Peace and Love Principle: Difference between revisions

Jump to:navigation,search
No edit summary
No edit summary
Line 5: Line 5:
== Introduction ==
== Introduction ==
常见的软组织和著名的原则jury management include principles such as [[RICE]] and [[POLICE Principle|POLICE]], but there is so much more complexity to the management and rehabilitation of soft tissue injuries. These well-known methods focus on the acute management of soft tissue injuries and do not really provide any information on the sub-acute and chronic stages of [[Soft Tissue Healing|soft tissue healing]]. More recently Dubois and Esculier (2019) proposed two new acronyms to optimise soft tissue recovery:'''和平'''and'''LOVE'''.Dubois B, Esculier J. Soft-tissue injuries simply need PEACE and LOVE. British Journal of Sports Medicine 2020;54:72-73. These two acronyms (PEACE and LOVE) include the full range of soft tissue injury management from immediate care to subsequent management. It highlights the importance of patient education and addressing the psychosocial factors involved that will aid recovery. It also highlights the potential harmful effects of using anti-inflammatory medication for recovery.
常见的软组织和著名的原则jury management include principles such as [[RICE]] and [[POLICE Principle|POLICE]], but there is so much more complexity to the management and rehabilitation of soft tissue injuries. These well-known methods focus on the acute management of soft tissue injuries and do not really provide any information on the sub-acute and chronic stages of [[Soft Tissue Healing|soft tissue healing]].
More recently Dubois and Esculier (2019) proposed two new acronyms to optimise soft tissue recovery: PEACE and LOVE.Dubois B, Esculier J.[https://scholar.google.com/scholar_url?url=https://bjsm.bmj.com/content/54/2/72.abstract&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=3498167544575584574&ei=HFewYqLcIYOM6rQP9tS_0AU&scisig=AAGBfm1IOU_Py6VdpZL-yqLA4UfQuI-qaQSoft-tissue injuries simply need PEACE and LOVE.]British Journal of Sports Medicine 2020;54:72-73. These two acronyms (PEACE and LOVE) include the full range of soft tissue injury management from immediate care to subsequent management. It highlights the importance of patient education and addressing the psychosocial factors involved that will aid recovery. It also highlights the potential harmful effects of using anti-inflammatory medication for recovery.


== Peace ==
== Peace ==
Line 13: Line 15:
==== P = Protect ====
==== P = Protect ====


*unloador restrict movement for 1 - 3 days
*Unloador restrict movement for 1 - 3 days
**thisreduces bleeding
**Thisreduces bleeding
**preventsdistension of injured fibers
**Preventsdistension of injured fibers
**reducerisk of aggravating injuryBleakley CM, Davison G. Management of acute soft tissue injury using protection rest ice compression and elevation: recommendations from the Association of Chartered Physiotherapists in sports and exercise medicine (ACPSM)[executive summary]. Association of Chartered Physiotherapists in Sports and Exercise Medicine. 2010:1-24.
**Reducesrisk of aggravating injuryBleakley CM, Davison G.[https://scholar.google.com/scholar_url?url=https://pure.ulster.ac.uk/en/publications/management-of-acute-soft-tissue-injury-using-protection-rest-ice--3&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=10147242636766910502&ei=7FewYseYNKybywSaiL3IBQ&scisig=AAGBfm3X3lOtU4m1uyIG54NGtrcnadBE5AManagement of acute soft tissue injury using protection rest ice compression and elevation:]recommendations from the Association of Chartered Physiotherapists in sports and exercise medicine (ACPSM)[executive summary]. Association of Chartered Physiotherapists in Sports and Exercise Medicine. 2010:1-24.
*minimiserest
*Minimiserest
**prolongedrest compromises tissue strength and qualityBleakley CM, Glasgow P, MacAuley DC. PRICE needs updating, should we call the POLICE?British Journal of Sports Medicine 2012;46:220-221.
**Prolongedrest compromises tissue strength and qualityBleakley CM, Glasgow P, MacAuley DC.[https://scholar.google.com/scholar_url?url=https://bjsm.bmj.com/content/46/4/220.short&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=5335587548519241893&ei=GFiwYp-cO-CO6rQP5oGtqAc&scisig=AAGBfm1NeChpEnyLrndNkGek-LxUF5t_0wPRICE needs updating, should we call the POLICE?]British Journal of Sports Medicine 2012;46:220-221.
*letpain guide removal of protection and gradual reloading
*Letpain guide removal of protection and gradual reloading


