What are soft tissue injuries?

Think strains and sprains to our muscles, ligaments, and tendons. Common soft tissue injuries include hamstring tears, calf tears, and ankle sprains. Soft tissue injuries are extremely common, particularly now that the holiday period is over and people are returning to sport. As a result, appropriate management of these injuries is essential. Several acronyms over the years have been available to assist in the early management of these injuries – from ICE, RICE, PRICE and POLICE. The most well-known being RICE or rest, ice, compression, and elevation (Figure 1.).

The purpose of RICE is to assist in the immediate and early management of soft tissue injuries. Recently a new acronym, PEACE & LOVE (Figure 2.), has been proposed by Dubois & Esculier (2020). This new guidance addresses both the immediate care (PEACE) and the subsequent care following the injury (LOVE). This makes care more complete across the recovery continuum for soft tissue injuries. You can read more on RICE here.

So, what does PEACE & LOVE mean?

PEACE is for the initial management, immediately after the soft tissue injury. It stands for protect, elevate, avoid anti-inflammatories, compression, and education.

Protect

The aim is to protect the initial injury and avoid causing further bleeding or potential damage. This is done by reducing load or aggravating movements. However, individuals should limit prolonged rest or immobilization as this can impact on strength, flexibility, and quality of tissue healing. Instead, pain is used to guide the gradual return to normal activity.

Elevate

The goal is to elevate the injured limb above the level of the heart. This will help to promote swelling and other fluid away from the injured tissue.

Avoid Anti-inflammatories

Inflammation is a vital early component of tissue healing. Anti-inflammatory medication can delay or impact upon this initial healing. Examples, include Nurofen and Voltaren. Anti-inflammatories are widely accepted in the early management of injuries, but they can impede the initial healing of soft tissue injuries.

Compression

Compression assists with managing and reducing swelling within and around the injured tissue. Tools to assist with compression include bandages, compression garments, and taping. 

Education

Education is crucial in the early management of soft tissue injuries to ensure the best outcome is achieved. Education can consist of advice around best management strategies, the injury itself and expected recovery timeframes, and appropriate load management to ensure optimal healing and loading of the injured tissues.

After a few days we move from PEACE to LOVE. LOVE stands for load, optimism, vascularization, and exercise.

Load

Returning to your normal activities as your pain allows is the recommended approach. Optimal loading is important to achieve the best result in the management of soft tissue injuries. It promotes tissue repair and increases tissue tolerance to load, whilst avoiding overloading the injured tissues and irritating them further.

Optimism

It is important to be aware that psychological factors can impact recovery. Fear, catastrophization, and depression can act as barriers to recovery. Therefore, it is important to be realistic but optimistic about recovery.

Vascularization

Increased blood flow to injured tissues can promote tissue healing. This can be done through early return to cardiovascular exercise and movement. Furthermore, early return to exercise can improve function and return to work.

Exercise

The aim of exercise is to restore mobility, regain strength, and improve proprioception as early as possible after injury. Specific exercises will assist in recovery and return to pre-injury function. Again, let pain be your guide for the progression of exercises.

Physiotherapists are experts in the management of soft tissue injuries and returning people to sport or usual daily activities. If you or someone you know has experienced a soft tissue injury and needs some PEACE & LOVE give us a call on 4962 8700 and book in with one of our physiotherapists. Alternatively, you can book online on our website https://auappts.gensolve.com/ethos_health/  

References

Dubois, B., & Esculier, J. F. (2020). Soft-tissue injuries simply need PEACE and LOVE. British journal of sports medicine, 54(2), 72-73.