RICE vs. PEACE and LOVE: Modern Treatment for Sprains and Strains

For most strains and sprains, the standard treatment protocol is rest, ice, compression and elevation (RICE). This has long been viewed as an effective and quick way to offer pain relief and promote healing.

This approach has its advantages, but that doesn’t mean there isn’t room for some modification.

First, consider what’s happening inside your body after an acute injury. A sprain is an injury to one of your ligaments or joints, while a strain is an injury to one of the muscles or tendons that surround and support the joint. As soon as the injury occurs, there will be an immediate surge of inflammation. When the RICE protocol was developed in the 1970s, it was considered important to get that inflammation under control as quickly as possible.

Today, we know that inflammation sometimes gets a bad rap. During the first five to seven days of an injury, inflammation is your body’s way of kickstarting the healing process. So, if that initial inflammatory response is suppressed, it can actually slow down healing.

Another potential drawback with the RICE protocol is that too much rest can also slow recovery. It might be better to add a second “R” to the acronym – for relative rest.

The Shift from RICE to PEACE and LOVE

PEACE and LOVE – a new approach named by Canadian researchers – is essentially an evolution of the RICE protocol. Key differences include an emphasis on putting as much weight as can be tolerated weight on the injured limb sooner rather than later. It also worries less about controlling healthy inflammation during the early stages of healing.

Here are the steps for the PEACE and LOVE protocol:

• Protect. Limit movement for the first day or two.

• Elevate. Keep the injured limb up to help reduce swelling.

• Avoid. Skip the ice and anti-inflammatory painkillers, such as ibuprofen. Pain-relievers like acetaminophen are fine.

• Compress. Wrap the limb with tape or a bandage for support.

• Educate. Talk with a doctor or physical therapist if you have any qualms about treating the injury on your own.

• Load. But weight on the injured limb and move as soon as possible.

• Optimism. Have a positive mindset to speed your recovery.

• Vascularization. Aerobic exercise can help your recovery by creating a healthy blood flow. This could include walking, cycling or swimming.

• Exercise. Once healing begins, strive to strengthen the joint or tissue with exercises.

This approach may be particularly valuable with ankle sprains. There have been several studies showing that early movement can help you heal faster, with fewer long-term side effects. In years past, it was common to immobilize ankle sprains. Today, there is a much greater emphasis on getting patients up and moving around on injured ankles.

Should You Avoid Ice for Sprains and Strains?

While the PEACE and LOVE protocol has its strengths, it doesn’t necessarily mean you should skip ice while recovering from a sprain. There is no hard and fast rule here, and ice has its advantages – particularly in terms of pain management. Applying ice immediately after an acute injury can also help manage swelling.

You want the inflammation to do its job, but not at the cost of leaving someone with significant pain. A key part of the equation is how important it is to make a speedy recovery. If you are a serious or professional athlete who needs to return to play as soon as possible, then it may make sense to limit the ice. But for the average person – with no particular return timetable – a slower, but more comfortable recovery may be preferred.

When to See a Doctor for a Sprain or Strain

Not everyone wants to rush off to the emergency room or urgent care clinic when they suffer a sprain or strain. And you may be fine treating it at home. But know when it’s time to get professional help.