==== E = Elevate ====
==== E = Elevate ====


*elevatethe injured limb higher than the heart
*Elevatethe injured limb higher than the heart
**thispromotes interstitial fluid flow out of the injured tissue
**Thispromotes interstitial fluid flow out of the injured tissue
**although可怜的证据——它仍然建议there is a low risk-benefit ratioDoherty C, Bleakley C, Delahunt E, Holden S. Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis. British journal of sports medicine. 2017 Jan 1;51(2):113-25.
**Although可怜的证据——它仍然建议there is a low risk-benefit ratioDoherty C, Bleakley C, Delahunt E, Holden S.[https://scholar.google.com/scholar_url?url=https://bjsm.bmj.com/content/51/2/113.short&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=16845756041109022354&ei=VFiwYtX6O6ybywSaiL3IBQ&scisig=AAGBfm20BySKIqad3cbf4xDlMN-0orj2MwTreatment and prevention of acute and recurrent ankle sprain:]an overview of systematic reviews with meta-analysis. British journal of sports medicine. 2017 Jan 1;51(2):113-25.


==== A = Avoid anti-inflammatory modalities ====
==== A = Avoid anti-inflammatory modalities ====


*anti-inflammatory medications may negatively affect long-term tissue healing
*Anti-inflammatory medications may negatively affect long-term tissue healing
**optimalsoft tissue regeneration is supported by the various phases of the inflammatory process
**Optimalsoft tissue regeneration is supported by the various phases of the inflammatory process
**makinguse of medications to inhibit the inflammatory process could impair the healing processVuurberg G, Hoorntje A, Wink LM, Van Der Doelen BF, Van Den Bekerom MP, Dekker R, Van Dijk CN, Krips R, Loogman MC, Ridderikhof ML, Smithuis FF. Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. British journal of sports medicine. 2018 Aug 1;52(15):956-.Duchesne E, Dufresne SS, Dumont NA. Impact of inflammation and anti-inflammatory modalities on skeletal muscle healing: from fundamental research to the clinic. Physical therapy. 2017 Aug 1;97(8):807-17.
**Makinguse of medications to inhibit the inflammatory process could impair the healing processVuurberg G, Hoorntje A, Wink LM, Van Der Doelen BF, Van Den Bekerom MP, Dekker R, Van Dijk CN, Krips R, Loogman MC, Ridderikhof ML, Smithuis FF.[https://scholar.google.com/scholar_url?url=https://www.tandfonline.com/doi/abs/10.1080/14763141.2020.1778777&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=8107047546428303534&ei=m1iwYumZLpb0yASIuozQBQ&scisig=AAGBfm0ah4ymYWJHQGtnSyzHUyUctZ5HPwDiagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline.]British journal of sports medicine. 2018 Aug 1;52(15):956-.Duchesne E, Dufresne SS, Dumont NA.[https://scholar.google.com/scholar_url?url=https://academic.oup.com/ptj/article-abstract/97/8/807/3826991&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=5214150032638131419&ei=u1iwYt2mNJb0yASIuozQBQ&scisig=AAGBfm1c0mU-CbOc2dJ-EbrJfg0iabrXhwImpact of inflammation and anti-inflammatory modalities on skeletal muscle healing:]from fundamental research to the clinic. Physical therapy. 2017 Aug 1;97(8):807-17.
*avoidice
*Avoidice
**useof ice is mostly analgesic
**Useof ice is mostly analgesic
**althoughit is widely accepted as an intervention there is very little high quality evidence that supports the use of ice in the treatment of soft tissue injuriesvan den Bekerom MP, Struijs PA, Blankevoort L, Welling L, Van Dijk CN, Kerkhoffs GM. What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults?. Journal of athletic training. 2012 Jul;47(4):435-43.
**Althoughit is widely accepted as an intervention there is very little high quality evidence that supports the use of ice in the treatment of soft tissue injuriesvan den Bekerom MP, Struijs PA, Blankevoort L, Welling L, Van Dijk CN, Kerkhoffs GM.[https://scholar.google.com/scholar_url?url=https://meridian.allenpress.com/jat/article-abstract/47/4/435/111307&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=6165411568504853691&ei=hFqwYtH2MuCO6rQP5oGtqAc&scisig=AAGBfm2QgHoBFElaobEUggI0J9G16VuMzgWhat is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults?.]Journal of athletic training. 2012 Jul;47(4):435-43.
**icemay potentially disrupt inflammation, angiogenesis and revascularisation
**Icemay potentially disrupt inflammation, angiogenesis and revascularisation
**icemay potentially delay neutrophil and macrophage infiltration
**Icemay potentially delay neutrophil and macrophage infiltration
**icemay potentially increase immature myofibers
**Icemay potentially increase immature myofibers
***thiscan result in impaired tissue regeneration and redundant collagen synthesisSingh DP, Barani Lonbani Z, Woodruff MA, Parker TJ, Steck R, Peake JM. Effects of topical icing on inflammation, angiogenesis, revascularization, and myofiber regeneration in skeletal muscle following contusion injury. Frontiers in physiology. 2017 Mar 7;8:93.
***Thiscan result in impaired tissue regeneration and redundant collagen synthesisSingh DP, Barani Lonbani Z, Woodruff MA, Parker TJ, Steck R, Peake JM.[https://scholar.google.com/scholar_url?url=https://www.frontiersin.org/articles/10.3389/fphys.2017.00093/full&hl=en&sa=T&oi=gsb-ggp&ct=res&cd=0&d=15066500779413184542&ei=oVqwYsrOHuOEywS36r7QBQ&scisig=AAGBfm1SkJN3MbcHkUFY2DBMsXGnAAmaKgEffects of topical icing on inflammation, angiogenesis, revascularization, and myofiber regeneration in skeletal muscle following contusion injury.]Frontiers in physiology. 2017 Mar 7;8:93.


