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Peace and Love (or, a new way with soft-tissue injuries)

How often have you been told to ‘RICE it’? Or, possibly, ‘PRICE it’? These are approaches to the treatment of a soft tissue injury in its initial, acute stage. Soft tissue injuries are damage (such as a twist or a tear) to muscles, tendons, or ligaments, often called sprains or strains. The original R, I, C and E stand for Rest, Ice, Compression and Elevation. Over time, a P was added for ‘Protect’ (which means avoiding loading on the injured part, for example by using crutches or a boot for a lower leg injury). Many people also use anti-inflammatories such as ibuprofen to reduce the swelling from a soft tissue injury.

I had heard about new guidance on treating soft tissue injury called ‘PEACE & LOVE’. This protocol makes some adjustments to treatment in the acute stage and goes further in explaining how to safely return to activity. I had the opportunity to try the protocol out recently when I strained a muscle in my back – and was surprised by the genuine difference it seemed to make to the pace of my recovery. Below I outline the stages of PEACE & LOVE and explain how I applied them.

P is for Protect. As in PRICE, in the first step is to look after the injury site. Try to avoid loading it for one to three days, to prevent further damage, and to reduce bleeding. With my back injury I took three days of complete rest, until pain levels had dropped to a point where I could comfortably walk a short distance.

E is for Elevate. Again, the protocol follows PRICE in the early stages. Elevating the limb is thought to allow some of the fluid from the injury site to drain away. This was tricky in the case of my back, but if you’ve injured an ankle or foot, it’s easier to follow this one.

A is for Avoid. Now we deviate from RICE. New evidence suggests that the use of ice and anti-inflammatories, while initially reducing swelling, may in fact slow down healing in the long term, as inflammation is the body’s efforts to heal the torn tissues. In my case I didn’t ice at all, and I used only a small amount of ibuprofen gel when the pain was particularly bad. Once I could manage the pain, I stopped using the gel.

C is for Compression. This one is also still recommended to limit further damage while still allowing the injured area a full range of movement. Also difficult for a back injury, so I skipped this step!

E is for Educate. Educate is about learning to allow our body to do its thing. At the acute, early stage of the injury, we don’t need unnecessary interventions such as massage or acupuncture. Our body will heal itself if we give it chance. I chose not to visit a doctor or physio because I was 95% sure my injury was a simple soft tissue problem. You should still seek medical advice if you’re not sure, or if your pain doesn’t improve.

The key difference then, for the initial management stages, is the avoidance of intervention and the idea of allowing inflammation to happen, because this is the start of the healing process. After the first few days of PEACE, we can move on to LOVE.

L is for Load. As soon as we can, we need to begin re-loading the joint. Too much rest will not help us now; the injury site might become stiff and muscles will start to weaken. The key is appropriate loading. This might be very small amounts of activity, at a greatly reduced intensity level. On day four of my back rehab, I took two 30-minute walks, which was more than enough at that point.

O is for Optimism. There is research evidence which shows that our mental approach to injury is as important or maybe even more important than the physical steps. Catastrophising, depression and fear can all slow down the healing process. This means we need to be realistic but optimistic about our healing journey. Rehabbing my back was the first time I had actively and consciously tried this approach, and I was astonished by the effectiveness – I healed more quickly than I’d expected, and I experienced little frustration, fear or upset about the injury.

V is for Vascularisation. We need to promote blood flow through the injury site. Blood is what heals the damaged tissues, so even if you’re not able to do your usual activity, doing something else which gets your blood moving around the body will help the healing. I was able to walk without too much pain, so I swapped my usual run sessions for gentle walks.

E is for Exercise. As the healing progresses, specific exercises may help to return strength, function, and mobility to the injured area. This will also help to avoid re-injury. As with loading, pain should be used as a guide to how much exercise is good, and at this point it could worth seeing a physio to establish which exercises will most help you. I focused on mobilising exercises – gentle twists and rotation which encouraged my muscles to start moving again.

As you can see, a key difference between the two approaches is in the inclusion of the return to activity in LOVE. We shouldn’t keep on resting, icing and taking anti-inflammatories, and then hope to bounce straight back to normal training a few weeks later. Instead we need to slowly ease back in, using the body’s pain response to guide us. This is an inherently more thoughtful approach that requires us to be honest with ourselves, and in tune with our bodies. We have to really pay attention to the body’s signals. The other big difference is the acknowledgement of the mental aspect of healing in LOVE.

Please note that I’m not a healthcare professional, and as such I can’t give you medical advice. This blog outlines my own experience of trying this approach – you should discuss your treatment with your doctor or physio.

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