In the past, when someone had an acute soft tissue injury, general advice was to follow the PRICE method (Protect, Rest, Ice, Compression, Elevation). For example, if you rolled your ankle playing basketball, you had the ankle wrapped, iced and were told to rest, take
anti-inflammatories and elevate until the pain went away. After this, most people returned to their usual activities.
However, current research suggests that the PRICE method can actually delay healing and increase reinjury risk in the future. To treat acute soft tissue injuries, the current advice is to follow the PEACE and LOVE method. This helps speed up the healing process, return to safe activity/sports faster and decrease injury risk. An important note to keep in mind is that this method does not apply to bone injuries (i.e., breaks, stress fracture or complete ligament tears). These injuries most often require rest and bracing for prolonged periods of time.
When an injury occurs (i.e., rolling ankle, muscle strain/tear, pulled muscle), the body starts the healing cascade. This is a complex process but in simple terms, inflammatory cells come to the injury site to initiate tissue repair and protect the area. If this response is delayed by taking too many anti-inflammatory medications, this delays the healing process. Additionally, while using ice can help with pain relief/numbing the area, it can also disrupt the inflammatory cycle needed to start recovery.
PEACE stands for Protect, Elevate, Avoid anti-inflammatories/icing, Compression, Education. While this is similar to PRICE, the advice is to only follow PEACE for the first few days of injury. We first want to protect the injury site by unloading the injured body part and avoiding activities that increase pain. This can help reduce risk of further damage. You can elevate and wrap the injury site as needed to reduce swelling, but make sure not to restrict full range of motion in the injured joint when providing compression. Additionally, education plays a big role in recovery.
Find a healthcare provider (PT, trainer, orthopedist, etc.) who provides proper education about how to start the healing and recovery process, which should include the LOVE principles: Load, Optimism, Vascularization, Exercise. This involves gradual optimal loading of the injury site, ideally with the help from a healthcare professional.
After the first few days of PEACE, we now want to load the area in pain free and/or tolerable ranges. This may not look like your usual workouts but can include table/mat, body weight, range of motion or mobility exercises. Over time, the load should increase appropriately with gradual return to your prior level of function.
We also want to focus on optimism. When an injury occurs, a big barrier that can delay recovery is psychological; i.e., fear of reinjury, fear that pain will never go away, or catastrophizing (an exaggerated, negative response brought on by a painful experience). This can lead to feeling helpless and depressed, which can definitely delay recovery. While it’s important to stay realistic about recovery timelines, it’s also important to find ways to maintain optimism throughout the process.
A good way to keep the feelings of helplessness at bay is through optimal loading and exercise. Exercise gives you the opportunity to stay in control of your recovery and puts you back in the driver seat. Instead of relying on medication and resting on the couch for weeks feeling helpless, movement becomes the medicine. Additionally, seeking guidance from mental health professionals can be very helpful.
The last two letters represent revascularization and exercise. Revascularization involves cardiovascular exercise (i.e., pain free aerobic activities). If you injured yourself running and have to take a break to heal while in PT, try modifying your aerobic exercise with biking or swimming. This helps increase blood flow to the damaged tissues to promote healing. Additionally, exercise involves restoring range of motion, strength and balance early on. This goes hand in hand with optimal loading and can help with staying optimistic, increasing confidence in your ability to regain strength.
In summary, try to avoid excessive anti-inflammatory medication use and ice and start performing active recovery and gentle movement. Recovery is not just about numbing the area and pain management. Prolonged rest (“wait and see” method) compromises tissue strength and flexibility. Healing involves appropriate loading of the area so you can gradually return to sports or other activities. Optimal gradual loading of tissues can help increase tissue repair and reduce reinjury risk. Physical therapy can help appropriately load the injury site and start restoring range of motion, mobility and strength as well as speed up recovery/return to sport safer and faster.
Not sure where to start or have any questions? Book a consult with your friendly neighborhood physical therapist.
Jenny is a local private physical therapist and owner of Next Step PT. She specializes in general orthopedics for adults and teens, is a pelvic floor specialist, works with pregnancy and postpartum women, is a running gait analyst, and more. For a free PT consultation or more information, contact [email protected].
