Peace, Love, & Ankle Sprains?

What does PEACE and LOVE have to do with soft-tissue injuries like an ankle sprain?

As you may know, the medical field loves acronyms. For a long time, the gold standard for an acute injury like a sprain was RICE.

RICE stands for: Rest, Ice, Compression, Elevation.

Rest: is pretty self explanatory. Don’t use the injured limb/joint for several days to allow it some time to rest.

However, over the years, we have learned that this can lead people to believe they should be following a passive approach to recovery.

The problem with this is that we know this can actually slow down recovery time, and is not necessarily the best approach when recovering from a new injury.

Ice: The rule is 20 minutes on 20 minutes off with an ice pack as frequently as possible for the first several days following an injury. The purpose is to help with pain and reduce swelling as much as possible.

However, believe it or not, we actually want swelling; at least within reason.

Your body is supposed to swell when we acquire an injury. That’s because in that swelling comes a flood of white blood cells and nutrients to help with healing. If we completely stop swelling, we limit the healing abilities that our bodies naturally have.

Compression: This refers to using an elastic bandage around the injury to help control the swelling (not completely get rid of it).

When using an elastic bandage to wrap an injury, you want to start on the side of the injury furthest from the heart and move toward your heart starting out with about a 50% stretch on the bandage, and gradually reducing the resistance as you wrap toward the heart. This is to create higher pressure on the opposite side of the injury so the fluid is pushed toward your heart so your body can get rid of it.

You don’t want to do this too tightly and you definitely don’t want the wrap tighter on the side closest to your heart as this will trap swelling in the injury site.

Elevation: When elevating an injury, simply getting it up off the floor isn’t going to cut it. You want to elevate the injury above the level of the heart. This is to take advantage of gravity in pulling the excess fluid from swelling toward your heart so it can eventually be pumped to your kidneys, then the bladder, and then… you know where.

RICE is still effective, but is considered outdated as the medical field has discovered the significant benefits of a more active approach to recovery.

Plus, while I don’t have proof of this, I think the medical field wanted to just sound more groovy, so they came up with the acronyms PEACE and LOVE. So let’s take a look at these…

The acronym PEACE has replaced RICE, and for good reason.

PEACE stands for: Protection, Elevation, Avoid Anti-inflammatories (and ice), Compression, and Education.

Protection: For the first 2-3 days after the injury you want to try and stay moving as much as able, but in non-painful activities. This replaces the Rest phase in RICE as it doesn’t imply we should lie in bed for 3 days, but rather encourages us to keep moving in ways that aren’t going to increase our pain.

Elevation: This is the same as before. You need to elevate the injury above the level of the heart.

Avoid Anti-inflammatories: Avoid taking anti-inflammatory medications or using ice. As we already discussed, some swelling is a good thing so we don’t want to completely get rid of it.

Compression: Again, this is the same as earlier. Using an elastic bandage to apply pressure to the injury, and starting by wrapping on the side furthest from the heart and moving toward the heart.

Education: Physical therapists are a great resource for when you get injured. Even if you don’t have a massive injury that has been hurting for months, you can still talk to a Physical Therapy to help guide you in returning to movement safely.

The biggest two differences between PEACE and RICE is that PEACE takes an active approach to recovery which helps you recover from an injury faster.

Second, it acknowledges that having some swelling is actually a good thing, and pivots its focus on managing swelling rather than eliminating it.

Once you have been recovering from an injury for 3-7 days, it is time to move to the LOVE phase of recovery.

LOVE stands for: Load, Optimism, Vascularization, and Exercise.

Load: This refers to increasing weight or use of the injured area. Let pain be your guide on this. Generally the phrase “No Pain, No Gain” is false when it comes to this. If pain starts to increase as you begin to increase use, back off until the pain is manageable. You know your body best, so listen to what it’s telling you.

Optimism: Condition your brain for optimal recovery by being positive and confident. This may sound a little weird, but there is a fair amount of research that supports this. People that believe they will recover from an injury and remain positive actually tend to get better faster. So stay positive!

Vascularization: Participate in pain-free or non-pain-provoking cardiovascular activities to increase blood flow. This helps circulate nutrients to the injured area and speeds up recovery.

Exercise: Restore mobility, strength, endurance and proprioception through an active approach to recovery (i.e., Physical Therapy).

If you have a new injury that you’d like some guidance on how to get moving safely and recover faster, or an old injury that just won’t seem to get better, Idaho Direct Physical Therapy can help you recover from injury and get ready for your next adventure!

Schedule a No-Charge Consultation by phone or video chat here.


Disclaimer: This content is for general, informational purposes and does not constitute medical advice.


Dr. Tyler Burke

DPT, Owner and Founder of Switchback Direct PT

We help injured outdoor enthusiasts to stop hurting and start adventuring.

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