I remember growing up on the soccer field and seeing injury after injury. Usually these were just minor ankle sprains, soft tissue strains, and the occasional broken bone. I also remember hearing the term “R.I.C.E.”.  Rest, Ice, Compression, and Elevation. Now that I am working with my own patients, performing around 25,000 treatments over the last decade, I think it is important to explore and educate about what are some of the best ways to manage an injury. While there is still a lot of debate in the medical community, here is a blueprint of how I manage sprains, strains, and more with my patients.

Initial Steps After an Injury: Checking for Fractures

After an initial injury, depending on the mechanism of injury and your presentation (i.e. if it is a leg injury, can you put weight through that leg), it may be a good idea to rule out a bone fracture (broken bone) with a simple X-Ray. These are low cost interventions and will give you a peace of mind to start using the injured body part. Once a bone fracture is ruled out, you can proceed with the initial injury management. While RICE was always used and may still be of benefit (the jury is still deliberating), I now tend to educate my patients on the acronyms PEACE and LOVE.

First Steps for Effective Injury Recovery with PEACE

Protect the Injury

You typically want to limit excessive movement and loading for the first 48 hours. However, this does not mean to sit around all day. You typically want light movement and loading within your pain tolerance to prevent more damage to the injured tissue while also ensuring restoration of strength and quality of the repairing tissue.

Elevation for Swelling

While there is not an abundance of evidence for this, it appears to help clear inflammation and interstitial fluid, particularly in injuries far from the heart such as a foot/ankle.

Avoid Anti-Inflammatory Medications and Ice

This may be the area most open for debate and I tend to let my patients know about the arguments on both sides before they make their decision. The idea is to allow the inflammatory process to take place. A great metaphor I use is if there is a car accident on a freeway, if you block all lanes in and out, there will be no way for first responders to go in to clear the accident and take the involved people to get help. You want this flow of cells such as macrophages (help clear out damaged cell debris) and growth factors (help with tissue regeneration) to be able to access the injury site. If you constrict all of the blood vessels via cold therapy or anti-inflammatory meds, you may impair your body’s ability to cope with the injury.

Compression to Manage Swelling

Compressing around the injury site, not too aggressively, may help limit the amount of fluid build up and retention. The idea is that it still is allowing the inflammatory process to occur without getting out of hand. 

Education for Effective Injury Recovery

Alright, this one is on us as physical therapists. It is our job to help equip you with as much information to make an autonomous decision, avoiding medical jargon so you can better understand the process. Besides a bone fracture, soft tissue and joint injuries should be managed actively. Safe movement and a plan to progressively load the injured tissue is what we currently know to provide the best outcomes. Your physical therapist should be able to best provide you with this progressive loading plan to allow your body to optimally adapt to restore normal function in the injured tissue.

Moving Forward with the LOVE Approach to Injury Recovery

Loading Activities for Injury Recovery

To maximally promote tissue repair and remodeling, you should take an active approach to rehabilitating your injury. Progressive loading within your pain tolerance is indicated at this point of the healing process. I typically start my patients with low-load isometric contraction holds because they tend to be safe. I have also seen that this helps to normalize some of the local muscle contraction if there has been any guarding after the injury. 

Optimism and Mindset in Injury Recovery

This may sound a bit silly, but our minds play a large role in our recovery. Pain is an experience that is occurring, which takes many factors into consideration such as your belief about your injury, past experience, and your expectations. Fear of movement is where I see this play out the most. The best way to address this mindset is to show your brain that your body can move safely with little to no pain to reset your expectations about your recovery.

Vascularisation and Improving Circulation

There are benefits with early mobilization and aerobic activity. Remember the freeway accident metaphor? Increasing your movement, safely with little to no pain, helps with circulation. In most cases, circulation has a large correlation with healing. Not only does this help with tissue repair but also, with your overall mindset. I like low-load activities to start, like stationary bike riding.

Exercise Importance in Recovery

Ok, I have to admit that I am heavily biased towards this intervention with my 6 years as a personal trainer and decade as an outpatient physical therapist. All of the above steps are to get you to return to exercise safely. Exercise should be specific to the ways you move throughout the day to complete activities of daily living and recreational activities such as golf, swimming, bike riding, or pickleball. This is the area where I see people fall short. Their pain improves with time and light movement, but they don’t put the exercise time in to improve their capacity to better tolerate the things they love to do. Then, you are out on the pickleball court and you step awkwardly. Before you know it, you have another soft tissue injury and are starting the recovery process all over again. Prevent, Prevent, Prevent! Have your therapist provide you with the strength training tools to prepare your body for whatever the day has in store for you.

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