Soft Tissue Injury Management - All they need is PEACE & LOVE
March 22, 2021
Whether you’re a regular gym goer, occasional walker or someone who is keen to start exercising injuries can occasionally occur. This blog discusses what evidence suggests is the best way forward after sustaining a soft tissue injury. At Physiotherapy Matters we want to educate and encourage our staff, patients and members of the community on how they can best help themselves whilst providing evidence-based advice to enable a return to full health & fitness.
Over the years there has been much debate on how we should treat and manage acute injuries. Previously as physiotherapists we would encourage rest, ice, compression and elevation. However, conflicting results and current research suggests new management strategies should be encouraged.
The British Journal of Sports medicine released an article in 2020 supported by up-to-date evidence that may challenge some people’s current injury management. Guidance follows the anagram of PEACE (for initial soft tissue injury management) & LOVE (for subsequent management) which will be discussed below.
Immediately after an injury – the injury requires PEACE
P – PROTECTION
Unload from weight bearing or heavy use and restrict movement for 1-3 days after injury. This will prevent further injury, reduce bleeding and the risk of injury aggravation. However, complete or prolonged rest and inactivity is unadvised as this can lead to poor outcomes (stiffness, weakness and fear avoidance). Pain levels should help guide your return to movement and use.
E – ELEVATE
When able elevate the injured limb above the heart to encourage circulation and aid swelling management
A – AVOID ANTI-INFLAMMATORIES
Our bodies create an inflammatory response to protect and help us heal. Taking an anti-inflammatory such as Ibuprofen or naproxen can prevent these natural processes from occurring thus Negatively affecting long-term healing (especially when high doses are used). Standard acute care of soft tissue injuries should not include anti-inflammatories. Secondly the acute use of ICE which is common practice, has very limited high-level evidence to support its beneficial effects in injury management. Some reports suggest it could disrupt natural inflammation and vascularization leading to impaired tissue repair and healing.
C – COMPRESSION
Pressure around the injury site via taping or bandages may help to reduce local bleeding and swelling. This in turn has been found to help with pain and quality of life.
E – EDUCATION
Active rather than passive approach to recovery is essential in soft tissue injury management. Physiotherapy can aide patient education for patients on the condition and load management will help avoid further injury. This in turn reduces the likelihood of unnecessary injections or surgery, and supports a reduction in the cost of healthcare. We strongly advocate for setting realistic expectations with patients about recovery times instead of chasing the ‘magic cure’ approach
After the first few days – The injury requires LOVE
L – LOAD
Appropriately loading the injured area with movement and exercise benefits most musculoskeletal soft tissue injuries. Gentle, gradual and progressively mechanical stress/load should be added early. Normal activities should be encouraged as soon as pain allows. Optimal loading promotes repair, remodelling and builds tissue tolerance and capacity.
O – OPTIMISM
Optimistic patient expectations are associated with better outcomes and prognosis. Psychological factors such as catastrophisation, depression and fear can create barriers to recovery. Beliefs and emotions are thought to explain more of the variation in symptoms following certain injuries rather than the injury itself .
V – VASCULARISATION
Cardiovascular activity is essential in the management of musculoskeletal injuries. Pain-free aerobic exercise should be started a few days after injury to boost motivation and increase blood flow to the injured structures. Such as cycling, swimming, rowing machine, cross-trainer walking. Early mobilisation and aerobic exercise improve physical function, supporting return to work and reduce the need for pain medication in individuals with musculoskeletal conditions.
E – EXERCISE
There is a strong level of evidence supporting the use of exercise for the treatment of soft tissue injuries and for reducing the prevalence of recurrent injuries. Exercises help to restore mobility, strength and proprioception early after injury. Pain should be avoided to ensure optimal repair during the subacute phase of recovery, and should be used as a guide for exercise progressions
This blog identifies the basics of acute injury management and will give a few tips to help manage injuries in the future. If you suffer with an injury you may require specific treatment and guidance. At Physiotherapy Matters we specialise in individualized patient assessment, advice, treatment and appropriate care to ensure you have the best opportunity for recovery. Please contact our team on 0333 2200 238 or email us at firstname.lastname@example.org to speak with one of our musculoskeletal physiotherapists for further advice and guidance.