Almost every athlete knows the standard advice for pulled muscles, ankle sprains and other soft-tissue injuries: RICE, an acronym for rest, ice, compression, and elevation. But in recent years, experts have begun to question whether these steps do more harm than good.
“Many injury-management practices are founded on beliefs, rather than science,” explained physiotherapist and clinical scientist Blaise Dubois. “The science—when there is science—is not always black and white.”
Dubois cites the “I” in RICE as one example. American sports doctor Dr. Gabe Mirkin coined the term ‘RICE’ in 1978, using the assumption that ice tamps down inflammation. But in 2015, he backtracked on this initial hypothesis, writing that research shows ice “may delay healing, instead of helping.” As it turns out, inflammation is actually a good thing for a soft-tissue injury, as it forces the body to rush healing resources to the injured area via increased blood flow.
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To replace the outdated method, Dubois and his team of researchers developed a new injury-management protocol acronym published in the British Journal of Sports Medicine encourages PEACE and LOVE.
PEACE and LOVE takes a comprehensive, evidence-based approach to injury management. The first word, PEACE, focuses on immediate care:
The latter half of the protocol, LOVE, outlines steps for rehabilitation:
“In addition to addressing how anti-inflammatory modalities, like pills and ice, slow down repair of the affected tissues, we included education, which is key in the world of over-medication, over-investigation, and over-treatment,” said Dubois. By adding “education,” the approach is the first injury-management protocol to address the “Dr. Google” phenomenon that plagues so many athletes. Trying to find a quick fix on the internet often does more harm than good.
The psychosocial component is also addressed with the addition of “optimism,” or conditioning the brain for optimal recovery. Research shows optimistic patient expectations are associated with better outcomes and prognosis. In fact, beliefs and emotions about an injury explain more of the variation in symptoms following an ankle sprain than the degree of pathophysiology—the more you catastrophize your injury, the more you’ll be limited by your symptoms.
Another important addition to the protocol can be found in the final two letters: VE, for vascularization and exercise. Previous injury-management strategies have not included movement, despite evidence showing that pain-free aerobic exercise should be started a few days after injury to boost motivation and increase blood flow to the injured structures and accelerate repair.
“Taking care of soft-tissue injuries is not only for the first week,” explained Dubois. “Managing soft-tissue injuries is more than short-term damage control. Similar to other injuries, clinicians should aim for favorable long-term outcomes and treat the person with the injury, rather than the injury of the person.”