At some point in your life, particularly if you’ve sprained an ankle/wrist or had a muscle strain, you were likely advised by a parent, coach, trainer, doctor, etc. to follow the RICE protocol. RICE = Rest, Ice, Compression, Elevation. Sound familiar? The idea behind this protocol was essentially to prevent further injury and manage swelling and pain - all good things. Over the past few years, the sports medicine and rehab community has been making efforts to shift away from the RICE protocol. Why? Well, the research gathered over time (we are scientists after all, so we have to pay attention to the research!) doesn’t strongly support that all of the pieces of RICE are actually doing what we intended. And, these principles don’t guide us in what to do beyond the first few days after injury! There is such a thing as too much rest, and the whole point of exercise and rehab is that movement is medicine. Though more of a mouthful, the new guidelines below help break down what is thought to be better advice immediately following injury, and also into the subacute healing period in the following weeks. Keep in mind, this is meant to apply to soft tissue injury, not necessarily to cases of surgery or fractures!
“Immediately after injury, do no harm and let PEACE guide your approach”
PEACE = Protect, Elevate, Avoid Anti-Inflammatories, Compress, Educate
Protect
For a few days avoid activities that increase pain, but DO keep moving the area of injury! Let pain be your guide to what is too much vs. what feels okay.
Elevate
A few times per day, elevate the limb higher than the heart to manage swelling
Avoid Anti-Inflammatories
The body goes through its own inflammatory processes at the cellular level in order to self-heal. Use of anti-inflammatories can interrupt this process.
Don’t be attached at the hip (or ankle, wrist, etc.) to an ice pack! Ice can numb the injured area, but similar to use of anti-inflammatory medications, overuse can negatively affect the body’s ability to self-repair.
Compress
Athletic taping or compression bandages can help with swelling management, but shouldn’t fully restrict movement. By managing swelling and pain this should actually help facilitate light activity!
Educate
This is really where we come in :) It’s our job to educate the patient on what the injury is, what our treatment plan is, and why that is. We need to educate on how to make progress through this PEACE phase and work together to set realistic expectations about recovery!
“After the first days have passed, soft tissues need LOVE”
LOVE = Load, Optimism, Vascularization, Exercise
Load
Begin easing back into normal activities as soon as pain allows! Progressively stressing/loading the tissue promotes repair.
Optimism
The brain rules everything, so we can’t ignore the mental injury that happens with a physical injury. After setting realistic expectations with Education back in PEACE, now we work to keep you optimistic to get the best outcome!
Vascularisation
Pain-free cardiovascular/aerobic activity helps boost you psychologically and also increases blood flow to the injured tissues
Exercise
Specific exercises for your injury should be used early on to restore mobility and strength. Continue to minimize pain and use that tolerance to guide how we progress exercise!
Did you tweak something recently and have questions if your body now needs some PEACE or LOVE? Come see us! For more information and scheduling, call (857) 267-6033 or email dinalucchesi@coreptp.com
For more detailed information about PEACE and LOVE, check out these sources which helped me to write this post!