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1.10 PEACE & LOVE: Management of soft-tissue injuries

ICE, RICE, PRICE, POLICE, POLICE-CANAI... It’s time to integrate a little more rigor and kindness into the treatment of musculoskeletal injuries. There are many changes to be made: forget about the “I” (Ice), emphasize the importance of psychology, consider the nocebo effect of hypermedicalization and, finally, present the steps in their order of application. The acronym has now been updated in light of the most recent scientific advances in the field.

 

It is with much love and peace of mind that we propose this refined acronym, PEACE & LOVE. Think about it when dealing with an ankle sprain, a hamstring tear or any other musculoskeletal injury!

 

 

 

 

 

PEACE brings together the therapeutic components that should be used in the short term. At the very beginning, protect (P) the injured structure by eliminating the painful stressors, which can be done by reducing the load on the injured limb or avoiding the use of certain muscles. Elevate (E) the leg higher than the heart to help minimize stagnation of distal fluids. Optimizing healing also means letting nature take its course. Therefore, it is important to avoid anti-inflammatory (A) drugs such as ibuprofen, diclofenac and naproxen - over-the-counter or prescription-, as they slow down tissue healing. You should even avoid applying ice. Compress (C) the injured area using taping or a bandage to decrease swelling. It is also essential to ensure patient education (E) on the risks of overtreatment. This will help avoid repeated passive “treatment” sessions with healthcare professionals, costly, stressful and often useless imaging as well as non-essential medications.

 

The degree of the sprain or tear will in part determine the time required to resume exercise. A few days after the injury, think about “LOVE”. Gradually adding load (L) will facilitate the return to normal activities and promote healing. Guide the progression by listening to your body (avoid increases in pain and swelling). The brain also plays a key role in the healing process. Stay optimistic (O) as it directly influences the perception of pain and recovery speed, which could reduce the risk of persistent pain. As soon as Day 3 post-injury, pain-free cardiovascular exercise can be resumed, as much as twice a day for 20 minutes, to facilitate vascularization (V) of the injured tissues. Finally, choose an active approach to recovery. Stretching, strengthening and balance exercises (E) can help recover range of motion, strength and proprioception.

PEACE & LOVE!

 

 

See our editorial in the British Journal of Sports Medicine for more details and scientific references: Click here