Over the years, the acronym used to guide the management of soft tissue injuries changed from ICE (Ice, Compression, Elevation) to RICE (Rest, Ice, Compression, Elevation), then to PRICE (Protection, Rest, Ice, Compression, Elevation).

ICE/RICE/PRICE emphasizes on the acute phase soft tissue healing, but ignores the subacute and chronic stages. To optimize the healing process, two new words have been used: PEACE and LOVE. These two new terms focus on the recovery of soft tissue damage from the acute phase (PEACE) to the next stage treatment (LOVE).

PEACE and LOVE It also mentions the importance of patient education, in addition to pointing out psychosocial agents to accelerate the recovery process. In addition, while anti-inflammatory has been shown to be beneficial in pain management and rehabilitation, the two words also warn of the potential for adverse effects on the optimization of soft tissue recovery.

Stage immediately after soft tissue injury, do not harm – use PEACE approach to soft tissue injury management

P (Protect)

Do not exert pressure or limit movement for 1-3 days to reduce bleeding, limit edema of damaged tendon fibers and reduce the risk of aggravating the injury.

Complete rest (REST) should be minimized because prolonged rest can adversely affect soft tissue tension and quality. Based on pain signs to guide the removal of the splint and allow the patient to gradually regain strength.

E (Elevate)

Elevate the limb above the level of the heart to help drain fluid out of the tissue. Although there is not much evidence to support this, over-the-counter medicine is still recommended because of the low risk-benefit ratio.

A (Avoid anti-inflammatory modalities)

Anti-inflammatory drugs can have a negative impact on future healing. Different stages of inflammation contribute to the optimization of soft tissue regeneration. Drug blocking of the inflammatory process is not recommended because it can adversely affect soft tissue healing, especially when the drug is used in high doses.

Although ice is used by doctors and patients, there is no strong evidence for its effectiveness. (ICE) in the treatment of soft tissue injuries. Even if used primarily for pain relief, ice can potentially interfere with inflammation, angiogenesis, and vascular remodeling, interfere with leukocyte and macrophage infiltration, and increase number of immature muscle fibers. All of the above problems lead to hindering the regeneration of soft tissue and creating excess collagen.

C (Compress – compression tape)

External mechanical compression using bandages or splints helps limit intra-articular edema and tissue hemorrhage. Despite extensive research, compression in ankle sprains appears to reduce edema and improve quality of life.

E (Educate)

Physiotherapists should educate patients about the benefits of patient recovery in a proactive manner. Educating patients well about their illness and managing limb load-bearing problems will help avoid over-treatment. Because this in turn increases the likelihood that patients will need injections, or surgery, and increases the burden on the health system.

After the first days have passed, soft tissues need LOVE

L (Load – Bearing)

An active approach involving movement and mobilization is beneficial in most patients with musculoskeletal conditions. The patient should be subjected to mechanical stress early and return to normal activities as soon as possible when the patient’s symptoms subside. Appropriate painless load-bearing helps repair, regenerate, and create load-bearing capacity of tissues, tendons, muscles, and ligaments.

O (Optimism)

The brain plays an important role in rehabilitation interventions. Psychological factors can form a barrier to healing. Advise the patient to be optimistic to increase the likelihood of good healing.

V (Vascularization)

Painless physical activity should be started a few days after injury to increase blood flow to injured structures. Early mobilization and participation in aerobic exercises help improve function, return to work, and reduce pain in patients with osteoarthritis.

E (Exercise)

Exercises help restore mobility, tension, and postural sensation early after injury. Pain should be avoided to ensure maximum healing in the subacute phase, and should serve as a guideline to increase the difficulty of the exercises.

Treating soft tissue injuries is not a simple task.

We are used to RICE practice (rest, ice, compression, elevation), do you think the new guidelines above make sense?

Forget RICE, try PEACE and then LOVE

According to BJSM Blog

Mr. Dr. Nguyen Thai Duy

PK Requires Musculoskeletal

Hospital District 2

Refer:

Early injury management, it’s now all about PEACE and LOVE, not HARM

Early injury management….it’s now all about PEACE and LOVE, not HARM

The new RICE: https://www.contagiousenthusiasm.com.au/new-rce/

Soft tissue injuries simply need PEACE & LOVE: https://blogs.bmj.com/bjsm/2019/04/26/soft-tissue-injuries-simply-need-peace-love/

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