John's Post-Injury Guidance
The most crucial treatment window of an acute injury is the 24-72 hours immediately following trauma. Recent research has developed a more contemporary acronym encompassing the entire rehabilitation continuum from immediate care (PEACE) to subsequent management (LOVE).
Traditional passive approaches, ICE, RICE, PRICE or even POLICE, include the use of ice and anti-inflammatories to reduce swelling. The below Peace & Love concept omits ICE and NSAIDS from most acute injury management. The research indicates it could potentially disrupt the body's natural inflammatory process.
"Immediately after injury, do no harm and let peace guide your approach"
Protection - Avoid activities and movements that increase pain during the first few days after injury. This will minimise bleeding, reduce swelling and mitigate the risk of aggravating the injury.
Elevation - Elevate the injured limb higher than the heart as often as possible to promote a reduction in swelling.
Avoid anti-inflammatories - Avoid taking anti-inflammatory medication and using ice as they reduce tissue healing. The various phases of natural inflammation actually help repair damaged soft tissues. Inhibiting inflammation using medications or ice may negatively affect long-term tissue healing and could potentially disrupt the inflammatory process, impair tissue repair, and promote premature scar tissue formation.
Compression - Use an elastic bandage or taping to help limit intra-articular oedema and tissue haemorrhage (reducing swelling and bleeding).
Education - Your body knows best. Avoid unnecessary passive treatments and medical investigations and let nature play its role. Passive modalities early after an injury have insignificant effects on pain and function compared with an active approach and may even be counterproductive in the long term.
"After the first days have passed, soft tissues need love"
Load - Let pain guide your gradual return to normal activities. Your body will tell you when it's safe to increase the load. Optimal loading without exacerbating pain promotes repair and remodelling and builds tissue tolerance within the capacity of tendons, muscles and ligaments through a process known as mechanotransduction.
Optimism - Condition your brain for optimal recovery by being confident and positive; this is associated with better treatment outcomes and prognosis. Psychological factors such as catastrophization, depression and fear can represent barriers to recovery.
Vascularisation - Choose pain-free cardiovascular activities to increase blood flow to repair tissues. Early mobilisation and aerobic exercise improve physical function, supporting a return to activity and reduce the need for pain medication in individuals with musculoskeletal conditions.
Exercise - Restore mobility, strength and proprioception by adopting an active approach to recovery. Pain should be avoided to ensure optimal repair during the subacute phase of recovery and should be used as a guide for exercise progressions.
IF YOU THINK YOU MAY HAVE SUSTAINED A SEVERE INJURY (I.E., BROKEN BONE, EXCESSIVE PAIN / RAPID BRUISING), IT IS ADVISED THAT YOU ATTEND A&E IMMEDIATELY.
Bibliography: Dubois, B. and Esculier, J., 2019. Soft-tissue injuries simply need PEACE and LOVE. British Journal of Sports Medicine