Soft tissue injuries such as muscle strains, ligament sprains and bruising are extremely common in sport, exercise and everyday life. For many years, acute injuries were commonly managed using the “RICE” method (Rest, Ice, Compression, Elevation) in the initial phases. While some aspects of RICE remain useful, research has improved our understanding of how tissues heal and recover.
Modern injury management now commonly follows the PEACE & LOVE framework 1. This approach recognises that healing involves more than simply reducing pain and swelling. It also highlights the importance of education, gradual movement, physical loading and psychological factors in recovery.
PEACE
Adopt the following “PEACE” strategies in the first 1-3 days after injury:
P – Protect
Protection involves reducing movement and loading of the injured area for a short period to minimise further tissue damage. Protection should be short-term and based on symptoms- it is important that you are assessed by your Physiotherapist to determine the appropriate level of immobilisation suitable for your individual injury.
- Using crutches and/or a CAM boot after an ankle injury
- Wearing a sling for a shoulder injury
- Avoiding aggravating activities
- Temporarily modifying work or sport
Complete immobilisation for long periods is usually discouraged because tissues heal better when gradually exposed to movement and load 2. Your Physiotherapist will determine the appropriate timeframe of immobilisation suitable to your injury.
E – Elevate
Elevation helps reduce swelling by assisting fluid drainage away from the injured area.
The injured body part should ideally be positioned above the level of the heart when possible.
- Supporting an injured wrist on cushions
- Raising an ankle on pillows while resting
Although evidence supporting elevation is limited, it is simple, safe and may assist comfort 1.
A – Avoid Anti-Inflammatory Modalities
One of the more controversial components of PEACE is the recommendation to avoid routine use of anti-inflammatory medications and excessive icing.
Inflammation is a natural and necessary part of tissue healing. Suppressing this process too aggressively may potentially interfere with recovery.
Anti-inflammatory Medications
Non-steroidal anti-inflammatory drugs such as ibuprofen or diclofenac may reduce pain in the short term, but some research suggests they could impair tissue healing if overused. This does not mean these medications are always inappropriate. They may still be useful in some situations under the guidance of your treating GP or pharmacist.
Why no more ice/RICE Method?
Ice can temporarily reduce pain, particularly in injuries involving significant swelling 3, but evidence supporting improved long-term healing is limited.
If ice is used:
- Apply for comfort rather than “healing”
- Use short durations (10–15 minutes)
- Avoid direct skin contact
C – Compress
Compression may help limit excessive swelling and provide support.
- Elastic compression bandages
- Compression sleeves
- Taping techniques
Compression should feel firm but not overly tight. Proper application is important to avoid restricting circulation. Signs that compressive garments may be too tight include:
- Numbness
- Tingling
- Increased pain
- Skin colour changes
E – Educate
Education is a key part of modern injury management.
Your Physiotherapist will provide clear advice about:
- Expected healing timelines
- Safe activity levels
- Pain management
- Gradual return to sport or work
- Self-management strategies
Passive treatments alone are rarely enough for optimal recovery. People generally recover better when they understand their injury and actively participate in rehabilitation.
Fear and uncertainty can increase pain and slow recovery. Reassurance and realistic expectations are therefore important.
LOVE: Ongoing management
Once the early inflammatory phase settles, rehabilitation progresses to LOVE principles.
L – Load
Appropriate loading is one of the most important factors in tissue healing.
Tissues become stronger when exposed to gradual and progressive stress. Loading should be guided by your Physiotherapist and your symptoms.
- Walking after an ankle sprain
- Strength exercises for a muscle strain
- Controlled resistance training
- Gradual return to running or sport
Some discomfort during rehabilitation is often acceptable, provided symptoms settle reasonably afterwards. Physiotherapists commonly use structured exercise programs to progressively reload tissues safely.
O – Optimism
Psychological factors strongly influence recovery.
Research shows that fear, anxiety, stress and negative beliefs about injury can contribute to:
- Increased pain
- Reduced confidence
- Slower recovery
- Persistent symptoms
Optimism does not mean ignoring pain or forcing activity. Instead, it involves maintaining realistic confidence in recovery.
- Setting achievable goals
- Understanding healing timelines
- Staying socially connected
- Continuing modified activity where possible
V – Vascularisation
Cardiovascular exercise promotes blood flow, supports tissue healing and maintains general fitness 4, 5.
Pain-free or low-pain aerobic activity is usually encouraged early in recovery where appropriate.
- Walking
- Stationary cycling
- Swimming
- Upper body exercise during lower limb injuries
Benefits of aerobic exercise may include:
- Improved circulation
- Reduced pain sensitivity 6
- Better mood
- Maintenance of fitness
Exercise intensity should match the individual’s injury and tolerance.
E – Exercise
Exercise is central to successful rehabilitation. Your Physiotherapist will create a home exercise program tailored to you.
Rehabilitation exercises are designed to improve:
- Strength
- Mobility
- Balance
- Coordination
- Endurance
- Sport-specific function
Exercise programs should be individualised based on:
- Injury type
- Severity
- Activity goals
- Age
- General health