Soft Tissue Injuries
Introduction
Soft-tissue injury rehabilitation can be quite confusing. Different acronyms have been used throughout the years to guide their management, which evolved from ICE to RICE, and PRICE to POLICE. However, these acronyms mainly focus on the acute stage of the injury, leaving aside the subacute and chronic stages of tissue healing. [1]
Acute soft tissue injuries have classically been managed through various acronyms: the most well-known are RICE and POLICE.
- These acronyms have been around for many years and focus primarily on the acute stages of a soft tissue injury. Research has progressed making these acronyms outdated and inaccurate. eg the use of NSAIDs in an acute injury can actually be detrimental to the recovery and healing process. [1]
- Most of the research uses an acute lateral ankle sprain as the clinical example. It can be helpful to apply these principles to a patient with that type of injury.
New research promotes new acronyms to apply to the acute and sub-acute stages of an injury and promote loading and activity.
PEACE and LOVE
See link PEACE and LOVE
- In the acute stage of an injury apply PEACE. [1] P: Protect E: Elevate A: Avoid anti-inflammatories/use Ice C: Compression E: Educate
- In the sub-acute stage, LOVE should be used L: Load O: Optimism V: Vascularisation E: Exercise
History of Soft Tissue Management
ICE: Initially soft tissue injuries were managed through ICE. I: Ice C: Compression E: Elevation
- Focused heavily on the cryotherapy. We now know that ice can potentially cause slower healing times as it disrupts normal inflammation and revascularisation. There is evidence to show that ice is useful for analgesia. More evidence is required to fully understand the physiological processes that occur when ice is used in an acute injury. [2]
- Compression and Elevation are also advised in the ICE acronym. These are mainly anecdotal in recommendation and there is no set advice regarding duration of compression or elevation. Elevation has been shown to help reduce inflammation however, this inflammation is normal and is useful in the normal process of healing. [2]
RICE and PRICE
RICE and PRICE were recommended as an addition to ICE.
- Long periods of rest and protection can be detrimental to recovery, leading to muscle wastage and altered bio-mechanics of the limb. [3] However, following an acute injury, rest and protection of the limb is still recommended in the acute stages.
- Early mobilisation and weight bearing has been shown to accelerate recovery in acute soft tissue injury [4].
Here are some videos explaining the RICE treatment for acute injuries:
POLICE
POLICE is an acronym that stands for Protection, Optimal Loading, Ice, Compression, and Elevation. It promotes and guides safe and effective loading in acute soft tissue injury management. POLICE was introduced to promote loading in the affected area and prevent long term immobilisation.
Here's a nice video that outlines the subtle difference between RICE, PRICE, and POLICE:
Clinical bottom line
As research has progressed, the need to educate the patient, and promote loading has become apparent in order to fully recover from an injury. As physiotherapists, this is not new information, however, the need for PEACE and LOVE to be more publicised should be priority in physiotherapy clinics.
- The advice to "avoid anti-inflammatories" has been contradictory although the evidence supports this in the acute stages of injury. [8]
- PEACE and LOVE are useful for clinicians and patients as it does not only focus on the immediate short-term injury but promotes rehabilitation and exercise.
Resources
References
- ↑ 1.0 1.1 1.2 Dubois B, Esculier J. Soft-tissue injuries simply need PEACE and LOVE. British Journal of Sports Medicine. 2020:54 (2):72-73
- ↑ 2.0 2.1 van den Bekerom MP, Struijs PA, Blankevoort L, Welling L, Van Dijk CN, Kerkhoffs GM. What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults?. Journal of athletic training. 2012 Jul;47(4):435-43.
- ↑ Bleakley CM, Glasgow P, MacAuley DC. PRICE needs updating, should we call the POLICE?British Journal of Sports Medicine 2012;46:220-221.
- ↑ Bleakley CM, O’Connor SR, Tully MA, Rocke LG, MacAuley DC, Bradbury I, Keegan S, McDonough SM. Effect of accelerated rehabilitation on function after ankle sprain: randomised controlled trial. Bmj. 2010 May 10;340.
- ↑ Nurse Sarah Jeffries. What Is the RICE Method for Injuries? | Home Remedies for Acute Injuries | Nurse Sarah. Available from: https://www.youtube.com/watch?v=qvLJQnqcPzA&ab_channel=NurseSarahJeffries (accessed 22nd March,2025 ).
- ↑ The Center Orthopedic and Neurosurgical Care Using the RICE Method for Injuries - Rest, Ice, Compress, Elevate. Available from: https://www.youtube.com/watch?v=TZqDBgiEfL8&ab_channel=TheCenterOrthopedic%26NeurosurgicalCare (accessed 22 March 2025).
- ↑ La Fisioterapia.net. POLICE - Acute injury management. Available from: https://www.youtube.com/watch?v=-5cT6_PFV80&ab_channel=LaFisioterapia.net (accessed 22 March 2025).
- ↑ Vuurberg G, Hoorntje A, Wink LM, Van Der Doelen BF, Van Den Bekerom MP, Dekker R, Van Dijk CN, Krips R, Loogman MC, Ridderikhof ML, Smithuis FF. Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. British journal of sports medicine. 2018 Aug 1;52(15):956-.