Peace And Love For All Your Soft Tissue Injuries
A soft tissue injury is the damage of muscles, ligaments and tendons throughout the body. Most soft tissue injuries are the result of a sudden unexpected or uncontrolled movement like stepping awkwardly off a curb and rolling over your ankle. Injuries to these structures can be in the form of a muscle strain or ligament sprain. Recently British Journal of Sports Medicine has put forward the most current evidence based management strategies for soft tissue injuries.
Previous literature has put forward acronyms including ICE, RICE, PRICE, POLICE. Some of you may be familiar with these acronyms but there is still uncertainty with regards to icing, the use of heat, to take or not to take anti-inflammatories. This proposed article and approach is designed to clear up those concerns.
The article proposes two new acronyms to replace the previous mentioned above and these are PEACE & LOVE. These new terms include the sub-acute and chronic stages of tissue healing. This approach involves treating the person with the injury as opposed to the injury of the person.
PEACE & LOVE ACRONYMS ARE DESCRIBED BELOW:
P is for Protect. A period of rest may be required but equally remaining mobile as pain allows is important. Avoiding return to strenuous activity is recommended. The article recommends considering unloading 1-3 days to prevent bleeding/ further damage to the injured tissue fibres. It is important to find a balance between unloading and loading and you should be guided by pain and swelling in this instance.
E is for Elevation. The key thing here is to emphasise that the limb must be elevated above heart level to promote fluid flow out of the tissue.
A is for avoidance of anti-inflammatories and ice. This is relatively new research which considers anti-inflammatories being detrimental for long term healing. The medication is thought to slow down tissue healing. Ice is thought to have a pain reducing effect but this article is questioning its role in reducing swelling
C is for Compression. Compression will influence the vascular pressures and the evidence suggests it helps reduce swelling. Taping and bandages will help to limit swelling.
E is for Education. The promotion of an active over passive approach to recovery is key. Undertaking an active recovery, it is important for tissue healing, pain and function. By moving away from the reliance on the ‘need to be fixed’ approach and better understanding of how to actively re-start loading the tissue will help avoid overtreatment and poorer outcomes. Quick fixes often do not exist.
SOFT TISSUES ALSO NEED LOVE AFTER THE FIRST FEW DAYS:
L is for Load. Loading the tissue will facilitate the return to normal activities and promote healing. Guide the progression by listening to your body (avoid increases in pain and swelling). By moving early and respecting pain, it promotes repair, remodelling and builds the tolerance of the tissue.
O is for Optimism. The brain has an important say in the rehabilitation process. Optimism influences the perception of pain and recovery speed, which could reduce the risk of persistent pain. Working close with a physiotherapist will give the opportunity to ask questions and resolve any underlying concerns.
V is for Vascularisation. Exercises with a cardiovascular input is important in the management of any soft tissue injury. As soon as Day 3 post-injury, pain-free cardiovascular exercise can be resumed, as much as twice a day for 20 minutes, to facilitate vascularization of the injured tissues.
E is for Exercise. Choose an active approach to recovery. Stretching, strengthening and balance exercises can help recover range of motion, strength and proprioception. There is a strong level of evidence suggesting that exercise helps with reducing the prevalence of recurring injuries. Pain should be avoided to ensure optimal repair in the sub-acute phase of recovery. Use pain levels also as a guide to progress the exercises.