A grapplers guide to managing acute injuries: Forget RICE, try the Peace & LOVE approach

Last updated: February 2022


Acute injuries are a painful but ultimately inevitable consequence of taking part in contact sports like grappling. Effective early management of soft-tissue injuries will optimise tissue healing and support and earlier return to normal activities.


Our evolution in management is led by the evidence. First, we had ICE (Ice, Compression, & Elevation), then we had PRICE (Protect, Rest, Ice, Compression, & Elevation), and then we called the POLICE (Protect, Optimally Load, Ice, Compression, & Elevation), and now we have PEACE & LOVE.


Following a recent Instagram post on this topic, this blog expands on the topic and provides information to support grappling managing fresh injuries.


Peace and love is a two part acronym, with the former part dedicate to the initial management, and the latter part directed at the following sub-acute


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


Protection

Aim to avoid activities and movements that significantly increase pain during the first few days.

Unload or restrict movement for 1-3 days to minimise bleeding and prevent further damage to the injured tissues.

Rest should be minimised to avoid deconditioning and compromised tissue strength but can be important in the short term.


Elevation

Elevate the injured limb above the heart as often as possible to promote interstitial fluid flow out of the injured area.

This is particularly useful in the first few days when you notice a significant amount of swelling after an injury.


Avoid Anti-inflammatories

Early inflammation is key to helping repair damaged soft tissues. The use of medications can inhibit this important process and may negatively affect long-term tissue healing.

Avoid these for at least 72hrs.

Try using ice or non-NSAID medications if you need some pain relief soon after the injury


Compression

Mechanical pressure helps to control swelling and limits excessive tissue bleeding, aiding in recovery.

Use an elastic bandage or a thick compression sleeve soon after injury until the swelling subsides.


Education

Avoid unnecessary overtreatment through passive treatments and medical investigations where possible, but don't be afraid to seek a health professional's opinion if you're unsure.

Take the time to consider the nature and extent of the injury.

Understanding the injury helps athletes to set realistic expectations of healing times and effectively plan the necessary rehab.


After the first days have passed, soft tissues need LOVE.

Load

Mechanical stress through movement should be applied as soon as symptoms allow.

Early loading without exacerbating pain promotes repair, remodelling and builds tissue capacity and tolerance through mechanotransduction.

Let pain be your guide to return to normal activities. Some discomfort is okay, but don't push too much into pain.


Optimism

Condition your brain for optimal recovery by staying positive.

Optimistic expectations are associated with better outcomes and recovery times. Take control of the controllable's, maintain a positive outlook, and you'll be back into full training soon enough.


Vascularisation & Exercise

There is strong evidence for active approaches as favourable for short and long term outcomes.

Restore mobility, strength and proprioception by adopting an active approach to recovery.

Choose pain-free cardiovascular activities to boost motivation and increase blood flow to repairing tissues. Early mobilisation and aerobic exercise also reduce the need for medications and improve physical function.


Make sure you check out the Return to Grappling Framework for help getting safely back on the mats


 

References

  • Dubois and Esculier (2020) Soft-tissue injuries simply need PEACE and LOVE. British Journal of Sports Medicine.

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