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PEACE & LOVE - A Kinder Approach to Soft-tissue Injuries
A contemporary approach to soft tissue injury management
Note: Soft tissue injuries, such as those in this blog are recommended to be treated with guidance from a health-professional including any of our friendly physios, and not this blog alone
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In this blog, we are going to explore a new proposed acronym for dealing with sprains, strains, bumps and bruises.
In a recent paper by Dubois and Esculier, a new acronym was proposed for dealing with the management of soft tissue injuries - P.E.A.C.E & L.O.V.E
Previous acronyms guiding acute management of soft tissue injuries
• R.I.C.E (rest, ice, compression, elevation)- Coined by American sports doctor Dr Gabe Mirkin in 1978
• P.R.I.C.E (protection, rest, ice, compression, elevation)
• P.O.L.I.C.E (protection, optimal loading, ice, compression, elevation)
Why is a new acronym is required?
• Previous acronyms focus on initial management, ignoring long term outcomes.
• Anti-inflammatories (e.g. ice and non-steroidal anti-inflammatories such as ibuprofen) may have a potentially harmful effect on optimal tissue repair.
• The PEACE and LOVE acronyms encompass the rehabilitation continuum from immediate care to subsequent management.
PEACE
“Immediately after injury, do no harm and let PEACE guide your approach"
P for Protect
• Unload or restrict movement for 1-3 days to minimize bleeding, prevent swelling of injured fibres and reduce the risk of aggravating the injury.
• Rest should be minimised as prolonged rest can compromise tissue strength and quality.
• The level of pain should guide when to wean off protection
E for Elevate
• Elevate the limb higher than the heart to promote fluid flow out of tissues.
• Evidence is weak for the support of this technique, but there are minimal risks and potential benefit.
A for avoid anti-inflammatories and ice
• The various phases of inflammation help repair damaged soft tissues.
• Reducing inflammation using medications and ice may negatively affect long-term tissue healing.
C for compress
• External mechanical pressure using taping or bandages helps limit swelling and bleeding.
• Compression after an ankle sprain seems to reduce swelling and improve quality of life.
E for educate
• Patients should be educated on the benefits of an active approach to recovery.
• Passive modalities (e.g. manual therapy, such as massage and joint mobilisation) early after injury have insignificant effects on pain and function compared with an active approach and may be counterproductive in the long term.
• Better education on the condition and load management will help avoid overtreatment and in turn, reduces the risk of unnecessary injections or surgery.
• Set realistic expectations with patients about recovery times instead of chasing the “magic cure” approach.
LOVE
“After the first days have passed, soft tissues need LOVE"
L for load
• An active approach with movement and exercise benefits most patients with musculoskeletal disorders.
• Mechanical stress should be added early, and normal activities resumed as soon as symptoms allow.
• Optimal loading without exacerbating pain promotes repair and recovery.
O for Optimism
• Optimistic patient expectations are associated with better outcomes and prognosis.
• Psychological factors such as catastrophizing, depression and fear can represent barriers to recovery.
• Beliefs and emotions are thought to explain more of the variation in symptoms following an ankle sprain, rather than the extent of the injury.
V for Vascularization
• Pain free aerobic exercise should be started a few days after injury to boost motivation and increase blood flow to the injured structures.
• Early mobilization and aerobic exercise improve physical function, supporting return to work and reduce the need for pain medication.
• Further research is required on dosage.
E for exercise
• Exercise helps to restore mobility, strength, and joint positional awareness, early after an 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.
Take Home Message
Managing soft-tissue injuries is more than short term damage control and needs to also look at long term outcomes. The "Peace and Love" approach demonstrates a new proposal for managing these long-term outcomes.
References
• https://www.physio-pedia.com/Peace_and_Love_Principle#cite_note-:1-1
• Dubois B, Esculier JF. Soft-tissue injuries simply need PEACE and LOVE. Br J Sports Med. 2020 Jan;54(2):72-73. doi: 10.1136/bjsports-2019-101253. Epub 2019 Aug 3. PMID: 31377722.
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