Introduction
Acute soft tissue injury is often managed by various acronyms, most notably RICE and POLICE.
- These acronyms have been around for many years, focusing on the acute phase of soft tissue injury, and advances in research have made these acronyms outdated and inaccurate. For example, the use of NSAIDs in acute injuries may actually be detrimental to the recovery and healing process. [1]
- Most studies have used acute lateral ankle sprains as clinical cases, so it may be helpful to consider applying these principles to patients with such injuries.
Image 1: Hematoma development.
New research prompts application of new acronyms to acute and subacute phases of injury and facilitates load and activity.
PEACE and LOVE
See link PEACE and LOVE
- Apply PEACE in the acute phase of injury. [1] P: Protection E: Elevation A: Avoid anti-inflammatories/ice C: Compression E: Education
- LOVE should be used in the subacute phase L: load O: optimism V: vascularization E: exercise
History of soft tissue management
ICE: Initially soft tissue injuries are managed with ICE. I: Ice C: Compression E: Altitude
- Focus on cryotherapy. We now know that ice may cause slower healing times because it disrupts normal inflammation and revascularization. There is some evidence that ice can be used for pain relief. More evidence is needed to fully understand these physiological processes Occurs when ice is used for acute injury. [2]
- Compression and boosting are also suggested in the ICE acronym. These are mostly anecdotal recommendations, with no firm recommendations for duration of compressions or elevations. Altitude has been shown to help reduce inflammation, but this inflammation is normal and works for normal people The healing process. [2]
RICE and PRICE
RICE and PRICE are then recommended as complements to ICE.
- Prolonged periods of rest and protection can be detrimental to recovery, leading to muscle atrophy and altered limb biomechanics. [3] However, rest and protection of the extremity during the acute phase is still recommended after an acute injury.
- Early mobilization and weight bearing have been shown to accelerate recovery from acute soft tissue injuries [4].
POLICE
POLICE is an acronym that stands for Protect Optimal Load Ice Compression and Lifting. It promotes and guides safe and effective weight bearing in the management of acute soft tissue injuries. Police were introduced to facilitate loading in affected areas and prevent long-term immobilization. see police link
Clinical bottom line
As research progressed, the need to educate and facilitate weight bearing became apparent in order to fully recover from injury. As a physical therapist, this is not new information, but communicating the need for peace and love should be prioritized in physical therapy clinics.
- Advice to avoid anti-inflammatory drugs has been conflicting, despite evidence to support this in the acute phase of injury. [5]
- PEACE and LOVE is useful for clinicians and patients because it not only focuses on immediate short-term damage, but actually promotes recovery and exercise.
Resources
PRICE principle
PEACE and LOVE explained
PEACE and LOVE in our clinics
Lateral ankle injury
Soft tissue healing
References
- ↑ Jump up to:1.0 1.1 Dubois B, Esculier J Soft-tissue injuries simply need PEACE and LOVE British Journal of Sports Medicine 2020;54:72-73
- ↑ Jump up to:2.0 2.1 van den Bekerom MP, Struijs PA, Blankevoort L, Welling L, Van Dijk CN, Kerkhoffs GM. What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults?. Journal of athletic training. 2012 Jul;47(4):435-43.
- ↑ Bleakley CM, Glasgow P, MacAuley DC. PRICE needs updating, should we call the POLICE?British Journal of Sports Medicine 2012;46:220-221.
- ↑ Bleakley CM, O’Connor SR, Tully MA, Rocke LG, MacAuley DC, Bradbury I, Keegan S, McDonough SM. Effect of accelerated rehabilitation on function after ankle sprain: randomised controlled trial. Bmj. 2010 May 10;340.
- ↑ Vuurberg G, Hoorntje A, Wink LM, Van Der Doelen BF, Van Den Bekerom MP, Dekker R, Van Dijk CN, Krips R, Loogman MC, Ridderikhof ML, Smithuis FF. Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. British journal of sports medicine. 2018 Aug 1;52(15):956-.
