Peace and Love for Acute Injuries

PLEASE NOTE: the following information applies to soft-tissue injuries such as sprained ankles, strained biceps, or contusions (bruises) to your thigh. If you think your injury is more severe, please seek immediate attention by visiting your doctor, physiotherapist, or in extreme cases going to the emergency room.

For more information, click on one of the topics below:

What are common treatment acronyms for acute injuries / soft tissue injuries?

You may be aware of some common acronyms to help you remember what to do when you get a soft tissue injury, like ICE (Which stands for Ice, Compression, and Elevation) or PRICE (with the addition of Protect and Rest). You may even be aware of the newer acronym of POLICE (which replaced Rest with Optimal Loading) that started to introduce the idea of an active approach.

POLICE (Protect, Optimal Loading, Ice, Compression and Elevation)

PEACE (Immediate Care in First 72 Hours)

The PEACE acronym is for IMMEDIATE CARE in the first 72 hours after an injury. A way to remember this is: “Immediately after a soft tissue injury, do no harm and let PEACE guide your approach.”

P is for Protect

Following a soft tissue injury, it’s important to limit the use of the injured site or to restrict movements that cause pain for 1-3 days in order to prevent further injury. This can be done by not overusing that area of the body or by using a brace, sling, or crutches as needed.

Previous acronyms for recovery emphasized rest; however, prolonged rest beyond 72 hours can actually compromise the strength and quality of the healing tissues. That is why it can be helpful to protect the area for those first few days but to avoid complete rest.

To encourage optimal recovery, pain can be your guide as to what or how much you’re able to do in those first 72 hours; however, beyond that timeline pain becomes less useful as a guide to movement.

E is for Elevate

This means placing the injured limb above your heart. Scientific evidence has found this step to be safe and helpful with the initial healing process.

A is for Avoid Anti-Inflammatories

Although this may go against what has previously been recommended after an injury, certain evidence has recently found that anti-inflammatory medications MAY negatively impact tissue quality in the long-term healing process.

Anti-inflammatories do help with pain management, but because the inflammatory response is the first step in your body’s natural healing response, it may interfere with long-term healing. In order to encourage optimal recovery, it may be beneficial to avoid the use of these types of treatments that are aimed at stopping your body’s natural healing process.

Consider discussing with your family doctor (or pharmacist) alternative pain relief medications that do not have anti-inflammatory properties, or if risks outweigh the benefits for your condition.

C is for Compression of the Injury Site

The gentle pressure of an elastic bandage, sleeve or tape around the limb can help to decrease swelling after an injury.

Make sure that this compression is snug but not too tight that it cuts off your circulation. Check your toes or fingers to ensure you still have good blood flow through that limb and you aren’t losing sensation. This can easily be done by squeezing the tip of your finger or toes and watching for a normal return of the colour to your nail bed. If the colour does not return within 2 seconds, or they become purplish or blue, cold to the touch, or numb or tingly, the compression is too tight and should be loosened.

Additionally, it may be beneficial to remove or loosen this bandage before bedtime, as you aren’t able to monitor any changes while you sleep.

E is for Education

Learning about your injury and the importance of letting your body heal, including learning this acronym, is an important part of the recovery process. Being informed about the benefits of an active approach to recovery, involving movement and return to function, is equally important.

Many passive approaches, such as acupuncture, ultrasound and manual therapy typically provide short term pain relief, but have limited benefits for tissue healing. These approaches can be viewed as “band-aid” treatments in the initial stage that can provide immediate symptom relief, but do not actually address the root cause of the problem. By educating yourself on your condition and following this acronym, you can limit the use of passive treatments for short-term relief, and instead focus on your active recovery.

That being said, beyond the 72 hour period of the initial stage of healing, these passive treatment options can be beneficial for that short term pain relief in order to help get you back to moving; which leads us to the next stage of recovery…

Does Ice help with an Acute Injury?

The use of ice is also highly debated. There is a lack of evidence demonstrating any benefit of ice towards healing, but ice has been found to be a safe option for pain relief after an acute injury.

In general, if using ice like a bag of peas or crushed ice, it can be applied for 5 to 30 minutes at a time, but this may change depending on the area of injury. Make sure to let your skin temperature return to normal prior to re-applying to the injury site, and watch for any allergic reactions like hives, tingling, or itchy skin and remove the ice immediately.

LOVE (After the 72 Hours)

The LOVE acronym applies to the days following that initial stage, after the 72-hour period, once your initial symptoms have begun to settle. At this point, it comes time to rehab your injury through progressive movement. You can remember it by: “After the first days have past, soft tissues need LOVE.”

L is for Load

After giving your injury time to heal, it’s important to put more pressure through the injured body part to promote continued healing and to improve your function. Loading the limb by using it more helps to build tissue strength and quality, avoid muscle weakness in surrounding muscles, and minimize loss of range of motion of the limb.

This active approach should be done gradually, as injured tissue will likely not be at full strength and require progressive return to normal function.

O is for Optimism

It is understandable that an injury can impact many areas of your life and get you feeling down. Research has shown that your thoughts and expectations about your injury can impact the speed of your recovery. Maintaining hope while you actively work towards a realistic plan for your healing journey gives you the best chance at getting back to the things you love.

V is for Vascularization

This is the idea of promoting blood flow in your body by performing cardiovascular activities within your pain tolerance.

These include any activities that increase your heart rate, such as walking, running, cycling, or swimming. For example, if you have recently sprained your ankle, try cycling or doing mostly upper body focused swimming.

Alternatively, if you recently sprained your wrist, try walking or running. By increasing the blood flow through your body, you are promoting continued repair to the injured tissue.

E is for Exercise

This final step emphasizes the continued rehabilitation beyond the injured phase. Once you feel less sore, it can be tempting to return to all the activities you were doing before, but it’s important to remember that your tissues likely aren’t as strong as they were before your injury. A variety of exercises that help restore, or even improve, your pre-injury movement, strength and balance can help increase your capacity for activity and reduce the risk of another injury.

Exercise has also been found to decrease pain levels by releasing natural pain-mediator chemicals in your body, which can reduce the need for pain medications. Once again, the difficulty of these exercises should be gradually increased and varied, while being performed at a tolerable level, which will differ person-to-person.

By following this process of PEACE and LOVE for acute soft tissue injuries, you will be able to guide yourself through recovery and return to your previous activities. Just remember, recovery times will vary depending on the severity of the injury and other factors in your life, but listen to your body and respect the natural healing process. If you are unsure or need some help getting back to your usual function, seek out a physiotherapist who can guide you through a personalized recovery plan.

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Dubois B, Esculier JF. Soft-tissue injuries simply need PEACE and LOVE. Br J Sports Med. 2020;54(2):72-73. doi:10.1136/bjsports-2019-101253

Healthwise Staff. (2019, June 29). Learning About Compression Bandages. Retrieved from https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=abr6087

Koltyn, Kelli F., et al. “Mechanisms of exercise-induced hypoalgesia.” The Journal of Pain 15.12 (2014): 1294-1304.