Updating RICE Part 2: LOVE
After the first 1-3 days of taking care of an injured area with PEACE, it is time for a little LOVE. LOVE is used up until the injured area has regained all the function, range of motion and strength that it had from before the injury took place. Ideally, you will end up in an even better spot with more strength and control than before the injury.
The first part of LOVE is Load. Unfortunately, soft tissues do not understand what we want them to do, so we must learn to speak their language. The language of soft tissues, fortunately, is load. Tissues only know if they have been loaded or not and will adapt accordingly. Add load, and they will change to tolerate that load. If you never load them, they will slowly lose their ability to sustain load. Appropriate load to soft tissues early in the rehabilitation phase increases tissue repair and remodeling allowing it to become more resilient. This only occurs however with the right amount of load, too little, and no change will occur, too much and re-injury will occur. Optimal load will not exacerbate pain while you do it but will feel challenging.
The second part of LOVE is Optimism. It is important to remain positive throughout the rehabilitative process. Optimistic patients have shorter repair times, and return to activity faster. While it is never fun to be injured, it is important to maintain a positive outlook through the whole time.
Third is Vascularization. Cardiovascular activity that is pain free is vital to healing of soft tissue injuries. Aerobic activity promotes system wide blood flow which bathes injured tissues in oxygen and nutrient rich blood. It can also be used to improve physical function, reduce the time to return to activity and decrease the overall need for pain medication.
The final step is Exercise. Exercise is helpful in the reduction of recurrent injuries. Once an injury has been sustained, the odds of a repeat injury increase if proper treatment does not identify any underlying causes and treat them. This is often stability and motor control drills for athletes to teach them to be able to resist and control dynamic and shifting loads. Exercises can also be done to increase mobility and strength of tissues. Stronger tissues are more injury resistant. Exercise should never increase pain from a previous injury but should be difficult.
Managing injuries is more than just pain reduction. It is a responsibility of all healthcare providers involved to guide the individual into a higher state where they are better, and more resilient than before.
