PEACE & LOVE: Rethinking How We Manage Acute Injuries

For years, the go-to advice was RICE: Rest, Ice, Compression and Elevation. More recently, this evolved into PRICE and POLICE, recognising the importance of protection and optimal loading.

In 2020, Dubois and Esculier proposed another update: PEACE & LOVE. Rather than focusing only on the first 48 hours after an injury, this framework considers the entire rehabilitation journey—from the initial injury through to returning to sport, work and everyday life.

Why was a new approach needed?

Previous acronyms focused primarily on reducing pain and swelling immediately after an injury. While these can be important, they don't address what happens next.

Modern research tells us that successful recovery isn't just about controlling symptoms—it's about helping tissues heal while gradually restoring strength, movement and confidence.

PEACE & LOVE reflects this shift by combining early injury management with active rehabilitation and patient education.

PEACE: What to do in the first few days

P – Protect

Protect the injured area for the first 1–3 days to minimise bleeding and prevent further damage.

Importantly, this doesn't mean complete rest. Dubois and Esculier emphasise that prolonged unloading can reduce tissue strength and delay recovery. Instead, pain should guide how much protection is needed before gradually increasing activity.

E – Elevate

Elevating the injured limb above heart level may help reduce swelling.

While the evidence supporting elevation isn't particularly strong, it is simple, low risk and may provide some benefit.

A – Avoid routine anti-inflammatory treatments

This is probably the most controversial part of the framework.

Inflammation is often viewed as something to eliminate, but it's actually an essential stage of tissue repair. The authors suggest avoiding the routine use of anti-inflammatory medications because suppressing inflammation may interfere with optimal long-term healing.

They also question the routine use of ice. While ice can temporarily reduce pain, there is currently no high-quality evidence that it speeds healing, and experimental research suggests excessive cooling may interfere with processes such as inflammation, angiogenesis (new blood vessel formation) and tissue regeneration.

That doesn't necessarily mean ice should never be used. If icing helps control pain and allows you to move more comfortably, it can still be a useful short-term pain management strategy. The important distinction is that ice should be viewed as symptom relief rather than a treatment that accelerates healing.

C – Compress

Compression bandages or braces may help limit swelling and improve comfort, particularly after injuries such as ankle sprains.

Although research findings are mixed, compression appears to have a favourable risk-benefit profile.

E – Educate

One of the biggest messages from PEACE & LOVE is that education is treatment.

Rather than relying solely on passive treatments, clinicians should help people understand their injury, expected recovery timeline and the importance of gradually returning to activity.

Dubois and Esculier caution against creating a "need to be fixed" mindset through excessive reliance on passive therapies. Instead, they encourage empowering patients to take an active role in their recovery.

LOVE: What happens after the acute phase?

Once the initial pain begins to settle, recovery shifts towards rebuilding capacity.

L – Load

Our muscles, tendons and ligaments become stronger when exposed to the right amount of mechanical stress.

Returning to normal movement and progressively loading the injured tissue—as symptoms allow—stimulates tissue repair through a process called mechanotransduction, where cells respond to mechanical forces by promoting healing and adaptation.

O – Optimism

Recovery isn't only physical.

Research shows that factors such as fear, catastrophising and negative expectations can influence recovery. Conversely, maintaining realistic optimism and confidence can improve rehabilitation outcomes.

This doesn't mean "thinking positively" heals injuries—but your beliefs and confidence can affect how you engage with rehabilitation and return to activity.

V – Vascularisation

Once appropriate, pain-free cardiovascular exercise is encouraged.

Activities such as walking, cycling or swimming increase blood flow, maintain fitness and may help reduce the need for pain medication while supporting overall recovery.

E – Exercise

Exercise is arguably the most important component of rehabilitation.

Progressive strengthening, balance, mobility and functional exercises help restore tissue capacity and reduce the risk of future injury. Rehabilitation should be individualised and gradually progressed according to symptoms and goals.

So... should you still use ice?

Probably the biggest misconception surrounding PEACE & LOVE is that it says "never ice an injury."

That's not really the takeaway.

Current evidence suggests:

• Ice can provide short-term pain relief.

• There is little evidence that it speeds healing.

• The body's inflammatory response plays an important role in tissue repair.

If ice helps reduce pain, improves comfort or allows you to move more easily, it can still be useful. Just don't rely on it as the primary treatment. Long-term recovery is far more dependent on progressive loading, exercise and an active rehabilitation plan than on how much time you spend with an ice pack.

The Bottom Line

PEACE & LOVE represents a shift away from simply treating swelling and towards supporting the body's natural healing process.

While pain relief still has its place, the strongest evidence continues to support:

• Early, appropriate movement

• Progressive loading

• Individualised exercise

• Patient education

• Maintaining confidence throughout recovery

If you've recently suffered a sprain, strain or other soft tissue injury, a physiotherapist can help guide you through each stage of recovery and develop a rehabilitation plan that's tailored to your goals.

References

Dubois B, Esculier JF. (2020) PMID: 31377722

Marinta R. (2025) PMCID: PMC12489226