Picture this: its a beautiful day and you’re walking your dog when - AAHHHHOUCHHH! - you just rolled your ankle. It’s swelling up almost immediately. There’s pain and you hobble along back home. You need to get some ice on it quickly, right? WRONG.
There’s so much confusion around sprains, strains, bruising, tears, etc. and rightfully so. Back in the 70s a doctor coined the acronym “R.I.C.E.” which apparently was very effective because people still use it to this day. R.I.C.E. stands for “rest”, “ice”, “compress”, “elevate”. Since then, we have gone through a couple other acronyms - P.R.I.C.E. (protect, rest, ice, compress, elevate), then P.O.L.I.C.E. (protect, optimal loading, ice, compress, elevate). However, times have changed and research has evolved. Luckily, we now know more than we did in the 1970s in regards to how to handle an acute injury. Drum roll please….we now have - P.E.A.C.E. & L.O.V.E.! Let’s break this one down.
P.E.A.C.E. represents the acute phase of the injury, say between 1-7 days depending on the severity of the injury. Whereas L.O.V.E. represents the subacute and beyond (7+ days).
P - protection
E - elevation
A - avoid anti-inflammatory meds and ice
C - compression
E - elevation
Some of these recommendations are tried and true such as protecting the newly injured bodypart, compression of the injury (such as a wrap around a sprained ankle), and elevation above the heart. There are two glaringly new changes here: first, you no long want to rest completely. Now you do want to use common sense. For example if you sprain your ankle, its probably not a good time to go for a run. Or even for a walk if you’re limping in pain. But staying in bed for more than a day or two isn’t a great idea either. You want to keep moving in any way you possibly can which doesn’t irritate your injury. Second big change, the cons tend to outweigh the pros in regards to taking anti-inflammatory medication and icing. Will you feel better from them immediately afterwards? Yes. However, anti-inflammatory medication and icing has been shown to delay long term healing. There are molecular changes in the inflammatory process that we want to happen. When we alter those for short term relief we sacrifice long-term optimization and healing. Now certain situations do call for anti-inflammatory meds and ice, such as after a surgery to control the inflammation enough to stay functional. Consult with your medical provider when these situations are warranted. Otherwise, stay away from them.
After the inflammation and pain begins to level out, usually after 1-7 days, you want to give it some L.O.V.E.!
L - load
O - optimism
V - vascularization
E - exercise
Our bones, muscles, tendons, ligaments and connective tissues love to move and be challenged. This is the time when you want to be moving in the pain-free range, and even beginning to apply gentle resistance to the tissue as tolerated. Back to our sprained ankle example, double leg heel raises, toe taps, and towel slides would be great to start as soon after the acute phase as possible. The longer you wait to load the tissue and move through your full range of motion, the weaker and stiffer you’ll be respectively.
Now, what does optimism, attitude and mental health have to do with getting injured? People who see the glass half full, sort to speak, may heal faster than the other folks with the same injury. This is not some fluffy advice; it is well-researched that psychological factors play a huge role in how quickly and effectively you heal. In fact, many studies have concluded depression and ability to cope are stronger predictors of pain intensity and functional limitations than the severity of the injury itself. This is also well documented with chronic pain.
Vascularization and exercise go hand-in-hand. Don’t let an injury prevent you from exercising altogether. Continue to do cardiovascular exercise, such as biking, swimming, hand bike, etc. This will keep you conditioned, bring blood flow to the healing tissues, and has been shown to reduce the need for pain medication. Specific exercises for your injured body part is crucial. This is where the art and science meet: everyone is different. You want to challenge yourself enough but not so much to re-injury yourself. You will need to train the muscles and nervous system surrounding the affected joint. Don’t expect your body to hop right back where you were pre-injury; you’ll need to train the foundations including strength, motor control, balance, speed, etc. Training will also act as a preventative measure from a repeat experience!
Physical therapists are well versed in tissue healing, therapeutic exercises, neuromuscular reeducation, manual techniques and the latest research to help get you back to where you want to be. If you need help, reach out to one.
Peace and love,
Kira
A few of the many available sources on this topic (and written about in this blog):
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