The best protocol for management of soft tissue injuries: RICE VS PEACE & LOVE

Introduction

So you’ve just rolled your ankle and it's quite sore and becoming the size of a soccer ball …OUCH !! You’re probably thinking back to PDHPE class in school, when you were taught the RICE principle and are saying to yourself, "I know what to do, this should be a piece of cake." But how current are you with the latest protocols for managing acute soft tissue injuries? There’s a new acute soft tissue management protocol and your physiotherapist from Stay Active Longer is going to explain if RICE still plays a role in your initial rehabilitation or if PEACE & LOVE is the new way to manage sprains and strains better.

Physiotherapist Prash implementing gradual active treatment in the rehabilitation plan to restore client function and strength!

History - How were soft tissue injuries managed?

The acronym RICE (Rest, Ice, Compression, Elevation) was first published in The Sportsmedicine Book in 1978 to help treat sports injuries and gained widespread acceptance in the fitness and rehab industry.

Since then however, it has been discovered that the RICE approach may in fact be delaying healing as rest and ice can reduce the effectiveness of our bodies natural processes that heal damaged tissue ie inflammation.

In 2019, the British Journal of Sports Medicine published an article on ‘Soft Tissue Injuries simply needing Peace & Love” with the intent of emphasising a more holistic approach to address the development of sub-acute and chronic pain relating to acute soft tissue injuries. 

To understand the relevance of the acronyms RICE and PEACE and LOVE and the appropriate implementation of them, we need to first understand what they abbreviate. So let’s break them down to understand each of these processes and the pros and cons of each. 

The R.I.C.E. Method for managing soft tissue injuries

R.I.C.E. has been a staple process/acronym that has carried the first line of care for acute soft tissue injuries for many years. Here’s what it stands for and entails:

1. Rest: Avoid activities that cause pain or exacerbate the injury. Rest is essential to prevent further damage and to begin the healing process.

2. Ice: Apply ice to reduce swelling and numb the pain. Ice should be applied for 15-20 minutes every 1-2 hours during the initial 48 hours.

3. Compression: Use compression bandages to help reduce swelling and provide support to the injured area.

4. Elevation: Elevate the injured area above heart level to help reduce swelling by allowing fluids to drain away from the injury site.

   
   

Pros of R.I.C.E.:

• Widely known and practiced

• Simple and easy to implement 

• Effective in the immediate aftermath of an injury to reduce swelling and pain.

Cons of R.I.C.E.:

• May not address all aspects of injury recovery.

• Rest can lead to muscle atrophy if prolonged.

• Ice may reduce blood flow and potentially slow healing in some cases.

The P.E.A.C.E. & L.O.V.E. Method for managing soft tissue injuries

The P.E.A.C.E. & L.O.V.E. method is a more recent approach that focuses on optimizing recovery through a comprehensive, long-term strategy:

P.E.A.C.E. stands for:

1. Protection: Protect the injured area from further harm but avoid complete immobilization.

2. Elevate: Elevate the injured area to reduce swelling, similar to R.I.C.E.

3. Avoid Anti-Inflammatories: Avoid using non-steroidal anti-inflammatory drugs (NSAIDs) as they may interfere with the natural healing process.

4. Compression: Apply compression to control swelling, similar to R.I.C.E.

5. Education: Educate the patient about the injury and the importance of gradual, controlled movement.

   
   

L.O.V.E. stands for:

1. Load: Gradually load the injured area with appropriate activities to stimulate healing and regain strength.

2. Optimism: Maintain a positive attitude to aid in recovery and adherence to rehabilitation protocols.

3. Vascularization: Encourage activities that improve blood flow and healing, such as gentle movement and exercises.

4. Exercise: Engage in controlled exercises to restore function and prevent stiffness.

Pros of P.E.A.C.E. & L.O.V.E.:

• Promotes a balanced approach to injury recovery, combining protection with early and controlled movement.

• Encourages gradual loading and exercise, which can enhance healing and reduce long-term dysfunction.

• Avoids potential downsides of NSAIDs, such as interfering with the inflammatory healing process.

Cons of P.E.A.C.E. & L.O.V.E.:

• May be less familiar to practitioners and patients accustomed to R.I.C.E.

• Requires careful management and understanding of when and how to begin loading and exercising the injured area.

So now that we know what the acronyms RICE and PEACE AND LOVE stand for, what is the best way to manage acute soft tissue injuries? - Read on to hear from a physiotherapist's point of view!

Soft Tissue Injuries Simply Need Peace and Love - British Journal of Sports Medicine

Discussion

R.I.C.E. and P.E.A.C.E. & L.O.V.E. are just two acronyms of many that individuals and professionals will use to manage acute soft tissue injuries but P.E.A.C.E. & L.O.V.E is the latest approach when managing acute soft tissue injuries.

Pain is our bodies way of communicating with us and telling us that something is wrong. Pain shouldn't be ignored for this reason as you would want to implement the best strategy to overcome injury and maintain optimal wellbeing and quality of life.

Following an acute injury, resting ie not weight-bearing for 24-48 hours post injury is an appropriate response if you are in significant levels of pain and if there is a lot of swelling to the injured area. Rest may look something like taking a couple days off from training while the swelling and pain subsides. If the swelling and pain is tolerable, rest could like something like you taking small frequent breaks during the day i.e. sitting down after every hour if you are always on your feet.

Traditionally, it was recommended to ice the injured area for 20 min every 2 hours during the first day or two of the injury. Prolonged and extended ice use increases the risk of tissue damage. It is more appropriate now to use ice sparingly so applying ice for 10 minutes to the injured site and stopping for 20 min and repeating this process one or two more times only.

The R.I.C.E. method, although a little dated, can still have its place for injuries like sprains and for individuals who may experience significant pain symptoms. It is important to note however that research is suggesting that rest and ice can slow healing time frames and implementing movement and exercises that don't cause pain can promote healing. P.E.A.C.E. can be the method used during the first 3 days of the injury and LOVE on day four and onwards to gradually expose the injured tissue to load and function.

What is important to take into account however are factors like patients reported levels of pain, age, fitness and medical history as one approach may not be appropriate for everyone. If you cannot weight bear and pain and swelling isn't improving after 3 days, it is important to seek Medical advice.

Conclusion

So let's back track...you’ve rolled your ankle, there’s a lot of swelling and pain. How should you manage this? Based on what you’ve just read, you can infer that you could go with either R.I.C.E. or the P.E.A.C.E. & L.O.V.E. approach. In the end it comes down to where you are in the recovery process and your unique circumstances. One singular approach doesn't work for every body.

If you are concerned about pain, you need to ask yourself how much pain you are in and what level of pain you can tolerate. If your pain levels are a 4/10 and you can weight-bear for example, the approach you take will be different compared to a person who feels a pain level of 8/10 and cannot bear weight on their foot. If you want to rehab your injury well, you’d want to consider some of the elements of P.E.A.C.E. & L.O.V.E. allowing natural healing processes to take place acutely, and implementing loading strategies to sustain this as you begin to progress towards pre-injury activity.  Prolonged rest and extended use of ice can slow healing time.

If you do happen to get stuck, this is where you’re probably best off seeking help from a professional who will conduct a thorough examination of the cause, nature and state of your injury, where you are in your recovery process, and how to get you towards your best outcome/goal. A physiotherapist is one health professional you can consult who can help you do this. 

If you'd like myself or a member of our team to help you manage any injuries or provide you with guidance on how to get back to your best active self, give us a call on 0421 944 301 or book in through our website.

Soft Tissue Ankle Injuries are a very commonly treated injury at Stay Active Longer!