In 1978 Dr. Gabe Mirkin published on using R.I.C.E for acute musculoskeletal injuries. Since that time this acronym for REST, ICE, COMPRESSION, ELEVATION has become widely accepted as “what to do” when you have a new sporting injury.

As sports medicine continues to learn many professionals are moving away from this older practice towards a holistic approach which encourages the body to do what it does best after injury. That means REST and ICE, plus any anti-inflammatory drugs people would have previously opted for are no longer part of gold standard practice to treat acute injuries. Dr Gabe has since spoken in favour of new research which moves away from his RICE acronym. Here is why..

Our bodies and those of your children already have the software installed to begin the healing process!

Inflammation used to be the “bad guy” when thinking about injury. Ice would be applied to cause the blood vessels to constrict and reduce inflammation around the site of injury. It also did a pretty great job and numbing out that pain response. While on the surface this all sounds great, here is the issue. In order to get to the repair and re-modelling phase of injury, we must first go through the inflammatory stage. It is within the inflammatory phase that all the great cells are sent to an injury site to begin working on the injury. If we prevent that from happening with ice, that slows how much of the great blood flow, with our repair kit onboard, will make it to the injury site. It can delay or even damage the tissue further if you leave it on too long!

So what should we do instead…

Load is where its at. Switch Inflammation to the “good guy” and let the body do what it needs to do.

Two physical therapists have offer in its place another acronym. They published in the British Journal of Sports Medicine in 2019.

P.E.A.C.E & L.O.V.E

Protect- for 48 hours after injury avoid doing activities that increase the pain

Elevate- if possible elevate the injury above heart level first 24 hours.

Avoid anti-inflammatory - no ice or anti-inflammatory drugs. We welcome blood flow :)

Compress- use a compressive band to limit excessive swelling

Educate- understand that the body does a great job at providing the toolkit via blood flow to assist healing. There is no need to head to the Doc straight away, unless you’re concerned of possible fracture.

Load- load actually helps with healing. Let the pain levels guide your child back into movement and load.

Optimism- be positive. The mind-body link is a real thing. Use positive language to reinforce to your child that their body is doing its job and helping repair. Pain is a way of giving the body boundaries through which to move.

Vascularization- encourage blood flow. After 48 hours integrate Heat bags. Do pain free exercise eg. swimming

Exercise- take a proactive response to recommencing exercise. In order to restore strength and mobility. Pain always an indicator as to tolerance of load.

The PEACE & LOVE acronym is a positive step forward in changing the way we approach musculoskeletal injuries.