When you first injure yourself, the first thing to do is ➽ P.E.A.C.E

Following the first few days add in the ➽ L.O.V.E

If you find yourself with a new soft tissue injury, the most recent evidence supports a different approach than you might be used to.

P.E.A.C.E.

P: PROTECT Unload or restrict movement for 1 to 3 days to minimize internal bleeding, prevent stretch or aggravation of the injured fibers and reduce the risk of increasing the injury. Rest should be minimized as prolonged rest can compromise tissue strength and quality. Do as much as you can without increasing the pain after,

E: ELEVATE  When resting don’t keep an ankle down on the floor off a chair, but rest it on a chair next to you, for an arm, place it on a pillow next to you rather than resting it in your lap.

A: Avoid Anti-inflammatories if possible. Anti-inflammatory medications may potentially increase the time it takes for long-term tissue healing to complete. The various phases of inflammation contribute to optimal soft tissue regeneration and it is a necessary part of the healing process.

C: Compression External mechanical pressure using taping or bandages helps limiting intra-articular edema and tissue hemorrhage. This can help flush out the swelling and then when releasing it new fresh blood can come in and continue repair.

E: EDUCATE! Better education on the condition and load management will help avoid overtreatment.  In an era of technology and hi-tech therapeutic options, we strongly advocate for setting realistic expectations with patients about recovery times rather than chasing the magic treatment approach.  It is our job to educate our patients on the benefits of an active approach to recovery. It has been suggested that overtreatment can increase the likelihood of injections or surgery and higher costs to healthcare systems because of disability compensation (e.g. in low back pain). Additionally, fueling the ‘need to be fixed’ can create dependence on the doctor, and thus contribute to persistent symptoms.

L.O.V.E.

after the first few days (3-4 days out from injury)

L: Load: An active approach with movement and exercise benefits most patients with musculoskeletal disorders. Mechanical stress should be added early and normal activities resumed as soon as symptoms allow. Optimal loading without exacerbating pain promotes repair, remodeling and building tissue tolerance and capacity of tendons, muscles and ligaments.

O: Optimism While staying realistic, our doctors encourage optimism to enhance the likelihood of the best recovery. The brain plays a key role in rehabilitation interventions. Psychological factors such as catastrophization, depression, and fear can represent barriers to recovery. They are even thought to explain more of the variation in symptoms and limitations following an ankle sprain than the degree of pathophysiology. Pessimistic patient expectations are also associated with suboptimal outcomes and worse prognosis.

V: (cardio)Vascular Activity: Physical activity that includes cardiovascular components represents a cornerstone in the management of musculoskeletal injuries. While research is needed on dosage, pain-free cardiovascular activity should be started a few days after injury to boost motivation and increase blood flow to the injured structures. Early mobilization and aerobic exercise improve function, work status and reduce the need for pain medications in individuals with musculoskeletal conditions.

E: EXERCISE There is a strong level of evidence supporting the use of exercises for the treatment of ankle sprains and for reducing the prevalence of recurring injuries. Exercises will help to restore mobility, strength and proprioception early after injury.Pain should be avoided to ensure optimal repair during the subacute phase of recovery, and should be used as a guide for progressing exercises to greater levels of difficulty.

Managing soft tissue injuries is more than short-term damage control. Similar to other injuries, our doctors always aim for long-term outcomes and treat the person with the injury rather than the injury of the person. Whether they are dealing with a lumbar spine sprain or hamstring strain, we hope this blog post, with help from BJSM will encourage everyone to give PEACE a chance, because perhaps all soft tissue injuries need is LOVE

References

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