Learn the new protocols for your soft-tissue injuries
Traditionally, the recommended management for soft tissue injuries has been the RICE, PRICE or POLICE methods. These models only accommodate for the acute management of these injuries, the first 72 hours following injury. A process as complex as tissue healing may have in those protocols a very vague and non-specific approach that doesn’t change as the condition moves through the several stages of tissue healing and rehabilitation.
For this reason, researchers Blaise Dubois and Jean-Francois Esculier, have recently suggested up-to-date evidence-based new acronyms that are much more comprehensive than previous proposals as they encompass the rehabilitation continuum from immediate care (PEACE) to subsequent management (LOVE).
Immediately after an injury, use the PEACE protocol listed below…
P for Protect – When we cut ourselves, we try protecting the area, until the skin is again strong to take most of our daily activities, therefore unload the area and/or restrict movement for the first 3 days to minimize bleeding, prevent distension of injured fibers and reduce risk of aggravating the injury. However, prolonged rest can compromise tissue strength and quality, so this should be minimized. Your body will use pain as an adviser on what an appropriate time and degree of loading will be.
E for Elevate – Elevate the limb higher than the heart to promote reduction of swelling in the injured area.
A for Avoid Anti-Inflammatory Modalities (and ICE) – Avoid anti-inflammatories as these can be detrimental to tissue healing. Inflammation is a good thing, as it’s the initial response of the body to heal the injured area, and its various phases contribute to optimal soft tissue regeneration. Inhibiting such an important process using anti-inflammatories is not recommended as it could impair tissue healing, especially when a higher dosage is taken.
Regarding the application of ice, there is no high-quality study on the efficacy of ice for treating soft tissue injuries. Ice is mostly used to numb the area of pain and help you cope with the pain. Theoretically ice could potentially disrupt inflammation, creation of new vessels on the new tissue and delaying its healing and repair, thus reducing the final tissue quality.
C for Compress – Compression to affected area, via bandaging or compression bandage helps to limit joint swelling and reduce loss of range of movement.
E for Educate – Education provided by health professional, a crucial part of injury management. An active approach to recovery should be encouraged, including strength-based rehabilitation exercises. Realistic goals and time frames for recovery should be set, and patient workloads managed accordingly.
AND after the first days after the injury have passed, your soft tissue needs LOVE:
L for Load – Load the area, gradually and as tolerable. An active approach to therapy via exercise is beneficial to most musculoskeletal injuries. This promotes tissue healing and remodeling and helps improve the tissue tolerance to further loading in future.
O for Optimism – A positive outlook towards rehabilitation has a massive impact patient prognosis. Focusing on pain, catastrophizing (thoughts that you will never recover), depression and fear can lead to poorer or longer recoveries.
V for Vascularization – Get the limbs moving to promote blood flow in and out of the area. Some early cardiovascular exercises (walking, running, cycling, swimming) can help improve tissue recovery and pain, and also serves to help improve motivation.
E for Exercise – There is a strong level of evidence supporting the use of exercises for treatment of sprains/strains and for reducing the prevalence of recurring injuries. Exercise as therapy in musculoskeletal injuries will help restore mobility, strength, and proprioception of the affected area. However, this must be done sensibly and high levels of pain should be avoided to ensure optimal repair during the subacute phase (between the 4th to the 21st day after the injury occurs) of recovery and should be used as a guide for progressing exercises to greater levels of difficulty.
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