PEACE & LOVE

As research helps us to understand the processes that occur within the body when it gets injured, it will no doubt lead to a change in how we manage that injury. Most people who have had a soft tissue injury will have heard of RICE or even the later acronym of PRICE. The acronyms give us a basis for helping to manage soft tissue injuries. Unfortunately, they don’t cover the full spectrum of the healing process though and as tissues continue to repair on their normal path there are changes that take place which won’t fit with the PRICE acronym. So with this a new acronym has been proposed, PEACE & LOVE. It’s a more holistic model which not only includes the immediate care but also the longer-term treatment involved in the management of the injury.

PEACE

As soon as you have a soft tissue injury the immediate care should follow the gentle approach. Imagine you cut your finger and how you would manage it. You would want the bleeding to stop so you don’t keep moving it around, you might put a little compression on it to stop the bleeding and depending on how sever it was you might even elevate it a little. These are some of the main components of a soft tissue injury, it’s just we can’t see it.

Protect

Limit the movement for 1-3 days to help reduce the bleeding.

Don’t move it about a lot, we don’t want to keep stretching the fibres that we want to be healing I the early stages. Let the fibres start to knit together a little. Imagine a scab forming on you finger if you cut it, you want the scab to form so you don’t want to keep opening it up or knocking it.

Try not to re injure the area. Think about that cut again, it takes longer for the scab to form and tissue to heal if the top keeps getting knocked off.

Try not to rest too much. We don’t want to become deconditioned.

Use pain as a guide to load the tissue and gradually reduce the protection on the injured area.

Elevate

Lifting a limb higher than your heart can help with the flow of fluid out of the injured tissues.

Avoid anti-inflammatory modalities and Ice

Anti-inflammatories work by altering the chemical processing and cascade that occurs when we have an injury. If we remove one of these chemical process it may have a negative affect on our longer term tissue healing because all of the stages of the inflammatory process are not allowed to be completed due to the medical intervention.

The use of ice in soft tissue injuries is thought mainly to have an effect on pain.It is thought that ice may disrupt the inflammatory process and lead to poorer tissue regeneration and impaired collagen resynthesis.

Compress

Swelling and bleeding can be helped by compression. We certainly see this on an external soft tissue injury and the same is true for intra-articular edema and other soft tissue bleeding. Applying an external mechanical compression can be helpful in those very early days for example using tape or bandages. It’s important to note that we still need blood flow to the limb so if you do bandage a soft tissue make sure you get some guidance and monitor fingers or toes for warmth and circulation.

Educate

Physiotherapists are all about keeping mobile and being active so educating our patients about the injury and returning to activity is really important. We try to encourage an active approach to recovery and giving our patient the right information and expectations on their condition can be very helpful for the longer-term recovery.

LOVE

So, we’ve given our tissues some PEACE for those first few days we now need to look to the next step which is giving them some LOVE

Load

Moving as normally as possible as soon as possible after an injury, whilst respecting pain is beneficial in the management of soft tissue injuries. Loading tissue within pain tolerances facilitates the healing process and promotes the repair and remodelling of the tissues.

Optimism

Giving our patients realistic expectations and goals can help them in the early days of an injury. How a patient views and understands an injury can have significant affects on pain and this can have a knock on effect to how well a patient rehabilitates as the tissue heals.

Vascularisation

We talked in the early phase about reducing the bleeding. Now we want it to increase. We want blood to flow to the injured area to supply it with oxygen and the nutrients it needs to fully heal. The best way we know to increase blood flow is through cardiovascular exercise and not only does it help with tissue healing but we know that exercises cause us to release endorphins. These are a great mood boosting hormone but also have an affect on pain modulation. Working out the best exercise can sometimes be tricky but there are seated bikes, step machines and arm bikes which can all be helpful.

Exercise

Physios are always giving exercises and talking about the benefits of exercise. In the early days after an injury, exercises help to restore mobility, strength and proprioception and assist in the optimal repair. It also has an effect on our mental health and as we start to see progress with ranges of movement, strength and function it gives us the confidence to work oat our rehab and can have a positive effect on our pain pathways. We need to remember though that in the sub-acute phase we are not wanting to push into pain. We want that tissue to heal and get mobile but without causing additional trauma.   

Summary

The management of acute soft tissue injuries needs to focus primarily in the early days on the short-term control of tissue damage, but we then need to quickly move onto the longer-term outcomes for that patient. Treating not just the tissue and injury but considering the person as a whole.