Should you ice after an injury? Practise PEACE & LOVE

What does the current scientific evidence and the PEACE & LOVE protocol framework say?

Ice is one of the oldest and most commonly used anti-inflammatory strategies after an injury, whether it's a sprain, a bruise, or in situations of pain or swelling of unclear origin. Most people have resorted to applying ice in these contexts. However, in light of current scientific knowledge, it is important to question whether ice and rest remain the best approach in the initial stages of an injury.

For decades, ice has been widely used in physiotherapy as a primary strategy for managing acute soft tissue injuries. This approach gained notoriety with the RICE protocol – rest, ice, compression, and elevation – proposed in 1978 by physician Dr. Gabe Mirkin.

From the RICE approach to scientific questioning

With the advancement of knowledge, the RICE protocol has been adjusted. In 2012, PRICE emerged – Protection, Rest, Ice, Compression, and Elevation – and later, POLICE – Protection, Optimal Loading, Ice, Compression, and Elevation. However, more recent studies have shown there is no robust scientific evidence to support these protocols as ideal strategies for the management of acute soft tissue injuries.

In 2015, Dr. Gabe Mirkin himself acknowledged that, while ice may help reduce pain when applied immediately after an injury, it can also interfere with the body's natural tissue regeneration processes. In particular, applying ice can hinder the migration of cells responsible for healing to the injury site, potentially delaying recovery.

Recent investigations suggest that strategies aimed at aggressively reducing inflammation, such as ice or the use of anti-inflammatory medications, may negatively interfere with the recovery process, especially in the acute phase. Inflammation is now understood as an essential stage of tissue repair.

From POLICE to POLICE-CANAI

In this framework, the POLICE-CANAI protocol emerged, representing an evolution of previous models. It maintains the principles of Protection, Optimal Loading, Compression, and Elevation (POLICE), and adds appropriate Cardiovascular Activity (CA), through pain-free aerobic exercise, as well as the Non-use of Anti-Inflammatories (NAI), recognising the role of inflammation as an integral part of the tissue healing process.

Nevertheless, these models continued to insufficient consider the biological, psychological, and emotional factors, which play a decisive role in the perception of pain and the recovery process, even in the initial stages of the injury.

PEACE & LOVE: A modern approach to acute injury

Given these limitations, the PEACE & LOVE protocol was proposed, developed by Canadian physiotherapists and researchers Blaise Dubois and Jean-François Esculier. This approach advocates for an active, dynamic, and informed recovery, in which the injured person takes a central role in their recovery process.

The protocol is divided into two complementary phases: PEACE, in the first few days after the injury, and LOVE, in the subsequent phase.

The PEACE phase: the first few days after injury

• Protection Avoid movements and activities that significantly increase pain in the first 1 to 3 days. Complete rest is discouraged as it can compromise tissue quality and strength.
• ElevationWhenever possible, elevate the injured limb above heart level to facilitate fluid drainage.
• Avoid anti-inflammatories. Avoid anti-inflammatory strategies, such as anti-inflammatory medications or ice, due to their potential negative impact on healing processes.
• Compression Use compression bandages or elastic bands to help control swelling.
• Education Adopt an active approach, with realistic expectations regarding recovery time, allowing the body's natural processes to play their part.

The LOVE phase: supporting functional recovery

• Charge Allow pain to guide a gradual return to activities. The increase in load should be progressive and adjusted to individual tolerance.
• Optimism Recognise the role of the central nervous system in recovery. Factors such as fear, pessimism or catastrophising can negatively interfere with the rehabilitation process.
• Vascularisation: Include cardiovascular activities that do not cause pain, favouring increased blood flow to the recovering tissues.
• Exercise: To promote the recovery of mobility, strength, and motor control through exercises adapted to the clinical condition.

An informed and individualised approach

Scientific knowledge is constantly evolving, allowing for increasingly refined strategies for injury recovery. The PEACE & LOVE protocol values the body's natural adaptation mechanisms and replaces prolonged immobilisation with controlled and progressive movement.

It is important to highlight that, despite these recommendations being supported by scientific evidence, they do not replace individualised assessment by a physiotherapist. Each injury presents its own characteristics, and no protocol should be applied rigidly or indiscriminately.

At Integrativa, the approach to acute traumatic injuries is not based on the automatic application of protocols, but rather on careful and personalised functional assessment. We value the natural healing processes, functional recovery, and the active participation of the individual in their rehabilitation process, with the aim of supporting a safe and progressive return to daily routine.