THE R.I.C.E. PRINCIPLE IS OUTDATED. P.E.A.C.E. AND L.O.V.E. IS THE NEW TO DO AFTER AN INJURY
The most widely known acronym for what to do after an injury is the RICE principle
Rest, Ice, Compression, Elevation
It was developed by Dr. Gabe Merkin in 1978, and most of us have thrown on an ice pack while watching tv after tweaking a body part in the hope that it’ll go away.
But in 2015 Dr. Merkin retracted his statement because the current evidence no longer supports complete rest or ice in the management of acute injury. So what should we do instead?
P.E.A.C.E. & L.O.V.E.
The PEACE and LOVE protocol was developed in 2019 as a replacement for the RICE protocol. The PEACE principle is used for the first 3 days after an injury. The LOVE principle is for the subacute phase, beginning 4 days after the injury.
The PEACE and LOVE principle is focused on using the body’s natural healing mechanisms to recover, rather than trying to impede them with ice and pain meds.
Immediately after injury let PEACE guide your approach.
P = Protection
- Unload or restrict movement for 1-3 days.
- Resting for longer than 3 days leads to decreased strength but short term rest can help decrease bleeding, swelling, and decrease the risk of aggravating the injury.
E = Elevation
- Elevate the limb higher than the heart. (Not just propped up on the coffee table)
- This promotes swelling to flow out of tissues and back towards the heart.
A = Avoid anti-inflammatory modalities
- Inflammation helps repair damaged soft tissues.
- Inhibiting inflammation using medications (like ibuprofen or naproxen) may negatively affect long term tissue healing.
- Inhibiting inflammation using ice disrupts revascularization and delays white blood cells infiltrating the area. Both of these things help with tissue remodeling, and inhibiting them may lead to impaired tissue repair.
C = Compression
- External pressure with tape or bandages can help limit joint swelling and tissue bleeding.
E = Education
- An active approach to recovery leads to better outcomes!
- Education from a well informed provider on the condition and load management will help improve outcomes.
After the first days have passed, soft tissues need LOVE.
L = Load
- Mechanical stress should be added early and normal activities resumed as soon as symptoms allow.
- Optimal loading without exacerbating pain promotes repair, remodeling, and builds tissue tolerance.
O = Optimism
- Optimistic patient expectations are associated with better outcomes and prognosis.
- Catastrophization, depression and fear can be barriers to recovery.
V = Vascularization
- Pain free aerobic exercise should be started a few days after injury to boost motivation and inc blood flow to the injured structures.
- Early mobilization and aerobic exercise improves physical function, supports return to work and reduces the need for pain medication.
E = Exercise
- Exercises to help restore mobility, strength, and proprioception early after injury improves outcomes.
- Pain should be avoided to ensure optimal repair during the subacute phase of recovery and should be used to guide exercise progressions.
Returning to activity as quickly as possible without increasing pain and swelling is the goal with all recovery and rehab. Using the PEACE and LOVE principle will help get you back to doing what you love as quickly as possible after an injury!
Dr. Erika