Acronyms are popular in sports medicine. They are helpful for patients trying to remember what to do after a medical visit.
One of the originals was ICE, which stood for ice, compression, and elevation for soft tissue injuries such as contusions, muscle strains, and joint sprains.
RICE followed, with R standing for “rest,” which quickly transformed to relative rest.
PRICE was next with the P meaning “protection,” which transformed, as well, to PRICEM, with “medication” added to the back end.
The most recent iteration has been POLICE, with “optimal load” substituting for “rest” but essentially equivalent to “relative rest.”
However, earlier this year, an editorial in the British Journal of Sports Medicine strongly suggested a significant break with the part of the past, suggesting instead PEACE and LOVE.
P remained, still standing for protection, yet with the warning, that “prolonged rest can compromise tissue strength and quality.”
E continued to stand for elevation. The theory is that having the injured part above the heart turns that pump into a suction device. According to the editorial, the scientific evidence to support the practice is weak but it involves no risk.
A will be the source of controversy. It was short for, “Avoid anti-inflammatory modalities.”
As the editorial explained, “The various phases of inflammation help repair damaged soft tissues.” Taking anti-inflammatory medication, then, will inhibit healing. Research to that effect has been reported in this space previously.
The real fuss, though, will come from these two sentences:
We also question the use of cryotherapy. Despite widespread use among clinicians and the population, there is no high-quality evidence on the efficacy of ice for treating soft tissue injuries.
More on that later.
C continued as compression.
E was repeated, standing for education this time. The better-informed patient is less likely to encounter complications or unrealistic expectations. So much for the initial strategy to address bump and bruise.
“After the first few days,” the editorial continued, “soft tissues need love.”
L was for load. “An active approach with movement and exercise benefits most patients with musculoskeletal disorders,” the editorial explained. “Mechanical stress should be added early and normal activities resumed as soon as symptoms allow.”
O meant optimism. “Optimistic patient expectations are associated with better outcomes and prognosis,” the editorial claimed.
V indicated vascularization. Even if the injury still requires immobilization, the victim should initiate pain-free aerobic exercise that will improve blood flow throughout the body, including the damaged area.
E was a bit redundant, signifying exercise to the site of the injury to improve motion and strength.
Overall, LOVE is a clever way of advocating relative rest.
Both acronyms are catchy, memorable, and — for the most part — backed by research.
When it comes to comes to avoiding ice, though, the advice did not entirely match the science.
If by “high-quality,” the editorial meant “double-blind,” then no argument here. Double-blind studies involve the use of a placebo (sugar pill or sham treatment), where the patient does not know what they are receiving, and the researchers do not know who received the real treatment and who did not, until the treatment course is completed.
Sorry, there is no placebo to substitute for ice. Still, there has been ample published research on the benefits of cryotherapy, much of it done at Indiana State. More on that next week.
John Doherty is a licensed athletic trainer and physical therapist. This column reflects solely his opinion. Reach him at firstname.lastname@example.org. Follow him on Twitter @JDohertyATCPT.