peace & love

protocol

during the first few days, soft tissues need p.e.a.c.e.

p

protection

avoid activities and movement that cause pain during the first few days after an injury.

Unload restrict movement for 1-3 days only to minimise bleeding, allow the injury to start the repair process and reduce the risk of causing further damage. Rest should be minimised as prolonged rest can lead to a reduction in tissue strength and quality. Let pain be our guide as to how much and when to stop resting and start re-loading.

e

elevation

elevate the injured limb higher than the heart as often as possible.

elevate the limb to promote fluid flow out of the tissues. The evidence for this is weak but there is a low risk in this activity.

a

avoid anti-inflammatories

anti-inflammatory medications are known to reduce tissue healing. Avoid the use of ice except for pain relief.

Inflammation is a critical phase of tissue repair. Even low dose anti-inflammatories can be detrimental to long term tissue healing. For this reason, the use of ice🧊 is also questioned despite its widespread use as there is no high-quality evidence on the effectiveness of ice for trading soft tissue injuries. Of course, you should always follow your doctor's advice.

c

compression

use an elastic bandage or taping to reduce swelling

External mechanical pressure using taping or bandages helps limit Intraarticular oedema (fluid) and tissue haemorrhage (leading to bruising). Despite conflicting studies, compression after an ankle sprain seems to reduce swelling and improve quality of life.

e

education

your body knows best. avoid unnecessary treatments and medical investigations and let nature take its course.

In an era of technology and hi-tech therapeutic options, we strongly advocate for setting realistic expectations with patients about recovery times instead of chasing the magic treatment approach. Better education on the condition and load management will help avoid overtreatment which has been suggested to increase the likelihood of further long term complications

after the first days have passed, soft tissues need l.o.v.e.

l

load

let pain be your guide to a gradual return to normal activities. Your body will tell you when it's safe to increase loading.

An active approach with movement and exercise benefits most patients with musculoskeletal disorders. Mechanical stress should be added early and normal activities resumed as soon as symptoms allow. Optimal loading without exacerbating pain promotes repair, remodelling and building tissue tolerance and capacity of tendons, muscles and ligaments.

o

optimism

condition your brain for optimal recovery by remaining confident and positive.

The brain plays a key role in rehabilitation interventions. Psychological factors such as catastrophisation, depression and fear can represent barriers to recovery. They are even thought to explain more of the variation in symptoms and limitations following an ankle sprain than the degree of pathophysiology. Pessimistic patient expectations are also associated with suboptimal outcomes and worse prognosis.

v

vascularisation

choose pain-free cardiovascular activities to increase blood flow to repair tissues.

Physical activity that includes cardiovascular components represents a cornerstone in the management of musculoskeletal injuries. While research is needed on dosage, pain-free cardiovascular activity should be started a few days after injury to boost motivation and increase blood flow to the injured structures. Early mobilisation and aerobic exercise improve function, work status and reduce the need for pain medications in individuals with musculoskeletal conditions.

e

exercise

restore mobility, strength and proprioception by adopting an active approach to recovery

There is a strong level of evidence supporting the use of exercises for the treatment of ankle sprains and for reducing the prevalence of recurring injuries. Exercises will help to restore mobility, strength and proprioception early after injury. Pain should be avoided to ensure optimal repair during the subacute phase of recovery and should be used as a guide for progressing exercises to greater levels of difficulty.