The new way to manage soft tissue injuries - with PEACE & LOVE

You’ve heard of RICER? Have you heard of PEACE & LOVE for soft tissue injury management?

When we or our kids are injured, often we pause and go hang on what are we meant to do again? That's when acronyms come in handy. And although this acronym is a bit longer it takes in a slightly bigger picture of the injury. So let's go through the different parts of PEACE & LOVE

PEACE is applied in the first few days after injury 

P - Protection: avoid movements and activities that cause pain. To try and minimise bleeding and further injury of sore structures. You do not need complete rest. Let rest be guided by the pain but remember prolonged rest can be a hindrance to your recovery

E - Elevate: bring the limb above the heart to promote blood flow from tissues 

A - Avoid anti inflammatories: wait what, that's a bit different to what i’ve been told. So inflammation is actually part of healing so if we stop the inflammation from doing it’s job it may impact our recovery. Ice can have a similar effect so this model is not recommending application of ice in early stages

C- Compress: applied with taping or a bandage this can help limit some oedema and tissue bleeding 

E - Educate: help them understand what has happened. Ensure the injured person knows their options which may help their recovery 

A few days after the injury then we want to give it some LOVE

L - Load: start using the injured area when you can but be guided by pain levels. If possible add an optimal load (without aggravating), it can promote repair, remodelling, capacity building and tolerance of the injured structures 

O - Optimism: Be optimistic about your recovery. Being optimistic is associated with better outcomes. Fear and catastrophizing can be  barrier to your recovery 

V - Vascularisation: pain free aerobic exercise should be started a few days after your injury to help promote blood flow and helps with motivation for recovery 

E - Exercise: Complete exercises to help your proprioception, strength and mobility but avoiding painful exercise 

What was wrong with RICER? 

Well RICER was focusing on the acute care of soft tissue injury but didn’t really consider past the acute stage? There is also a difference in applying ice in the PEACE & LOVE model but some things are similar including compression and elevation. 

Source:  Dubois B, Esculier J- F. Br J Sports Med 2020;54:72–73.