury: a systematic review of randomized controlled trials. The American journal of sports medicine, 32(1), 251-261.
Collins, N. C. (2008). Is ice right? Does cryotherapy improve outcome for acute soft tissue injury?. Emergency Medicine Journal, 25(2), 65-68.
Dubois, B., & Esculier, J. F. (2020). Soft-tissue injuries simply need PEACE and LOVE.
McGriff-Lee, N. (2003). Management of acute soft tissue injuries. Journal of Pharmacy Practice, 16(1), 51-58
Mirkin, G. (2016). Why Ice Delays Recovery.