A commonly asked question in the Lower Plenty Osteopathy clinic is should I use heat or ice for my injury or pain? There have been a number of theories and acronyms used over the years when managing acute soft tissue injuries (ankle sprains, muscle tears, etc) with the most commonly known of those being RICE – Rest, Ice, Compression, Elevation.
No more RICE, it’s time for PEACE and LOVE
Authors Dubois and Esculier in the British Journal of Sports Medicine in 2020 have suggested a new approach to the management of acute soft tissue injuries. It is broken down into PEACE for initial injury management followed by LOVE for ongoing management.
Of note is the avoidance of anti-inflammatories including ice which will be touched on after the explanation of the acronym.
INITIAL INJURY MANAGEMENT – PEACE
P – PROTECT
Unload or restrict movement for 1-3 days to minimise bleeding. Rest should be minimised and pain signals should be the guide to when this phase ends.
E – ELEVATE
Elevate the limb higher than the heart to promote fluid flow away from the injured tissues.
A – AVOID ANTI-INFLAMMATORIES (INCLUDING ICE)
Inhibiting inflammation may actually compromise the body’s long term tissue healing capabilities.
C – COMPRESS
Pressure taping or bandaging helps limit swelling.
E – EDUCATE
Come and see one of our osteopaths for advice on the steps needed to manage your injury and its progress towards your return to your favourite activities.
ONGOING MANAGEMENT – LOVE
L – LOAD
As soon as your pain and symptoms allow it you should begin to load the affected structures. Load should be incrementally increased and determined by your body’s response to that load both during and in the hours after. Be cautious but loading the tissues does help promote tissue repair.
O – OPTIMISM
It is known that psychology can play a role in the recovery from injury. Your osteopath can help give you a positive outlook on your recovery by giving you information about your condition and the steps towards recovery.
V – VASCULARISATION
Doing some pain free cardiovascular exercise (exercise bike, swimming, etc) will help increase blood flow to repairing tissues, assisting in your recovery.
E – EXERCISE
Restore mobility, strength and proprioception (your body’s ability to know where it is in space) through exercise. Your osteopath will be able to guide you with exercises to get you back performing the activities you enjoy.
SO NO MORE ICE? BUT I SEE IT ON THE TV ALL THE TIME!
As evidenced above, ice has the potential to interfere with tissue repair, however, it is still commonly seen at the elite sports level for acute injury management. There has already been a number of changes to acute soft tissue injury management and as the exact formula for all injuries has not yet been agreed upon, we are sure there will be further modifications in the future.
At Lower Plenty Osteopathy we still think that using ice as a pain reliever in the initial 24-48 hours is a viable option as long as it is not overdone and you are working towards not using it as soon as possible.
SHOULD I USE HEAT FOR MY INJURY OR PAIN?
Whilst not specifically mentioned in the acronym above, our osteopaths believe heat is a good option for more chronic pain and stiffness as it may help reduce discomfort and stiffness.
Our osteopaths at Lower Plenty Osteopathy are all comfortable treating acute soft tissue injuries so if you have any questions about your management, please book an appointment.
