Alright, you just hurt yourself and now everyone around you and their dog has an advice on what you should be doing which gets you wondering on what you should actually be doing! “Should I ice? Heat? Take anti-inflammatories? Wait for it to go away on its own?” The best up-to-date advice in terms of how to manage acute and subacute pains are well summarized by the acronym, “PEACE & LOVE”. Let’s look at it.
The PEACE part addresses how to rapidly manage an acute injury, most often caused by trauma.
«Immediately after injury, do no harm and let PEACE guide your approach.»(1)
P (protection) For at least the following 3 days, the first step is to limit your activities to avoid aggravating the injury, reducing a potential bleed(if it is a traumatic injury) and limit the pain.
E (elevation) This ‘elevation’ part applies to arms and legs injuries when the limb should be positioned above the heart level which will help to reduce swelling.
A («avoid anti-inflammatory modalities») Many believe that inflammation is bad for the healing process when it is the complete opposite! It is a crucial step because the inflammation will signal the body to send in the different cells and factors to help the tissu’s healing process. It is therefore recommended to leave aside the tylenol, advil, voltaren or any other anti-inflammatory in the first days following an injury.
C (compression) Compression has the same goal as elevation in that it serves to reduce swelling to the injured tissues as it may be problematic to the tissues around the injury. Compression may be done in many different ways such as with taping.
E (education) It is very important to understand and respect your body’s limits because it knows what is necessary to heal properly. It is also important to understand that when you get injured, the more active approach helps heal faster. In many cases, passive modalities (TENS, muscles work,etc.) may help accelerate the healing process but one cannot solely rely on those for an optimal recovery.
The LOVE acronym is for the subacute phase, to help recover faster and more efficiently.
«After the first days have passed, soft tissues need LOVE.»(1)
L («load» ?mechanical stress) When soft tissues are starting to heal, putting a load on them is important so that their fibers reorganize properly and can support whatever future demand is required of them. However, listening to your body is very important and therefore, do not go beyond pain.
O (optimism) Since the brain is the organ that sends healing signals throughout the body, it is important to have a positive approach to healing. It has been proven that people who are optimistic about the healing of an injury recover faster than people who only see the obstacles that the injury may bring.
V (vascularization) The supply of blood to an injury is essential to promote effective healing. It is therefore recommended to start practicing cardiovascular activity a few days after a muscle, ligament or bone injury. However, this activity must be done without pain.
E (exercise) Exercises are a very important part of the healing process. It will be important to look for movements that help enhance mobility, strength and proprioception (sense of position / balance) to regain the same functions as before the injury and more. It is the element of the process that will ensure progress is maintained over the longer term.
At this point, you are probably telling yourself: “But … I do not see either the ice or the heat in your explanations.” Indeed, even today studies do not quite agree on the subject. This could slow down the healing process, much like what is described for anti-inflammatory drugs. Therefore, ice is not recommended in the first days immediately following an injury.
However, it should never be forgotten that each injury is unique and requires a targeted approach, depending on each individual. Hence, it is important to get assessed quickly in order to set up an action plan and so promote optimal healing!
1.Dubois B, Esculier JF. Soft-tissue injuries simply need PEACE and LOVE. British journal of sports medicine. 2020;54(2):72-3.