What does the research say?
Over the past few years, studies have increasingly questioned the use of anti-inflammatory modalities in the acute phase. As a result, a new acronym has been proposed to help guide the management of an acute musculoskeletal injury: PEACE & LOVE. Introduced by physiotherapists and researchers Blaise Dubois and Jean-François Esculier in 2019 in the British Journal of Sports Medicine (Dubois B, Esculier J-F. Br J Sports Med. 2020;54:72–73), this acronym is designed to guide immediate care (PEACE) and the management in the days following the injury (LOVE). Read the article: La clinique du coureur
PEACE: immediately after the injury
- Protection: limit activities that place excessive stress on the injured area and increase pain;
- Elevation: elevate the injured limb above heart level, when possible;
- Avoid anti-inflammatories: refrain from taking anti-inflammatory medications and applying ice;
- Compression: elevation combined with the use of a compressive bandage can help reduce swelling;
- Education: take the time to learn about the normal stages of healing for this injury, as well as the actions that can help or hinder recovery. In this regard, a physiotherapist is a direct-access professional who can inform you and support you through these steps.
LOVE: recovery after the injury
Then, depending on the severity of the injury, the physiotherapist can also advise you on when to begin LOVE. Returning to meaningful activities and movement is essential for tissue healing.
- Load: gradually increase the load placed on the injured tissue without increasing pain or swelling;
- Optimism: healing takes time, so it is important to remain positive, optimistic, and consistent;
- Vascularisation: cardiovascular activities help maintain good circulation in the injured area and deliver what is needed for healing;
- Exercise: a progressive exercise program specific to the injured region has also been shown to be effective in improving function and often even preventing recurrence of the injury.
Inflammation: a natural ally
The human body has evolved over thousands of years with an effective healing mechanism: inflammation. Inflammation is a cascade of events orchestrated by our immune system to deliver all the necessary components for healing to the site of injury. The associated acute pain, although unpleasant, is a protective signal that prevents us from worsening the injury.
Important exceptions
Immediately after surgery, pain relief remains a priority. Excessive post-operative pain increases the risk of developing chronic pain. It has also been shown that cryotherapy can help reduce the use of certain pain medications, such as opioids (Pain Management Strategies After Anterior Cruciate Ligament Reconstruction: A Systematic Review With Network Meta-analysis, Davey, Martin S. et al., Arthroscopy, volume 37, issue 4, 1290–1300.e6).
In non-surgical cases, if pain is tolerable and swelling does not affect circulation, limiting ice and NSAIDs may promote better recovery.
Finally, when should you apply ice or take anti-inflammatories?
For a non-operative acute injury:
- If pain is manageable: avoid ice and NSAIDs, as they may slow healing.
- If pain is too severe and prevents movement or normal function, despite applying PEACE & LOVE, relieving pain can be beneficial, even if it slightly slows healing.
Each injury is unique. Ice and anti-inflammatories can be helpful for reducing pain, but not necessarily for speeding up healing. The best reflex? Consult a physiotherapist, who can guide you based on your situation and suggest appropriate strategies.
