by Chng Tian Ying,
Head Sports Trainer – RMIT University
When it comes to the management and rehabilitation of soft tissue injuries, there is much complexity involved. What is a soft tissue injury? Soft tissue injuries commonly involve sudden trauma or overuse to muscles, ligaments, or tendons. These injuries often occur during sports and exercise activities but can also be sustained in a situation such as from a misstep when walking, and in many more different scenarios.
The most common traditional first aid protocols for soft tissue injuries were the mnemonics R.I.C.E. (Rest, Ice, Compression, Elevation), P.R.I.C.E. (Protection, Rest, Ice, Compression, Elevation) or P.O.L.I.C.E. (Protection, Optimal Loading, Ice, Compression, Elevation).
These methods highlight the acute management of soft tissue injuries but do not cover the sub-acute and chronic stages of these injuries. In 2019, Blaise Dubois and Jean-Francois Esculier proposed a new protocol: P.E.A.C.E and L.O.V.E.
The PEACE and LOVE protocol is a new comprehensive guide that covers all stages of injury. It also emphasises the importance of patient education and the biopsychosocial model.
Current research has shown that an individual’s experience of pain is influenced by the complex interactions between their biological, psychological, and social factors; Thus, it is essential that they receive equal attention to optimise the individual’s recovery process.
This protocol is split into two parts. PEACE is used as immediate care in the acute stage (1-3 days) after injury, and LOVE as ongoing management in the subsequent phases of injury.
In the past, movement and exercise after injury have been frowned upon because of the fear of re-injury, but recent research has suggested that introducing easy and gentle movement during the early stages of injury can be beneficial. It can help with blood flow, joint mobilisation, and decreased fear to get back into activity later. It has been suggested that movement is safe as long as it does not exceed a 4/10 pain, does not worsen the existing condition, and is not done excessively.
You may be wondering why ice has not been suggested in this protocol as one familiar scene that has been seen repeatedly, especially in the sporting community, is the use of ice during the early stages of a soft tissue injury.
The PEACE and LOVE protocol holds a controversial opinion towards the use of ice. Despite ice being widely used, there is no high-quality evidence to back up the efficacy of it. It has been suggested that although it can help relief pain, it could also potentially disrupt the inflammatory process and delay healing, as inflammation is the body’s natural response to heal and repair damaged tissue. The avoidance of anti-inflammatories is also suggested for a similar reason.
With the continual advancement of research comes new knowledge; therefore, leading to the constant evolvement of treatment and rehabilitation strategies. This article is a brief introduction to the PEACE and LOVE protocol, and more details can be found online.
With that being said, if you do experience a soft tissue injury in future, don’t forget to treat them with PEACE and LOVE!