[Physio Explained] To ice or not to ice? Unpacking acute injury treatment with Jean-Francois Esculier
Oct 16, 2024
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In this enlightening discussion, Jean-Francois Esculier, a Canadian physiotherapist and clinical researcher, delves into modern approaches to acute injury treatment. He introduces the acronym "PEACE and LOVE" and explains its significance in managing musculoskeletal injuries. The conversation challenges traditional icing methods, highlighting limited scientific support for ice's effectiveness versus newer strategies focusing on optimal loading and education. Esculier also emphasizes the importance of patient comfort in deciding between ice and heat for recovery.
The PEACE and LOVE framework promotes a more evidence-based approach to acute injury management, emphasizing education and proper rehabilitation methods.
Current research challenges the traditional use of ice in injury treatment, highlighting the need to reconsider cultural biases and expectations in recovery practices.
Deep dives
Reevaluating Ice for Acute Injuries
Current research indicates that using ice after an ankle sprain does not significantly reduce pain or improve function compared to abstaining from ice. Despite its longstanding presence in injury management protocols, there is a lack of evidence supporting its effectiveness in acute injury treatment. For clinicians and patients alike, it's essential to reconsider the cultural attachment to ice, as many rely on it based on tradition rather than scientific backing. In situations where ice may provide psychological comfort, such as aiding sleep, its use might be justified, but it should not be seen as a necessity for healing.
Understanding the Peace and Love Approach
The Peace and Love acronym represents a modern framework for managing acute injuries, dividing care into immediate and later interventions. The 'Peace' component emphasizes protection, elevation, avoidance of anti-inflammatories and ice, compression, and education about recovery times. Following the initial phase, 'Love' focuses on load management, optimism, vascularization through aerobic exercise, and appropriate strength and mobility exercises. This approach is informed by current evidence and aims to promote better recovery practices compared to outdated protocols like RICE and PRICE.
Cultural and Psychological Factors in Treatment
The discussion around ice also highlights the role of cultural expectations in sports and injury treatment, where athletes often request ice based on tradition rather than evidence. Many clinicians encounter patients who have preconceived notions about recovery practices, leading to the automatic use of ice even when it may not be beneficial. Recognizing and addressing these cultural biases is crucial for developing better injury management strategies. Ultimately, promoting patient education while respecting their needs and concerns can foster a more effective healing environment.
In this episode with JF Esculier, we explore the new acronym of “PEACE and LOVE” in acute musculoskeletal injuries. We discuss:
What each of the letters in the acronym means and the evidence behind them being used in an acute setting
The evidence behind icing in acute injuries
Ice vs heat in acute injuries
The inflammatory response in acute musculoskeletal injuries
Jean-Francois (JF) Esculier PT PhD is a Canadian physiotherapist and clinician-researcher. His main research interests include knee pain, treatments for common musculoskeletal injuries, and running biomechanics and footwear. JF leads the Research & Development division at The Running Clinic, is a Clinical Associate Professor at the University of British Columbia and practices at his clinic, MoveMed Physiotherapy.
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Our host is @James_Armstrong_Physio
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