Soft-tissue injuries can be difficult to recover from. The acronyms used to manage them have changed over time, progressing from ICE to RICE, PRICE, and finally POLICE.

Although well-known, the aforementioned acronyms unfortunately ignore the subacute and chronic stages of tissue healing in favour of acute therapy. The rehabilitation continuum is covered by our modern acronyms, from urgent care (PEACE) through subsequent management (LOVE). In order to promote rehabilitation, PEACE and LOVE  emphasises the significance of educating patients and treating psychosocial problems. While anti-inflammatories have been shown to improve pain and function, our experts warn that they may be hazardous to the best possible tissue recovery. We propose that they might not be part of the typical treatment for soft-tissue injuries.

After an injury, avoid more harm and let PEACE direct your actions.
Protect with a P
To minimise bleeding, prevent distension of injured fibres, and lower the risk of exacerbating the injury, limit activity for one to three days. Rest is advised to be minimised since extended rest can degrade the quality and strength of tissues. The end of protection should be guided by pain signals.

E for elevate

To encourage the passage of interstitial fluid from tissues, elevate the limb above the level of the heart. Elevation has a low risk-to-benefit ratio notwithstanding the scant data in favour of its use.

A for avoiding inflammatory treatment methods.

The many stages of inflammation aid in soft tissue repair.  Therefore, utilising drugs to suppress inflammation may have a negative impact on long-term tissue healing, especially when greater dosages are utilised. Anti-inflammatory drugs shouldn’t be part of the standard of care for soft tissue injuries. We also dispute cryotherapy’s efficacy.

Although ice is frequently used by doctors and the general public to treat soft-tissue injuries, there is no high-quality data to support its effectiveness.

Ice may disrupt inflammation, angiogenesis, and revascularization, delay neutrophil and macrophage infiltration, and increase immature myofibres even if its primary effect is analgesia.
Ineffective tissue healing and excess collagen synthesis may result from this.

C is for compress
Limiting intra-articular oedema and tissue haemorrhage requires applying external mechanical pressure with tape or bandages.
Despite contradictory studies, compression seems to lessen swelling and enhance quality of life after an ankle sprain.

E is for educate
Patients should learn about the advantages of an active rehabilitation strategy from their therapists. Early on following an injury, passive modalities like electrotherapy, manual therapy, or acupuncture have little effects on pain and function compared to an active approach, and they may even be detrimental over time.
In fact, fostering an external locus of control or the “desire to be fixed” might result in behaviour that requires therapy. Overtreatment can be prevented with better load control and education about the problem. In consequence, this lowers the possibility of need-less injections or surgeries and supports a decrease in the cost of healthcare (eg, due to disability compensation associated with low back pain). In an era of cutting-edge therapy choices, we fervently support communicating with patients about realistic expectations for recovery times rather than pursuing the “magic cure” strategy.

Soft tissues require LOVE once the initial days are over.
L is for Load
Most individuals with musculoskeletal diseases benefit from an active therapy that includes movement and exercise.
As soon as symptoms permit, mechanical stress should be added, and regular activities should be resumed. Through mechanotransduction, optimal loading1 that doesn’t exacerbate pain encourages repair, remodelling, and develops tissue tolerance as well as the capacity of tendons, muscles, and ligaments.
O for optimism
Patient expectations that are upbeat are linked to better results and prognoses. Psychological issues including fear, despair, and catastrophizing might operate as obstacles to healing.
The degree of pathophysiology is believed to only partially explain the diversity in symptoms that occur after an ankle sprain.

V for vascularisation
The cornerstone of the therapy of musculoskeletal injuries is cardiovascular activity. Pain-free aerobic activity should be started a few days after injury to promote motivation and increase blood supply to the affected structures, though more research is required on dose.
In those with musculoskeletal disorders, early mobilisation and aerobic exercise increase physical function, encourage a return to work, and lower the need for painkillers.

E for Exercise
Exercise can be used to treat ankle sprains and lower the likelihood of repeat injuries. This is strongly supported by the available research.

Early on after injury, exercises aid in regaining mobility, strength, and proprioception.

To enable the best possible healing during the subacute phase of recovery, pain should be minimised. Pain should also be used as a guide for workout progressions.
Soft-tissue injury management goes beyond immediate damage control. Similar to previous injuries, clinicians should treat the patient with the injury rather than the patient with the damage and strive for favourable long-term outcomes. We hope this helps everyone, whether they have a hamstring strain or an ankle injury.

PEACE and LOVE for the management of injuries from the onset to the return to normal exercise is important. Help yourself get the optimal environment to heal in.

The above does not substitute for medical advice and if injured should consult an medical professional.

Thanks for reading

James