Rethinking RICE with Some Good Ol' PEACE & LOVE

When I think of the phrase “peace and love” my brain floods with faded photo album images of my hippy parents in the early ’70s, clad in faded denim bell-bottoms and an army jacket with pot leaf patches sewn on the sleeves. Other images of Cheech and Chong, roller rinks, and the early beats of funk and disco find their place in my mind’s eye as well. But all hippy stereotypes aside, “peace and love” is a beautiful thought when applied correctly.

Today I won’t be talking about the sentiments of “peace and love,” but rather the real applications of PEACE & LOVE Yep, in all capitals.

When it comes to soft tissue injuries, I’m sure most of you are familiar with the ol’ rest, ice, compression, and elevate or RICE method of healing. This has since evolved into PRICE and POLICE since my early high school sports days, but the British Journal of Sports Medicine has created two new acronyms that are tailored to optimize soft tissue recovery. This is the kind of PEACE & LOVE I’m talking about.

Designed to be used as a timeline of care, PEACE refers to the immediate action a soft tissue injury requires, while LOVE is focused on the subsequent management. We are stoked about these new acronyms because they include the psychological requirements and benefits in order to heal optimally. Furthermore, PEACE & LOVE outlines the potential harms that anti-inflammatory drugs traditionally used to manage pain may pose to your soft tissue’s overall recovery. Below is the short and sweet version of PEACE & LOVE; more resources will be provided at the end so you can keep on learning!

Immediately after a soft tissue injury, do no harm and let PEACE guide your approach

P for Protect

Give yourself a little time to unload or restrict movement for 1 to 3 days to minimize bleeding, prevent distension of injured fibers, and reduce risk of aggravating the injury. However, remember to appropriately minimize this part- too much rest can impact your muscle tone and strength. A decrease in pain can be a good indicator of when the protect phase is coming to an end (Bjsm, 2019).

E for Elevate

An oldie, but a goodie. Elevate the limb higher than the heart to promote interstitial fluid flow out of the tissue (Bjsm, 2019).

A for Avoid anti-inflammatory modalities

Although popping an Advil or three may not seem harmful, anti-inflammatory medications may potentially be detrimental for long-term tissue healing. Did you know the phases of inflammation contribute to optimal soft tissue regeneration? Interfering with such an important process using pharmacological modalities is not recommended as it could impair tissue healing, especially when a higher dosage is taken (Bjsm, 2019).

On that note, use ice sparingly. Using ice to reduce inflammation can have the same effects on natural stages that actually help to heal our soft tissues, not to harm them (Bjsm, 2019).

C for Compress

Taping or bandaging your injury helps limit intra-articular edema and tissue hemorrhage. Despite conflicting studies, compression after an ankle sprain seems to reduce swelling and improve quality of life (Bjsm, 2019).

E for Educate

Therapists should educate patients on the benefits of an active approach to recovery. Passive modalities such as electrotherapy, manual therapy or acupuncture, early after an injury have a trivial effect on pain and function compared with an active approach; it may even be counter-productive in the long term. Indeed, nurturing the ‘need to be fixed’ can create dependence to the therapist, be a significant nocebo, and thus contribute to persistent symptoms. Better education on the condition and load management will help avoid overtreatment which has been suggested to increase the likelihood of injections or surgery and higher costs to healthcare systems because of disability compensation (e.g. in low back pain). In an era of technology and hi-tech therapeutic options, we strongly advocate for setting realistic expectations with patients about recovery times instead of chasing the magic treatment approach (Bjsm, 2019).

After the first days have passed, soft tissues need LOVE

L for Load

You have to keep moving! Mechanical stress should be added early and normal activities resumed as soon as symptoms allow. Optimal loading without exacerbating pain promotes repair, remodeling and building tissue tolerance and capacity of tendons, muscles, and ligaments through mechanotransduction (Bjsm, 2019).

O for Optimism

Soft tissue injuries often become a mind over matter situation. Psychological factors such as catastrophization, depression, and fear can create barriers to recovery. Patients with negative expectations are also associated with suboptimal outcomes and worse prognosis. While staying realistic, practitioners should encourage optimism to enhance the likelihood of an optimal recovery (Bjsm, 2019).

V for Vascularisation

It’s imperative to resume cardiovascular activity to manage musculoskeletal injuries. It is recommended that pain-free cardiovascular activity should be started a few days after injury to boost motivation and increase blood flow to the injured structures. Early mobilization and aerobic exercise improve function, work status and reduce the need for pain medications in individuals with musculoskeletal conditions (Bjsm, 2019).

E for Exercise

There is a strong level of evidence supporting the use of exercises for the treatment of ankle sprains and for reducing the prevalence of recurring injuries. Exercises will help to restore mobility, strength, and proprioception early after injury. Pain should be avoided to ensure optimal repair during the subacute phase of recovery and should be used as a guide for progressing exercises to greater levels of difficulty (Bjsm, 2019).

Soft tissue injuries are just as much about the long-term as they are the short-term. It is vital that clinicians and practitioners treat their patients as the person who is injured rather than simply as an injury associated with a person. There are many mental, emotional, environmental, and physical factors that go into optimizing the recovery of a soft tissue injury. For more about PEACE & LOVE and the minds behind the acronym, follow the link below:

https://blogs.bmj.com/bjsm/2019/04/26/soft-tissue-injuries-simply-need-peace-love/

References:

Bjsm. (2019, April 30). Soft tissue injuries simply need PEACE & LOVE. Retrieved from https://blogs.bmj.com/bjsm/2019/04/26/soft-tissue-injuries-simply-need-peace-love/