Women's Football Hub

Author: Carolyn Kent

ICE, RICE, PRICE, POLICE, PEACE and LOVE, if you’ve been around long enough you’ll have heard of at least one of these acute injury management principles. ICE stands for ice, compress and elevate and the RICE protocol with R standing for rest, has been around since approximately 1978 (1). In 1998, RICE become PRICE as protection was added to the principle (2). It was another 14 years when POLICE replaced PRICE (3). POLICE stood for protect, optimally load, ice, compress and elevate (3). However, in 2020 an editorial in the BJSM suggested that a completely new set of principles were required, PEACE and LOVE.

The PEACE and LOVE principles were said to encompass the rehabilitation continuum and cover the sub acute and chronic stages of tissue healing (4). The use of ice was removed and education, exercise for rehabilitation and vascularisation, optimism, and avoidance of anti-inflammatories were brought in (4). In 2021, evidence was published that the use of ice may actually act as a barrier to recovery due to reduced blood flow (2). This fits with evidence as early as 2004 which shows that the addition of ice to compression alone did not have any significant effect on hospital in-patients, however, the review also stated that many more high quality studies were required before guidelines could be developed (5).

So with current consensus via the BJSM editorial Dubois and Esculier piece, will we see the loss of the ice pack from sport and will it now all be peace and love?

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References

1. Mirkin G, Mirkin ACPG, Hoffman M. The Sportsmedicine Book [Internet]. Little, Brown; 1978. Available from: https://books.google.co.uk/books?id=ZUoU20aeY78C2.

2. Wang ZR, Ni GX. Is it time to put traditional cold therapy in rehabilitation of soft-tissue injuries out to pasture? World J Clin Cases. 2021 Jun 16;9(17):4116-4122. doi: 10.12998/wjcc.v9.i17.4116. PMID: 34141774; PMCID: PMC8173427.

3. Bleakley CM, Glasgow P, MacAuley DC. PRICE needs updating, should we call the POLICE? Br J Sports Med. 2012 Mar 1;46(4):220.

4. Dubois B, Esculier JF. Soft-tissue injuries simply need PEACE and LOVE. Br J Sports Med. 2020 Jan 1;54(2):72.

5. Bleakley C, McDonough S, MacAuley D. The Use of Ice in the Treatment of Acute Soft-Tissue Injury: A Systematic Review of Randomized Controlled Trials. The American Journal of Sports Medicine. 2004;32(1):251-261. doi:10.1177/0363546503260757