If you’ve been my client for a while now, then you have probably heard me tell you this. Perhaps you’ve even gotten an email from me about it or found this blog post.
But in case you haven’t (or you still don’t believe me!), icing injuries slows down the healing process because it slows down blood flow to the area and interrupts the natural inflammatory process. Your body needs inflammation to heal and anything you do to slow that down will slow down your recovery (including icing, steroid shots, and non-steroidal anti-inflammatories such as ibuprofen).
So the RICE (Rest, Ice, Compression, Elevation) Method for soft tissue injury is out. What should you do instead?
Apply PEACE and LOVE to your injuries (Dubois & Esculier, 2009)!
Immediately after injury:
P- Protect- Unload or restrict movement for the first 1-3 days. This reduces bleeding and the risk of aggravating the injury. This does not mean you should stop moving completely! Keep it moving to help blood flow and tissue repair without loading it (eg: gentle pain free movement for an ankle sprain).
E- Elevate- Elevate the injured limb above the level of the heart when resting. This allows fluid to flow out of the injured tissue.
A- Avoid anti-inflammatories- The inflammatory process in the early stages of an acute soft tissue injury is a crucial part of the healing process. Artificially reducing inflammation at this stage delays the body’s ability to create new blood vessels, new cartilage, and can cause muscle fibers to never form correctly. Avoid ice/cryotherapy as well for the same reasons.
C- Compress- Swelling and edema may be limited by external compression such as taping, bandages and compression garments.
E- Educate- Your body is amazing! Learn more about what it is doing to help give it what it needs, read the symptoms and to help you gauge where you are in your recovery.
After the first few days have passed, your injury needs LOVE:
L- Load- Soft tissue injuries benefit immensely from an active approach with movement and exercise as soon as symptoms allow for it. Early mechanical stress without increasing pain promotes repair and remodeling and builds soft tissue tolerance.
O- Optimism- The brain plays a significant part in rehabilitation and some barriers include catastrophization, depression and fear. Beliefs and emotions regarding an injury and ability to recover have been shown to play a bigger role than the actual tissue damage in ankle sprains. Do not minimize this.
V- Vascularization- Musculoskeletal injury management needs to include cardiovascular physical activity. Pain-free cardiovascular exercise is a motivation booster and increases blood flow to injured structures.
E- Exercise- Evidence supports the use of exercise therapy in the treatment of soft tissue injuries. Benefits include restoring mobility, strength and proprioception. It is important to avoid pain in the early phases and then use pain as a guide to progress exercises gradually.
