Immediately after a soft tissue injury, do no harm and let PEACE guide your approach

P = Protect

• Unload or restrict movement for 1 – 3 days
• This reduces bleeding
• Prevents distension of injured fibres
• Reduces risk of aggravating injury
• Minimise rest
• Prolonged rest compromises tissue strength and quality
• Let pain guide removal of protection and gradual reloading

E = Elevate

• Elevate the injured limb higher than the heart
• This promotes interstitial fluid flow out of the injured tissue
• Although poor evidence for it – it still is recommended as there is a low risk-benefit ratio

A = Avoid anti-inflammatory modalities

• Anti-inflammatory medications may negatively affect long-term tissue healing

• Optimal soft tissue regeneration is supported by the various phases of the inflammatory process
• Making use of medications to inhibit the inflammatory process could impair the healing process
• Avoid ice

• Use of ice is mostly analgesic
• Although it is widely accepted as an intervention there is very little high-quality evidence that supports the use of ice in the treatment of soft tissue injuries
• Ice may potentially disrupt inflammation, angiogenesis and revascularisation
• Ice may potentially delay neutrophil and macrophage infiltration
• Ice may potentially increase immature myofibers
• This can result in impaired tissue regeneration and redundant collagen synthesis

C = Compress

• Intra-articular edema and tissue haemorrhage may be limited by external mechanical compression such as taping or bandages, but should still allow full range of movement at the joint.

E = Educate

• It is our responsibility as physiotherapists to educate our patients on the many benefits of an active approach to recovery instead of a passive approach
• Early passive therapy approaches such as electrotherapy, manual therapy or acupuncture after an injury has a minimal effect on pain and function when compared to an active approach
• If physiotherapists nurture a patient’s “need to be fixed” it may create dependence to the physio and actually contribute to persistent symptoms
• Patients need to be better education on their condition
• Load management will avoid over-treatment of an injury

• Over-treatment may increase the likelihood of injections or surgery and higher costs
• It is critical for physiotherapists to educate their patients and set realistic expectations about recovery times