By Liam Neyland
How often have you heard the phrase ‘Put some ice on it’? Whether you’re young or old, someone at some point would have recommended this, maybe even a health professional like your local GP. The reason this saying is used so frequently is due to the RICER method. For those of you who are unfamiliar with this, RICER is an acronym used in the health profession to treat acute injuries. It stands for rest, ice, compress, elevate and refer, and is a step-by-step guide on how to approach at home care of acute pain caused by an injury. This form of treatment was originally coined in 1978 by Dr Gabe Mirkin, an American sports doctor. However, latest research indicates that the use of ice may have a more negative impact on the healing of acute injuries than initially thought.
Just like technology the medical industry is constantly in a state of fluctuation and adaption to find the best guidelines for treatment. This can be both a blessing and a curse as age old advice that has been around for 30+ years has become a household go to, may now be no better than doing nothing, so the question is why the sudden change? Recent research has found that post
soft tissue injuries initiate an inflammatory phase in which special inflammatory cells recognise damage has occurred to the extracellular matrix (large network of molecules that surround, support and give structure to tissue and cells). When this happens immune cells such as neutrophils and macrophages are recruited to clear up damage and perform phagocytosis (eating excessive debris). Further, processes occur such as the secretion of growth factors as well as a myriad of other functions which are designed to move, rebuild and produce cells as well as blood supplies. This whole process is pro-inflammatory which means it happens the moment the affected limb or area starts to swell. The reason this is important is that the use of ice could
negatively affect this process. Ice is a vasoconstrictor, which means it limits blood supply to the area thus reducing swelling. By reducing the blood supply and swelling, it takes longer for important cells to reach the area and delays the process of healing. Knowing all that, you may be asking what should we do for acute injury management? This is where the new acronym
PEACE and LOVE come into place.
PEACE and LOVE is the most up to date method recommended in treating acute soft tissue injuries. For the first few days of an injury PEACE is used.
P- Protect: De-load the affected limb or area for the first couple of days. This does not mean avoidance of movement but instead gentle pain free motion with little to no loading.
E- Elevate: Like the original RICER method, elevate the affected limb to the best of your ability, higher than hips for lower limb and higher than the heart for upper limb at a bare minimum.
A- Avoid...items that may negatively impact the inflammation process such as ice or anti-inflammatory medication.
C- Compress: Use compression garments and taping to limit tissue haemorrhage and joint oedema.
E- Educate: Understanding what is happening in the body and it’s tissues is an invaluable tool in recovery to know the next best step as well as have realistic expectations of recovery time frames.
After the initial 1-3 days of using plenty of PEACE is when we start to introduce some LOVE to the affected area or limb.
L- Load: Use of early mechanical stress with loading promotes repair and builds soft tissue tolerance, be mindful to perform when little to no pain is present.
O- Optimism: The brain is a power aspect in injury and recovery as studies have shown that having a brighter outlook can positively affect the recovery time frame.
V- Vascularisation: Use of pain-free exercise that increases the resting heart rate can increase blood flow to injured structures positively affecting how the structure is handling load and how fast it can heal.
E- Exercise: Specific rehab exercise program introduction
With all that in mind it is important to understand that not all treatment is a one size fits all as every person is different. It can be difficult to understand and gauge the best approach to acute injuries, as for some individuals ice may be more beneficial due to the analgesic effects (pain relief) it provides. Being up to date on latest research as well seeking advice from qualified medical practitioners on best practice for you and your issue is important.
Soft-tissue injuries simply need PEACE and LOVE - PubMed (nih.gov)
Peace and Love Principle - Physiopedia (physio-pedia.com)
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