RICE Or Peace And Love
Imagine this scenario: You injure yourself, but not to the level of needing to go to your physician or the emergency department. You want to treat yourself.
For years, the advice I handed out for these types of sprains and strains came with this handy acronym:
RICE - Rest, Ice, Compress and Elevate.
And it worked pretty well. RICE has gotten me through many injuries over the years.
But in 2019, the British Journal of Sports Medicine published a rebuttal to RICE and the authors proposed a new way of thinking about acute injuries. Taking into account the latest research about what happens at the cellular level in regard to tissue repair, their proposed new acronym has been making its way into the rehab world.
And I want to share it with you:
Peace and Love.
Let's start with PEACE.
In the first 1- 3 days after an injury,
P - Protect. Imagine you have sprained your ankle or strained your shoulder. Go ahead and wear an ankle brace or sling for a day or two. Don't force your tissues into painful motions, protect them.
E - Elevate. This works well for the ankle, knee, and even the elbow and hand, but your shoulder or back can be trickier. But in general, let gravity help drain the swelling by getting your injury above the level of your heart.
A - Avoid anti-inflammatories and ice. This one can be hard. If you can, resist the inclination to start self-medicating with anti-inflammatories and ice, ice, ice. Allow the inflammation to happen, as it is the way tissues begin to heal. Taking anti-inflammatories and using ice may cause a delay in actual healing, interfering with how collagen is formed, disrupting revascularization and macrophage infiltration (they clean up the mess).
C - Compress. Taping or using some sort of bandage can reduce swelling and possibly help you be more functional.
E - Educate. This is where your physiotherapist comes in. We help determine the damage and make a plan on how to best get you back to your life as quickly as possible without long-term problems.
After the first few days, your tissues now need LOVE.
L - Load. Too often, injuries are left in the protection phase for too long. We now know that we heal best when a load is added, small at first, but steadily increasing, for full recovery to happen. You want your tissues to heal strong, not vulnerable. In order for your tissues, including tendons, ligaments, muscle, and even bone, to heal optimally, we need to load them.
O- Optimism. Don't let your brain get in the way of healing. Fear, depression, and catastrophizing are all barriers to fully healing. This is another spot in the process where your physiotherapist can really help move you along. Don't wait 8 weeks and then seek help. If you are not making steady, daily progress, get into PT and get support, encouragement, and a plan.
V - Vascularization. Get your blood moving with exercise! Pain-free cardio work is going to help bring the good nutrients to the injured area and flush out the bad stuff. It is also good for reducing pain.
E - Exercise. Get yourself moving with weights, balance exercises, and mobility. You need to activate your tissues and stimulate repair, resting for too long impedes full recovery.
Let me know, how does this resonate with you? Have you been practicing PEACE & LOVE with your injuries? Does it feel hard to avoid ice and anti-inflammatories?
In Peace and health,
Dr. Andrea PT
Reference
Dubois, B., & Esculier, J. F. (2020). Soft-tissue injuries simply need PEACE and LOVE. British journal of sports medicine, 54(2), 72–73. https://doi.org/10.1136/bjsports-2019-101253