==== C = Compress ====
==== C = Compress ====
Line 47: Line 49:
* It is our responsibility as physiotherapists to educate our patients on the many benefits of an active approach to recovery instead of a passive approach
* It is our responsibility as physiotherapists to educate our patients on the many benefits of an active approach to recovery instead of a passive approach
* Early passive therapy approaches such as electrotherapy, manual therapy or acupuncture after an injury has a minimal effect on pain and function when compared to an active approach
* Early passive therapy approaches such as electrotherapy, manual therapy or acupuncture after an injury has a minimal effect on pain and function when compared to an active approach
* If physiotherapists nurture a patient's "need to be fixed" it may create dependence to the physio and actually contribute to persistent symptomsLewis J, O’Sullivan P. Is it time to reframe how we care for people with non-traumatic musculoskeletal pain?British Journal of Sports Medicine 2018;52:1543-1544.
* If physiotherapists nurture a patient's "need to be fixed" it may create dependence to the physio and actually contribute to persistent symptomsLewis J, O’Sullivan P.[https://scholar.google.com/scholar_url?url=https://bjsm.bmj.com/content/52/24/1543%3FhootPostID%3D0a2a070acfeb06d58906390ef1859fab&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=14934433947019830930&ei=MlmwYtWBHaybywSaiL3IBQ&scisig=AAGBfm3hucBkVCwiTTXKgtYDbl8OC41HsAIs it time to reframe how we care for people with non-traumatic musculoskeletal pain?]British Journal of Sports Medicine 2018;52:1543-1544.
* Patients need to be better education on their condition
* Patients need to be better education on their condition
* Load management will avoidovertreatmentof an injury
* Load management will avoidover-treatmentof an injury
**Overtreatmentmay increase the likelihood of injections or surgery and higher costsGraves JM, Fulton‐Kehoe D, Jarvik JG, Franklin GM. Health care utilization and costs associated with adherence to clinical practice guidelines for early magnetic resonance imaging among workers with acute occupational low back pain. Health services research. 2014 Apr;49(2):645-65.
**Over-treatmentmay increase the likelihood of injections or surgery and higher costsGraves JM, Fulton‐Kehoe D, Jarvik JG, Franklin GM.[https://scholar.google.com/scholar_url?url=https://onlinelibrary.wiley.com/doi/abs/10.1111/1475-6773.12098&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=8504867669241570845&ei=TlmwYqetIoOM6rQP9tS_0AU&scisig=AAGBfm2h2fhAocOYcNsGUJD1wmPeyQtDOgHealth care utilization and costs associated with adherence to clinical practice guidelines for early magnetic resonance imaging among workers with acute occupational low back pain.]Health services research. 2014 Apr;49(2):645-65.
* It is critical for physiotherapists to educate their patients and set realistic expectations about recovery times
* It is critical for physiotherapists to educate their patients and set realistic expectations about recovery times


