Traditionally, the recommended management for soft tissue injuries has been the RICER, RICE or PRICE methods. These models however only accommodate for the acute management of these injuries (0-72 hours after injury, depending on severity). A new model of soft tissue management has been proposed recently, suggesting that these injuries need PEACE and LOVE.
These acronyms are elaborated on below, and in the graphic:
P – Protect the injured area by unloading the area for 1-3 days post-injury. Unloading should be kept to a minimum based on severity, so as to reduce loss of tissue strength and quality.
E – Elevate the affected limb to promote interstitial fluid flow out of the area.
A – Avoid anti-inflammatory modalities (neurofen, voltaren, both gel and oral applications) as these can be detrimental to tissue healing.
C – Compression to affected area, via bandaging or compression bandage – helps to limit joint swelling and reduce loss of range of movement.
E – Education provided by health professional, a crucial part of injury management! An active approach to recovery should be encouraged, including strength-based rehabilitation exercises. Passive modalities (soft tissue massage, acupuncture/dry needling, and electrotherapy) should be avoided if possible, as there is limited evidence to support these in rehabilitation. Realistic goals and time frames for recovery should be set, and patient workloads managed accordingly.
AND after initial management of injury:
L – Load the area, gradually and as tolerable. An active approach to therapy via exercise is beneficial to most musculoskeletal injuries. This promotes tissue healing, tissue remodelling and helps improve the tissue tolerance to further loading in future.
O – Optimism! A positive outlook towards rehabilitation has a massive impact patient prognosis. Focusing on pain, catastrophising (thoughts that it will never recover), depression and fear can lead to poorer OR longer recoveries.
V – Vascularisation – get the limbs moving to promote blood flow in and out of the area. Some early cardiovascular exercises (walking, running, cycling, swimming are good examples) can help improve tissue recovery and pain, and also serves to help improve patient motivation.
E – EXERCISE!!! There is strong levels of evidence for exercise as therapy in musculoskeletal injuries, to help restore mobility, strength and proprioception of the affected area.
Injury management is more than just short term damage control! Clinicians working with injured individuals should all aim to treat the person with the injury, and not just the injury of the person.
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Rehabilitation of soft tissue injuries can be complex. Over the years, acronyms guiding their management have evolved from ICE to RICE, then to PRICE and POLICE. Although widely known, the evidence supporting the elements of these treatments is limited.
We posit that two new acronyms can optimize recovery. Our acronyms encompass the rehabilitation continuum from immediate care (PEACE) to subsequent management (LOVE).
Article source: Blaise DuBois and Jean-Francois Esculier, & British Journal of Sports Medicine.