Sports Injury Prevention Management by SKH Physio Dept

Injured? Try a little PEACE

By Melissa Chan, Physiotherapist, Department of Physiotherapy, Sengkang General Hospital

When it comes to sports and physical activities, acute injuries such as ankle sprains and muscle strains are common occurrences. As an immediate first aid treatment, the RICE (Rest, Ice, Compression, Elevate) method has been the mainstay treatment in soft tissue injury to minimise bleeding, swelling, and reducing discomfort. 

However, recent research from the British Journal of Sports Medicine not only suggests that RICE may not be as effective as we think, it has also collectively supported the notion that it promotes too much time resting, which does not enhance long-term tissue healing. 

While it is necessary for soft tissue injuries to receive immediate care, it is important to use an approach with continued rehabilitation support. The PEACE (Protect, Elevate, Avoid Anti-Inflammatories, Compress, Educate) protocol outlines the importance of patient education and mental wellness to optimise recovery.

Above: Crutches can be used to unload an injured leg.

PEACE for Injury Recovery Process

PEACE helps to simplify current evidence in the management of an acute injury. While pain and swelling is expected in the initial stages of recovery, consultation with a physiotherapist or doctor may be useful for advice on return to activities, especially if the issue persists. 

P for protect

Protecting the injured tissue is a more sophisticated approach compared to the ‘rest’ step in RICE.

Unload or restrict movement of the injured site for one to three days to reduce bleeding and prevent stretching of injured structures. This may include relying on crutches, braces, taping or slings to minimise the risk of aggravation. However, resting after the three-day period is not recommended, as prolonged rest can weaken tissue strength and quality.

Active rest after an ankle sprain includes moving your ankle within your pain and functional limits, maintaining general fitness such as cycling or walking in a pool, and training the uninjured leg and upper body. 

E for elevate

Elevate the injured limb above the heart level to help drain unwanted fluid from the injured tissue.  

A for avoid anti-inflammatories

The human body has an innate ability to activate a cascade of healing responses to repair damaged tissue: bleeding, inflammation, proliferation and remodelling. Inflammation is a natural component in recovery and hence, taking unnecessary anti-inflammatory medication can inhibit inflammation which may adversely affect long term-tissue healing, especially when higher doses are consumed. 

Icing or cryotherapy, previously used to limit inflammation and reduce bleeding, could potentially impede tissue healing and promote redundant collagen formation, compromising the strength and pliability of the healed tissue. Therefore, apply ice for its numbing effect instead of reducing inflammation. 

C for compress

While external mechanical compression (bandaging or taping) can help reduce swelling and tissue bleeding, it should allow a full range of joint movements without affecting functional tasks such as walking. 

E for educate

Understanding the benefits of active recovery will help you make informed decisions during your immediate and long-term healing process. Instead of searching for ‘quick fix’ interventions like complete rest, massage and electrotherapy, which have poorer effects on pain and return to activities, it is important to understand the condition and apply proper load management to avoid overtreatment.

Contributed by 

Ms Melissa Chan, Physiotherapist

Department of Physiotherapy, Outpatient Rehabilitation - Musculoskeletal 

Sengkang General Hospital

This is part of an outreach program by the Department of Physiotherapy, SengKang General Hospital. 

References

Bleakley, C. M., Glasgow, P., & MacAuley, D. C. (2012). PRICE needs updating, should we call the POLICE?. British journal of sports medicine, 46(4), 220-221.

Dubois, B., & Esculier, J. F. (2020). Soft-tissue injuries simply need PEACE and LOVE. British journal of sports medicine, 54(2), 72-73

Duchesne, E., Dufresne, S. S., & Dumont, N. A. (2017). Impact of inflammation and anti-inflammatory modalities on skeletal muscle healing: from fundamental research to the clinic. Physical therapy, 97(8), 807-817.

Grey, J., & Rawlinson, G. (2013). The physiotherapy management of inflammation, healing and repair. Teoksessa S. Porter (toim.) Tidys Physiotherapy, 15, 253-271.

Hansrani, V., Khanbhai, M., Bhandari, S., Pillai, A., & McCollum, C. N. (2015). The role of compression in the management of soft tissue ankle injuries: a systematic review. European Journal of Orthopaedic Surgery & Traumatology, 25, 987-995.

Singh, D. P., Barani Lonbani, Z., Woodruff, M. A., Parker, T. J., Steck, R., & Peake, J. M. (2017). Effects of topical icing on inflammation, angiogenesis, revascularization, and myofiber regeneration in skeletal muscle following contusion injury. Frontiers in physiology, 8, 93.

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