Over the years there has been much debate about what is ‘best practice’ in the management of soft tissue injuries, which can often leave you feeling more than a little confused! Should you rest it? Should you take anti-inflammatories? Are you able to carry on with any exercise? Managing soft tissue injuries effectively using up-to-date, evidence based practice, during the acute stages and in the subsequent phases of tissue healing, is vital to ensure a speedy and efficient recovery.
You may be familiar with the ‘PRICE’ protocol – Protection, Rest, Ice, Compression, Elevation. This has now become quite outdated advice as it focusses on mainly unloading the affected area and avoiding movement to prevent further damage.
You may also recognise the ‘POLICE’ protocol – Protection, Optimal Loading, Ice, Compression, Elevation. This is a more proactive approach, where rest is replaced by a gradual and balanced rehabilitation programme. Evidence shows that early activity accelerates tissue healing and promotes early recovery.
Both of these protocols focus purely on the acute, first few hours/days of injury, and do not provide guidance as to the subacute and chronic stages of tissue healing that occurs over the subsequent weeks and months. Researchers have now developed a contemporary acronym that works with the entire rehabilitation continuum – from immediate care (PEACE) to further, long term management (LOVE), in order to enhance recovery.
PEACE – the initial days after injury
P – Protect
Avoid aggravating activities or movements and reduce the amount of load / weight on the affected area for 1-3 days. This helps to minimise bleeding, reduce swelling and reduce the risk of further aggravating the injury. The amount of pain you’re experiencing is used to guide how much offloading is required. Remember, prolonged rest can compromise tissue strength and quality, therefore it is advisable to keep rest to a minimum.
E – Elevate
Elevate the limb regularly, higher than the level of the heart – support it on cushions to help keep it there for at least 20 minutes at a time. This helps to promote fluid to flow out of the tissues and reduce swelling.
A – Avoid anti-inflammatory modalities
In these initial stages, inflammation is USEFUL! Inflammation is our bodies natural response to injury to help repair damaged tissues. Inhibiting inflammation using medications may negatively affect long-term tissue healing, therefore they should be avoiding. Pain relief, such as paracetamol can be used to help control pain, however always discuss this with your GP first if you have any queries.
C – Compression
Using external mechanical pressure such as taping or bandages can help to reduce swelling and bleeding. You should always monitor circulation to the limb when using any form of compression bandage and seek advice from a health care professional if you have any concerns.
E – Educate
This is where Physiotherapy comes in! Recovering from an injury can often be a nervous and stressful time. We can help you work through an active recovery and rehabilitation programme to reduce pain and optimise function. Establishing a realistic timeframe from recovery is important, especially if you’re working towards your next race or fitness goal. Unfortunately there is no ‘magic wand’ in our toolbox that can get rid of an injury. Our bodies do need time to heal but optimising the environment they have to do so will make for an efficient recovery.
LOVE – after the first few days have passed
L – Load
An active approach with graduated loading of the affected area benefits most patients with a musculoskeletal injury. Adding movement and exercise to the regime early, whilst still being mindful of not exacerbating pain, actually promotes repair and remodelling of tissues, helping to build their tolerance and capacity to stress.
O – Optimism
How we feel about our injury, how it has impacted on our everyday lives and what our expectation is with regards to recovery, actually has an impact on tissue healing. The more optimistic we are in our expectations and the better our understanding is of our injury, the better results we gain in terms of our prognosis and recovery.
V – Vascularisation
Pain-free aerobic exercise should be started a few days after injury, to boost motivation and increase blood flow to the affected area. Depending on the injury, this could be activities such as swimming or cycling, or even simply modifying your normal aerobic exercise to be pain free – reducing the speed, the resistance or the distance, for example.
E – Exercise
Exercise helps to restore movement, strength and proprioception (the awareness of where your limb is) early after injury and reduces the risk of re-injury. Pain should be avoided to ensure optimal repair during the subacute phase of recovery and is used to guide exercise progressions.
So whether you’re recovering from an ankle sprain, a hamstring strain or any other soft tissue injury, try to encourage PEACE and give your soft-tissues a little LOVE!
We are always seeking to achieve the best long-term outcome and the most favourable recovery after an injury. If you would like any help and support to help you optimise your recovery, then please get in touch.