Line 59: Line 61:
==== L = Load ====
==== L = Load ====


*肌肉骨骼疾病患者受益from an active approach with movement and exercisesKhan KM, Scott A. Mechanotherapy:howphysical therapists’ prescription of exercise promotes tissue repair. British journal of sports medicine. 2009 Apr 1;43(4):247-52.
*肌肉骨骼疾病患者受益from an active approach with movement and exercisesKhan KM, Scott A.[https://scholar.google.com/scholar_url?url=https://bjsm.bmj.com/content/43/4/247%3Ffbclid%3DIwAR3HxUTUeOuw7EgUgu3dSbBLgjLR4tjSXRD3B_fQiU2OccXUbgilS6M_at0&hl=en&sa=T&oi=gsb-ggp&ct=res&cd=0&d=10436507919762413243&ei=h1mwYq28Cpb0yASIuozQBQ&scisig=AAGBfm32cWf-i8tH5PYX9KQB7DNTTwNbuQMechanotherapy:] Howphysical therapists’ prescription of exercise promotes tissue repair. British journal of sports medicine. 2009 Apr 1;43(4):247-52.
* Normal activities should continue as soon as symptoms allow for it
* Normal activities should continue as soon as symptoms allow for it
* Early mechanical stress is indicated
* Early mechanical stress is indicated
* Optimal loading without increasing pain
* Optimal loading without increasing pain
**promotesrepair and remodeling
**Promotesrepair and remodeling
**buildstissue tolerance and capacity of tendons, muscles and ligaments via mechanotransduction
**Buildstissue tolerance and capacity of tendons, muscles and ligaments via mechanotransduction


==== O = Optimism ====
==== O = Optimism ====


* The brain plays a significant part in rehabilitation interventionsLin I, Wiles L, Waller R, Goucke R, Nagree Y, Gibberd M, Straker L, Maher CG, O’Sullivan PP. What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. British journal of sports medicine. 2020 Jan 1;54(2):79-86.
* The brain plays a significant part in rehabilitation interventionsLin I, Wiles L, Waller R, Goucke R, Nagree Y, Gibberd M, Straker L, Maher CG, O’Sullivan PP.[https://scholar.google.com/scholar_url?url=https://bjsm.bmj.com/content/54/2/79.abstract&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=454386171011024193&ei=r1mwYvHQOKCM6rQP46yK0AU&scisig=AAGBfm3jC5gpEg4yD2XZGQPD443LwvPQDgWhat does best practice care for musculoskeletal pain look like?]Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. British journal of sports medicine. 2020 Jan 1;54(2):79-86.
* Barriers of recovery include psychological factors such as:
* Barriers of recovery include psychological factors such as:
**catastrophisation
**Catastrophisation
**depression
**Depression
**fear
**Fear
**researchshows that these factors may more explain the variation in symptoms and limitations after an ankle sprain than the degree of pathophysiologyBriet JP, Houwert RM, Hageman MG, Hietbrink F, Ring DC, Verleisdonk EJ. Factors associated with pain intensity and physical limitations after lateral ankle sprains. Injury. 2016 Nov 1;47(11):2565-9.
**Researchshows that these factors may more explain the variation in symptoms and limitations after an ankle sprain than the degree of pathophysiologyBriet JP, Houwert RM, Hageman MG, Hietbrink F, Ring DC, Verleisdonk EJ.[https://scholar.google.com/scholar_url?url=https://www.sciencedirect.com/science/article/pii/S0020138316304466&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=13907493756664720355&ei=ylmwYprvCJyR6rQPoaOg2Ak&scisig=AAGBfm1tr-0rnN3avvbKxo0B5uUEHRztAAFactors associated with pain intensity and physical limitations after lateral ankle sprains.]受伤。2016年11月1;47(11):2565-9.


