Management of acute sprains/strains- PEACE & LOVE
Anti-inflammatories may be the first thing that may come to your mind after an acute injury and swelling. Do you know that anti-inflammatories may not be the best choice?
Did you just suffer from an ankle sprain, ligament sprain, or muscle strain?
Do you know that REST is not the best strategy after injuries? Prolonged rest can delay your recovery and compromise your tissue strength and health.
Are you familiar with RICE or PRICE acronyms? They were (still are) very popular in the management of acute soft tissue injuries but they do not provide much benefit in subacute or chronic stages of tissue healing.
Let us discuss the evidence-informed management of soft tissue injuries such as ankle sprains, hamstring strains, or any other muscle/ligament injuries. Let us give injuries some PEACE & LOVE!
Introduce PEACE right after the injury:
P: Protect
You can protect the area from further bleeding and distension for 1-3 days based on the injury. Prolonged rest should be avoided as rest can compromise tissue quality and strength.
E: Elevate
Elevate the injured area above the level of your heart to reduce the swelling in the tissues.
A: Avoid anti-inflammatories
We need stages of inflammation to promote tissue healing. Inhibiting these stages by using higher doses of medications can affect tissue healing and tissue quality in the long term.
Cryotherapy is very popular in the rehab world. There are no high-quality research trials to support the use of ice on tissue healing. Ice has an analgesic effect and can help with pain relief BUT it can also interfere with tissue healing by reducing inflammation, angiogenesis (new blood vessel growth), and re-vascularization.
C: Compress
Compression can help to reduce tissue edema and hemorrhage. You can use taping or bandages for the compression.
E: Educate
Education on the active approach to recovery is very important. Reliance to rest, medication and electrotherapy can delay the healing process.
After the first few days have passed, Introduce LOVE:
L: Load
Introduce gradual loading and resume normal activities of daily life as soon as the symptoms allow. Optimal loading without an exacerbation of pain can help to promote repair, build tissue tolerance, and improve the capacity of tendons, ligaments, and muscles.
O: Optimism
Fear of injury, depression, and catastrophizing can act as barriers to recovery. Optimistic patient expectations are associated with better outcomes.
V: Vascularization
Cardiovascular activities and aerobic activities should be introduced after a few days of the injury to promote blood flow to the injured tissues. This can help you to reduce the need for pain medications.
E: Exercise
There is a strong level of evidence that exercise can help in the effective management of ankle sprains and reduce the prevalence of recurrences. Exercise can help to restore your mobility, strength, and proprioception. Pain can be used as a guide to exercise progressions. Seek help from your physiotherapist to learn individualized progressive exercises.
Your physiotherapist should focus on the long-term outcomes of your injuries. Your physiotherapist should treat you as a whole person v/s just your injury.
If you have any questions about your injury or would like to seek help, feel free to contact me.
Roopdeep Kaur, PT, FRCms, MSc. PT, BPT
Registered Physiotherapist
Reference:
Dubois B, Esculier JF. Soft-tissue injuries simply need PEACE and LOVE. Br J Sports Med. 2020 Jan;54(2):72-73. doi: 10.1136/bjsports-2019-101253. Epub 2019 Aug 3. PMID: 31377722.
