PEACE & LOVE: A Better Protocol for Managing your Soft Tissue Injuries
/by Dr. Jamie Haroldson
The PEACE & LOVE protocol is a guideline for managing soft tissue injuries that addresses both the acute and longer-term stages of healing. The protocol emerged from a growing body of research highlighting the need for a more holistic approach to injury management. The approach combines two frameworks: PEACE, which focuses on immediate post-injury care, and LOVE, emphasizing sub-acute and long-term recovery and rehabilitation
Why PEACE & LOVE?
The PEACE component was developed as a response to the traditional RICE (Rest, Ice, Compression, Elevation) method, which has been widely used but often fails to account for modern understanding of the biological healing processes. PEACE stands for Protection, Elevation, Avoidance of anti-inflammatories, Compression, and Education. This framework emphasizes protecting the injured area, understanding the injury, and avoiding interventions that might delay natural recovery, such as excessive ice or anti-inflammatory medications.
Following the acute phase, the LOVE component guides individuals through the recovery journey. LOVE stands for Load, Optimism, Vascularization, and Exercise. This part of the protocol encourages controlled loading of the injured tissue, fostering a positive mindset, promoting blood flow, and integrating exercise tailored to individual needs.
The Protocol
PEACE: A Guide for Immediate Care
the first few days following injury
● Protect: unload or restrict movement for 1-3 days following injury to reduce aggravation, limit bleeding, and limit stretching of injured tissues
● Elevate: elevate the limb above the level of the heart to encourage the movement of interstitial fluid out of the damaged tissues
● Avoid Anti-Inflammatories: inflammation is a necessary evil; it's the first of 3 steps to healing. Inhibiting the inflammatory phase may negatively affect long-term tissue healing
● Compress: external pressure from tape or a tensor bandage can help limit bleeding and fluid build-up within the joint
● Education: Focus on passive care shows insignificant effect on pain and function compared to active care. Find a therapist who takes time to explain the injury and encourages an active approach.
LOVE: A Guide for Sub-Acute Management
after the first few days
● Load: normal activities should be returned to as soon as symptoms allow. Optimal loading promotes repair, remodelling, and builds tissue tolerance and capacity
● Optimism: optimistic expectations are associated with better outcomes! Negative beliefs and emotions can represent barriers to recovery
● Vascularisation: pain-free aerobic exercise (cardio) should be started a few days after injury to promote blood flow to the injured tissue and boost motivation
● Exercise: pain-free exercise can help restore mobility, strength, and proprioception after injury. Let pain guide the progression of exercise
In Summary…
The PEACE & LOVE protocol offers numerous benefits. By focusing on both immediate and long-term recovery, it fosters a more comprehensive understanding of recovery, enhancing healing outcomes and reducing the risk of re-injury. The emphasis on education empowers patients, enabling them to make informed decisions about their recovery process. Additionally, promoting early movement and controlled loading not only accelerates healing but also helps restore strength and functionality more effectively. Whether you’re an athlete or someone recovering from everyday injuries, this protocol can guide you toward a healthier, more resilient future.
References: Dubois, B., Esculier, J.F. (2020). Soft tissue injuries simply need peace and love. BJSM, 54 (2)