I’m sure you have all heard of RICER. That magical thing we do after we roll our ankle on the sporting field, the pièce de resistance to rehabilitation, the best form of management of acute injuries. What if I told you the world of sports medicine is changing, and RICER has been replaced?
RICER has been the go-to form of management for sporting injuries since 1978. The acronym stands;
Rest
Ice
Compression
Elevate
Referral
This method of injury treatment came about with the intent to minimise inflammation and speed up healing and recovery. However, evidence and research are always changing and in recent years this acronym has undergone some change also. This latest change is PEACE & LOVE. So what exactly are these changes and what do they mean for injury management?
Firstly PEACE & LOVE works to target not only our acute management of injury but also the sub-acute period after inflammation has settled.1 By targeting an injury in the different phases of healing it will provide better care to an individual and promotes more beneficial tissue healing.
PEACE looks predominately at the acute management of an injury. Let’s dive in to what this acronym stands for and how we can best utilise the recommendations.
Protect:
The first step in injury management is to protect the injured area. It is advised that you should unload or reduce movement for 1-3 days after the initial injury. This helps to minimise bleeding, reduce aggravation of the injury and reduces distention of injured fibres.1
Elevate:
This step has some weak evidence surrounding the benefits of elevation however there is also low risk to performing this step. Due to the low risk-benefit ratio it has still been included in injury management.1 This step involves placing the injured limb higher than the level of the heart in attempts to promote fluid draining out of the injured tissue.
Avoid anti-inflammatory modalities:
The third step may be one of the more controversial steps to have been changed. Avoiding anti-inflammatory modalities includes the use of anti-inflammatory medication (eg Voltaren and Nurofen) and the use of ice. It has been shown that the inflammation released by the body helps repair damage to soft tissue. This occurs through allowing the body to take its natural course of healing. By inhibiting inflammation you could potentially be causing negative long-term effects. When we injure ourselves the body sends out inflammatory cells. This signal then sparks the release of the hormone growth factor, whose sole purpose is to start healing through killing damaged tissue.2 A lot of people report that ice makes their injury feel better through its numbing effect. But ice has little effect on the muscles effected as applying ice to the skin doesn’t change the temperature of muscles.2
Compression:
Compression involves the use of taping or bandages to apply pressure to the injured area. This reduces the bruising and swelling. A study actually showed that the quality of life of the patient and the level of swelling experienced was better in patients who applied compression following an ankle sprain.
Education:
Education on active recovery is a very important part of injury management. Using only passive treatments such as acupuncture, massage and electrotherapy may be counterproductive in the long term when compared to an active approach.1 Facilitating thoughts that something needs to be fixed can cause a therapy dependent behaviour in an individual which can in turn lead to over-treatment. To combat this your physiotherapist should work with you to set realistic goals and expectations about recovery.
LOVE starts to work more into the sub-acute timing of recovery.
Load:
As mentioned above, to achieve an active approach we need to use movement and exercise. Mechanical stress or loading should be done as early as symptoms will allow. Through loading without exacerbating pain the body is pushed along in terms of repairing, remodelling and building strength in the injured tissue. By achieving these things normal activities of the patient can be returned to sooner rather than later.
Optimism:
When patients approach their injuries with optimism and a positive outlook, they tend to have better outcomes and prognosis.1 A study showed that the variance of symptoms between patients with ankle sprains could be attributed to their beliefs and emotions surrounding the injury.3
Vascularisation:
Blood flow is a vital part of the bodies healing process. It helps deliver nutrients and oxygen to the tissues in the body. As this is a natural part of healing it makes sense to want to promote blood flow to injured areas. Pain free aerobic exercise should be started as early as possible after injury to increase the blood flow. Through doing this you will improve your function and it may even help you return to sport quicker. It is also a really nice way to maintain your physical fitness while you’re out of the game.
Exercise:
Exercise is one of the best things you can do to get back to pre-injury levels and back to sport. Exercises are there to help increase your mobility, strength, balance, proprioception and muscle control after an injury.4 Working closely with your physiotherapist will allow correct exercise prescription for your individual symptoms and sporting demands. Through making sure your body is able to handle the specific demands of your sport and that you are back to pre-injury fitness and strength it can help reduce the risk of recurrent injuries.
So next time you hurt yourself push RICER to the side, cause sometimes all our body needs is a little PEACE & LOVE.
For any enquiries about injury management contact Carlingford (9871 2022) or Kellyville (9672 6752) clinics to speak to our friendly staff.
References:
- Dubois B, Esculier J-F. Soft tissue injuries simpky need PEACE & LOVE. Br J Sports Med 2020;54:72–73.
- Wood, Z. To ice or not to ice an injury? Physionetwork. 2020.
- Briet JP, Houwert RM, Hageman M, et al. Factors associated with pain intensity and physical limitations after lateral ankle sprains. Injury 2016;47:2565–9.
- Vuurberg G, Hoorntje A, Wink LM, et al. Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. Br J Sports Med 2018;52:956.
- Brooke Sullivan (Bachelor Exercise and Sport Management; Masters of Physiotherapy)
