Out with RICE, in with PEACE & LOVE: An updated guide to soft tissue injury recovery & rehab
For the last few decades, a common basic recovery method for most basic soft tissue injuries like an ankle sprain for example was RICE - Rest, Ice, Compression, & Elevation. On the surface this acronym makes sense overall and has been used from anyone from athletes, therapists, to standard population to help recover from injuries. The idea of resting an injury is sound, icing the area reduces pain and swelling which people often associate with recovery (this will be discussed/debated further later), compression to reduce swelling, and elevation to allow gravity to help pull fluids out of the area.
As a clinician myself, I have noticed that most patients have heard of RICE even if they do not know what the acronym means as it is very engrained in the injury/rehab community. Looking at how I treat patients, how I see other clinicians treating patients, and what I notice people recover from the best includes some parts of RICE, but often is greatly lacking overall.
Recently I was reviewing my colleague’s treatment philosophies and I started to notice the acronym PEACE & LOVE. After further research I noticed this acronym has been showing up more and more in the rehab community, completely replaces RICE and aligned perfectly with my view of injury recovery for patients.
PEACE & LOVE stands for:
Protection
Elevation
Avoid anti-inflammatories
Compression
Education
Load
Optimism
Vascularization
Exercise
I will break these down and share my thoughts on this protocol for injury management in general. I have also made a video going over this on the Leduc Beaumont Devon YouTube channel that can be reviewed, here.
Protection: Protection is indicated during the initial onset of injury to reduce potential risk of further injuries occurring in the immediate future. This can include casts, tensor wraps, avoiding contact, etc. Protecting an affected area in the initial stages of recovery for something like a sprained ankle is extremely important.
Elevation: This one aligns with the RICE concept. Elevating an injured area immediately post-accident/injury will allow gravity to help pull fluids out of the area, reduce swelling, and potentially slightly help with pain management.
Avoid anti-inflammatories: As with any medication we always recommend discussing with your physician, and anti-inflammatories have their place for some people with certain conditions. Though these medications do help to reduce inflammation (in some situations) and may reduce pain, (also in some situations) there is a growing body of research indicating that they delay and or slow down tissue healing; current research is showing that icing an injury may have a similar effect on healing by slowing it down. Fun fact! There is a substantial amount of research which shows that anti-inflammatory medications stop muscle hypertrophy (growth) post work out via the inhibition of the mTor (mechanistic target of rapamycin) pathway.
Compression: Another recommendation taken from RICE, compressing an injured area like a sprained ankle immediately post injury can help to reduce swelling, thus slightly helping with pain management, also providing some protection and rigidity to the area immediately post injury.
Education: Educations is a very important and valuable tool for anyone recovering from an injury. If you have an injury, seeking assistance and education from a qualified health professional to help you understand what has happened, how to treat it, and what to expect, is incredibly important. This provides buy-in from the patient; when a patient is committed to their recovery the likelihood of a positive outcome is significantly higher.
Load: Now we have moved onto the second word of the acronym (LOVE) and now we start to discuss the methods of recovery after the initial few days or week(s) following the event and the injury has stabilized. Using a sprained ankle for an example - initially you will use a crutch or something similar so there is no load (weight, pressure) on the joint. Once the joint is just able to weight bear, even to a small extent, or perform basic exercises, it is very important to begin loading the joint as soon as the tissues can handle it with limited symptoms. The sooner you are able to load the area, the sooner the tissues in the area are able to be worked and develop. Often the worst part of an injury itself isn't the recovery process, it’s the weakness due to atrophy of not using the joint or area as soon as possible. In a personal view, I think that there is strong support that the sooner you are able to safely load the joint, the better likelihood of a positive recovery. Once again this is to be handled with a health care professional.
Optimism: Being injured is difficult physically and mentally. But there is strong support showing that individuals with positive outlooks on their injures, their recovery process, and their goal orientation, have significantly better recovery outcomes, both short and long term.
Vascularization: This is incredibly important at this stage of recovery due to increasing the blood flow into the area to help bring healing factors and increase recovery rates. One major reason certain joints do not recover faster is due to them having poor blood supply. Helping to keep more blood flowing in and out of the joint via using the joint in movements or exercises helps to pump and flush the joint. This will increase blood flow that brings in healing factors and then you flush out certain metabolites to aid in recovery.
Exercise: The final letter is E for exercise, which is all encompassing of this stage in recovery. This includes the initial early stages of basic rehab, to more functional movements, and progressing back to full functionality. Exercise needs to include load, progressions, and variation, and are the cornerstones to all recovery from injury and ties the whole acronym together.
PEACE & LOVE. This acronym is far more in-depth and specific then the old RICE concept, is progressive in nature, and can follow you through the recovery process for the injury. For example, during the initial onset of injury, focus on the PEACE aspect of the acronym. As you progress in recovery, the LOVE aspect becomes the primary focus. Overall, I think this is a positive step to help people understand injury recovery and rehabilitation. Obviously, this will not cover all injuries in every situation, but as a general rule, and for a great deal of musculoskeletal injuries, this acronym can be helpful, and I hope it becomes a common vernacular in society and replaces RICE soon. PEACE & LOVE > RICE.
Adrien DeGroot is the Exercise Specialist at the Leduc Beaumont Devon Primary Care Network. See how he, and other members of the Team-Based Care Program, can help you in your health journey.
