PEACE & LOVE - The new management for soft-tissue injuries
There is ever changing advice regarding immediate management of your soft tissue injuries. These injuries may include ankle sprains, muscle tears, sore knees or even sometimes an acute back episode. Over the years, management has evolved from the simple ‘rest and ice’ model, to a much more active recovery. The British Journal of Sports Medicine has developed a new management acronym which addresses both the immediate care of an injury (PEACE), and also addresses the subacute stage of an injury (LOVE):
Immediately after an injury, do no harm and let PEACE guide your approach:
Protect
Unload or restrict movement for 1-3 days to minimise bleeding and to reduce the risk of aggravating the injury. However, rest should be minimised as prolonged rest can compromise tissue strength and quality.
Elevate
Elevate the limb higher than the heart to promote fluid flow out of the injured tissues.
Avoid Anti-inflammatory modalities
Inflammation actually helps repair damaged soft tissues! Thus, inhibiting inflammation using medications (voltaren, nurofen) may negatively affect long-term tissue healing.
There is also no high-quality evidence that supports using ice for soft-tissue injuries. Even if for pain relief, ice could potentially disrupt inflammation and impair tissue repair.
Compress
External mechanical pressure using taping or bandages helps limit swelling and tissue bleeding.
Educate
This one is for our health professionals! Education on the benefits of an active approach to recovery and outlining realistic expectations on recovery time. Tissue healing takes time - there is no quick, magical cure!
After the first days have passed, soft tissues need LOVE
Load
An active approach with movement and exercises benefits most patients with musculoskeletal disorders. Optimal loading should be added early and normal activities resume as soon as symptoms allow.
Optimal loading without exacerbating pain promotes repair, remodelling of tissues and builds tissue tolerance - particularly the capacity of tendons, muscles and ligaments.
Optimism
This is a new one! It highlights the importance of psychological factors in recovery. Optimistic expectations are associated with better outcomes and prognosis. Factors such as catastrophisation, depression and fear can represent barriers to recovery. In fact, beliefs and emotions explain more of the variation of symptoms following an ankle sprain than the degree of injury!!
Vascularisation
Pain-free aerobic exercise should be started a few days after injury to boost motivation and increase blood flow to the injured structures.
Early mobilisation and aerobic exercise improve physical function and reduce the need for pain medications in individuals with musculoskeletal conditions.
Exercise
There is a strong level of evidence supporting the use of exercise for the treatment of ankle sprains in reducing the prevalence of recurrent injuries. Exercises 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 exercise progressions.
Management of soft tissue injuries extends beyond the first few days of damage control. Injuries regularly re-occur because they are mis-managed in the early phases. Too often in the clinic we either see injuries which have been immobilised way too long or have been pushed too hard too soon. So put those ice packs away and get moving!!
