PEACE and LOVE: The New Acronym For The Management of Acute Soft Tissue Injuries

Dr. Linnea Omholt, Physical Therapist

Let’s say you roll your ankle. What's your immediate thought? Rest, ice, compression, elevation… right? I know for years growing up, I always heard the acronym, RICE, to help with injuries. That’s some of the guidance that’s been shared for years and still is by some professionals.

In 2019, two new acronyms were proposed to optimize soft tissue recovery: PEACE and LOVE. These acronyms help guide management of a soft tissue injury immediately in the short term (PEACE) and in the subsequent phase (LOVE).

PEACE

“Immediately after a soft tissue injury, do no harm and let PEACE guide your approach.”

The acute phase can last a few days to a week depending on the injury. Inflammation is necessary after an injury for tissue healing. Give your body "PEACE" as your body moves through this phase.

P: Protect

Unload or restrict movement for 1-3 days to reduce risk of aggravating the injury, reduce bleeding, and prevent swelling of injured areas. Try not to completely stop moving, though, as prolonged rest can compromise tissue strength and quality. Keep moving without loading the injury (ie. gentle, pain free movement for your ankle). Let pain guide gradual return to activity and reloading.

E: Elevate

Elevate the limb higher than the heart to promote fluid flow out of the injured tissue. There is not great evidence for this, but it is still recommended since there is very low risk.

A: Avoid anti-inflammatory medications

Anti-inflammatory medications may negatively affect long-term tissue healing. The inflammatory process is necessary to support optimal soft tissue regeneration and use of these medications could impair the healing process.

It is also now recommended to avoid ice as a treatment. Ice is mostly used for pain but could disrupt inflammation and other processes required for tissue healing. I recommend using ice only as needed to help calm the pain.

C: Compression

External compression such as taping, bandages, or compression garments can be applied to help limit intra-articular edema and tissue hemorrhage. It should still allow full movement at the joint.

E: Education

It’s important to understand what is happening within the body and tissues during the healing process. Having realistic expectations about what to expect and recovery times, as well as, focusing on an active approach, rather than a passive approach, can be beneficial!

LOVE

“After the first days have passed, soft tissues need LOVE!”

The subacute phase can begin at day four and last up to 6 weeks. The inflammation settles and your body begins to repair the tissues. It may take 2-3 weeks to months/years for these tissues to return to the quality, strength, and organization they may have had previously.

L: Load

Soft tissue injuries benefit from an active approach with movement and exercise. Normal activities should continue as soon as symptoms allow. This will aid in the healing process including stimulating tissue repair.

O: Optimism

Stay positive and confident in your recovery. Your brain plays an important role in your healing. Barriers can include fear, depression, and catastrophization and staying realistic but optimistic can improve chances of optimal recovery.

V: Vascularization

Increase blood flow to the recovering tissues with pain-free cardiovascular activities and movement near the injury. Benefits of early mobility and aerobic exercise include improvement in function, improvement in work status, and reduction in the need for pain medication.

E: Exercise

Restore mobility, strength, and body awareness by adopting an active approach to recovery. Use pain as a guide to progress exercises gradually and promote optimal repair.

So that’s it, remember PEACE and LOVE following a soft tissue injury and you will be back up and moving in no time!

Treatment and management of soft tissue injuries is always changing. Beyond Physio is a physical therapy practice currently providing virtual (to anyone in Illinois) and mobile visits (to those located in the Tri-Cities) to help you return to your activities, pain free, as soon as possible. We love helping people through this process and are happy to answer any questions you have.

The information provided is intended as general guidance and information only and should not be relied upon as a basis for planning individual medical care or as a substitute for specialized medical advice and evaluation.

Adapted from: Dubois B, Esculier JF. Soft-tissue injuries simply need PEACE and LOVE. Br J Sports Med. 2020 Jan;54(2):72-73. doi: 10.1136/bjsports-2019-101253. Epub 2019 Aug 3. PMID: 31377722.