RICE, PEACE and LOVE

This blog post is for informational and educational purposes only, and should not be considered as medical advice. If you are experiencing any medical problems or injuries, consult with a qualified healthcare professional for diagnosis and treatment.

As runners, we push our bodies to achieve our goals, whether it's completing a first 5k or setting a new marathon personal best. Unfortunately, with increased training volume and intensity comes the risk of injury. Then, we face a difficult dilemma: push through and continue training, or rest and risk losing your hard-earned fitness?

Injury and Inflammation

Soft tissue injuries, such as muscle strains, ligament sprains, and tendon issues, are common occurrences that can sideline even the most dedicated runners. When these injuries occur, one of the body's first responses is inflammation.

Inflammation is a natural biological process that is often misunderstood. Inflammation is not inherently bad; in fact, it is a crucial part of the initial healing phase. It's the body's way of signaling that something is wrong, initiating repair processes by increasing blood flow to the injured area, and bringing in cells that are essential for tissue regeneration.

However, excessive or prolonged inflammation can become problematic and hinder recovery. Think of inflammation as the body's initial alarm system and clean-up crew arriving at the injury site. In the right amount, it's beneficial. However, if the alarm keeps blaring for too long or the clean-up crew becomes too aggressive, it can cause more harm than good.

Therefore, understanding how to manage inflammation appropriately, rather than simply suppressing it, is key to effective injury management.

RICE

For years, the acronym RICE has been the go-to approach for managing these acute injuries. You've probably heard of it, and maybe even used it yourself. Let's quickly recap RICE:

• Rest: Avoid activities that aggravate the injury.

• Ice: Apply ice to reduce pain and inflammation.

• Compression: Use bandages to minimize swelling.

• Elevation: Keep the injured area raised above the heart to further reduce swelling.

RICE has been widely accepted and implemented, providing a simple and easy-to-remember guideline for initial injury management. It focuses on reducing pain and inflammation in the acute phase.

While RICE is a good starting point, research has highlighted some limitations. One key aspect is the overemphasis on rest. Prolonged rest, while seemingly intuitive, can actually be detrimental to recovery. While initial rest is important to protect the injured tissue, extended inactivity can lead to muscle weakness, joint stiffness, and delayed tissue healing.

Furthermore, RICE is largely a passive approach, focusing on what not to do rather than actively promoting recovery. Perhaps most importantly, the traditional view of inflammation as solely negative is now being challenged. Inflammation is a natural and necessary part of the healing process, and aggressively suppressing it with ice and anti-inflammatory medications may actually hinder long-term tissue repair.

PEACE and LOVE

This is where PEACE & LOVE comes in. This more contemporary and comprehensive framework builds upon and improves the principles of RICE, offering a more holistic and evidence-based approach to soft tissue injury management. It is divided into two phases: the immediate PEACE phase and the subsequent LOVE phase. Let's break down the PEACE acronym, which is relevant for the first 1-3 days after injury:

• Protect: Reduce aggravating movements and restrict activity for the first 1-3 days to prevent further damage. However, minimize prolonged rest.

• Elevate: Elevate the injured limb above the heart to promote fluid drainage.

• Avoid anti-inflammatories: Avoid taking anti-inflammatory medications (like Ibuprofen, Diclofenac or Aspirin) as they may impede tissue healing. Inflammation is a crucial part of the initial healing process.

• Compression: Use elastic bandages or wraps to reduce swelling.

• Education: Educate yourself about your injury and recovery. Seek advice from healthcare professionals and follow evidence-based recommendations. This empowers you to take an active role in your recovery.

Once the initial pain and swelling start to subside, the LOVE phase kicks in to promote optimal tissue repair and recovery. The acronym LOVE stands for:

• Load: Gradually reintroduce movement and loading to the injured area. Optimal loading, without exacerbating pain, promotes tissue repair. This could involve gentle range-of-motion and progressing to weight-bearing activities as tolerated.

• Optimism: Stay positive and confident! Psychological factors play a significant role in recovery. Optimism and a positive mindset can contribute to better outcomes.

• Vascularisation: Choose pain-free cardiovascular activities to increase blood flow to the injured tissues. Improved blood flow delivers essential nutrients and oxygen, aiding in healing. Think about activities like cycling, swimming, or walking (if appropriate for your injury) that don't directly stress the injured area.

• Exercise: Restore mobility, strength, and proprioception through targeted exercises. Work with a physical therapist or your running coach to develop a progressive exercise program tailored to your specific injury and running goals.

PEACE & LOVE represents a significant shift in thinking about soft tissue injury management. It moves away from a purely passive approach to a more active and holistic one.

It is preferred because it is grounded in the latest scientific understanding of tissue healing and rehabilitation, emphasizing the importance of early, controlled loading and movement to stimulate tissue repair, rather than prolonged rest. It appropriately addresses inflammation, acknowledging its beneficial role in the initial healing phase and advising against unnecessary suppression with anti-inflammatories.

Furthermore, PEACE & LOVE takes a holistic approach, considering psychological factors (optimism) and the importance of education and active patient participation in recovery. Finally, it provides a clear progression with distinct immediate and subacute management phases, offering a roadmap for recovery.

Practical

So, how can you, as a runner, apply PEACE & LOVE when faced with a soft tissue injury? In the immediate phase, remember PEACE. Listen to your body and stop running or any activity that caused the pain. Protect the area by avoiding movements that significantly aggravate the pain, but don't become completely inactive; gentle movements within a pain-free range are encouraged.

If it's a lower limb injury, elevate your leg when resting. Initially, try to skip the Ibuprofen or Aspirin unless advised by a doctor, and consider alternatives such as Paracetamol or topical pain relief if needed. Use a compression bandage to control swelling, ensuring it's not too tight. Crucially, educate yourself about your injury by consulting reliable sources and understanding what to expect, which can reduce anxiety and promote better adherence to your recovery plan. Consult professional healthcare providers and don’t be afraid to ask them for more specific advice or context on your injury.

Once you move into the subacute phase, embrace LOVE. As pain decreases, start to load the injured area gradually. For a runner, this might mean starting with pain-free walking, then progressing to walk-run intervals, and gradually increasing running volume and intensity. Always pay close attention to your pain levels and avoid pushing through pain. Throughout your recovery, maintain optimism, focusing on what you can do and celebrating small victories, and connect with your running community for support.

Vascularisation is key, so engage in low-impact cardio that doesn't stress the injured area, such as cycling or swimming, to improve blood flow and healing. Finally, exercise purposefully to regain range of motion, strength, and stability. This is where working with a running coach or physical therapist becomes invaluable, as they can design a tailored exercise program to address your specific needs and help you safely return to running.

Conclusion

Moving beyond RICE and embracing PEACE & LOVE represents a significant step forward in how we manage soft tissue injuries. Understanding and implementing these principles can lead to faster, more effective recovery and a more resilient body in the long run. Remember to listen to your body, seek professional guidance when needed, and approach your recovery with both patience and proactive engagement.

For more information, refer to the free paper available at https://bjsm.bmj.com/content/bjsports/54/2/72.full.pdf.