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Treating Injuries with Peace and Love

By 24 September 2020Injury Rehab, Latest

Why we’re now treating injuries with PEACE and LOVE

 
Many of you reading with be familiar with the acronym “RICE”: rest, ice, compress, elevate. You may have noticed that I have often evoked this protocol in my previous injury-related blog posts, encouraging you to manage inflammation in the first 72 hours following an injury and rest, elevating where possible, compressing if you have access to compressive clothing or someone who can apply a compressive bandage.

More recently, we have been encouraged to use PRICE and then POLICE for acute injury management; the P stands for “protect” (i.e. avoid using the injured limb, use crutches or a sling or boot where appropriate) in both cases, and the more recent acronym includes O and L for “optimal loading”. You may notice that replaces the “rest” in the previous acronym, but the “optimal” part (combined with the “protect” part) implies what I have previously termed relative rest: load, if appropriate, but less than before, or differently to before – for example, a runner may be able to “rest” or “optimally load” by cycling at a lower intensity to keep fitness and strength up, without causing further stress to damaged tissues.

Either way, you can forget most of that now, because we are now treating acute injuries with “PEACE” and “LOVE”. Doesn’t that sound great? But what does it actually mean?

PEACE

PProtect – nothing has changed here!

EElevate – still no change – get that injured limb up, reversing the pull of gravity, whenever you can!

AAvoid anti-inflammatories (note: this includes ice and medication such as ibuprofen) – this is a major change and one that requires me to reverse some of the advice I have given before. It is helpful to understand a little about inflammation to make sense of this: inflammation is an increase in blood flow to an injured site (which brings heat, redness, and a swollen appearance). The blood brings nutrients to help rebuild damaged tissues and carries away waste products such as fragments of damaged tissue. As such it is absolutely vital to the healing process! A caveat: excessive inflammation can be harmful, as in the case of compartment syndrome, as it can reduce the range of motion in the tissues and cause structural damage to surrounding tissues. If swelling and inflammation seem excessive, please do consult a medical professional.

CCompress – again, no change here – though now this, along with elevation, seems particularly
important given we are not trying to stop the natural inflammation process; we allow the extra blood
flow to happen, but the compression and elevation helps prevent pooling of fluid that could, as
described above, lead to further damage.

EEducate – possibly my favourite part of this new acronym. Take the time, while you are protecting and elevating, to research your injury and your options. Get it properly diagnosed. Learn what you can and can’t do. Find out your plan of action for management – how are you going to structure your rehab, what is the long-term goal? Don’t be afraid to ask a professional any of these questions (note: despite the wealth of information, Dr. Google does not constitute a medical professional). If it sounds wishy-washy, trust me, it isn’t – it can be your most powerful tool for coming back stronger than ever from your injury.
So that’s the PEACE component. Not too different, but more understanding of the body and the importance of being proactive when managing an injury.

On to LOVE:

LLoad (optimally) – this was present with POLICE, and again, refers to an appropriate amount of loading to strengthen tissues that aren’t damaged. Getting this right will probably require the input of an experienced professional, as you may be able to load a joint (e.g. ankle) without stressing the injured tissue (e.g. the ATFL in your ankle) by avoiding certain movements. This will all depend on your training status, your goals, and the proper diagnosis of your injury.

OOptimism – Yes, optimism matters to injury recovery, and I say this as a pessimist. Learn to reframe your injury: it’s an opportunity to spend more time on other hobbies, to discover new training methods, to come back stronger, to learn more about your body. I would add that being realistic is important; after I tore my ACL there would have been no use in me optimistically asserting I would be back to jiu-jitsu in three months (it’s a 12-month rehab process), but I did choose to focus on how much better a trainer and therapist I would be after living the experience (and I knew I would come back with legs stronger than ever). Again, please don’t hesitate to discuss this aspect with your therapist: ask them what you can expect to achieve, in what time frames, and be honest about how you are feeling about your injury. If you don’t feel you are getting sympathetic guidance or advice that motivates you, seek another therapist.
I think it’s important to add here, that you’re still allowed to feel down, frustrated, or angry about your injury. You may even experience grief, mourning a routine or skill that has been lost (hopefully only temporarily). It’s not helpful to quash those feelings. Let yourself feel them, accept and acknowledge them, and then find ways to reframe how you’re feeling (for example, rather than thinking “I’m so sad I can’t play football”, try and encourage yourself “I can’t wait to play football again, I’m going to do everything I can to recover fast and come back stronger”). If you find yourself unable to see a positive, if your therapist dealing with your physical injury isn’t able to help with your mood or mindset, then it’s also important to seek support for your mental health to support the physical recovery process.

VVascularisation (i.e. circulation) – For the same reasons we don’t want to stunt the natural inflammation processes, we want to encourage blood flow throughout the body as much as possible.
Any movement will help increase blood flow; some sort of gentle (appropriately-chosen)
cardiovascular exercise will encourage circulation and keep you fit and healthy throughout your injury. Needless to say, you should be avoiding any type of exercise that causes pain or that directly stresses the injured tissues (or puts them at risk; so maybe you can cycle with your injury, but choosing an indoor stationary bike over an outdoor ride protects you from falls that could turn a mild injury into a much bigger one). Plus, regular exercise is beneficial for your mental health, so this part can help with the Optimism part.

EExercise – Reinforcing the importance of keeping fit, strong, healthy, positive, and proactive.
Focus on what you can do versus what you can’t, and prioritise those activities. This will not only help you recover faster from this injury but will help you return to previous levels of fitness faster,
helping with overall long-term motivation (that’s that Optimism part again).
If it seems like a long acronym, with lots of components, it’s worth pointing out that many of these feed into each other. The main takeaway is that it’s so important to stay physically active throughout your injury if you can. Being physically active throughout an injury requires you to take a pro-active and positive role in managing your injury: ask questions, seek to understand your body and the sensations it experiences, learn about the healing process, find ways to keep progressing throughout.

Reference: https://bjsm.bmj.com/content/54/2/72.full

 

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