Who knew that Peace and Love were part of the recovery vernacular when it comes to soft tissue injuries!!

PEACE & LOVE

The application of ice during the acute stages of a soft tissue injury (e.g. muscle, ligament, tendon) has been an integral part of first aid since the 1980s, and to this date, it still appears to be an ingrained part of the acute injury management process. For example, if we recall a recent local football game where a player sprained their ankle, there is a high probability that ice was instinctively applied (1). However, recent research has expressed that perhaps it isn’t as simple as that…

 

HISTORY

If we recall back to 1978, the RICE (Rest, Ice, Compression, Elevation) principle was introduced by Dr. Gabe Mirkin intending to guide the acute management of soft tissue injuries (2). In 2007, this protocol evolved to PRICE (P = Protection) and in 2012, this was later replaced with POLICE, with the addition of Optimal Loading (OL) and removal of Rest (R) (3).

The inclusion of Optimal Loading (OL) (i.e. appropriate exercise) in-fact accelerates recovery by promoting repair of tissues. Whereas Rest (R) was removed as it appeared hinder this process (2).

 

SO WHERE DOES ICE SIT AMONGST ALL OF THIS?

Well, the application of ice is believed to cause blood vessels in the area to narrow resulting in a restriction of blood flow to the injured area; reducing swelling, bleeding, and bruising. (4). Secondly, ice may also act as a great analgesic (pain-numbing agent) giving the impression the injured area is feeling less painful (5).

 

Interestingly, however, the inflammation and swelling that we try so hard to prevent by using ice, is actually an integral part of the body’s natural healing response as involves removing damaged tissue (6). However, when ice is applied to an acute soft tissue injury, we may be hindering the initiation of this healing process.

 

So in 2014, Dr. Gabe Mirkin himself, who coined the RICE acronym, removed ice from his initial protocol. Stating that “Coaches have used my ‘RICE’ guideline for decades, but now it appears that both ice and complete rest may delay healing, instead of helping” (7). Following this in 2020, the British Journal of Sports Medicine released an editorial piece that introduced a new acronym to guide the care of acute, sub-acute, and chronic stages of soft tissue management, this is known as PEACE & LOVE (8).

SO WHAT’S THE VERDICT, SHOULD WE STILL BE USING ICE?

As discussed, inflammation is an integral part of the body’s natural healing response. However, excessive swelling following surgery may be unfavourable and therefore ice may be suitable for management (9). Additionally, its application after an acute soft tissue injury may be appropriate for a short period (5-10minutes) for its analgesic effect. Although not all ice is created equal, and crushed ice has been shown to be superior for this purpose (10). Following this, our primary focus should be to adopt the PEACE & LOVE principle (8).

As you can see, the research is constantly evolving and therefore it is important to understand the context behind the application of ice, and this is where our experienced physiotherapists come in. We’ll provide a comprehensive assessment, diagnose your injury, and create an individualised treatment plan that will guide you through the PEACE & LOVE principle and may include discussing whether ice is appropriate for your recovery and return to performance.

If you are interested in setting up an in-depth consultation with a clinician, book and appointment online or check our locations page to find a clinic near you.

Symmetry Physiotherapy

REFERENCES

  1. Saw R, Finch CF, Samra D, Baquie P, Cardoso T, Hope D, Orchard JW. Injuries in Australian Rules Football: An Overview of Injury Rates, Patterns, and Mechanisms Across All Levels of Play. Sports Health. 2018 May/Jun;10(3):208-216. doi: 10.1177/1941738117726070. Epub 2017 Aug 21. PMID: 28825878; PMCID: PMC5958447.
  2. Mirkin, G. & Hoffman, M. (1978). The sports medicine book. (1st). Little Brown and Co.
  3. Bleakley, C. M., O’Connor, S., Tully, M. A., Rocke, L. G., Macauley, D. C., & McDonough, S. M. (2007). The PRICE study (Protection Rest Ice Compression Elevation): design of a randomised controlled trial comparing standard versus cryokinetic ice applications in the management of acute ankle sprain [ISRCTN13903946]. BMC musculoskeletal disorders8, 125. https://doi.org/10.1186/1471-2474-8-125
  4. Bleakley, C., McDonough, S., & MacAuley, D. (2004). The use of ice in the treatment of acute soft-tissue injury: a systematic review of randomized controlled trials. The American journal of sports medicine32(1), 251–261. https://doi.org/10.1177/0363546503260757