• Andrew
    174
    I've learnt the hard way that RICE (Rest/Ice/ Compression/Elevation) is no longer the acronym of choice for musculoskeletal injuries. Its now PEACE and LOVE.

    For the first few days after injury get some PEACE
    P= Protect from activity that makes pain worse
    E= Elevate damage higher than heart
    A= Avoid Anti-inflammatories (and Ice)
    C = Compression with Elastic bandage or the like
    E = Educate for yourself from your body's lesson. Give hokum treatments and investigations a miss and let nature do its thing.

    A few days after the injury, once it is settling try some LOVE
    L = Load up the injured area with work - but let pain be the guide.
    O= Optimism. Stay positive and let the body draw on positive feelings
    V = Vascular work. Get the heart moving to increase blood flow to damaged area.
    E = Exercise. Restore mobility with stretching, strengthening and balance exercises.

    I'm giving it a shot and reckon it will work.
  • Michael Wilson
    44
    I assume HARM is still HARM

    H - Heat
    A- Alcohol
    R- Running (exercise)
    M- Massage
  • Andrew
    174
    HARM aims to prevent aggravating the injury.

    PEACE aims to stabilise the injury, LOVE aims to assist rehabilitation

    HARM seems to focus on a negatives (and thus unhelpful) while P&L focuses on positives.
  • Cam Smailes
    0
    Surprised to hear the no to using anti inflammatories. Any medics on this forum to comment? With personal experience from lots of soft tissue injuries (non work related) compression has been excellent to help with swelling alongside anti inflammatories. If not during the initial phase but soon after?
  • Andrew
    174

    The growing body of evidence suggests the use of non-steroidal anti-inflammatory (NSAID) medications such as Ibuprofen does not in reality lead to a stronger and more effective return to function. The evidence is now suggesting it can delay healing due to their effect on inflammation. Plus there are other potential side-effects with NSAIDs


    It is well understood that the inflammatory phase of an injury has important healing properties such as stimulating and facilitating soft-tissue repair, regeneration and growth. Ergo - if you introduce drugs that inhibit that process you delay overall healing time.

    You could enter the rabbit warren here: https://www.ncbi.nlm.nih.gov/pubmed/23240270
  • Cam Smailes
    0
    Cheers Andrew. Happy with rabbit warrens and will start reading up.
  • Chris Peace
    25
    But Andrew, you didn't ask for my consent to use my family name!
    It was bad enough in the 1960s with Hippies coining Peace and Love but then along came those Greenpeace people who roguishly squatted on my name.
    It is, perhaps, fortunate that my friend Bruce Lovejoy and I did not set up a consultancy Lovejoy and Peace or we would have had a disagreement with the Salvation Army who, some years ago, used our good name to promote goodwill during the Christmas season. Bah!!! Humbug!
    I shall consult my lawyers, Sue, Grabbit and Run to find out what restitution I can seek!!!
  • Michael Wilson
    44
    In

    Not sure why you feel pointing out that some things can impede rehabilitation is a bad thing, but I do appreciate the heads up on this.

    I found the original post from the British Journal of Sports Medicine for those that are interested. https://blogs.bmj.com/bjsm/2019/04/26/soft-tissue-injuries-simply-need-peace-love/
  • Andrew
    174


    "Not sure why you feel pointing out that some things can impede rehabilitation is a bad thing, but I do appreciate the heads up on this."

    ???????
  • Michael Wilson
    44


    HARM seems to focus on a negatives (and thus unhelpful)
  • Andrew
    174
    Right time for an update on my personal experiences of this approach. Not medical advice - just something that might help you with rehab, Return-to-works and malingerers.

    Protect= I got this bit right from the start. Had a first aid kit on hand was able to apply strapping straight away
    Elevate= This was easy. A chance to lie on the couch for an afternoon. Perfect!
    Avoid Anti-inflammatories (and Ice). = Did this fine. Already knew about not taking antiflams so the lack of ice was a new thing. Seemed fine
    Compression. Got me a wetsuit material type compression thing, Compresses and gives support. Great!
    Educate = thought I was already reasonably well educated. This time I learnt about not taking pain killers (4 panadol was it) and listening for pain responses. Works very well. Except when asleep


    Load = got into this straight away and increased over time. Seems to be the useful thing to do
    Optimism. Managed this fine until I had to accept I had to withdraw from an event and loose half my entry fee. That hurt!.
    Vascular work. = Just getting into this now. And very pleased to be moving a bit faster again.
    E = Exercise. I did this pretty much straight away. A wee walk, then onwards to a long walk. Now on a bike

    Observations
    Being fit before an injury appears to be vital in rehab response
    There are two mind sets. Be positive or be negative. Positive is so much better.
    Stay off the drugs. Your body will let you know stuff
    Get moving - don't be a slouch.

    I'm happy with progress and so is physio.
  • Andrew
    174
    A further update. I've been ramping up the "V" and the "E".

    Had another catch up with the physio and seems I had a few wee fractures as well. But the view is I can avoid surgery and advance rehab plan by at least a month or two from date of injury. Important to avoid surgery as this would reset the rehab clock back to zero from date of surgery - thus lengthening incapacity time.

    I'm pretty well sold on PEACE and LOVE as a injury/rehab approach.

    This will be going into my injury management toolbox for our employees. First aiders and managers will be updated. I hope ACC case managers are well aware of it as this will now be my expected approach with any "light duty / return to work" plan they want to set up. The weakness being that by the time ACC get to case manage the employee will already have missed out on the initial PEACE stages.

    Credit to the Doctor and Physio (and MRI people) who are aware of and back PEACE and LOVE. Hopefully as the message gets out we'll see less and less time of work due to musculoskeletal injuries.
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