PEACE and LOVE: The principles of rehabilitation

In the sports medicine and physiotherapy world, a soft tissue injury used to be treated with the principle of RICE (Rest, Ice, Compression, Elevation). This simple guide later added a P for protection or the more complete PRICE principle or POLICE which further swaps out Optimum Loading for Rest. Over the years these principles have been debated, as has the quest for the perfect mnemonic. How about PEACE and LOVE? Given the state of affairs of the world, who could argue with these as being perhaps the perfect principles for our current times? The PEACE acronym references immediate management while the LOVE acronym subsequent management of an injury such as an ankle sprain. Read: Even one drink is too much! What? PEACE Immediately after a soft tissue injury, do no harm and let PEACE be your guide: Protect (unload or restrict, but minimize rest), Elevate, Avoid anti-inflammatory modalities (such as NSAIDs and ice), Compress, Educate. LOVE After a few days, injuries need LOVE: Load or active mobilization, Optimism for optimal recovery, Vascularization or need for cardiovascular activity, Exercise therapy, using pain as guide. You can argue that this is all a bit of a stretch to make a catchy phrase. These principles would likely work for an ankle sprain and showcase the trend towards an active rehabilitation approach as opposed to a passive, “let time heal all.” What if we were to use these same ideologies in a much broader sense? Could we apply PEACE and LOVE to a much larger scenario? What if the injury was psychic or an event that “hurt” my medical career? What if the trauma was a global pandemic? After a pandemic, let’s be specific—after THIS pandemic, we need to recover and heal. By the way, in Alberta way to report the results of RATs and apparently no COVID. The provincial government has declared these to be true and so they must be! Read: The 'perfect' clinic day With this in mind, let’s work through this post pandemic scenario… Protect yourself. It’s OK to say NO. Unload your frustration and vent. Minimize inertia and move in a positive way. Sleep is critical, too much “rest” not so. Let pain guide your gradual removal of protection. Elevate your mood with things you love to do—socialize, do hobbies, play music, exercise, go out to a restaurant, movie or concert. Allow yourself to be happy again. Avoid anything that is inflammatory (anti-healing) such as excessive alcohol consumption, news or social media. Compress your anxiety and negative thinking with mindfulness and cognitive behavioural therapy or behavioural activation techniques. Educate yourself on novel ways to improve resilience and specifically manage physician burnout. Set realistic goals and expectations for recovery. Once you’re through the initial phase of recovery, the longer-term rehabilitation needs to be set in motion. Load your life with love. Actively pursue your usual healthy lifestyle of social, family, work and spiritual activities. Optimism. Our brain plays a significant part in our recovery and ongoing pessimism will only delay progress and limit our recovery. Be realistic but allow optimism to permeate your thoughts and actions. Vascular flow. Get the blood flowing—literally and figuratively. Get moving on what you are passionate about. Exercise, frequently, vigorously and with purpose. Work your body and mind. Get an endorphin rush, elevate your monoamines and neurotransmitters, boost your Brain-Derived Neurotrophic Factor (BDNF)—all of this healthy bio-hacking is there for the taking! It all sounds so easy but we all know that rehabilitation is hard work. Positive gains can be incremental and incomplete despite best efforts. I’ve twisted my right ankle many times playing sports. Injuries hurt. Pain sucks. The COVID pandemic has been a whole lot bigger and complex than an ankle sprain. It is time for a major change for all of us including some active rehabilitation and healing. PEACE and LOVE to everyone reading this. Dr. Ted Jablonski is a singer-songwriter, emerging playwright and neophyte poet who has retired his family practice to focus on sexual medicine and transgender health in Southern Alberta. He finds himself advising medical students at the Cumming School of Medicine and while recovering from a pandemic.

PEACE and LOVE: The principles of rehabilitation

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Ted Jablonski