PEACE and LOVE for medical treatment

https://bjsm.bmj.com/content/bjsports/54/2/72.full.pdf

Soft-tissue injuries simply need PEACE and LOVE. By Blaise Dubois and Jean-Francois Esculier.

PEACE

P for Protect

Skip activites and movements that increase pain, during the first few days after injury. This helps minimise bleeding, prevent distension of injured fibres, and reduce the risk of aggravating the injury.

E for Elevate

Elevate the limb higher than the heart as often as possible. This promotes interstitial fluid flow out of tissues. Despite weak evidence supporting its use, elevation shows a low risk-to-benefit ratio.

A for Avoid Anti-inflammatories

Avoid taking anti-inflammatory medications, or using ice. These interfere with angiogenesis and revascularisation, and could delay neutrophil and macrophage infiltration, as well as increase immature myofibres. Inflammation helps repair damaged soft tissues.

C for Compress

Use external mechanical pressure, such as taping or bandages, to help limit intra-articular oedema and tissue haemorrhage. Compression after an ankle sprain seems to reduce swelling and improve quality of life.

E for Educate

Educate yourself on the benefits of an active approach to recovery and recovery times, instead of chasing any ‘magic cure’ approach, or any passive modalities, such as electrotherapy, manual therapy, or acupuncture, which may be counterproductive in the long term.

LOVE

L for Load

Let pain guide your gradual return to normal activities. Your body will tell you when it's safe to increase load. Add mechanical stress early, and resume normal activities, as soon as symptoms allow. Optimal loading without exacerbating pain promotes repair, remodelling, and builds tissue tolerance and the capacity of tendons, muscles and ligaments through mechanotransduction.

O for Optimism

Be confident and positive, because optimistic patient expectations are associated with better outcomes and prognosis. Beliefs and emotions are thought to explain more of the variation in symptoms than the degree of pathophysiology. Minimize negative thoughts such as catastrophisation, depression, and fear.

V for Vascularisation

Choose pain-free cardiovascular activities to increase blood flow to repairing tissues. Early mobilisation and aerobic exercise improve physical function, support return to work, and reduce the need for pain medication.

E for Exercise

Exercise and be active to restore mobility, strength, and proprioception. Use pain-free activities to ensure optimal repair during the subacute phase of recovery, and to guide exercise progressions.