Rehab of soft tissue injuries can be confusing. We have seen evolving acronyms and contrasting advice but the recent evidence is in support of PEACE & LOVE to cover the acute and sub-acute phases (24-72hours) after an injury (i.e. an ankle twist on the trails).
But what does PEACE & LOVE stand for?
Protect : Unload and avoid aggravating for the first 48-72hours. Progression from this stage is dictated by pain.
Elevate : There is little evidence for its benefits however it goes hand in hand with protecting and therefore continues to be recommended.
Avoid Anti-Inflammatories : Avoid these modalities in the initial stages as these can impair long term tissue healing.
Compress : Mechanical pressure i.e. taping or bandages can limit tissue swelling.
Educate : Active recovery is heavily encouraged. Passive modalities such as manual therapy, acupuncture can in fact be counter-productive in the long term.
After these initial acute stages: Soft tissues need LOVE
Load : Mechanical stress is dictated by symptoms however is critical in repair and tissue remodeling whilst avoiding muscle atrophy and deconditioning.
Optimism : The brain is fundamental in rehab. Negative expectations and anxiety can present as barriers to recovery.
Vascularisation : Pain-free cardio can be started soon after injury to increase blood flow and therefore facilitate healing.
Exercises : prescription of appropriate physiotherapy rehabilitation exercises will enhance the recovery and prevent recurrence.
If you think about it, with sports like trail running many injuries could be avoided with careful consideration of training load and complementary conditioning/mobility work.
However, injuries happen – that’s a fact and so for their initial management –
(1) Don’t panic!
(2) Ensure the inflammation settles the right way with the PEACE & LOVE strategy & (3) Make sure you seek advice & guidance from a medical professional for the longer-term management and for help to return to your chosen sport stronger.
Although these initial stages are crucial, we must not forget that tissue healing takes longer than we are all guilty of allowing. Rehabilitation should continue to play a part in your training and competition for at least 6 months post injury.