Recover faster with peace and love
You most likely have used the RICE (Rest, Ice, Compress, Elevate) protocal for your injured muscle, ligament, tendon and fascia injuries, so you might be surpised to find out it has been replaced with PEACE & LOVE.
Dr. Mirkin, who coined RICE, said in his 2015 blog, "Coaches have used my “RICE” guideline for decades, but now it appears that both ice and complete rest may delay healing, instead of helping." This can be a massive breakthrough to help you recover faster and avoid the frustations of being stuck in a hopeless pain cycle that is stopping you from doing what you love.
What Is PEACE & LOVE?
It stands for Protect, Elevate, Avoid Anti-Inflammatories, Compress, Educate, & Load, Optimism, Vascularisation, Exercise.
Sciences are shifting from helping people to live longer to helping people live longer and better, which has lead to a large influex of research in pain, and neuromusculoskeletal (nerve, muscle, and skeleton) fields. Sometimes word of mouth approaches that make sense are accepted as fact instead of being tested through science and even some scientific theories that seem true will be disprovin with technological and research advances. Sadly, people are the ones who get the short end of the stick when this happens and it is heart breaking seeing people suffer unnecessarily.
Let's get you on the road to recover faster by going into each one of these letters briefly. The first thing to know is that PEACE is for the intial 1-3 days and LOVE is for treatment after that period.
Choose light exercises or limit movement for 1–3 days to limit bleeding, prevent expansion of injured fibres and reduce the risk of making the injury flared up. Now that does not mean that safe movement should be avoided because prolonged rest can compromise tissue strength and quality.
This is where pain should be your guide and we use a 1-10 scale (1 being no symptoms and 10 being suicideal thoughts). We tell all of our patients that with 1-2 pain you are sore, but safe (However, soreness should not last past 1-2 days). We stop our patiants anytime a movenemt gets to 5-6 on the pain scale.
When possible, elevate the injuried area higher than the heart to let excess fluid flow out of tissues. Despite weak evidence supporting elevation, it shows a low risk-to-benefit ratio.
Avoid anti-inflammatory modalities
The various phases of inflammation help repair damaged soft tissue. This would mean using anti-inflammatory medications may negatively affect long-term tissue healing, especially when higher dosages are used. Standard of care for soft-tissue injuries should use a pain medication that would not include anti-inflammatory component.
As we pointed out in the first sentences the use of ice, aka cryotherapy, is highly questioned. There is no high-quality research on the benet of ice for treating soft-tissue injuries. The issue with using it for a pain killer is becuase it could potentially stop or hinder inflammation, the development of new blood vesseles, hinder re-establing new blood supply, delay the bodies natural clean up cells, as well as undeveloped muscle fibers. This could lead to limited or improper tissue repair and too much collagen synthesis making you feel tight and stiff.
External mechanical pressure using taping or bandages helps limit the excessive fluid inside a joint and tissue blood leaking. Despite conflicting studies, compression seems to reduce swelling, without the negative side affects of ice, and improve quality of life.
Therapists should educate patients on the benefits of moving safely, early and often as the gold standard to recovery. When therapies are done by themselves movement is better then passive modalities (like TENS unit), manual therapy, acupuncture, and dry needling. Without movement these therapies may even be unsuccessful in the long term.
Education is crucial to address the wrong thinking of I ‘need to be fixed’, instead of being treated and maintaining an active movement lifestyle. Without education people can be wrongfully lead into long therapy-dependent treatments. Education combined with load management will help avoid unneeded treatment. This leads to less of a likelihood of needing unnecessary injections or surgery, and lowers the cost of healthcare, and less disability. We are an instant gratification soceity so we have to set realistic expectations with patients about recovery times instead of chasing the ‘magic cure’.
Movement is medicine and exercise benefits most patients with neuromusculoskeletal disorders. Load on tissues should be added early and often, normal activities should resume as soon as symptoms allow. Optimal loading without flaring up pain promotes repair, remodelling and builds tissue tolerance and the capacity of tendons, muscles and ligaments through mechanotransduction (In living humans/animals this is when mechanical stresses, aka load, applied to our basic unit that makes us (called cells, think about the lego pieces that make up a castle) are received into chemical signals that promote the healing response.
People who look for the silver linings and keep pain in context of being a short part of healing that will go away, have better long term healing and less pain. We have a course on how much a road block to recovery yellow flags/psychological factors like pain catastrophisation, depression and fear of movement can be. Beliefs and emotions are thought to explain more of the variation in symptoms following injuries and play a crucial role in a patient recovering, instead of geting stuck in chronic pain.
Bring blood to the injured area through cardio type activities is a huge piece in the management of musculoskeletal injuries (this is why we encourage all our patients to find something they love doing for movement). Research is needed on how often and how much, however pain-free aerobic exercise should be started a few days after injury to boost motivation and increase blood flow to the injured area. Early movement and aerobic exercise improve physical function, supporting faster return to work/play and reduces the need for pain medication in individuals with musculoskeletal conditions
There is a strong level of evidence supporting the use of exercise for the treatment of soft-tissue injures and for reducing the chance of more recurrent injuries in the future. Exercises help to quickly restore mobility, strength and your body in space awareness post injury. Lower perceived levels of pain should be worked through and higher levels of pain should be avoided to ensure optimal repair during the subacute phase of recovery. Pain should be used as a guide for exercise progressions making sure we stay in the sore, but safe levels.
Too many people in america (estimated 121 million) can no longer do the things they love becuase they are stuck in a chronic pain cycle. To move past this epidemic in the future we need to use PEACE & LOVE for soft-tissue injuries instead of traditional co-dependent therpies that aim for damage control and create fear of return to movement.
If you’re currently experiencing a new injury that has you scared to return to movement, we want to help you get your life back. If you are stuck in pain we want to help you break the cycle. Book an appointment today so we can perform an assessment and provide you with the best treatment options to get you back to doing what you love.