Acute short-term injuries happen suddenly such as when a person falls, receives a blow, or twists a joint, for example, sprains and dislocations .
Over the years there has been many different acronyms guiding the management of acute/short-term injuries. Firstly, and arguably, the most well-known, RICE (rest, ice, compression, elevation). Dr. Mirkin et al. developed this acronym, in their book “Sports Medicine” (1978). They argued that, to reduce inflammation and accelerate healing after acute injury, cooling agents should be used . This initial guideline became the preferred method of treatment for acute musculoskeletal injuries for almost 20 years. The acronym then added the importance of protection and was included in the protocol (PRICE), 14 years later. It was then discovered that long-term rest was detrimental to recovery, in which POLICE (protection, optimal loading, ice, compression, and elevation), became the new guideline. These acronyms focused on acute injury management and ignored the subacute and chronic stages of tissue healing .
In 2019, new studies have shown that ice is not as effective as once thought, in advancing the recovery process. Therefore, it has been completely removed from the treatment guideline with the latest and most comprehensive acronym: PEACE & LOVE. These acronyms encompass the entire rehabilitation process from immediate care (PEACE) to subsequent management (LOVE) .
This has now become the preferred management of acute injuries and what I would encourage people to do immediately after an injury. Let’s delve further into what this acronym stands for.
Immediately after injury, let PEACE guide your approach
Protection: restrict movement for 1-3 days. This will help to minimise bleeding, prevent distension of injured fibres, and reduce the risk of aggravation. Rest should be minimised as prolonged rest can weaken the tissue. Pain signals should guide the period of protection.
Elevation: elevating the limb higher than the heart promotes the interstitial fluid to flow out of the tissue. There is not much research done on this area, but elevation shows a low risk-benefit ratio.
Avoid anti-inflammatory drugs: inflammation is an important phase of recovery as it helps to repair damaged soft tissues. Therefore, preventing inflammation with medications may negatively affect long-term tissue healing, especially when higher doses are used.
We also want to avoid ice in treating an acute injury as ice can disrupt inflammation, the formation of new blood vessels, blood supply, delay neutrophil and macrophage infiltration (which helps with inflammation), as well as increase immature muscle fibres which will increase the chance of muscle weakness.
Using ice is not all bad. Ice should only be used as an analgesic and only used in the first 24 hours after injury. As stated by Wang and Ni (2021), “the cold application on acute muscle fibre injuries should not last long and needs to be controlled precisely to avoid harming the neuromuscular muscle function”.
Compression: using pressure on an injury in the form of taping or bandages helps to limit swelling and tissue haemorrhage. Despite conflicting studies, compression seems to reduce swelling and improve quality of life.
Education: an active approach to recovery has proved to have many benefits after an injury. Therapists should educate patients on these benefits as well as the condition and load management as this will help avoid overtreatment. Research shows that modalities such as electrotherapy, manual therapy, or acupuncture, early after injury has limited effects on pain and function compared with an active approach and may be counterproductive in the long term. Seeking such modalities and having a ‘need to be fixed’ mindset can lead to therapy dependent behaviour. This also reduced the chances of unnecessary injections or surgery and supports a reduction in the cost of healthcare. It is important to educate patients and set realistic expectations about recovery times instead of encouraging the patient to find the ‘quick fix’ approach.
After the first few days have passed, soft tissues need LOVE
Load: it is important to take an active approach and introduce movement and exercise early on in recovery as soon as symptoms allow. This will promote repair, remodelling and builds tissue tolerance in the injured muscle.
Optimism: research shows that optimistic patients often have better outcomes and prognosis. Catastrophisation, depression and fear can act as barrier to recovery, so it is important to have an optimistic outlook.
Vascularisation: pain-free aerobic exercise should start a few days after injury. This helps to boost motivation and increase blood flow to the injured structures. It has also been found to improve physical function, supports a return to work and reduce the need for pain medication.
Exercise: evidence shows that the use of exercise reduces the risk of a recurrent injury. Exercise is important early after injury as it helps to restore mobility, strength, and proprioception. Pain should be avoided to ensure optimal repair during the subacute phase of recovery and should be used as a guide for exercise progression [1, 3, 4].
 Wang, Z & Ni, G 2021. Is it time to put traditional cold therapy in rehabilitation of soft-tissue injuries out to pasture? World J Clin Cases, 9(17), pp. 4116-4122.
 Mirkin G & Hoffman, M 1978. The Sports Medicine Book. Boston: Little, Brown and Company.
 Scialoia, D & Swartzendruber, A 2020. The RICE Protocol is a Myth: A Review and Recommendations. The Sport Journal, pp. 1-19.
 Dubois, B & Esculier, J-F 2022. Soft-tissue injuries simply need PEACE and LOVE. Br J Sports Med, 52(2), pp. 1-5.