The Complete Guide to Soft Tissue Injury Management

With the recent increases in club sport gameplay, there’s been a lot of misinformation going around about properly addressing soft tissue injuries. So, in light of all of the confusion, here is a complete guide to the early and late stages of management for a classic sprain & strain.

Introduction:

Soft tissue injuries are among the most common types of injuries in sport. They can be caused by a variety of things, such as over-stretching, falls, collisions, repetitive motions, and/or an extreme contraction of a muscle.

Soft tissue injuries can be classified as either a strain (muscle) or sprain (connective tissue: ligament, tendon). Each of these can be further categorised into various grades of severity, but this exceeds the scope of this article for now (this will be a topic for a later date).

Soft Tissue Injury Management

There’s so much information out there that it becomes complicated for an athlete to know hot to properly treat their own injuries. Luckily, there are (and have been) recently published frameworks to help guide treatment.

The pain associated with these injuries can be debilitating and there is no one-size-fits-all solution for recovery. This is why it’s important to have proper guidance along the way!

It’s important to note that best treatment for a soft tissue injury (regardless if it’s a strain/sprain) is an understanding of what may have lead to this incident, how to manage pain, and a gradual loading program that is typically directed by a Health Care Practitioner (i.e Physical Therapist, Athletic Trainer, etc). With these points in mind, the below sections will elaborate into the specific steps that need to take place.

The Framework:

There have been a few iterations of acronyms to provide a step-by-step recovery guide, however due to the number of them, there has been a good deal of confusion as to which is most appropriate. This section will discuss the most up-to-date version.

Over the years, the old acronym “R.I.C.E.” turned into “P.O.L.I.C.E.” However, in recent years a new and more thorough one was published: “P.E.A.C.E. & L.O.V.E.”

Here’s it explained:

**P.E.A.C.E. should take place immediately after and continue for 1-3 days post-injury.**

P = Protection

• For only the first few days after the injury, avoid any aggravating or pain inducing movements
• Crutches, walking boots, or braces may be indicated at this time

E = Elevation

• Elevate the area as much as possible & above the level of your heart

A = Avoid Anti-Inflammatories

• NSAID medications (Ibuprofen, Aspirin, Naproxen, etc) may interfere with the healing process early on and should be avoided
• Using Ice on the injury is not supported due to potential reduction in healing benefits and speed

C = Compression

• Elastic bandages or taping can be used to help flush out oedema (ie swelling)

E = Education

• Understand that the body knows what’s best
• Athlete’s should avoid any passive and unnecessary modalities

**L.O.V.E. should take place around 5-7 days post-injury.**

L = Load

• Pain should guide the amount and type of exercises
• Consult with Health Care Professional for appropriate types and amounts of exercise

O = Optimism

• Stay positive & optimistic to condition your brain for an optimal recovery process

V = Vascularisation

• Choose light & pain-free cardiovascular exercise (ie stationary bike, elliptical, rower, ski Erg, etc) to help improve blood flow to injured area
• 20-30 mins can be a good starting place

E = Exercise

• Recovery should be an active process
• Gradually restore mobility, proprioception, and strength

The Wrap-Up:

Because there has been a recent spike in soft tissue related injuries, we wanted to highlight the most appropriate and updated guide for early/late stages of management. Hopefully this article has brought some clarity in guiding your recovery.

Just remember the next time you or someone you know suffers a sprain or strain, all they need is a little PEACE & LOVE.

If you have any questions or concerns regarding pain or injury management, please feel free to reach out. Or, book a discovery call so we can chat about the best plan of action for you!

Resources:

Bleakley CM, Glasgow P, MacAuley DC. PRICE needs updating, should we call the POLICE? British Journal of Sports Medicine 2012;46:220-221.

Dubois B, Esculier J. Soft-tissue injuries simply need PEACE and LOVE. British Journal of Sports Medicine 2020;54:72-73

La Clinique du Coureur. PEACE & LOVE: New acronym for the treatment of traumatic injuries. Published on 30 August 2019. Available from https://www.youtube.com/watch?v=HGTabgG7GIU (last accessed 25 June 2020)

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.

Vuurberg 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-.