* Pessimistic patient expectations influence outcomes and prognosis of an injuryBialosky JE, Bishop MD, Cleland JA. Individual expectation: an overlooked, but pertinent, factor in the treatment of individuals experiencing musculoskeletal pain. Physical therapy. 2010 Sep 1;90(9):1345-55.
* Pessimistic patient expectations influence outcomes and prognosis of an injuryBialosky JE, Bishop MD, Cleland JA.[https://scholar.google.com/scholar_url?url=https://academic.oup.com/ptj/article-abstract/90/9/1345/2738139&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=13197007117980280666&ei=_VmwYtmOEuOEywS36r7QBQ&scisig=AAGBfm0Fc2bcQbXtZ4PJSjS0THtIkWw4HwIndividual expectation: an overlooked, but pertinent, factor in the treatment of individuals experiencing musculoskeletal pain.]Physical therapy. 2010 Sep 1;90(9):1345-55.
* Stay realistic, but encourage optimism to improve the chances of an optimal recovery
* Stay realistic, but encourage optimism to improve the chances of an optimal recovery


Line 81: Line 83:


* Musculoskeletal injury management needs to include cardiovascular physical activity
* Musculoskeletal injury management needs to include cardiovascular physical activity
**moreresearch is needed on specific dosage, but pain free cardiovascular activity is a motivation booster and it increases blood flow to injured structures
**Moreresearch is needed on specific dosage, but pain free cardiovascular activity is a motivation booster and it increases blood flow to injured structures
* *早期动员和有氧练习的好处cise in people with musculoskeletal disorders include:
* *早期动员和有氧练习的好处cise in people with musculoskeletal disorders include:
***improvementin function
***Improvementin function
***improvementin work status
***Improvementin work status
***reducesthe need for pain medicationBleakley CM, O’Connor SR, Tully MA, Rocke LG, MacAuley DC, Bradbury I, Keegan S, McDonough SM. Effect of accelerated rehabilitation on function after ankle sprain: randomised controlled trial. Bmj. 2010 May 10;340.
***Reducesthe need for pain medicationBleakley CM, O’Connor SR, Tully MA, Rocke LG, MacAuley DC, Bradbury I, Keegan S, McDonough SM.[https://scholar.google.com/scholar_url?url=https://www.bmj.com/content/340/bmj.c1964.short&hl=en&sa=T&oi=gsb-ggp&ct=res&cd=0&d=3516441864455859489&ei=MFqwYpWcA5yR6rQPoaOg2Ak&scisig=AAGBfm3TTtjwxWHjY3HLgbqc_RKTnYAjHwEffect of accelerated rehabilitation on function after ankle sprain:]randomised controlled trial. Bmj. 2010 May 10;340.


==== E = Exercise ====
==== E = Exercise ====
Line 91: Line 93:
* Evidence supports the use of exercise therapy in the treatment of ankle sprains and it reduces the risk of a recurring injury
* Evidence supports the use of exercise therapy in the treatment of ankle sprains and it reduces the risk of a recurring injury
* Benefits of exercise:
* Benefits of exercise:
**restoresmobility
**Restoresmobility
**restoresstrength
**Restoresstrength
**restoresproprioception, early after an injury
**Restoresproprioception, early after an injury
* Avoid pain to promote optimal repair in the subacute phase
* Avoid pain to promote optimal repair in the subacute phase
* Use pain as a guide to progress exercises gradually to increased levels of difficulty
* Use pain as a guide to progress exercises gradually to increased levels of difficulty

Latest revision as of 13:24, 20 June 2022

Original Editor-Wanda van Niekerk

Top Contributors-Wanda van Niekerk,Naomi O'Reilly,Kim Jackson,Vidya Acharya,Candace GohandChelsea Mclene

Introduction[edit|edit source]

常见的软组织和著名的原则jury management include principles such asRICEandPOLICE, but there is so much more complexity to the management and rehabilitation of soft tissue injuries. These well-known methods focus on the acute management of soft tissue injuries and do not really provide any information on the sub-acute and chronic stages ofsoft tissue healing.

