When you think of treating an injury, ice is probably the first thing that comes to mind. For decades it’s been the go-to treatment.
However, ‘cryotherapy’, as it’s also termed, has had a rough press in recent years. Indeed, three years ago, Dr Gabe Mirkin, the physician who coined the acronym RICE (Rest, Ice, Compression, Elevation) in the 1970s, wrote an article saying that ice could actually delay rather than aid recovery. It is thought that ice could inhibit the body releasing a hormone called ‘insulin-like growth factor’ (IGF), which promotes healing.
However, ice and other anti-inflammatories are still recognised as having their place in limiting pain so physiotherapists are not completely giving cryotherapy the cold shoulder.
In recent years, however, the new acronyms LOVE and PEACE were being recommended to clinicians by the British Journal of Sports Medicine in connection with the treatment of soft tissue injuries. Soft tissue relates primarily to muscles, tendons, ligaments, fascia, nerves and fibrous tissues – in other words, anything that doesn’t involves bones.
We asked sports physio Nick Worth, national lead clinician for Ascenti, to expand on some of the principles of PEACE and LOVE, and to explain how applying them can make us better runners.
The short-term fix
Unload or restrict movement of the affected area for the first three days after the injury, with the time depending on how much pain there is.
Nick tells us: “The whole point of this phase is that you don’t want to keep doing the same thing as you’ll make it worse.”
However, don’t necessarily just put your feet up. The article also warned, “prolonged rest can compromise tissue strength and quality”.
This is a well known treatment. The idea is to elevate the affected area so it is higher than the heart to allow fluid to drain away from the area.
However, the article points out there is weak evidence supporting its use. So, although numerous sources suggest two to three hours per day, unless you plan on watching quite a bit of television or have some other reason to sit around, it’s worth bearing in mind what Nick has to say later on the matter of compression (below).
Avoid anti-inflammatory modalities
Inflammation – despite its often negative connotations in the world of sports injuries – actually helps repair damaged tissues. Therefore, the BJSM advises against such methods and even goes as far as to question the use of ice. “Despite widespread use among clinicians and the population, there is no high-quality evidence on the efficacy of ice for treating soft-tissue injuries,” they wrote.
If you don’t have time to sit around for hours with your leg in the air, it’s worth noting what Nick says when asked about the time versus benefit ratio of elevation. “Compression is more important than elevation,” he replies. “A compression stocking or sock will do the same as elevation.”
Therefore, while not everyone wants to be seen wearing those long compression socks for racing or training, they’re handy to wear below your jeans as recovery from races or from injury.
This might seem just a handy word to end the acronym, but Nick agrees it is important that runners educate themselves effectively via reputable sources – either online or in person.
“You would be amazed at the amount of things I hear about runners saying what other runners have told them,” he said. “The amount of old wives’ tales that get shared around. That’s often the dangerous thing.”
Specifically, the BJSM is talking about us becoming aware of the importance of an active approach to recovery. The physios write: “Better education on the condition and load management will help avoid overtreatment,” which includes unnecessary injections and surgery, they add.
A few days later
Once you’ve applied the principles of PEACE, in the coming days you’re going to need to practice a little self-love...
A few days after a soft-tissue injury has occured, you can try to resume normal activities as dictated by pain.
“Optimal loading without exacerbating pain promotes repair, remodelling and builds tissue tolerance and the capacity of tendons, muscles and ligaments,” the BJSM piece continues.
Nick explains: “It’s getting blood around the area. It’s about normalisation. Your body will be used to getting regular exercise and then that suddenly stops.” But he cautions: “Loading has to be pain-free. There is a difference between pain and discomfort.”
Being optimistic about your prognosis has been scientifically shown to speed up recovery.
“Have a positive outlook rather than be annoyed, depressed, angry that you can’t run,” says Nick. “It’s about saying you will get better.”
The last two elements are closely linked. Here, cardiovascular activity refers more to getting the blood flowing around the body after a few days. The most obvious way to achieve this is to be more active, but crucially you need to be able to find applicable activities that don’t cause you any pain.
Aside from the abovementioned need for cardio work, the kinetics of the exercise will assist the recovery from injury. This can be resumed within a few days as long as it doesn’t cause pain. This is particularly helpful when it comes to ankle sprains. “Exercises help to restore mobility, strength and proprioception early after injury,” writes the article.
Nick Worth explains: “The key thing to remember is, just because there isn’t a large amount of evidence to support ice it doesn’t mean it doesn’t work.” He further adds that the latest approach PEACE and LOVE itself doesn’t have a lot of strong scientific evidence.
“Ice is very useful for that short-term effect,” says Nick, who advises applying it for around only five minutes at a time as a means of counteracting pain.