PEACE and LOVE in your recovery
Almost everyone is familiar with the acronym RICE for an acute injury. Recent guidelines, however, recommend PEACE and LOVE instead.
RICE, involves the protocol of Rest, Ice, Compression, and Elevation. These guidelines are most pertinent for acute injuries only, and unfortunately folks have applied parts of it–usually the ice–for far too long after the initial phase. “PEACE and LOVE,” as first described by Dubois and Esculier1 offer a more complete care protocol and address both acute (PEACE) and subacute or chronic (LOVE) symptom management. Additionally, the new guidelines discuss the potential long-term effects of some injury management interventions such as anti-inflammatory medications.
For acute management of an injury, PEACE plays the greatest role in help toward recovery: protection, elevation, avoidance of anti-inflammatory medications, compression, and education.
Protection focuses on unloading and restricting movement for one to three days following the acute injury. Pain guides recovery during these first few days; don’t push through the pain to get back to activity during this initial period. Do perform gentle movements or light activity without pain.
Elevate the limb when at rest, keeping the injured area above the level of the heart to decrease swelling.
Avoidance of anti-inflammatory medications is optimal; medications like ibuprofen and naproxen “negatively affect long-term tissue healing” by inhibiting the essential first phases of the healing process.1 If pain is preventing sleep, consider instead acetaminophen.
Compression can be applied using compression garments, wraps, or tape to limit excess swelling and protect the injured structure, thereby enhancing the healing process.
Educate yourself on the best methods to enhance healing with your specific injury: when in doubt, consult with your physical therapist or other health care provider for more detailed screening and advice.
For the subacute and chronic management of an injury, LOVE: load, optimism, vascularization, and exercise.
Load, reintroduced systematically and progressively via activity modification and exercise to develop healthy and robust tissue following an injury. Progressive loading results in the release of growth factors and signals the healing tissue to produce and remodel proteins including collagen (which is a good thing).
Optimistic expectations regarding healing are prognostic of better outcomes; practicing mindfulness and positive self-talk can improve recovery by reducing the negative side effects of fear and hyper-focus.
Vascularization involves the continued performance of a pain-free or pain-reduced aerobic activity to stimulate blood flow to healing tissues.
Exercise, individualized to respect the injury in both load and dosage, should be performed to intentionally stimulate healing and develop resistance to future injury.
If you have questions regarding an injury that you are experiencing, be sure to begin by consulting with one of our physical therapists. Although the acronym is simple, rehab and the progressive reintroduction of load can be extremely nuanced depending on the injury. Advanced Physical Therapy’s skilled clinicians are here to assist the APU community throughout their rehabilitation process.
Dubois B, Esculier JF. Soft Tissue Injuries Simply Need PEACE & LOVE. Br J Sports Med. 2020 Jan;54(2):72-73