Soft tissues is the name for the bits of our body that connect and support other tissues and/or surrounds our organs, including: muscles, fat, blood vessels, nerves, tendons and tissues surrounding our bones and joints). When we become injured, getting it better and back to our usual level of function in both strength and range of movement, isn’t always as quick and simple we’d like.

The Evolution from RICE to PEACE & LOVE

You’ve probably heard of the acronym ‘RICE’ (Rest, Ice, Compression, Elevation)? First designed by Dr Gabe Mirkin in 1978, it was used to advise us of a simple way to manage soft-tissue injuries immediately after they’ve happened and for the first few days. However, in 2014 Dr Mirkin publicly withdrew his professional support for R.I.C.E, as more recent evidence pointed away from that advice and towards the new and more clinically proven acronym P.E.A.C.E & L.O.V.E. Usefully, it guides us through the process of rehabilitation from the moment of injury, through rehabilitation and back on our feet (so to speak)!

Implementing PEACE Immediately After Injury

Protectunload or restrict the range of movement (ROM) and the load placed on the injured area while it’s starting to heal. The length of time will depend on the severity of the injury. Using a pain scale 1-10 with 10 being the most painful, try to keep pain under a 3 or 4/10 if possible.

Elevateif there’s swelling or bleeding, to reduce the pressure in local blood vessels and help swelling drain away.

Avoid – if possible, anti-inflammatory modalities. Inflammation is our body’s natural healing response to tissue injury, as it sends an influx of white blood cells across. These are our first line of defence and start the healing process alongside extra blood. Anti-inflammatory medications and/or ice reduces the speed lymph and blood supply reaching the injured area, and therefore the body’s ability of dealing with damaged tissue. If swelling lasts longer than 2-3 weeks despite following these guidelines, speak with a doctor or healthcare professional for more advice. 

Compressionapplying external pressure while still allowing for full ROM, such as bandages, can help to limit joint swelling and tissue bleeding.

Educateunderstanding what the injury is and how best to manage it will help reduce the risk of re-injury and avoid over-treating it. It can be reassuring to know whether what we’re doing is likely to be helping or hindering. 

Rehab With LOVE

Load we start taking steps towards returning to our normal activities as soon as we comfortably can. Start small and as improvements are seen in strength and ROM, increase the load and at the right pace for you. Inflammatory symptoms can have a delayed reaction, so what you do today may not hurt at the time, but may remind you later the same day or the next.

Optimismthis can massively improve healing! Pain is a complicated warning system to protect us from harm. Imagine two people cooking together – one is a professional chef and the other cooks occasionally. The pan spits a small amount of fat which happens to hit both people on the forearm. The chef is more likely to have plenty of previous experience with small burns and is unlikely to be hugely affected by pain from this. The other person who hasn’t had as much ‘small burns’ experience would probably feel more pain because the brain doesn’t have the same level of experiences to draw on so the threat of danger seems higher. Pain science is a huge topic and our knowledge of it has changed massively in the past 4 years alone, so if the geek in you wants to read more, I’d definitely recommend it!

Vascularisation – having good blood flow to an area trying to heal can be very useful 🙂 Doing an activity that increases your heart rate while not hurting the affected area, will help to increase blood flow to your whole body including the area of injury.

Exercise – designed to help restore our usual ROM and strength in the affected area, and improve our proprioception post-injury. This means knowing where the bits of our body are without looking at it, which can be affected after an injury. 

Adapting To Modern Insights

Dr Mirkin explained, ‘Coaches have used my ‘RICE’ guideline for decades, but now it appears that both ice and complete rest may delay healing, instead of helping.‘ Research has now shown that using ice on injured soft tissues can also increase the amount of immature muscle fibres developed, leading to impaired tissue repair and reduced collagen production. None of which are great for healing!

However, ice can still have a place in the right situations. For instance, if using a cold pack on the area after the initial phase has passed, helps to make you more comfortable after exercising the area so you can sleep or to allow you to still move about and function, it can be a useful tool as part of your rehab if used with caution.

The Take Home?

Successful rehab involves both short-term relief and helping us to achieve the best possible outcomes in the longer term.

Like most things in life, new research and findings mean what we ‘know’ now will almost certainly keep change in the future as we learn new and better ways to treat things. At the moment we now know that R.I.C.E is out and P.E.A.C.E & L.O.V.E are in, as the useful set of strategies to help manage soft tissue injuries that are based on up to date clinical evidence. Whether we choose to manage an injury on our own or want to seek some advice, being open minded and flexible in our approach will help increase our chances of successful outcomes.

I hope you found this useful and thank you for taking the time to stop by! If you have any questions or comments at all, I’d love to hear from you!

Take care,

Lisa 🙂