More recently Dubois and Esculier (2019) proposed two new acronyms to optimise soft tissue recovery: PEACE and LOVE.[1]These two acronyms (PEACE and LOVE) include the full range of soft tissue injury management from immediate care to subsequent management. It highlights the importance of patient education and addressing the psychosocial factors involved that will aid recovery. It also highlights the potential harmful effects of using anti-inflammatory medication for recovery.[1]

Peace[edit|edit source]

"Immediately after a soft tissue injury, do no harm and let PEACE guide your approach"[1][edit|edit source]

P = Protect[edit|edit source]

  • Unload or restrict movement for 1 - 3 days
    • This reduces bleeding
    • Prevents distension of injured fibers
    • Reduces risk of aggravating injury[2]
  • 减少休息
    • Prolonged rest compromises tissue strength and quality[3]
  • Let pain guide removal of protection and gradual reloading

E = Elevate[edit|edit source]

  • Elevate the injured limb higher than the heart
    • This promotes interstitial fluid flow out of the injured tissue
    • Although poor evidence for it - it still is recommended as there is a low risk-benefit ratio[3][4]

A = Avoid anti-inflammatory modalities[edit|edit source]

  • Anti-inflammatory medications may negatively affect long-term tissue healing
    • Optimal soft tissue regeneration is supported by the various phases of the inflammatory process
    • Making use of medications to inhibit the inflammatory process could impair the healing process[5][6]
  • Avoid ice
    • Use of ice is mostly analgesic
    • Although it is widely accepted as an intervention there is very little high quality evidence that supports the use of ice in the treatment of soft tissue injuries[7]
    • Ice may potentially disrupt inflammation, angiogenesis and revascularisation
    • Ice may potentially delay neutrophil and macrophage infiltration
    • Ice may potentially increase immature myofibers
      • This can result in impaired tissue regeneration and redundant collagen synthesis[8]

C = Compress[edit|edit source]

Intra-articular edema and tissue hemorrhage may be limited by external mechanical compression such as taping or bandages, but should still allow full range of movement at the joint.[5]

E = Educate[edit|edit source]

  • It is our responsibility as physiotherapists to educate our patients on the many benefits of an active approach to recovery instead of a passive approach[4]
  • Early passive therapy approaches such as electrotherapy, manual therapy or acupuncture after an injury has a minimal effect on pain and function when compared to an active approach[4]
  • If physiotherapists nurture a patient's "need to be fixed" it may create dependence to the physio and actually contribute to persistent symptoms[9]
  • Patients need to be better education on their condition
  • Load management will avoid over-treatment of an injury
    • Over-treatment may increase the likelihood of injections or surgery and higher costs[10]
  • 它对物理治疗师教育至关重要ir patients and set realistic expectations about recovery times[1]

Love[edit|edit source]

"After the first days have passed, soft tissues need LOVE"[edit|edit source]

L = Load[edit|edit source]

  • Patients with musculoskeletal disorders benefit from an active approach with movement and exercises[11]
  • Normal activities should continue as soon as symptoms allow for it
  • Early mechanical stress is indicated
  • Optimal loading without increasing pain
    • Promotes repair and remodeling[3]
    • Builds tissue tolerance and capacity of tendons, muscles and ligaments via mechanotransduction[11]

O = Optimism[edit|edit source]

  • The brain plays a significant part in rehabilitation interventions[12]
  • Barriers of recovery include psychological factors such as:
    • Catastrophisation
    • Depression
    • Fear
    • Research shows that these factors may more explain the variation in symptoms and limitations after an ankle sprain than the degree of pathophysiology[13]
  • Pessimistic patient expectations influence outcomes and prognosis of an injury[14]
  • Stay realistic, but encourage optimism to improve the chances of an optimal recovery[1]

V = Vascularisation[edit|edit source]

  • Musculoskeletal injury management needs to include cardiovascular physical activity[12]
    • More research is needed on specific dosage, but pain free cardiovascular activity is a motivation booster and it increases blood flow to injured structures
    • Benefits of early mobilisation and aerobic exercise in people with musculoskeletal disorders include:
      • Improvement in function
      • Improvement in work status
      • Reduces the need for pain medication[15]

E =运动[edit|edit source]

  • Evidence supports the use of exercise therapy in the treatment of ankle sprains and it reduces the risk of a recurring injury
  • Benefits of exercise:
    • Restores mobility
    • Restores strength
    • Restores proprioception, early after an injury[5]
  • Avoid pain to promote optimal repair in the subacute phase
  • Use pain as a guide to progress exercises gradually to increased levels of difficulty[1]

[16]

Clinical Bottom Line[edit|edit source]

The management of soft tissue injuries, whether it is a hamstring strain or an ankle sprain, should not just focus on short-term damage control. Clinicians should also focus on long-term outcomes and focus on treating the person with the injury and not just treating the injury of the person.[1]

