RICE? PRICE? POLICE? OR PEACE & LOVE? What to do in the first few days of a soft tissue injury
You might be familiar with the acronyms RICE or PRICE standing for :
Prevention
Rest
Ice
Compression
Elevation
More recently (2012) the POLICE acronym was proposed to replace RICE and PRICE based on the appropriate research. Here, Optimal Loading replaces Rest which emphasises the need to incrementally load the injury or use the injured limb to ensure optimal healing and recovery:
Protection
Optimal Loading
Ice
Compression
Elevation
More recently still the PEACE and LOVE acronym was proposed in 2019. This includes immediate acute care as well as medium to long term management and is my personal favourite:
Protection
Elevation
Avoid Anti-Inflammatories
Compression
Education
&
Load
Optimism
Vascularisation
Exercise
I really like this acronym. It’s up to date in its use of the latest evidence and research as well as being descriptive and easy to follow. This is certainly going to influence my approach to patient care and is something I will steer people towards when they ask for advice.
So how can you use this if you’ve got a fresh soft tissue injury?
In the first 1-3 days after an injury:
Protect - Minimise movement of the area to avoid further tissue damage and bleeding. Avoid movements which provoke pain.
Elevate - Where possible raise the injured are above the heart to encourage drainage of the swelling. This advice has mainly stayed in more because there is little evidence to suggest it is harmful rather than there being lots of evidence to suggest it is beneficial.
Avoid anti-inflammatories - Inflammation helps to repair tissue damage so stopping this process with medication is not advisable. Cryotherapy or ice therapy is also questioned due to its effects on interfering with inflammation.
Compress - Using tape or bandages can minimise swelling and bleeding at the site of injury. Compression shouldn’t be so tight that it stops blood flow. It shouldn’t be so tight that the area is smaller or narrower than before the injury.
Educate - Let your body take control and do the repair. Beware of unecessary treatments and investigations. In the first few days. A correct diagnosis and advice on which types of movements to start doing and when from your osteopath will be far more beneficial. This will allow you to have a clear picture in your mind of what’s going on and will empower you to take control of your rehabilitation.
After 3 days it’s time to apply the LOVE part of the acronym.
Load - loading means to put force through or to use the joint or affected area. This should be without pain and should b movements you would use in your usual day to day life.
Optimism - Having realistic views on what to expect in terms of your recovery and by when can help to keep optimistic. Consulting an osteopath to get an accurate diagnosis and expert idea of how long different tissues take to heal is a good idea. This way you can see the bigger picture and appreciate each stage of progress.
Vascularisation - Raising the heart rate through pain free cardiovascular exercise will ensure good circulation to the injury site which can assist healing. This is also a good way to maintain overall health and motivation and to transition back to full function more easily.
Exercise - There is strong evidence to show that rehabilitation exercises improve range of motion, strength and proprioception and recovery from injury in general. So if your osteopath gives you exercises, make sure you do them.
So there you have it. Give yourself a little PEACE & LOVE and you’ll be well on your way to recovery.
The following research was used to inform this blog:
PRICE needs updating, should we call the POLICE? C M Bleakley, P Glasgow,D C MacAuley Br J Sports Med 2012;46 :220–221. doi:10.1136/bjsports-2011-090297
Soft-tissue injuries aimply need PEACE and LOVE Dubois B, Esculier J-F. Br J Sports Med 2020;54:72–73. Accepted 16 July 2019 Published Online First 3 August 2019
The content of this blog is copyright of Holly Elliott registered osteopath trading as Helping Hands Health 15a Clayton Road, Newcastle upon Tyne, NE2 4RP.