Acute injury rehabilitation

Over the years acronyms have come and gone, i.e. RICE and PRICE, and a new approach has been suggested; one of a continuum. This approach recognises how an injury affects "an individual" and therefore addresses what is required to successful rehabilitate the individual from the outset. Introducing, PEACE and LOVE for all species!

P is for protection. Protecting the injured area by restricting movement and/or load for 1-3 days to limit further bleeding or aggravation. Pain signals may determine the extent of restriction

E for elevate Elevate the limb higher than the heart to promote interstitial fluid flow out of tissues. A for reconsidering Anti-inflammatory modalities, particularly higher dosages, so not to affect long-term tissue healing. Despite our prolonged use of cryotherapy this has not shown to be efficacious. I would be interested in a systematic review of the use of the combined cryotherapy-thermotherapy; however, on-one to date has taken on such a feat! C for compression to limit intra-articular oedema and tissue haemorrhage. E for education of the patient/carer on the benefits of an active approach to recovery. The focus on passive modalities are less efficacious; however, this is were I think a distinction between humans and animals exists as our control over an animal's movement may need to be more rigourous to allow the healing process to occur. Irrespectively, overtreatment and education on the condition and rehabilitation process plays a vital part in successful treatment.

After PEACE, comes LOVE......

L for optimal load according to the stage of healing to promote repair, remodelling and tissue tolerance which is where I believe that human rehabilitation skills greatly assist the rehabilitation of animals.

O for optimism which drives better outcomes and prognosis. We know that an owner's feelings and behaviours significantly affect an animal and I wonder how much this may influence an animal's recovery. V for vascularisation of the injured structures through activity. Early mobilisation and pain free aerobic exercise improves physical function and reduce the need for pain medication for individuals with musculoskeletal injuries. I see that this is transferable to animals, with appropriate education, communication and implementation. E for exercises as they 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 exercise progressions.

My experience as a physiotherapist as well as an endurance athlete and carer of several different species has meant that I have been an advocate of this evidence-based article on managing soft-tissue injuries prior to its publication. It highlights that a PEACEful approach predisposes LOVE; in more ways than one in our world today.