Most of us have experienced going over on an ankle whether running or some other seemingly innocuous activity. Instantly you are hobbling or sitting on the floor clutching the offending foot and, if a runner, wondering when you’ll run again and quickly stopping the Garmin.
Advice for treatment has always followed acronyms based on similar protocol – RICE, PRICE and then POLICE. Protection, rest, ice, compression and elevation are the key components. New research, however, is challenging the familiar and blanket advice and suggests that some of these elements can even prolong or hinder recovery.
The 2019 study published in the British Journal of Sports Medicine in 2019 https://bjsm.bmj.com/content/bjsports/54/2/72.full.pdf have created a new acronym which takes a longer term view of treatment, rather than just the acute (immediate) phase.
Immediately post injury, the PEACE protocol should be used. This is a slight break away from conventional RICE advice.
PROTECT:
To enable the tissues to start healing and to prevent further injury, movement and load should be restricted for up to 72 hours. This doesn’t mean complete rest as complete immobility can negatively affect tissue strength, so move according to your pain signals.
ELEVATE:
Although there is little high quality evidence that elevating the sprain helps, it certainly doesn’t hurt and the theory is sound. Elevate the limb higher than the heart to encourage some blood flow.
AVOID ANTI-INFLAMMATORIES:
Possibly a controversial one here as they are often recommended but the inflammatory process is part of the way the body heals itself; it is its response to harmful stimuli. The inflammatory response actually minimises damage to the tissue and it is possible that using ice to calm down the inflammation can upset this natural process. Indeed it is questioned whether cryotherapy (ice treatment) for anything other than short term pain relief does any good or whether it is actually harmful. Sub acute inflammation and chronic inflammation is different and, indeed, is treated differently.
COMPRESS:
Compression is still advised as it helps to limit swelling and can help in stabilising the joint as well as reducing some swelling. Bandaging, taping and compression socks are all thought to help.
EDUCATE:
This is to get ‘buy in’ from people to understand that sometimes these things take time to recover and to be patient. There is no quick cure for all; aids like manual therapy or other modalities can help with pain symptoms and make the area feel more comfortable but there is no ‘magic cure’ that will increase recovery necessarily.
AND – after the first 3 days or so, your soft tissue needs some tlc and LOVE
LOAD: being active with recovery and keeping pain signals in mind is key, as this helps repair and remodel the tissues. Initially body weight load should be sufficient and increase frequency and duration (also loading) gradually and carefully.
OPTIMISM: Stress and depression (which can lead to sleep deprivation) can inhibit recovery. Remaining positive with optimistic expectations is thought to promote recovery 🙂
VASCULARISATION: This involves increasing blood flow to the area to improve recovery. Aerobic exercise and mobilising joints means that there is less of a need to have pain relief medicine and improves and quickens recovery.
EXERCISE: strengthening and rehabilitation exercise is key to subacute and then long term recovery from injuries. Exercises to restore mobility, strength and proprioception should be done progressively and with pain acting as a guide for progressive strengthening/exercising.
Feel free to contact me for bespoke treatment and rehabilitation advice.
Dubois B, Esculier J-F(2019) Soft-tissue injuries simply need PEACE and LOVE. Br J Sports Med January 2020 Vol 54 No 2
