Recover right – the new injury management guidelines

By Nick Kinnear

If you have ever played sport, or suffered an acute soft tissue injury then it’s likely you have seen the acronym RICE. RICE stands for Rest, Ice, Compression, Elevation and was the abbreviation given to those who have suffered acute soft tissue injuries after being developed in the 1970s by Dr Gabe Mirkin.The science and theory has changed several times since then so you may well have seen other acronyms such as PRICE (Protection, Rest, Ice, Compression, Elevation and POLICE (Protect, Optimal Loading, Ice, Compression, Elevation), however the thinking has changed, away from rest and ice towards active rehabilitation. This helped form the acronym PEACE and LOVE which was developed by Dubois and Esculier in 2020, which we will go through below.

Following an injury it is best to deload and restrict movement for 24 – 72 hours depending on the severity of the injury. This is to minimise bleeding, and prevent any further damage to the site, however we must make sure to minimise rest as much as possible as rest can compromise tissue strength and quality.


Elevate the limb higher than the heart, to promote interstitial fluid flow out of the tissues. There is not a great scientific backing for this step however the risk-to-benefit is low enough that it is unlikely to compromise the injury further.

Avoid anti-inflammatories

With the arrival of an injury there will also be inflammation present. Inflammation is a perfectly normal part of the healing process, and inhibiting the inflammation process may negatively affect long term tissue healing. For this reason it is best to avoid anti-inflammatories and let the body do it’s thing naturally.


External pressure is said to limit swelling and internal bleeding. There are some conflicting reports in the literature however it does appear that compression can reduce swelling and improve quality of life with injury.


Those with acute injuries need to be educated on the benefits of an active recovery in their recovery. Passive treatments (electrotherapy etc) are reported to have insignificant benefits when compared with active treatments. If someone with an injury is educated on their injury and how to manage the loads of the affected area there is more likely to be a better outcome.

And, Once a few days have passed…


Mechanical stress should be implemented early, and normal activities resumed as pain/symptoms become manageable.Optimal loading without exacerbation of pain promotes repair and remodelling and builds muscle capacity while developing tissue tolerance.


Having an optimistic approach to injury recovery can assist with outcomes and prognosis. On the other hand psychological factors such as catastrophization, depression and fear avoidance can become additional barriers in recovery.


Early mobilisation and aerobic exercise improves physical function. The focus should be on pain free or tolerating only low level pain to avoid any setbacks.


There is a strong level of evidence for exercise in helping to restore mobility, strength, and proprioception. When managing soft tissue injuries we should consider both short and long term risk-benefits and treat the person with the injury, not the injury with the person.


Dubois, B & Esculier, J-F 2020, ‘Soft-tissue injuries simply need PEACE and LOVE’, British Journal of Sports Medicine, vol. 54, no. 2, pp. 72–73.

Wang, Z-R & Ni, G-X 2021, ‘Is it time to put traditional cold therapy in rehabilitation of soft-tissue injuries out to pasture?’, World Journal of Clinical Cases, vol. 9, no. 17, pp. 4116–4122

Hansrani V, Khanbhai M, Bhandari S, et al. The role of compression in the management of soft tissue ankle injuries: a systematic review. Eur J Orthop Surg Traumatol 2015;25:987–95

Khan KM, Scott A. Mechanotherapy: how physical therapists’ prescription of exercise promotes tissue repair. Br J Sports Med 2009;43:247–52.