PEACE and LOVE: A new approach to soft tissue injuries
The old adage was "RICE" or Rest, Ice, Compression, and Elevation after a pulled muscle. This works great for the initial 1-3 days after an injury, but what about after that? Were we doing a disservice to our patients with these injuries by not giving them enough guidance after the initial 1-3 days?
More recently, we have more information of how muscles heal and rehabilitate after the 1-3 day "acute" period. PEACE and LOVE provides patients with these injuries a framework of how to work through injuries in days and weeks to come. Let's break down what this new acronym means...
Unload/restrict movement for 1-3 days to minimize further damage and promote the initial healing phase. This phase should be minimalized as much as possible to retain as much strength and tissue quality as possible.
Elevate the limb higher than the heart to promote swelling to leave the area of injury. This is a low-risk-to-benefit intervention.
A: Avoid anti-inflammatories
When promoting healing, we WANT inflammation to take place to help repair damaged tissues. There are good and bad inflammatory markers, and anti-inflammatory medication blocks both. Therefore, we want to avoid them at all costs to allow the GOOD inflammatory markers to do their job.
Taping, wraps, or bandages to limit swelling/edema and tissue hemorrhage. Decreasing swelling helps decrease pain.
Modalities such as electrotherapy, manual therapy or acupuncture early after injury have insignificant effects on pain and function compared to an active approach. There is no "magic cure" for soft tissue injuries, unfortunately. An active approach helps promote blood flow, loads the tissue to respond and heal better, and is more engaging. (more on this below)
Mechanical stress to the tissue should be added in early as symptoms allow. We want to work in a range that is not painful and promotes repair and tissue remodeling. This builds tissue tolerance and capacity.
Optimistic outcomes are associated with better outcomes. Limiting symptoms of fear, depression, and catastrophization are important to a decreased time of recovery.
Blood flow to the tissue is a good thing. It brings in nutrients to the tissue and flushes out old nutrients. Find a low-level cardiovascular activity that is relatively pain free helps boost motivation and increase blood flow to the area of injury.
Specific exercises to promote tissue healing and usage while avoiding pain. This helps to ensure optimal repair during the subacute phase of recovery.
As always, if you have questions of how to apply this to an injury or exercises needed for an injury, give us a call or schedule online!
BJSM. (2019, April 26). Soft tissue injuries simply need PEACE & LOVE. BJSM Blog - Social Media’s Leading SEM Voice. https://blogs.bmj.com/bjsm/2019/04/26/soft-tissue-injuries-simply-need-peace-love/