The First 72 Hours After a Soft Tissue Injury: PEACE & LOVE, Not RICE
If you rolled an ankle on Wellington Crescent yesterday or tweaked a hamstring at a softball practice this week, the advice you almost certainly got was some version of RICE — rest, ice, compression, elevation. It's been the standard answer since 1978, and most clinicians still default to it because it's easy to remember.
The problem is that two of those four letters don't hold up well to scrutiny anymore, and the framework misses the things that actually drive recovery. In 2019, Dubois and Esculier published a short editorial in the British Journal of Sports Medicine that proposed replacing RICE with two acronyms covering the full recovery arc: PEACE for the first few days, and LOVE for the days and weeks that follow1. It's caught on among sports physiotherapists and rehab-focused clinicians for good reason — it matches the biology better.
What changed about ice and rest
The case against prolonged ice is mechanistic and clinical. Inflammation in the early stage of soft-tissue healing isn't a bug — it's the recruitment phase that delivers the cells responsible for tissue repair. Suppressing it aggressively with ice and NSAIDs may delay or impair tissue healing in some models, and the human evidence for ice improving long-term outcomes after acute soft-tissue injury is thin2.
Rest is similar. Brief protection makes sense; extended immobilization doesn't. Connective tissue, muscle, and tendon all adapt to load — remove load, and they get worse, not better. This is the same principle that drives training-load thinking: tissue tolerates what you progressively expose it to.
PEACE — the first 1–3 days
P — Protect. Avoid activities that increase pain in the first day or two. Don't immobilize completely.
E — Elevate. Helps interstitial fluid drain back toward the heart, reducing swelling.
A — Avoid anti-inflammatories. Especially in the first 48 hours, when the inflammatory cascade is doing its job. This is the change most patients didn't see coming.
C — Compression. The one thing from RICE that survives intact. Reduces swelling and gives proprioceptive input.
E — Educate. Realistic timelines and active recovery framing produce better outcomes than passive medical-model framing.
LOVE — after the first few days
L — Load. Gradual, pain-tolerant loading, started early, restores tissue capacity. Optimal loading is the single most consistent predictor of return-to-activity outcomes across joint, tendon, and muscle injuries3.
O — Optimism. Catastrophizing predicts poor outcomes independently of injury severity in lower-limb injuries4. The mind matters here.
V — Vascularization. Pain-free aerobic activity early in recovery improves blood flow and motivation, and seems to support faster return to activity.
E — Exercise. Active rehab — strength, proprioception, mobility — restores function and reduces re-injury risk. Ankle sprains are the textbook example: people who do nothing have a 30–70% chance of recurrent sprain.
What this looks like in practice
Take a moderate hamstring strain — common in spring, especially in players returning to softball or soccer after a Manitoba winter. Day 0–2: protect, compression, elevate. No NSAIDs unless you're doing it under medical advice for a specific reason. Day 2–7: gentle, pain-free isometric loading and walking. Week 2 onward: progressive concentric and eccentric loading, sport-specific running progressions. Re-injury risk is highest in the first six weeks back, which is why the rehab progression matters more than the initial 72 hours5.
Where this fits
None of this is exotic — it's just the current evidence applied properly. The first 72 hours don't make or break recovery, but they set the tone. People who pivot toward early gentle loading and away from extended rest tend to recover faster, with fewer recurrences. That's the framework we walk new patients through at Boreal Spine & Sport, and it's the one we'd want for anyone in Winnipeg navigating a fresh sprain or strain.
References
- Dubois B, Esculier JF. Soft-tissue injuries simply need PEACE and LOVE. Br J Sports Med. 2020;54(2):72–73.
- Vuurberg G, Hoorntje A, Wink LM, et al. Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. Br J Sports Med. 2018;52(15):956.
- Glasgow P, Phillips N, Bleakley C. Optimal loading: key variables and mechanisms. Br J Sports Med. 2015;49(5):278–279.
- Briet JP, Houwert RM, Hageman MG, Hietbrink F, Ring DC, Verleisdonk EJ. Factors associated with pain intensity and physical limitations after lateral ankle sprains. Injury. 2016;47(11):2565–2569.
- Askling CM, Tengvar M, Thorstensson A. Acute hamstring injuries in Swedish elite football: a prospective randomised controlled clinical trial comparing two rehabilitation protocols. Br J Sports Med. 2013;47(15):953–959.
Author: Dr. Michael Minenna D.C., B.Sc., SFMA, FMS — Boreal Spine & Sport, Winnipeg, Manitoba.