In last week’s blog we talked about how the old treatment method of RICE (rest, ice, compression, elevation) is actually no longer the first line of defense after acute injury! BUT WHY? In a nutshell: Rest and ice can be detrimental to healing and recovery because they halt and delay our body’s natural healing processes.
Stated beautifully by researchers in 2020, “Managing soft-tissue injuries is more than short-term damage control” (Dubois et al. 2020). This is what ice, prolonged rest, and NSAIDS are: short term damage control. Moral of the story: Our bodies heal pretty well on their own, we just have to help it along and give it the right environment (one filled with PEACE and LOVE).
What does PEACE stand for?
Researchers note, “Immediately after injury, do no harm and let PEACE guide your approach” (Dubois et al. 2020).
P: PROTECT - Modify movement to keep it safe & tolerable. That does NOT mean you should completely rest or stop moving altogether. Use pain as a guide to stay moving as much as possible in a way that doesn’t further irritate the tissues - keep pain less than a 3-4/10. A little movement goes a long way, especially to get the blood flowing.
In these first few days, it is important to find the right balance of movement that allows healing to occur without aggravating the injury further. When can we exit the PROTECT phase? Researchers note that, “Pain signals should guide the cessation of protection” (Dubois et al. 2020).
E: ELEVATE the affected area above the level of the heart during these first few hours/days after injury. Don’t just hang out with your leg propped up for hours though! Sprinkle in some light movement, exploring what ranges of motion feel tolerable at this time.
A: AVOID anti-inflammatories! I know that one may be surprising, but the acute inflammation response is a natural part of healing (see last week’s blog on why we actually want some inflammation early on after injury). Our bodies are pretty smart, and we don’t want to halt this process. Picture 526 backed up because of a wreck (ie. your injury) and now the emergency response team (the healing biomarkers and blood flow that couple inflammation) can’t get to the accident. Not great. We also want to limit ice and cryotherapy/cold therapy here.
C: COMPRESS - in some cases it can be helpful to tape or wrap (think ACE bandaging a sprained ankle) to limit swelling and additional tissue hemorrhage.
E: Educate! Your PT should teach you how to take an active approach to healing. Understanding the healing process will help you make better decisions during your recovery! At Made 2 Move, we help set realistic time frames and goals for healing, rather than chasing some “quick fix” or “magic cure,” as these often just lead to expensive medical bills and don’t contribute to long term healing. Choose treatments that emphasize movement and muscle contraction rather than rest and passive modalities.
What does LOVE stand for?
Okay, you’re all zenned out after giving your injury some PEACE. Now what? After the first couple of days, tissues are ready for some LOVE!
L: LOAD. Okay let’s be CLEAR here for all my go-getters. This does not mean that as soon as you’re feeling better you get back on the field, court, or under the barbell. This is all about finding the optimal and appropriate dose of loading that promotes proper repair, healthy remodeling. Finding the right dose helps to build back up that tissue tolerance and capacity. Gradually increase the load here and remember to keep it tolerable!
O: OPTIMISM: Our outlook and mental state after an injury plays a huge role in how we recover from it. In fact, research in 2016 found that lower self efficacy was more responsible for symptom variation than the actual severity (grade) of ankle sprain (Briet et al. 2016). It’s important here to try not to catastrophize (“OMG my ankle will never get better”) or fear (“I sprained my ankle doing this ie. this movement is bad and I should never do it again”), as these thought patterns can negatively affect recovery.
Confusion and feelings of depression after injury are normal, so we often encourage our patients to try and take a different outlook on their injury. People often come to PT in a not so happy headspace feeling like, “This sucks, and now I’m out of my sport for months.” At Made 2 Move, we try to reframe injuries in the context of, “This sucks (yes, it still sucks), BUT what can I do to come out of this better?”
For example, let’s say you’re a Crossfitter who hurt their shoulder in last night’s WOD. Instead of saying, “This sucks now I can’t snatch or do gymnastics for months,” maybe we reframe it as, “This sucks, but now I can get my legs super strong and fine tune some of that skill work I’ve been avoiding.” This mindset and hard work can help you come out on the other side of injury a better athlete than you were before your injury.
V: VASCULARIZATION. Pain free cardiovascular exercise should be re-introduced ASAP to improve blood flow and promote a more optimal tissue healing environment.
E: EXERCISE! You knew this was coming! The goal here is to restore normal movement, strength, and proprioception (ie your body’s awareness of where it is in space and how it is moving). We also want to look deeper to figure out why this injury happened, and make sure we’re doing everything we can to reduce our risk of future injuries. Exercise is going to be HUGE for a full recovery to improve blood flow, promote an optimal tissue healing environment, and properly repair and remodel healing tissues.
Do’s and Don’ts after Acute Injury:
So let’s say you sprain your ankle in a pick up soccer game or pull a hammie on a run this weekend - what should you do?
❌ DON’T - completely rest or stop moving.
❌ DON’T- constantly ice the injured area. If it helps with pain, use it sparingly.
❌ DON’T- take anti-inflammatories. The acute inflammation response is a natural (and useful) part of healing.
✅DO - Move in ways that are safe and tolerable, using pain as a guide.
✅DO- Stay active and add in pain free aerobic exercise (walk, bike, swim, light jog, etc)
✅DO- Load the tissues (that means using weight and resistance) - start light and progress from there - keep it tolerable.
✅DO- Use elevation and compression in more severe cases, sprinkling in some light range of motion.
✅DO- Understand that our bodies are really great at healing and you WILL come back from this.
The 🔑’s:
After an acute injury, don’t reach for the couch, the ice, or the ibuprofen.
Rest and ice can be detrimental to healing and recovery because they halt our body’s natural healing processes.
Ice was originally claimed to "reduce inflammation" and speed up recovery in the short term, BUT inflammation is a part of our body’s natural healing process, and we don’t want to halt it.
Early mobility and movement is key.
Keep moving in ways that are tolerable - some discomfort is okay and to be expected, but we don’t want to push into sharp, intense pain.
Keep your head up!
Optimism can contribute to a better headspace and thus, a more optimal environment for healing.
Resting for too long after an injury actually has an overall negative effect on the recovery process.
When we rest, we’re not stressing the tissues. That’s why people get stuck in a frustrating cycle of: injury, rest, re-injury, rest, try again, get re-injured, on and on, into the injury pit of despair.
Next time you have an acute injury (which I hope you don’t), remember: PEACE, LOVE, and that you were MADE 2 MOVE!