RICER is out, PEACE and LOVE is in
As research and evidence continue to change, previous strategies to treat injuries continue to evolve pushing for better management. For years RICER was used to stop and reduce inflammation within the injured area. Inflammation was inherently thought as “bad” with RICER used to minimise and avoid inflammation wherever possible. However, we now know inflammation is not the enemy, and rather another step in the process of healing.
Inflammation is your body’s response to repair tissue damage and restore function post-injury. The inflammatory process helps remove damaged cells within the injured area, while promoting circulation and repairing damaged tissues.
Why the switch?
In 2019, the British Journal of Sports Medicine introduced a new and improved approach in managing acute injuries with a new easy to remember acronym, PEACE and LOVE.
The updated method moves away from the previous ideas of ICE, RICER, and POLICE and promotes a more educated approach to acute injury care.
The PEACE protocol is used for immediate Injury Management usually within the first 24-48 hours post injury.
Protect: Avoid activities that cause further pain to the injured area in the first few days
Elevate: Elevate the injury above your heart to control swelling, utilise the muscle pump with or without active movement.
Avoid Anti-Inflammatories and Ice: These can reduce tissue healing and blood flow to the injured area. Ice may help numb severe pain temporarily.
Compression: Apply compression to the area to manage swelling and support the muscle pump.
Educate: Resist unnecessary passive treatments and imaging. Professional guidance can help determine if and when imaging is necessary, potentially saving you from unneeded procedures.
The LOVE Protocol is used for sub-acute and sustained recovery. Normally this would begin 3-4 days after injury.
Load: Gradually apply load within pain tolerance to encourage recovery.
Optimism: A positive outlook can significantly enhance your healing process.
Vascularisation: Engage in exercise that promotes blood flow, excluding the injured limb if necessary.
Exercise: Incorporate pain-free exercises to support and accelerate recovery.
One case does not fit all
Although these guidelines create a great starting point in acute injury management, they may not be applicable to certain cases, chronic conditions or those with systemic inflammation. Similarly, those with minor injuries may be able to introduce principles of the LOVE protocol early. It is important to always check with a healthcare provider to tailor the appropriate treatment approach to you and your injury.
Moving forward
Looking to the future, if or when you have an injury, remember to embrace the PEACE and LOVE protocols and allow your body’s natural healing process. Contact your healthcare provider (doctor and/or physiotherapist) when an injury occurs for a specific and tailored approach to your early recovery management.
References
Dubois B, Esculier J-F. Soft-tissue Injuries Simply Need PEACE and LOVE. British Journal of Sports Medicine [Internet]. 2019;54(2):bjsports-2019-101253. Available from: https://bjsm.bmj.com/content/54/2/72
