The PEACE & LOVE recovery principle is a modern approach to soft tissue injury recovery, evolving from the older RICE principle (Rest, Ice, Compression, Elevation). It offers a more comprehensive framework for managing injuries across different stages of healing.
Since 1978 the RICE protocol has been the preferred method of treatment for acute musculoskeletal injuries.
The rationale behind RICE was that minimizing inflammation, swelling, and further injury in the initial stages after a soft tissue injury like a sprain or strain would create an optimal environment for healing. It was a widely accepted first-aid protocol recommended for acute soft tissue injuries.
However in 2014 Dr. Mirkin, the man who coined the term, recanted his original position on the protocol stating “…now it appears that both ice and complete rest may delay healing, instead of helping. Although cooling delays swelling, it does not hasten recovery from muscle damage.”
Research has challenged certain aspects of the RICE protocol and suggests that complete rest, icing, and compression may actually impede long-term recovery by inhibiting the inflammatory response needed for healing. This has led to alternative approaches emphasizing early mobilization and exercise.
A 2012 study published in the Journal of Athletic Training found that applying ice to an acute muscle strain did not improve functional outcomes compared to no icing. The study suggested that icing may actually delay healing by impairing the inflammatory response needed for tissue repair.
Inflammation is an inevitable and an essential biological response following acute soft tissue injuries. It is a protective attempt by the body to remove the damaging stimuli and to begin the healing process.
The inflammatory cells called macrophages release a hormone called Insulin-like growth Factor (IGF-1) into the damaged tissues, which helps muscles and other injured parts to heal. However, applying ice to reduce swelling delays healing by preventing the body from releasing IGF-1.
A 2020 article in the British Journal of Sports Medicine proposed the "PEACE and LOVE" model (Protection, Elevation, Avoid anti-inflammatories, Compression, Education, and Load, Optimism, Vascularisation, Exercise) as an alternative to RICE. This model emphasizes avoiding anti-inflammatory drugs, early mobilization, optimism, and exercise to promote healing.
PEACE
Protection
Restrict movement with a brace or wrap for 1-3 days to reduce bleeding and prevent further injury. Remove protection once pain level is manageable and gradual reloading can begin.
Elevation
Elevate the limb higher than the heart to promote fluid flow away from the injury.
Avoid anti-inflammatories
This is for both ice and NSAIDs. This one seems counter-intuitive, but the thought here is based on the previous statement that you do not want to deter the inflammatory process as this is what aids healing.
Compression
Compression comes after the initial 1-3 days of protection, this should not be as restrictive as in the protection phase and allow for full range of movement.
Education
A therapist should educate on the appropriate steps to move forward with your care. Although nothing is a perfect science, they have plenty of experience to set proper expectations regarding recovery and return to activity.
LOVE
Load
An active approach with movement aids in recovery. Normal activities should resume as soon as symptoms allow for it.
Optimism
Optimistic expectations are associated with better outcomes and prognosis; while pessimistic expectations negatively influence outcomes and prognosis of an injury.
Vascularisation
Pain-free aerobic exercise should be started a few days after injury to boost motivation and increase blood flow to the injured structures.
Exercise
Treating an injury through exercise has many benefits including: restoring mobility, strength, and proprioception.
Ice is useful in the immediate aftermath, within the first 12 hours of an acute injury, to help ease pain and reduce any secondary injury.
While the RICE protocol may still have some utility in the immediate aftermath of an acute injury; the PEACE and LOVE protocol is a more active, movement-based approach with early mobilization and exercise that may lead to better long-term outcomes for soft tissue recovery compared to strict rest and icing.
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