Understanding Soft Tissue Injuries

Overuse (injuries occurring gradually over time), overloading (sudden increase in exercise intensity), or physical trauma (a fall, twist, or blow) can lead to soft tissue injuries. Pretty much any injury that does not involve bone is considered a soft tissue injury.

Common Types of Soft Tissue Injuries:

• Sprains: swelling, bruising, pain, and inflammation
• Strains: pain, muscle spasms, swelling, and inflammation
• Contusions: Pain and skin discoloration
• Tendinitis: Swelling and pain that worsens during activity
• Bursitis: Swelling and pain

For decades, the prescription for healing a soft tissue injury was to apply RICE immediately after the injury occurred and continue the treatment for 24-48 hours.

The History and Evolution of RICE

RICE was introduced to the world in 1978 in Dr. Gabe Mirkin’s bestseller the “Sports Medicine Book.” RICE became the standard practice for the treatment of soft tissue injuries.

• R – Rest
• I – Ice
• C – Compression
• E – Elevation

(Eventually, RICE transitioned to PRICE. A “P” was added for “Protection.”)

Previously, inflammation was thought to be a bad thing. It is indeed painful. Ice was thought to keep the inflammation at bay and allow the area to heal faster. However, it is now understood that when tissue is damaged, inflammatory cells rush to the injured tissue to start the healing process. The inflammation irritates the nerves in that area, causing discomfort.

Today, some experts argue that ice constricts and shuts off the blood flow that brings healing cells to the injury. Dr. Craig Wassinger, professor in the Department of Rehabilitation Science at Tufts University School of Medicine, believes by taking NSAIDs or putting ice on the injury, “you're limiting your body's ability to heal itself when you're putting ice on an acute musculoskeletal injury.” Researchers are advocating that we get away from icing initially because you don't want to limit your body's ability to heal itself.

The Shift to PEACE and LOVE

Today, even Dr. Gabe Mirkin believes depending on the injury “both ice and complete rest may delay healing instead of helping.” Dr. Mirkin now promotes that anything that reduces inflammation also delays healing such as:

• cortisone-type drugs, almost all pain-relieving medicines, such as non-steroidal anti-inflammatory drugs like ibuprofen,

• immune suppressants that are often used to treat arthritis, cancer, or psoriasis,

• applying cold packs or ice, and

• anything else that blocks the immune response to injury.

Dr. Mirkin’s new recommendation for treatment is “if the injury is limited to muscles or other soft tissue, a doctor, trainer, or coach may apply a compression bandage. Since applying ice to an injury has been shown to reduce pain, it is acceptable to cool an injured part for short periods soon after the injury occurs. You could apply the ice for up to 10 minutes, remove it for 20 minutes, and repeat the 10-minute application once or twice. There is no reason to apply ice more than six hours after you have injured yourself.”

As a result of this shift, a new approach has emerged in the Sports Medicine community: The Push for PEACE and LOVE.

• P - Protection

• E - Elevation

• A - Avoid anti-inflammatories

• C - Compression

• E – Education

PEACE is recommended following an injury immediately after it occurs, and LOVE comes after the first few days of an injury has passed:

• L - Load, which means putting more weight on the injured body part

• O - Optimism, which speaks to the psychosocial component tied to healing

• V - Vascularization, a nod to increasing blood flow to the injury

• E - Exercise to help restore range of motion and strength

While many experts support the new model, there are those who seek more clarity before universally recommending this approach. Dr. Lauren Porras, clinical associate professor of orthopedics at Vanderbilt University Medical Center, stated, “PEACE and LOVE should be more robustly studied in humans before we adopt these recommendations universally.” “Ice and anti-inflammatories have been shown to improve pain and swelling and should still be considered as a resource for symptomatic relief,” she added.

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