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How to treat a sprain – an update on the latest research

Updated: 2 days ago

This article tells you about the latest, updated research on how to treat a sprain – that is, an acute ankle sprain or any other soft tissue sprain – in the first few days after it has happened and thereafter. The recommended process can be remembered with the acronym ‘PEACE and LOVE’, and it deals with situations where you have sprained but not broken something.


You may also find these articles useful:

- Should I go to A&E with a sprained ankle?

- How to avoid recurring ankle sprains

How to treat a sprain

In this article:

  1. A short history of acronyms for how to treat a sprain

  2. The updated research on how to treat a sprain – a two-stage process

  3. PEACE: The acute phase of treating a sprain

  4. LOVE: How to treat a sprain once the acute phase is over

  5. Need more help?

A short history of acronyms for how to treat a sprain


So, you’ve dodged a bullet and your sprain did not also involve a fracture. However, it is still important to apply the correct acute soft tissue injury management for your injured ankle or other joint that you’ve sprained to speed up your recovery and to avoid the injury recurring.

  • Now, some of you may go ‘Well, years ago it used to be called ICE: ice, compress, elevate. Everyone knew it. It was easy to remember.'

  • Then it became RICE: ‘rest, ice, compress, elevate’.

  • This was followed by PRICE: ‘protect, rest, ice, compress, elevate’.

  • And then, in about 2012, they decided to add in the O and the L to make it POLICE, which was ‘protect, optimally load, ice, compress, elevate’.

  • Most recently, in the last couple of years, through more and more research, they've decided on the acronym ‘PEACE and LOVE’, which is clearly a lot longer. It's harder to remember what it stands for, but it is actually really good advice for soft tissue injuries.

Steph also demonstrates and discusses the treatment mentioned below in more detail in this video:



The updated research on how to treat a sprain – a two-stage process


PEACE refers to the first three days, or the acute period after you have sustained a sprain. This is when you will probably experience the typical acute symptoms in the sprained joint, such as swelling, bruising, bleeding, and inflammation. LOVE refers to what you have to do once these acute symptoms have settled down.


PEACE: The acute phase of treating a sprain

  • P stands for ‘protect it’. So, you do need to rest your sprained joint and look after it. If you need to use crutches, use crutches. If you need to use a support, use a support. Protect the injury in the first few days.

  • As in previous acronyms, E still means ‘elevate’. For instance, if it's your ankle that you have sprained, you want to put it up on a footstool or lie on your front with some pillows behind you, with your foot up behind you, so you can elevate it and help to reduce that swelling.

  • A is a new one and stands for ‘avoid anti-inflammatories’. I still hear so many people say, ‘I have an injury, so I’ll take some ibuprofen.’ However, inflammation is the beginning of your healing process. It kickstarts your body into healing the injured tissue. You don't want to disrupt that in the first few days. If you take anti-inflammatories, it's going to dull down your own healing process.

  • C is still ‘compress’.

  • And the second E is ‘educate’. So, learn about what you're supposed to be doing for your injury to get it better.



LOVE: How to treat a sprain once the acute phase is over


The LOVE portion of this acronym is for the second group of things you do after that initial acute symptoms have calmed down, and you're ready to rehab it and try and get it better.

  • L stands for ‘load’, and it’s so important to do the right load at the right time. This is the sort of thing we physios can help you with. We can look at your injury and your situation and decide whether you should be sticking initially to weight-bearing exercises with body weight only, or whether you're ready to move on to resistance exercises or weighted exercises, and also when you're ready to move on to impact exercises and jumping and running and changing direction. It all has to be done at the right time, in the right order, so that you can get your ankle nice and strong again and hopefully avoid any further injury.

  • O is a strange and a new one. It stands for ‘optimism’. This is because they've done a lot of research, looking at people's attitude towards their injury, and they found that people who are more optimistic make a quicker and better recovery than those who are either really scared, really anxious, or what they call ‘catastrophise’ about their injury, as in think about it all the time and have it rule their lives. So, this is really about your attitude towards your recovery.

  • V stands for ‘vascularisation’. It’s a bit of a tongue-twister, and I think it’s one of those that they phrased to fit with the acronym. It’s about the cardiovascular recovery you can do while you're still injured and perhaps not able to run yet. So, for instance, for your ankle it will be things like going swimming or, if you don't have too much swelling, doing cycling, so that you try and get your cardiovascular system going again. This will improve your fitness as such as well as improve your blood flow to the area and help your injury to recover quicker.

  • And then, finally, E is for ‘exercise’. There's a lot of strong evidence to show that exercise, the right sort of strengthening, the right sort of balance exercises – static balance as well as dynamic balance – will really improve not only your recovery but improve your chances that this injury isn't going to happen again. Eventually you should also look at getting you back into your sport-specific movements that you need to do, but at the right time with the right amount of load.

Need more help?

If you need advice on any of the above, especially load management and exercises that are suited to your specific injury and your circumstances, please feel free to book a video consultation with one of our physios.

We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.


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About the Author

Steph is a chartered physiotherapist with more than 15 years' experience and a Master’s Degree in Sports and Exercise Medicine. You can read more about her here, and she's also on LinkedIn.



References:

  1. Dubois B, Esculier J Soft-tissue injuries simply need PEACE and LOVE British Journal of Sports Medicine 2020;54:72-73.