This is a very hot topic in the medical and sporting world at the moment. The old school RICE has been physically outdated to the new term PEACE LOVE. However practitioners and MDs are torn apart on which one to use as both have seen results.
So the classic terminology that we all know and grew up with is the RICE acronym –
REST –
Stop the activity as soon as you’re hurt, and rest as much as possible for the first 2 days
ICE –
Apply an ice pack (covered with a light, absorbent towel to help prevent frostbite) for 15-20 minutes every two to three hours during the first 24 to 48 hours after your injury.
COMPRESSION –
Wrap the injured area to prevent swelling. Wrap the affected area with an elastic medical bandage (like an ACE bandage). You want it to be snug but not too tight — if it’s too tight, it’ll interrupt blood flow
ELEVATE –
Raising the injured body part above the level of your heart.
This acronym has been used and taught all over the world for soft tissue injuries. This is what we have known and been told since a young age.
SO WHAT HAS CHANGED?
The British Journal of Sports Medicine mid 2019 proposed a new acronym for the management of soft tissue injuries – Peace & Love (Dubois and Esculier, 2019).
This acronym covers the whole recovery basis from immediate care (PEACE) to subsequent management (LOVE). This is definitely a change from the RICE method because RICE really only focused on the acute management of soft tissue injuries and does not really provide any information on what to do after the first couple of days. Whereas Peace and Love covers the whole recovery basis from immediate care (PEACE) to subsequent management (LOVE).
So let’s dig a little deeper into this protocol and what it actually stands for?
PROTECT
Unload or restrict movement for 1–3 days
Minimize bleeding,
Reduces risk of aggravating injury
Prevent distension of injured fibers
Minimize rest because it can compromise tissue strength and quality.
Let pain guide the cessation of protection.
ELEVATE
Elevate the affected area higher than the heart
AVOID ANTI-INFLAMMATORY MODALITIES
This is the biggest difference from the RICE protocol
Anti-inflammatory medications may negatively affect long-term tissue healing
Optimal soft tissue regeneration is supported by the various phases of the inflammatory process
making use of medications to inhibit the inflammatory process could impair the healing process
AVOID ICE
Use of ice is mostly analgesic >> like taking a panadol
Although it is widely accepted as an intervention there is very little high quality evidence that supports the use of ice in the treatment of soft tissue injuries
Ice may potentially affect the healing process of the affected tissue because
It disrupts inflammation, angiogenesis and revascularization,
Delays neutrophil and macrophage infiltration
As well as increase immature myofibers
COMPRESS
External mechanical pressure using taping or bandages helps limit intra-articular oedema and tissue haemorrhage
EDUCATE
Therapists should educate on the many benefits of an active approach to recovery instead of a passive approach
Early passive therapy approaches such as electrotherapy, manual therapy or acupuncture after an injury has a minimal effect on pain and function when compared to an active approach
Better education on the condition and load management will help avoid overtreatment
After the first days have passed, soft tissues need LOVE.
LOAD
Patients with soft tissue injuries and other muscle related injuries benefit from an active approach with movement and exercises
Normal activities should continue as soon as symptoms allow for it
Optimal loading without increasing pain
Promotes repair and remodeling
OPTIMISM
Optimistic patient expectations are associated with better outcomes and prognosis
Barriers of recovery include psychological factors such as: catastrophization, depression and fear.
Research shows that these factors may more explain the change in symptoms and limitations after an ankle sprain than the degree of the actual injury
VASCULARISATION
- Injury management needs to include cardiovascular physical activity
- However more research is needed on specific dosage
- Pain-free aerobic exercise should be started a few days after injury to boost motivation and increase blood flow to the injured structures
Benefits of early mobilisation and aerobic exercise in people with injuries include
- Improvement in function
- Improvement in work status
- Reduces the need for pain medication
EXERCISE
- There is a strong level of evidence supporting the use of exercise for the treatment and reducing the prevalence of recurrent injuries
- Exercises 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 exercise progressions.
It would be to not take any anti-inflammatory medications such as voltaren, ibuprofen for the first 3-5 days.
With icing however it depends if the pain is too severe then I would recommend icing to allow a faster return to basic movement and reduction in pain, however if the pain is bearable then avoid the icing process all together and base your recovery around the new acronym PEACE & LOVE.
Hope this gives you a bit more insight on the two different acronyms and to consider not only the short-term but also the long term impact of the injury and it’s recovery process.
And as always have a good day
– Aarvi
#MakingHealthySimple
References
Healthguideline. (2020). Rice Protocol for injured part [Image]. Retrieved from https://www.healthguideline.net/2019/10/rice-protocol.html
Dubois B, Esculier J. Soft-tissue injuries simply need PEACE and LOVE. British Journal of Sports Medicine 2020;54:72-73.
Peace and Love Principle. (2020). Retrieved 20 August 2020, from https://www.physio-pedia.com/Peace_and_Love_Principle
I, Wiles L, Waller R, Goucke R, Nagree Y, Gibberd M, Straker L, Maher CG, O’Sullivan PP. What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. British journal of sports medicine. 2020 Jan 1;54(2):79-86
Bleakley CM, Glasgow P, MacAuley DC. PRICE needs updating, should we call the POLICE? British Journal of Sports Medicine 2012;46:220-221.