Tip of the Month - December 2020
Coach Monika Says…
Sport Medicine: New Approach for Treatment of Injuries
PEACE & LOVE by Jill Parker, The Calgary Herald, posted August 31, 2020, was modified by Dr. M. Schloder
Professionals in Sport Medicine have used so-called ‘acronyms’ for treatment of injuries until recently. The common practice was to treat them with ICE (ice, compression, elevation).
Note: Acronym – word formed by abbreviating a phrase by combining certain letters of words (often the first initial of each) into a single term, example ICE.
Injuries tend to occur if athletes: (a) are lax in Warm-up exercises (not performing to full range of motion [ROM]); (b) are not serious about the exercises [goofing around]; (c) perform exercises incorrectly or use contraindicated exercises such as traditional jumping jacks [groin injuries] versus forward-backward stride jumps; and ‘cheat’ in the Cool-down (not long enough or not at all – i.e., leaving right after training).
Note: Contraindicated exercises are ‘known to be risky’ because they weaken vertebral discs, ligaments, and tendons that may be damaged at a later time or injured at the time of performance. The most common area of the body abused is the spine. Contraindicated exercises are those that carry higher risks to joint structure, soft tissue, or other risks. Because the risks typically outweigh the benefits, these exercises are inappropriate for most individuals
Note: During my surveillance of coaches I observed many incidences of athletes not performing the Warm-up and Cool-down correctly. In my opinion, the training session starts with the Warm-up and is not ‘some trivial activity’ because the purpose is to prepare the body physically and psychologically for the upcoming session.
Quick Review of Correct Warm-up and Cool-down Principles
Observing many training sessions over the years I noticed that the principles and progression for Warm-up were not ensued. Warm-up exercises prior to the actual training session should be about 20% of overall training time and consist of the following: (1) General Warm-up including (a) dynamic moving exercises; (b) dynamic stationary exercises; (2) Specific Warm-up including exercises related to the upcoming skill[s] to be taught or trained and are the transition or ‘flow’ to the training session.
The Cool-down should be about 10% of overall training time with the purpose of (a) physical and psychological recovery; (b) dealing with those muscles mostly used in the session; (c) include flexibility exercises (static and PNF), and/or (d) combination of flexibility with another component (example: flexibility and balance).
Over time, treatment strategies evolved, and acronyms expanded to include RICE (adding Rest); PRICE (adding protected); and POLICE (adding optimal loading). Two more acronyms – PEACE and LOVE – have recently been added to the sport lexicon. Two Canadian physiotherapists created an updated and more broad-based view to treat and manage acute soft tissue injuries, including strains, sprains, and bruises.
Blaise Dubois and Jean-Francois Esculier of The Running Clinic stated in the British Journal of Sports Medicine they designed a contemporary use of acronyms for a rehabilitation continuum from immediate care (PEACE) to subsequent management (LOVE). Dubois proclaims that the new acronyms take into consideration the psychological aspects of recovering from injuries as well as the importance of an active versus passive path for recovery. The latest approach to healing suggests that resting an injured body part is not the best strategy for a speedy and optimal recovery.
Passive recovery treatments like massage, electrical stimulation, manual manipulation, and anti-inflammatory medication do not speed healing, according to Dubois. He states, “Science now shows that moving earlier and loading the injured body part is a better approach to treatment.” PEACE should be the guiding principle in those first few days post-injury, followed by several days of LOVE until the injured body part returns to its pain-free fully functional state.
Common Injuries
PEACE
Protect
Reduce physical activity days 1-3 post-injury to help minimize additional trauma and allow physiological processes responsible for healing to occur
Avoid absolute Rest because it causes unnecessary reduction in strength and resiliency to the joint and surrounding soft tissue
Let pain be the guide in obtaining regular function one is able to maintain
Keep in mind that some movement is better than NO movement
Elevate
Reduce pooling of the fluid at the joint or around the injury by elevating the affected limb higher than the heart
Avoid
Avoid anti-inflammatory medication designed to reduce swelling, which can actually impede healing despite common advice suggesting differently
The same applies to the traditional practice of applying ice to an injury, which seems to lack scientific evidence in supporting such role, according to Dubois and Esculier
Compress
Wrap the affected body part with tape or bandage as soon as possible to help reduce the discomfort and limitation to normal function caused by the build-up of fluid and internal bleeding that often accompany an injury
Educate
Sports Medicine specialists need to inform injured athletes or people exercising or working out that no miracle exists, including the kind of therapies used by physio- and athletic therapists
It does not mean one should not seek professional advice when dealing with an injury but a therapist’s approach to repair does not always produce better results than following the procedures of PEACE and LOVE
Passive techniques such as electrotherapy, manual therapy, or acupuncture early after an injury have significant effects on pain and function compared to an active approach, and may even be counterproductive in the long term, according to Dubois and Esculier
After PEACE, the next stage is LOVE, which should begin after two consecutive days. There might still be some discomfort without pain when pursuing the full functional movement of the body. According to Dubois, as long as any residual pain disappears when exercise or movement ceases, no additional harm is caused. LOVE should be the final and most important part of the treatment.
LOVE
Load
Refers to the active part of recovery, involving moving and loading injured tissues as soon as pain dissipated to the point where it is tolerable
In the case of a sprain or strain, limping is better than avoiding weight-bearing, and range of motion (ROM) should be tested early and often
Optimism
Athletes and injured exercising people, who are optimistic about their return to full function heal faster than those who are anxious or worried about discomfort and disruption to their daily routine
Vascularization
Pain-free aerobic exercise should be started a few days after injury to enhance motivation and increase blood flow to the injured body part, according to Dubois and Esculier
Improving blood flow means more healing properties are delivered to the injured body part
Turn to biking or swimming if weight-bearing exercise is too painful, walking or running once pain and swelling have begun to subside
Exercise
Exercising is the key to restoring injury-related loss in strength, agility, and mobility
Pain is used to gaged to start appropriate exercise intensity and volume and the gradual return to regular exercise or training routine
References:
Barker, J. (2020) Acronyms in the sport medicine lexicon reflect new approaches to treating injuries. Calgary, AB, Canada: The Calgary Herald, p. AB, August 31, 2020.
Dubois, B., & Esculier, J-F. (2020). Soft tissue injuries simply need peace & love. Blog: British Journal of Sports Medicine. Posted April 26, 2019. British Journal of Sport Medicine, 54(2), 72-75. Retrieved September 15, 2020, from https://blogs.bmj.com/bjsm/2019/04/26/soft-tissue-injuries-simply-need-peace-love/