PEACE & LOVE for your injuries

Acute sprain, muscular strain and bruising all have sudden and traumatic appearance. The acronyms to help us remember the best approach to follow after injury have been many, from ICE to RICE, then to PRICE. In 2012, an author from the United Kingdom introduced a new idea with his acronym POLICE: “PRICE needs updating, should we call the POLICE? “. In 2017, the acronym had an extra few new letters added: POLICE-CANAI.

 

In April 2019, Quebec physiotherapists updated the international scientific community with a publication in the British Journal of Sports Medicine (BJSM). The time had come to incorporate a little more rigor and softness into the treatment of musculoskeletal trauma. The changes were numerous: remove the “I” (ice – ICE), add the psychological factor, take into account the nocebo effect of hypermedicalisation and finally, present the steps in their order of application. The acronym is now corrected in the light of scientific advances in the field.

PEACE & LOVE


Immediately after a soft tissue injury, do no harm and let PEACE guide your approach.

  • P = Protection (make sure not to cause pain during the first few days)
  • E = Elevation (raise the affected limb as often as possible so that it is higher than the heart)
  • A = Anti-inflammatory to be avoided (Reduce your use as much as possible)
  • C = Compression (apply an elastic bandage or ideally a taping to reduce initial swelling)
  • E = Education (learn best practice of care)

After the first few days, soft tissue need LOVE.

  • L = Load (good management practices by quickly integrating loading and pain-free movement)
  • O = Optimism (be confident and positive)
  • V = Vascularization (damaged tissue must be vascularized and its metabolism must be increased)
  • E = Exercises (gradual return to active life)

 


For the curious, here are the “old” acronyms:

P / R / ICE

  • P = Protection (make sure not to cause pain the first few days)
  • R = Rest or Activity Reduction (often misinterpreted as a cessation of activity)
  • I = Ice (apply ice pack 15 minutes during the first 2 to 3 days (every 1 to 2 hours))
  • C = Compression (apply elastic bandage or ideally taping to reduce initial swelling)
  • E = Elevation (raise the affected limb as often as possible so that it is higher than the heart)

 

POLICE (2012)

  • P = Protection (make sure not to cause pain during the first few days)
  • O L = Optimal Loading (quantify its mechanical stress by quickly integrating loading and movement without pain)
  • I = Ice (apply ice pack 15 minutes during the first 2 to 3 days (every 1 to 2 hours))
  • C = Compression (apply elastic bandage or ideally taping to reduce initial swelling)
  • E = Elevation (raise the affected limb as often as possible so that it is higher than the heart)

 

POLICE-CANAI (2017)

  • C A = Cardiovascular activity (from the third day, in order to accelerate healing, it is desirable that the damaged tissue is vascularized and its metabolism  increased)
  • N A I = No Anti-inflammatory (avoid anti-inflammatory drugs that slow the healing of damaged tissues)

Thank you to our Quebec physiotherapist colleagues for their involvement in the scientific community on the subject.

  • Blaise Dubois (@blaisedubois) s the president and founder of The Running Clinic, an organization providing continuing education internationally. In the clinic and in research, Blaise is interested in the prevention and treatment of running injuries, with a particular focus on footwear and bio-mechanics. (Quebec City, Canada).
  • Jean-Francois Esculier (@JFEsculiercombines clinical research (Department of Physical Therapy, University of British Columbia) with patient care (Vancouver, British Columbia) and knowledge translation (The Running Clinic, Canada). He loves to educate and empower patients so they can become the main actor of their rehabilitation.