RICE or PEACE & LOVE for acute injuries?
If you’ve ever twisted your ankle, sprained your wrist or torn a muscle then chances are you’ve heard of RICE (Rest, Ice, Compression, Elevation). But what if I told you we got it wrong? What if this ubiquitous method for treating acute injury was in fact delaying recovery? What if I told you that Dr Gabe Mirkin (the person who first coined the term RICE) recanted in 2014?
To understand what’s going on here a quick summary of the how the body recovers from injury is relevant and important. Tendon and ligament healing is dived into three overlapping stages; inflammation, proliferation/repair, and remodelling.
· Inflammation occurs straight after the injury and can last for several days. Inflammation is a natural response to injury and serves to initiate the healing process and ‘clean up’ debris from the injury.
· Proliferation or repair begins roughly two days after the injury occurs. In this phase specialised cells proliferate and migrate to the site of damage. These cells are important in synthesizing an extracellular matrix (ie. repairing the site with fibrous tissue) and re-establishing an internal vascular network. Growth factor molecules are released at this stage and are important in directing this healing activity.
· Remodelling commences 1-2 months post injury. During this phase the fibrous tissue (type III collagen) is gradually replaced by tendon like scar tissue (type I collagen). This process is said to take 10 weeks but in fact can last for years. Appropriate guided reloading is critical during this phase to promote strong healthy tissue.
Growing understanding of this healing process led Dr Mirkin and others to question the wisdom of RICE. The contention centres around the use of ice and anti-inflammatory medication in the acute phase of the injury. Ice reduces blood flow to the area while anti-inflammatory medication disrupts the body’s signalling cascade which induces inflammation. Both delay or at least subdue the inflammatory process, impeding the body’s ability to repair damaged tissue.
In response a new acronym was proposed by Dubois and Esculier in 2020. PEACE & LOVE recommends a more comprehensive understanding of the healing process, with an emphasis on avoiding anti-inflammatory drugs and encouraging early movement when appropriate.
PEACE replaces the RICE acronym and provides guidance for the acute phase of injury:
Protect: The "P" in PEACE stands for protecting the injured area. It involves avoiding activities that may exacerbate the injury and using supportive measures like bracing or taping if necessary.
Elevate: "E" is for elevating the injured limb or area. Elevating the affected part can help reduce swelling and improve circulation.
Avoid Anti-Inflammatory Modalities: This component suggests avoiding anti-inflammatory treatments, like nonsteroidal anti-inflammatory drugs (NSAIDs), during the initial stages of injury as they could interfere with the natural healing process.
Compression: "C" involves applying compression to the injured area using bandages or wraps to help reduce swelling and provide support.
Education: It emphasizes educating the individual about the nature of their injury, the healing process, and the importance of following a rehabilitation plan.
LOVE is an extension of PEACE and supports the recovery phase, it stands for:
Load: Gradually introducing appropriate loads and stresses to the injured area as it heals to encourage tissue repair and adaptation.
Optimism: Maintaining a positive mindset and having confidence in the recovery process can play a role in healing.
Vascularization: Encouraging blood flow to the injured area through gentle movement and exercises.
Exercise: Engaging in specific rehabilitation exercises to promote strength and flexibility in the affected region.
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