skip the r.i.c.e, think p.e.a.c.e & l.o.v.e!



When we get injured, the first thing we think of is R.I.C.E (Rest, Ice, Compress, Elevate). We are taught this from our parents, from the media, from researching on google, from back in the days in our elementary school physical education classes, etc…



But for those of you who have read our TO ICE OR NOT TO ICE blog, we realize that the R.I.C.E principle is actually outdated and not fully supported by evidence. In fact, Ice has been shown to potentially impair recovery by reducing the levels of a hormone called IGF-1 (Insulin-like growth factor), a hormone responsible for tissue recovery.



As physios, we have never been fans of the R.I.C.E principle as we believe it encourages a passive and sedentary nature to the treatment of injuries. Instead, we push for education on the injury, gradual loading, positive and realistic prognostic expectations, and exercise. For that reason, we fully support this new acronym of PEACE & LOVE:



P: Protect

E: Elevation

A: Avoid anti-inflammatories

C: Compression

E: Education

&

L: Load

O: Optimism

V: Vascularisation

E: Exercise


We will touch briefly on the most important points below.



Protect:



It is essential to learn what specific activities to avoid instead of stopping ALL activities (which we commonly see as the first reflex post-injury). For example, if you hurt your back, you shouldn’t be shoveling snow (excessive loading) the next day, but it would still be good to do specific physio exercises and walking. Do not just lie in bed.



Avoid Anti-Inflammatories:



Inflammation is normal and important. It is an essential process in the body to recover. Without inflammation, there is no recovery. However, at times, inflammation levels may be excessive and it is only at those moments that anti-inflammatories should be taken.



Education:



This may be one of the most important aspects of the principle. So many patients we see in the clinic suffer from rather mild injuries, but due to fear and not comprehending the injury, they may overprotect and compensate which may lead to a poor recovery. Understanding what the injury is, what to do, what not to do, how your body may respond to X or Y activity, and how long it will take to recover are essential steps to a proper recovery. I mean think about it: how are you supposed to fix a problem if you don’t know what the problem is?



Load:



Following an injury, it is very important to gradually load the affected area within pain tolerance. Avoiding loading will only lead to de-conditioning and weakening, which in turn makes the recovery more difficult. Instead, it is important to identify the right exercises for your back that is both safe and the right intensity. That’s where we come in!



Optimism:



The psychological aspect is often overlooked in the rehabilitation of an injury. Fear-avoidance behavior and catastrophization can occur when we don’t understand the injury, and they are both associated with potential poor recovery. With the proper guidance of a physio, you’ll realize that you CAN recover from this injury by following the steps that we have outlined. Positive but realistic expectations have been repeatedly proven in research to provide a better outcome.



Exercise:



Similar to the previous LOAD point, but if for example, you hurt your shoulder, you should still try as much as possible to exercise the rest of the body. This will help encourage vascularisation throughout the body, and blood flow is essential to recovery.



So next time you have an injury, think of PEACE & LOVE, not RICE, and seek the help of a physiotherapist to guide you through and accelerate the recovery process. If you are not sure what physios do, check out this article we wrote. If you are unsure if you need to see a physio, check out our quick 7-point questionnaire.


If you have any questions, please don’t hesitate to reach out to our team at 514-534-0380 or [email protected].


Stay safe everyone!