It sucks, but injuries happen. Sometimes in the gym, other times at home while gardening, maybe during a soccer match with friends, or even playing with your kids or grandkids. If a muscle is injured, we call it a strain. If it’s a ligament or joint capsule, a sprain.
Over the years we had different acronyms to help guide the recovery process, such as RICE (Rest, Ice, Compression, Elevation) and POLICE (Protection, Optimal Loading, Ice, Compression, Elevation). Those acronyms focused mostly on acute management, which means the first few days after an injury.
More recently, Canadian researchers suggested a new Acronym(1), one that also considers the sub-acute and chronic phases after an injury, while considering the psychosocial factors that can help, or hinder, recovery. They called it PEACE and LOVE.
PEACE is for the first few days after an injury, and it stands for: Protect, Elevate, Avoid anti-inflammatories, Compress and Educate. After that (4-5 days later), then what injuries need is LOVE: Load, Optimism, Vascularization and Exercise. So let’s understand a bit more what that means.
PEACE:
Protecting: Do not aggravate, simple. That doesn’t mean stopping all physical activities. If you hurt your ankle, you still can - and probably should - exercise your upper body, as long as you choose exercises that won’t impact your ankle. Pain should guide the process. Exercises and activities that create or increase pain should be suspended.
Elevating: Elevating the limb higher than the heart can promote interstitial fluid flow out of the injured tissues, which may accelerate recovery. The authors highlighted that the evidence is weak though.
Avoiding anti-inflammatories: Inhibiting inflammation through medications could negatively affect tissue healing in the long term, particularly when high dosages are used. Also, note that ice is not recommended anymore, for similar reasons.
Compressing: Compression could reduce swelling, but evidence is also weak here.
Educating: Professionals should educate their clients about the benefits of an active approach (LOVE), set realistic expectations for recovery and guide them to avoid unnecessary treatments.
LOVE:
Load: Loading can happen in different ways: doing more reps, doing a more difficult exercise, walking/running longer, etc. When optimal loading is used, pain doesn’t increase and we accelerate tissue repairing. The goal is to continuously increase the capacity of the muscles, tendons and ligaments to handle stress, and to mitigate the risk of newer injuries.
Optimism: This is straight-forward: people with optimistic expectations usually have better outcomes. Fear can lead to guarded movements and avoidance of exercise, delaying the recovery process.
Vascularization: Pain free aerobic exercise increases blood flow to injured structures, accelerating recovery.
Exercise: Also straight-forward. Exercise builds strength, mobility, proprioception, balance, coordination, etc. Again, exercises should be pain free, and pain should be used as a guide for movement selection and progression.
So this is it guys. Injuries happen, and when they do, we need to “treat the person with the injury rather than the injury of the person”, as the authors suggested. Movement is medicine!
Willian Alba
1- PMID: 31377722
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