Moving beyond PEACE and into LOVE

Not long ago we talked about managing soft tissue injuries – not by the old acronym of RICE (Rest, Ice, Compression, Elevation) but via PEACE (Protection, Elevation, Avoid Anti-inflammatories, Compression, Education).

So, you’ve done a good job of managing the acute stage of your injury. You’ve managed the swelling, the inflammation and the anxiety that can come with a new injury or the aggravation of an old one!

Now what?

Well, if you want to regain full function – not just regaining normal range of movement but getting out amongst it, competing or just living your active life – then we need to be thinking about what it takes to deliver you optimal healing.

When we think of healing we probably think of resolution of swelling, settling or tenderness and pain, and formation of scar tissue. A lot of this will somewhat happen anyway: pain and swelling tends to reduce naturally, and scar tissue forms steadily over time…

…sometimes pain doesn’t settle, and scar tissue isn’t always great quality.

L = Load
O = Optimism
V = Vascularisation
E = Exercise

I’m taking these out of order by starting with Optimism. This isn’t just a case of put on the smiley face – there’s good reason to think things are going to be okay. The human body is an amazing thing that does a fantastic job of patching itself up, so there’s no reason to necessarily be pessimistic or to worry about your injury: it is more than likely your soft tissue injury (or even a nerve or bone injury) will recover and you will regain full function. If we treat the recovering tissue well IT’S GOING TO BE OKAY, ALRIGHT? Being overly worried and protective of a soft tissue injury can serve to make the body and brain more sensitive, and by doing so it can prolong pain.

So, there’s good reason to be optimistic. Despite how initially worrisome an injury can be – especially if it occurs at a particular point in the sports season, or if it bums you out that you are missing out on competing or training or playing your favourite sport or being active with your friends – injuries heal, and there will be plenty of time to get back into things. Especially if you manage the recovery process well.

If you recall the illustration from the last article, scar tissue initially arranges itself in a patchy, unstructured, mish-mash of fibres. This is fine when stuff simply needs to start knitting back together. But if we want scar tissue that can withstand the tension it needs to for training and competing – or just dealing with that odd instance when you need to lift a heavy item or move suddenly – then we need those fibres aligned to better cope with tension and stretching. The only way this can happen is to apply Load.

Loading soft tissue injuries prompts the body to lay down collagen fibres where they are needed. Initially this load may be light but over time, with professional guidance, you can progressively apply more and more load, so the tissues become stronger and more tolerant of dealing with the stresses of sport and life.
In Physio-land we will guide people through stages including isometric loading (static load), eccentric loading (lowering load), concentric loading (lifting the load) and ultimately ballistic loading (explosive, bouncing load).

(We actually have a brilliant new piece of equipment called a Kbox, which is especially good for mid- to late-stage rehab, tendon conditioning and advanced performance! And our Class 4 K-Laser can help boost fibroblast activity to produce more collagen. If you want more info, get in touch.)

Along with arranging those collagen fibres efficiently we need tissues to have great blood supply. In the short term this can be achieved by simply warming the area with a hot pack (which you don’t do in the acute stage!), exercising the area, moving it and possibly tapping into some cutting-edge technology like Blood Flow Restriction (BFR) Training.

BFR is not widely practiced in Australia as yet but switched-on therapists and Trainers are starting to use this method to allow people to work muscles during the early stages of rehab that would normally only involve light loading – but with BFR the results are like you have done a heavy weights workout!

Without going into detail (we can do that another day), one of the effects of BFR is that when the pressure is released a specific hormone (VEGF) that promotes blood vessel growth is also released, so Vascularisation can be promoted this way as well.

Exercise is a pretty broad description of the many ways we can regain full tissue integrity and function after a soft tissue injury. Determining which exercises you need to do to rehabilitate following your specific injury, to suit your specific needs, is best arranged through a Physio who is comfortable with exercise prescription or an Exercise Physiologist familiar with musculoskeletal rehab.

We can generally recommend initially light exercise that can be progressed to heavy, rapid loading such as you may need for competition, but again, please do get some advice from an expert so you progress at the optimal rate, loading the specific tissues that require repair, and don’t get ahead of your body’s ability to cope. We use evidence-based progressions but work with you based on your feedback.

So, there you have it: a slightly different approach to soft tissue injury management – PEACE and LOVE.  And you’ve been given the heads-up on some unique and highly effective methods we employ at 6S PHYSIO.  Get in touch if you would like to know more.