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  • The Review Course in Family Medicine

Out With RICE! Start Healing MSK Injuries With PEACE and LOVE!

The RICE protocol for MSK injuries has been around since 1978, yet its utility remains controversial. When used longer than in the immediate post-injury period, this approach may delay recovery. The FIVE main concerns with RICE:

  1. The RICE protocol is designed to reduce inflammation but thus inhibits the physiological mechanisms for controlling cellular injury and initiating tissue repair

  2. Recovery is optimized NOT when inflammation is restricted, but with adequate clearance of inflammatory debris from the tissue

  3. Prolonged rest delays revascularization while slowing lymphatic drainage and allowing waste products to accumulate

  4. Ice causes vasoconstriction, which has some analgesic effect, but results in hypoxic injury to already damaged tissue

  5. In healthy individuals, allowing the physiological mechanism for tissue repair and early return to activity is strongly supported by the literature

Transitioning away from RICE, and toward PEACE and LOVE might be a better strategy for recovery. Protecting an injury with short-term restriction of movement can prevent worsening Elevation promotes the drainage of interstitial fluid out of injured tissue Avoid anti-inflammatories as they disrupt the physiological tissue healing process Compression helps limit intra-articular edema and tissue hemorrhage Education empowers people to be active participants in their recovery process Load the injury early, and resume normal activities where tolerated- Let pain be your guide! Optimism towards recovery is associated with better overall outcomes Vascularization is promoted through early aerobic exercise Exercise helps restore mobility, strength and proprioception, for good long-term outcomes References: 1. Dubois B, Esculier J-F. Soft-tissue Injuries simply need PEACE and LOVE. Br J Sports Med 2020;54:72–73 2. Scialoia. D, Swartzendruber, A.J. lThe R.I.C.E Protocol is a MYTH: A Review and Recommendations.



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