Resources[edit|edit source]

References[edit|edit source]

  1. ↑1.01.11.21.31.41.51.6Dubois B, Esculier J.Soft-tissue injuries simply need PEACE and LOVE.British Journal of Sports Medicine 2020;54:72-73.
  2. ↑Bleakley CM, Davison G.Management of acute soft tissue injury using protection rest ice compression and elevation:recommendations from the Association of Chartered Physiotherapists in sports and exercise medicine (ACPSM)[executive summary]. Association of Chartered Physiotherapists in Sports and Exercise Medicine. 2010:1-24.
  3. ↑3.03.13.2Bleakley CM, Glasgow P, MacAuley DC.PRICE needs updating, should we call the POLICE?British Journal of Sports Medicine 2012;46:220-221.
  4. ↑4.04.14.2Doherty C, Bleakley C, Delahunt E, Holden S.Treatment and prevention of acute and recurrent ankle sprain:an overview of systematic reviews with meta-analysis. British journal of sports medicine. 2017 Jan 1;51(2):113-25.
  5. ↑5.05.15.2Vuurberg G, Hoorntje A, Wink LM, Van Der Doelen BF, Van Den Bekerom MP, Dekker R, Van Dijk CN, Krips R, Loogman MC, Ridderikhof ML, Smithuis FF.Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline.British journal of sports medicine. 2018 Aug 1;52(15):956-.
  6. ↑Duchesne E, Dufresne SS, Dumont NA.Impact of inflammation and anti-inflammatory modalities on skeletal muscle healing:from fundamental research to the clinic. Physical therapy. 2017 Aug 1;97(8):807-17.
  7. ↑van den Bekerom MP, Struijs PA, Blankevoort L, Welling L, Van Dijk CN, Kerkhoffs GM.What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults?.Journal of athletic training. 2012 Jul;47(4):435-43.
  8. ↑Singh DP, Barani Lonbani Z, Woodruff MA, Parker TJ, Steck R, Peake JM.Effects of topical icing on inflammation, angiogenesis, revascularization, and myofiber regeneration in skeletal muscle following contusion injury.Frontiers in physiology. 2017 Mar 7;8:93.
  9. ↑Lewis J, O’Sullivan P.Is it time to reframe how we care for people with non-traumatic musculoskeletal pain?British Journal of Sports Medicine 2018;52:1543-1544.
  10. ↑Graves JM, Fulton‐Kehoe D, Jarvik JG, Franklin GM.Health care utilization and costs associated with adherence to clinical practice guidelines for early magnetic resonance imaging among workers with acute occupational low back pain.Health services research. 2014 Apr;49(2):645-65.
  11. ↑11.011.1Khan KM, Scott A.Mechanotherapy:How physical therapists’ prescription of exercise promotes tissue repair. British journal of sports medicine. 2009 Apr 1;43(4):247-52.
  12. ↑12.012.1Lin I, Wiles L, Waller R, Goucke R, Nagree Y, Gibberd M, Straker L, Maher CG, O’Sullivan PP.What does best practice care for musculoskeletal pain look like?Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. British journal of sports medicine. 2020 Jan 1;54(2):79-86.
  13. ↑Briet JP, Houwert RM, Hageman MG, Hietbrink F, Ring DC, Verleisdonk EJ.Factors associated with pain intensity and physical limitations after lateral ankle sprains.受伤。2016年11月1;47(11):2565-9.
  14. ↑Bialosky JE, Bishop MD, Cleland JA.Individual expectation: an overlooked, but pertinent, factor in the treatment of individuals experiencing musculoskeletal pain.Physical therapy. 2010 Sep 1;90(9):1345-55.
  15. ↑Bleakley CM, O’Connor SR, Tully MA, Rocke LG, MacAuley DC, Bradbury I, Keegan S, McDonough SM.Effect of accelerated rehabilitation on function after ankle sprain:randomised controlled trial. Bmj. 2010 May 10;340.
  16. ↑La Clinique du Coureur. PEACE & LOVE: New acronym for the treatment of traumatic injuries. Published on 30 August 2019. Available fromhttps://www.youtube.com/watch?v=HGTabgG7GIU(last accessed 25 June 2020)
Retrieved from "http:///index.php?title=Peace_and_Love_Principle&oldid=309558"