Soft tissue injuries simply need PEACE & LOVE. Rehabilitation of soft tissue injuries can be complex.
Over the years, acronyms guiding their management have evolved from ICE to RICE, then to PRICE and POLICE. Although widely known, the evidence supporting the elements of these treatments is limited.
We posit that two new acronyms can optimize recovery. Our acronyms encompass the rehabilitation continuum from immediate care (PEACE) to subsequent management (LOVE).
Immediately after a soft tissue injury, do no harm and let PEACE guide your approach.
P for Protect - Unload or restrict movement for 1 to 3 days to minimise bleeding, prevent distension of injured fibers and reduce risk of aggravating the injury.
E for Elevate - Elevate the limb higher than the heart as often as possible to promote interstitial fluid flow out of tissue.
A for Avoid anti-inflammatory modalities - Avoid taking anti-inflammatory medications as they reduce tissue healing. Avoid icing.
C for Compress - External mechanical pressure using taping or bandages helps limiting intra-articular edema and tissue haemorrhage.
E for Educate- - Your body knows best. Avoid unnecessary passive treatments and medical investigations and let nature play its role.
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, remodeling and building tissue tolerance and capacity of tendons, muscles and ligaments through mechanotransduction.
O for Optimism - The brain plays a key role in rehabilitation interventions. Psychological factors such as catastrophisation, depression and fear can represent barriers to recovery.
V for Vascularisation - Choose pain-free cardiovascular activities to increase blood flow to repairing tissues.
E for Exercise - Exercises will help to restore mobility, strength and proprioception early after injury. Pain should be avoided to ensure optimal repair during the subacute phase of recovery, and should be used as a guide for progressing exercises to greater levels of difficulty.