P for Protection
Avoid activities and movements that increase pain during the first 1-3 days after the injury. Rest should be minimised as prolonged rest can compromise tissue strength and quality. Use pain or discomfort as a guide for gradual increase in activity.
E for Elevation
Elevate the limb higher than the heart as often as possible to help reduce swelling.
A for Avoid anti-inflammatories
This is an interesting one. Avoid taking anti-inflammatories as they can reduce tissue healing. It is thought that the various phases of inflammation contribute to optimal soft tissue regeneration. If you inhibit these phases with medication it could impair tissue healing.
They have also suggested to avoid icing in this part. They said in the blog, that there is no high-quality evidence on the efficacy of ice for treating soft tissue injuries. You can read my blog post here with my thoughts on the use of ice. If you do use ice, only apply it for 10 minutes at a time.
C for Compression
Use elastic bandage or taping to reduce swelling.
E for Education
Your body knows best. Avoid unnecessary passive treatments and medical investigations and let nature play its role. It is important learn about the benefits of an active approach to recovery. In their blog they said that “passive modalities such as electrotherapy, manual therapy, or acupuncture, early after injury has a trivial effect on pain and function compared with an active approach”.
This is when soft tissues need LOVE
L for Load
Let pain guide your gradual return to normal activities. Your body will tell you when it’s safe to increase load. This is where an active approach can benefit most musculoskeletal disorders. Loading the injury with appropriate stress should be started as soon as symptoms allow.
O for Optimism
Condition your brain for optimal recovery be being confident and positive. You have probably heard of the placebo effect, but have you heard of the Nocebo effect? Basically this is if you think something won’t work, it most likely won’t work (read my blog post on this here). In the article they said “pessimistic patient expectations are associated with sub-optimal outcomes and worse prognosis”. Obviously we need to be realistic, but always try and stay positive.
V for Vascularisation
Choose pain free cardiovascular activities to increase blood flow to repairing tissues. They suggested in the blog that “pain free cardiovascular activity should be started a few days after injury to boost motivation and increase blood flow to the injured structures”.
E for Exercise
Restore mobility, strength and proprioception by adopting an active approach to recovery. Of course, we need to avoid pain to help ensure optimal repair during the sub-acute phase of recovery. As it was mentioned previously, let pain be your guide as to when to progress the exercises. In my mind proprioception is key here. When we mobilise and move a joint we are activating the proprioceptors which are telling the brain how that joint is moving. The more accurate this information is, the better your brain will be able to control it and the better the recovery.
So there you have a new acronym to use when dealing with a soft tissue injury. What do you think? I really like it, especially when looking at an injury as more than just getting rid of the initial pain, but more about the longer term outcomes. In this day and age we all want results now, but healing takes time and a simple quick fix (like taking and anti-inflammatory) may actually be detrimental to your long term function.