Over the last 10 years, guidelines for managing acute injuries—such as sprained ankles—have changed significantly. The well-known RICE method (Rest, Ice, Compression, Elevation) may not be as effective in aiding soft tissue healing as once believed, and may even hinder the process.
American sports doctor Dr Gabe Mirkin, who coined the term ‘RICE’ in 1978, revised his stance in 2015, writing that ice “may delay healing, instead of helping.” The initial inflammation that occurs following a soft tissue injury plays a critical role in delivering the cells needed for tissue repair and healing. Since ice is a vasoconstrictor (it narrows blood vessels and restricts blood flow), it may reduce the effectiveness of this early inflammatory response.
The most recent guidelines emphasise both immediate care and long-term management of soft tissue injuries. These are summarised using the acronym PEACE & LOVE:
PEACE: Immediate Care
Protection: Unload and restrict movement for 1–2 days to reduce the risk of aggravating the injury. Rest should be relative to pain, as too much rest can compromise tissue strength.
Elevate: Raise the injured limb above heart level to promote fluid drainage from the tissues.
Avoid anti-inflammatories (including ice): Inflammation is an essential part of tissue repair. Anti-inflammatory medications such as Nurofen or Voltaren, as well as ice, can disrupt this process. These should be avoided during the first 5–7 days post-injury.
Compress: Compression with bandages or taping can reduce swelling and improve comfort.
Educate: Patients should be empowered to take an active role in their recovery, rather than relying heavily on passive treatments like massage or dry needling. Education helps reduce dependence on treatment and encourages better long-term outcomes.
LOVE: Ongoing Recovery
Load: Introduce movement and gentle exercise early. As symptoms permit, resuming normal activities promotes repair, tissue tolerance, and strengthens muscles, tendons, and ligaments through a process known as mechanotransduction.
Optimism: Positive expectations are linked with better recovery. Psychological barriers like catastrophising, depression, and fear can hinder healing, so addressing mindset is key.
Vascularisation: Cardiovascular activities like walking, cycling, and swimming are vital for musculoskeletal injury management. Pain-free aerobic exercise should begin a few days post-injury to enhance motivation and blood flow, reduce pain medication use, and support return to work and physical function.
Exercise: There is strong evidence supporting exercise in treating acute injuries and preventing recurrence. Early exercise helps restore mobility, strength, and proprioception. Pain should be used as a guide to safely progress exercises during the subacute recovery phase.
Osteopath Jesse loves helping people recover from acute injuries—so book in today!